2 nd Brazilian Consensus on Chagas Disease, 2015.

Chagas disease is a neglected chronic condition with a high burden of morbidity and mortality. It has considerable psychological, social, and economic impacts. The disease represents a significant public health issue in Brazil, with different regional patterns.

[Brazilian Consensus on Chagas Disease, 2015].

Chagas disease is a neglected chronic condition that presents high morbidity and mortality burden, with considerable psychological, social, and economic impact. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease.

[New challenges and the future of control].

The epidemiological situation of Chagas disease in Brazil was substantially altered in the last decades, partially as a consequence of the control measures implemented and partially due to the environmental, economical and social changes that took place in the country. Domicile vector transmission was interrupted when caused by Triatoma infestans and importantly controlled when associated with native species of the vector. Transfusion transmission is no longer a problem since generalized screening of blood donors came into routine.

[The national survey of seroprevalence for evaluation of the control of Chagas disease in Brazil (2001-2008)].

A survey for seroprevalence of Chagas disease was held in a representative sample of Brazilian individuals up to 5 years of age in all the rural areas of Brazil, with the single exception of Rio de Janeiro State. Blood on filter paper was collected from 104,954 children and screened in a single laboratory with two serological tests: indirect immunofluorescence and enzyme linked immunoassay. All samples with positive or indetermined results, as well as 10% of all the negative samples were submitted to a quality control reference laboratory, which performed both tests a second time, as well as the western blot assay of TESA (Trypomastigote Excreted Secreted Antigen).

[The control of vectorial transmission].

Between 1950 and 1951, the first Prophylactic campaign against Chagas Diseases was carried on in Brazil by the so existing Serviço Nacional de Malária. The actions involving chemical vector control comprehended 74 municipalities along the Rio Grande Valley, between the States of São Paulo and Minas Gerais. Ever since, until 1975, the activities were performed according the availability of resources, being executed with more or less regularity and coverage.

[Summary of results from the national surveys].

This article aims to correlate the main results of three large national surveys on Chagas disease (entomologic, seroprevalence and electrocardiographic) carried out in Brazil from late 1970's to early 1980's, which served as baseline for definition of the control measures adopted in the country. The proportion of infected people was much higher in areas where Triatoma infestans, the most efficient vector of Chagas disease among the five principal species involved in transmission at that time, was predominant. Similar result was observed in places where Triatoma sordida was dispersed, mainly in the country's central region, which corresponds to its native area.

[Seroprevalence survey of human Chagas' infection (1975-1980)].

The results of the Serological survey for the prevalence of chagasic infection in Brazil, 1975/1980, were published before (Camargo et al, 1984) but the detailed geographical distribution is described in this paper. This was an initiative of two governmental bodies: the Superintendencia de Campanhas de Saúde Pública a Ministry of Health Division in charge of all public health policies, and, the Research National Council of the Ministry of Science and Technology through a program called Integrated Program for Endemic Diseases. Results obtained were extremely useful for a precise delimitation of the area with endemic transmission of Chagas disease, and hence, to direct the activities for vector control, which were implemented from 1975 onwards.

[Entomological survey (1975-1983)].

After the systematization and re-dimension of the vectorial control in all the Country by 1975, it was considered necessary to have an up-to-date information on the distribution of vectors in Brazil, and differentiate precisely the role of each of the different species on the intra-domiciliary transmission of Chagas disease. For this purpose, sampling regional surveys for regions with non reliable information were performed, as well as, a house by house search for vectors on those areas considered at risk. For this last, 1,942 municipalities from 19 states were searched, as by the political division of the country by 1980, that was taken as a reference in this paper.

[Institutional insertion of Chagas' disease control].

After the starting of the Center for studies and prophylaxis of Chagas disease in 1943, with the help of Oswaldo Cruz Foundation, in the city of Bambuí, state of Minas Gerais, technological and methodological basis for the extensive control of the disease were conceived. A main step to achieve success was the introduction of a new insecticide (gammexane, P 530) and the demonstration of its efficacy in the vector control. A consequence of these improvements was the official inauguration of the first prophylactic campaign for Chagas disease in Brazil, held in Uberaba in May, 1950.

Current epidemiological trends for Chagas disease in Latin America and future challenges in epidemiology, surveillance and health policy.

Chagas disease, named after Carlos Chagas, who first described it in 1909, exists only on the American Continent. It is caused by a parasite, Trypanosoma cruzi, which is transmitted to humans by blood-sucking triatomine bugs and via blood transfusion. Chagas disease has two successive phases: acute and chronic.

[Assessment of an entomological surveillance system for Chagas disease with community participation in Mambaí and Buritinópolis, State of Goiás].

Entomological surveillance of Chagas disease in Mambaí and Buritinópolis, in the State of Goiás, Brazil, has been kept up through the local population's participation, consisting of reporting the presence of vectors inside their homes. A long time has elapsed since instituting these control measures and it has now been certified that vector transmission has been halted. Thus, this study sought to evaluate the population's knowledge and practices in this situation.

The epidemiologic importance of Triatoma brasiliensis as a chagas disease vector in Brazil: a revision of domiciliary captures during 1993-1999.

To clarify the epidemiologic importance of Triatoma brasiliensis, the most important Chagas disease vector in the Northeastern of Brazil, capture data related to this species, its distribution, capture index, and percentages of natural infection by Trypanosoma cruzi were examined in 12 different Brazilian states. The Brazilian National Health Foundation collected these data from 1993 to 1999, a period during which a total of 1,591,280 triatomines (21 species) were captured in domiciles within the geographic range of T. brasiliensis.

[Evaluation of the impact of vector control of Chagas disease through serological testing in Mambaí/Buritinópolis, Goiás State].

In 1999, we performed serological and entomological surveys to evaluate the impact of vectorial control measures against transmission of Chagas' disease in the endemic area of Mambaí and Buritinópolis (GO). A census was undertaken of the population, after which the entomological survey was performed regarding the dwelling units and serological evaluation of the human population. Blood samples were collected by digital puncture in filter paper.