key: cord-0031165-smi9nb6b authors: Bartoloni, Alessandro title: Waiting for a success story in prevention, control and treatment of Chagas disease in non-endemic countries date: 2022-04-15 journal: Mem Inst Oswaldo Cruz DOI: 10.1590/0074-02760210277chgsa sha: 49f6456b6c76675c8b3ab4e30ecfbe549265e88b doc_id: 31165 cord_uid: smi9nb6b nan The response to the worldwide spread of CD, known as a neglected disease of poor, rural, and forgotten people of Latina America, implies a series of interventions starting from breaking of the epidemiological silence, intended as lack of detected cases. (9) Underdiagnosis is in part related to the little or no experience with the detection and management of CD of most European health professionals, but also to the lack of an efficient approach to case finding and transmission control in many countries. It is evident that priority actions are the implementation of screening programs of target populations and of national and international surveillance systems, as well as the training of professionals in the detection of possible cases and in their appropriate management. Reliable data on documented and undocumented migrants from endemic countries should be available. Barriers to the access of health care services should be identified in order to develop and implement practical solutions for healthcare professionals, health authorities and governments to help overcome them. Any effort should be made to include undocumented immigrants, at risk of being excluded from the national health systems. Psychosocial barriers, such as fear of the disease, and stigma must also be taken into consideration. Community interventions have been reported as successful when implemented in Barcelona (Catalonia, Spain). (10) Cooperation with and involvement of patients' associations and community is useful to access to individuals at risk, providing information and improving awareness of CD. In this perspective, the International Federation of Associations of People Affected by Chagas Disease (FINDECHAGAS), was founded in 2010, bringing together more than 20 associations of affected people in the Americas, Europe, and the West Pacific. Recently, screening asymptomatic adult Latin American migrants for CD in Europe and treating T. cruzi-seropositive individuals with antiparasitic therapy has been found a cost-effective strategy. (11) In the setting of travel medicine, raising awareness on oral transmission of CD will allow staff to correctly inform travelers to endemic areas on the risk and prevention measures, and to recognise the early symptoms of acute CD in patients returning from Latin American countries. It is evident that CD must be taken seriously with a global perspective and a success story in the prevention and control of CD is now waited from NEC. In 2007, the World Health Organization (WHO) and PAHO convened a meeting of endemic Latin American countries and non-Latin American countries. A major outcome of the meeting was to highlight the presence of T. cruzi infection outside Latin America. Recognising the globalisation of CD, the 28 participating countries called for the establishment of an additional initiative to deal with CD in the NEC. WHO held an informal consultation on the control and prevention of CD in Europe at its headquarters in Geneva, Switzerland, on December 2009. The meeting was jointly organised by WHO headquarters and the WHO Regional Office for Europe. A total of 31 participants representing nine countries, WHO and the Special Program for Research and Training in Tropical Diseases attended the meeting. The aims of the meeting were to build consensus on the implementation of national measures to prevent and control CD in Europe and to target the harmonisation of national policies at the European level through recommendations to European and national authorities. (8) Different activities are currently ongoing in NEC to better define the magnitude of CD burden, to implement national surveillance systems, to promote screening programs to target populations, to map the national diagnostic capacity, to evaluate strategies to improve the access to diagnosis and treatment of CD, to raise awareness among health care personnel, public and policy makers. (8) Research activities are expected to provide further important results to fill knowledge gaps and to help define the appropriate strategies to prevent, control, diagnose and treat CD, including cost-benefit evaluation. Diagnostic procedures, as well as procedures for treatment and clinical management, should be harmonised, validated and spread through appropriate guidelines. (8) The same harmonisation process should be followed in the implementation of national policies. NEC have the opportunity to write another successful story on CD, addressing this new public health threat generated by the migrant flux from Latin America. Following the SCI experience, a scientific consensus on the strategies to be used would be desirable and sharing protocols and legislation, when successfully implemented in some countries, could reach this. As PAHO had a key role in the SCI implementation, continuity, and success, WHO is now supporting healthcare professionals, health authorities and governments towards the implementation of the necessary measures to stop CD transmission and provide care to patients in Europe, as well as in the other NEC. The worldwide spread of CD is certainly a critical challenge that must be addressed seriously but, at the same, it may represent an opportunity to generate or reinforce international network activities of academic and research institutions, within a perspective of south-north and north-south collaboration. The ultimate beneficiaries of a worldwide multidisciplinary effort will be the affected neglected populations in both endemic and non-endemic countries. Chagas in the Americas -Fact sheet for health workers Current epidemiological trends of Chagas disease in Latin America and future challenges: epidemiology, surveillance, and health policies Chagas disease, from discovery to control -and beyond: history, myths and lessons to take home Southern Cone Initiative for the elimination of domestic populations of Triatoma infestans and the interruption of transfusional Chagas disease. Historical aspects, present situation, and perspectives Significance of a neglected tropical disease: lessons from a paradigmatic case of 'success in translation Sleeping sickness epidemics and colonial responses in East and Central Africa, 1900-1940 Commentary: Chagas disease: 100 years since discovery and lessons for the future Report of a WHO informal consultation (jointly organized by WHO headquarters and the WHO regional office for Europe) The hidden Chagas disease burden in Europe Comparative evaluation of community interventions for the immigrant population of Latin American origin at risk for Chagas disease in the city of Barcelona Cost-effectiveness of Chagas disease screening in Latin American migrants at primary health-care centres in Europe: a Markov model analysis