Silent and Silenced: Raising Awareness for Chagas Disease

A triatomine insect in front of a heart.

“Silent and silenced.” These are words sometimes used to describe Chagas disease, a neglected tropical disease that primarily affects impoverished communities in Latin America. The disease has a slow and oftentimes hidden progression, leading to many people going undiagnosed—thus, it is “silent.” Affecting mostly poor and marginalized communities, the disease is also subject to chronic and systemic neglect in the global health agenda, leading to low visibility and political will to address expanding access to treatment—thus, it is “silenced.”

To change course on this neglected tropical disease, the World Health Organization (WHO) observes World Chagas Disease Day on April 14. The theme for this year’s World Chagas Disease Day is “Prevent, Control, Care: Everyone’s Role in Chagas Disease,” representing how concerted efforts across sectors and across governments are necessary to address Chagas disease.

Chagas disease is caused by a parasite called Trypanosoma cruzi. The parasite infects people through contact with feces or urine from an infected triatomine insect—colloquially known as the kissing bug or vampire bug for how they feed on human and animal blood. At night, the bugs come out to feed, defecating or urinating near the bite. When a person or animal goes to scratch the bite, they can smear feces or urine into the bite, another open wound, or into the eyes or mouth, where the parasite can enter the host’s body. The parasite can also be transmitted from mother to child during pregnancy or birth, from person to person through blood transfusion or organ transplant, or by consuming contaminated food, though, these methods of transmission are less common.

Chagas disease is mainly found in Latin American countries, where the parasite and its vector are endemic to the region. The disease is associated with poverty because the insect vectors live in crevices common in substandard housing. It’s estimated that more than 7 million people globally are living with a T. cruzi infection, while more than 10,000 people die of Chagas-related causes every year.

Chagas disease has two phases: an acute phase and a chronic phase. During the acute phase, which lasts about two months after the initial infection, patients may have no symptoms or mild symptoms that are non-specific, such as fever, headache, or swollen lymph nodes. Patients who are treated with parasite-killing drugs during the acute phase have a high chance of being cured; however, because the disease mainly affects those in poverty and symptoms can be mild, infected patients may not choose to or be able to access health care during this period. Many go undiagnosed—an estimated 70 percent of people with Chagas disease are unaware of their infection.

When Chagas disease is not treated in the acute phase, the disease progresses into the chronic phase. In the chronic phase, the parasites go dormant, hiding mainly in the heart and digestive muscles. Patients may be asymptomatic during this period, but over time, one in three people with Chagas disease develop heart disease, and one in 10 develop gastrointestinal or neurological disorders. Administering treatment during the chronic phase is less effective, but it may help with managing the disease and preventing harmful complications.

Addressing the global burden of Chagas disease is a challenge because Chagas disease is a “silenced” disease, meaning it is not a priority on the global agenda. There is currently no vaccine to prevent Chagas disease. Most efforts center around vector control—for example, by spraying insecticide on houses—but new challenges are emerging due to climate change, as the distribution and reproductive cycle of the triatomine vector is changing.

Regional partnerships and intergovernmental initiatives in Latin America have seen success in reducing transmission and increasing access to diagnosis and treatment; however, Chagas disease is increasingly being detected in non-endemic countries due to rising population movement and migration. This presents a problem for vertical transmission from mother to child in non-endemic countries, as health care providers may lack the awareness or knowledge to screen for Chagas disease. Implementing educational and training initiatives on Chagas disease for clinicians and medical students in non-endemic countries could therefore reduce complications and save lives.

This World Chagas Disease Day, the WHO is calling for increased awareness of Chagas disease, united action for prevention, control, and research, and support for those affected by the disease. Despite mounting uncertainty and challenges with funding across the globe, it’s important to keep fighting to address neglected tropical diseases—to make sure diseases like Chagas disease are no longer silenced. To learn more about the challenges and opportunities surrounding Chagas disease, access our resource pack on Global Chagas Disease or check out the selected resources below.

Selected Resources

Teaching Resource

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