7th European Congress on Tropical Medicine & International Health                  Barcelona, 3 - 6 October 2011          ...
Chagas disease taken into account in new areas                     Framework achievements           New strategic approach...
3Lisbon, February 26th 2010
4
- Congenital transmission was described in a child born in 1975 inRomania (Pehrson PO, Wahlgren M, Bengtsson E. Asymptomat...
WHO Informal Consultation onChagas Disease Control andPrevention in Europe (Jointlyorganized by WHOHeadquarters and WHOReg...
Epidemiological information update - EuropeDistribution of cases of T. cruzi infection in Europe by country, and reported ...
"It is clear that improvements                                                   in the lives of the poor                 ...
9
- …all transmission routes have to be tackled- to integrate the care of patients with acute andchronic clinical forms of C...
WHO is currently focusing on 17 NTDs:1.    Buruli ulcer disease (Mycobacterium ulcerans infection)2.    Chagas disease (Am...
12
Funda           ción d                 e     Enfer                             m                     - FUN os de Chag     ...
14
Euro Surveill. 2011;16(37):pii=19968Euro Surveill. 2011;16(37):pii=19968                                       15
Euro Surveill. 2011;16(37):pii=19968Chagas disease taken into account in new areas                         Framework achie...
WHO Programme on Control of Chagas disease                           Reduction of                          Chagas disease ...
Update of the world map                                                                       WHO NTD Report 2010  …main h...
Guidelines on the Management of Chagas diseasepatients at Primary Health Care level  IEC, distance education…             ...
WHO International      Biological Reference Preparations    for Chagas Disease Diagnostic Tests•    Provides a tool for co...
About the disease and its parasitological treatment      Diversity of parasites (Trypanosoma cruzi I, II, III, IV, V, VI) ...
WHO Programme for International Drug Monitoring      Full and Associate Member States                                     ...
Collaboration / partnership…• Working together with PAHO, EURO and  WPRO teams• Partnership/interaction with governments• ...
Moltes gràcies                 24
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Chagas disease bcn - who

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Dr Pedro Albajar Viñas presentación realizada en el Congreso Europeo de Medicina Tropical y Salud Internacional, en Barcelona ...

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Chagas disease bcn - who

  1. 1. 7th European Congress on Tropical Medicine & International Health Barcelona, 3 - 6 October 2011 Néstor Favré-Mossier 2007. SilenceChagas disease in Europe. Are we doing enough? What has been done after the Verona meeting? 1
  2. 2. Chagas disease taken into account in new areas Framework achievements New strategic approach & innovation Murcia, October 20th 2009 2
  3. 3. 3Lisbon, February 26th 2010
  4. 4. 4
  5. 5. - Congenital transmission was described in a child born in 1975 inRomania (Pehrson PO, Wahlgren M, Bengtsson E. Asymptomatic congenitalChagas disease in a 5-year-old child. Scand J Infect Dis 1981; 13(4): 307-8)- In 1982 was published the case of an adopted Latin American childby a Swedish family with probable congenital Chagas disease (Pehrson,PO, Wahlgren M, Bengtsson E. Intracranial calcifications probably due tocongenital Chagas disease. Am J Trop Med Hyg 1982; 31(3): 449-451)- In Spain was reported the first European case of laboratory accident in1983 (Alvar J. 1983. Un caso agudo de enfermedad de Chagas causado poruna inoculación accidental de laboratorio. Laboratorio 76(456): 645-648)- Transfusional transmission case after bone marrow transplant in1992 (Villalba R, Fornés G, Alvarez MA, Román J, Rubio V, Fernández M,García JM, Viñals M, Torres A. Acute Chagas disease in a recipient of a bonemarrow transplant in Spain: case report. Clin Infect Dis 1992;14(2): 594-5)- Congenital Chagas disease case in 2001, initially confused withcongenital leishmaniasis (Flores-Chávez M, Faez Y, Olalla JM, Cruz I,Gárate T, Rodríguez M, Blanc P, Cañavate C. Fatal congenital Chagasdisease in a non-endemic area: a case report. Cases J 2008; 1(1): 302)- In 1988 was published the case of acute Chagas disease in a Frenchwoman who travelled to Colombia (Brisseau JM, Cebron JP, Petit T,Mariolet M, Cuilliere P, Godin J, Grolleau JY. Chagas myocarditis importedinto France. Lancet 1988; 1 (8593): 1046)- In 1996 was described the case of Chagasic cardiomyopathy in aBolivian patient in Switzerland (Sztajzel et al. Chagas disease may alsobe encountered in Europe. European Heart Journal 1996; 17, 1289-1291)- In 1997 a survey was conducted in Berlin, Germany, among LatinAmerican migrants, showing 2% of infection prevalence (Frank M,Hegenscheid B, Janitschke K, Weinke T. Prevalence and epidemiologicalsignificance of Trypanosoma cruzi infection among Latin Americanimmigrants in Berlin, Germany. Infection 1997; 25(6): 355-8)- In 1997, in Italy was published the first case of an Italian traveller toan endemic country with acute Chagas disease (Crovato F, Rebora A.Chagas disease: a potential plague for Europe. Dermatology 1997; 195:184-5)-… 5
  6. 6. WHO Informal Consultation onChagas Disease Control andPrevention in Europe (Jointlyorganized by WHOHeadquarters and WHORegional Office for Europe),Geneva, Switzerland17 & 18 December 2009 6
  7. 7. Epidemiological information update - EuropeDistribution of cases of T. cruzi infection in Europe by country, and reported transmission among the European population (data reported to WHO as of Dec 2009) Chagas disease taken into account in new areas Framework achievements New strategic approach & innovation 7
  8. 8. "It is clear that improvements in the lives of the poor have been unacceptably slow, and some hard-won gains are being eroded by the climate, food & economic crises" But the report also cites big gains in cutting the rate of extreme poverty, getting children into primary schools, addressing AIDS, malaria and child health, and a good chance to reach the target for access to clean drinking water UN Secretary-General Ban Ki-moon Millennium Development Goals Report 2010, issued on 23 June 2010 • More than 1 billion people – 1/6 of the worlds population – suffer from one o more NTD. Primarily poor populations living in tropical and subtropical climates.• Infections are attribuitable to unsafe water, poor housingconditions and poor sanitation.• Children are most vulnerable to infections of most NTD.• NTD kill an estimated 534,000 people worldwide every year.Their impact on worker productivity adds up to billions of dollars lostannually and maintains low-income countries in poverty. 8
  9. 9. 9
  10. 10. - …all transmission routes have to be tackled- to integrate the care of patients with acute andchronic clinical forms of Chagas disease into primaryhealth services…- Increasing number of cases of Chagas disease incountries where the disease is not endemic… NewInitiative for prevention and control of Chagas disease innon-endemic regions- Mobilization of national and international, public andprivate financial and human resources… promoteintersectorial efforts and collaboration, and facilitatenetworking between organization and partners…- Reporting in the next 65 WHA (2 years period). 10
  11. 11. WHO is currently focusing on 17 NTDs:1. Buruli ulcer disease (Mycobacterium ulcerans infection)2. Chagas disease (American trypanosomiasis)3. Cysticercosis4. Dengue5. Dracunculiasis (guinea-worm disease)6. Echinococcosis7. Endemic treponematoses8. Foodborne trematode infections9. Human African trypanosomiasis (sleeping sickness)10. Leishmaniasis11. Leprosy (Hansen disease)12. Lymphatic filariasis (elephantiasis)13. Onchocerciasis (river blindness)14. Rabies15. Schistosomiasis (bilharziasis)16. Trachoma17. Soil-transmitted helminthiases 11
  12. 12. 12
  13. 13. Funda ción d e Enfer m - FUN os de Chag DECH as VIDA por la vida ASSOCIAÇÃO DOS PORTADORES DE DOENÇA DE CHAGAS E INSUFICIÊNCIA CARDÍACA – RECIFE – PERNAMBUCO - BRASILNew key actors… 13
  14. 14. 14
  15. 15. Euro Surveill. 2011;16(37):pii=19968Euro Surveill. 2011;16(37):pii=19968 15
  16. 16. Euro Surveill. 2011;16(37):pii=19968Chagas disease taken into account in new areas Framework achievements New strategic approach & innovation 16
  17. 17. WHO Programme on Control of Chagas disease Reduction of Chagas disease burden Stop transmission: Patient care: blood transfusion, diagnosis & treatment organ transplantation, of vertical transmission, … acute and chronic cases The two-pillar strategy 30 June & 1st July 2010 - Meeting of the STAG on NTDNew strategic approach & innovation World surveillance - Open transmission routes - Where the patients are to take care of them Primary Health Care versus specialists (chagologists, cardiologists) Information, Education & Communication tools Access to screening & diagnosis Access to parasitological and non-parasitological treatment 17
  18. 18. Update of the world map WHO NTD Report 2010 …main health determinants of the Latin American communities in a specific area (diversity and barriers such as their immigrant condition and socio-cultural-economic characteristics) is crucial to design and implement comprehensive health-care strategies for the care of people with Chagas disease. Specific innovative approaches are needed to make possible the meeting between the health system and the T. cruzi infected patients, such as: - Interdisciplinary approach; - Community approach; - Expert Patient Programme. 18
  19. 19. Guidelines on the Management of Chagas diseasepatients at Primary Health Care level IEC, distance education… 19
  20. 20. WHO International Biological Reference Preparations for Chagas Disease Diagnostic Tests• Provides a tool for comparison of results between different assays (biological measurement)• Supports regulatory authorities and manufacturers: harmonization of international regulations; establishment of quality and safety regulations…• Facilitates the development of diagnostic and therapeutic products Transmission through blood transfusion or organ, tissue & cell transplantation • Implementation of screening of the target population • Questionnaire taking into account the different country epidemiological profiles with their different history of transmission control • Implications of a systematic screening in blood banks and organ, tissue and cell transplantation 20
  21. 21. About the disease and its parasitological treatment Diversity of parasites (Trypanosoma cruzi I, II, III, IV, V, VI) Variety of clinical manifestations (South America versus Central & North America, Andean countries versus Central Brazil…) Silent & silenced chronic disease (>50% of acute and chronic cases are asymptomatic or olygosymptomatic) of the poorest populations (rural, periurban and migrant populations…) One of the highest burden of disease among NTDs in the Americas, in Europe… <20% of infected are diagnosed and treated >55,585 persons per year would require etiological treatment, but around 6,500 people are annually treated by benznidazol and 1,500 people are annually treated by nifurtimox (2nd-line treatment). Treatment• Parasitological and non-parasitological treatment.• Treatment to stop/delay clinical evolution of Chagas disease.• Access to specific treatments and protocols for their rational use.• Tolerance to specific treatments, surveillance with early detection of side-effects and their rapid management/treatment. 21
  22. 22. WHO Programme for International Drug Monitoring Full and Associate Member States Pharmacovigilance WHO Safety of medicines & Pharmacovigilance programme Quality and Safety: Medicines / Essential Medicines & Pharmaceutical Policies Innovative approach in the schools 22
  23. 23. Collaboration / partnership…• Working together with PAHO, EURO and WPRO teams• Partnership/interaction with governments• WHO Technical Groups• Collaboration with universities, scientific institutions• Partnership with private companies, foundations,NGOs…• Listening to patient associations "We must not fail the billions who look to the international community to fulfill the promise of the Millennium Declaration for a better world…" UN Secretary-General, Ban Ki-moon 23
  24. 24. Moltes gràcies 24

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