The Fight Against Chagas: Time to Focus on Patients

The international medical humanitarian organization Doctors Without
Borders/Medecins Sans Frontieres (MSF) today launched a campaign to
raise awareness of the parasitic disease Chagas. MSF is calling on
countries where the disease is endemic to stop neglecting the disease
by moving beyond prevention activities to increased diagnosis and
treatment.

The campaign, "Chagas: It's Time to Break the Silence," coincides
with the 100th anniversary of the discovery of one of the world's most
neglected diseases.

Approximately 10-15 million people in Latin America are infected
with Chagas every year. It is estimated that 14,000 people die of the
disease annually. Most Chagas patients are asymptomatic and the disease
often goes undiagnosed, so the true scope of Chagas-related deaths is
unknown. MSF is also calling for more research and development toward
new and more effective treatments, rapid diagnostic tests for use in
remote settings, and better methods for determining treatment success.

Additional background information on Chagas is available online:
https://doctorswithoutborders.org/publications/article.cfm?id=3696

Also visit MSF's Chagas website:
www.chagas-break-the-silence.com

Chagas disease is caused by the Trypanosoma cruzi parasite. In most
Latin American countries, the disease is transmitted by the bite of the
vinchuca insect although transmission is also possible from mother to
child, through blood transfusions, organ transplants, and contaminated
food. Chagas patients can be asymptomatic for years, but during the
chronic phase of the disease one third develop serious health
problems-mainly heart and intestinal complications-that can lead to
death.

"One of the main problems we have is that for years patients have no
symptoms, so they do not know they are sick and they receive no
treatment," said Dr. Nines Lima, MSF's tropical medicine advisor.
"Active case detection is essential to find and treat infected people."

Chagas is endemic in several Latin American countries but worldwide
migration means that more and more cases are being reported in the
United States, Europe, Australia, and Japan. Chagas is a potential
killer, but so far governments have focused on prevention and vector
control rather than on the treatment of patients. Integrating Chagas
care into primary health care facilities would greatly improve patient
access to treatment.

The sooner the disease is detected, the more effective the
treatment. The only two existing drugs-benznidazol and nifurtimox-were
developed over 35 years ago through research not specifically focusing
on Chagas. Although these medicines are very effective in newborn and
breastfeeding children, only about 60 to 70 percent of adolescents and
adults are successfully treated. The older the patients, the greater
likelihood they will experience side effects from the drugs.

"Doctors do not treat children, let alone adults, for fear of side
effects," said Dr. Tom Ellman, MSF head of mission in Bolivia, where
the organization runs a Chagas treatment program. "We are showing that
these effects are manageable in both cases. Leaving patients untreated
is no longer ethical."

However there is still an urgent need for better drugs for the
treatment of Chagas. The disease is one of poverty.and therefore has
been absent from research, development and political agendas for years.
A recent Global Funding of Innovation for Neglected Diseases (G-Finder)
survey, revealed that in 2007 only $10.1 million was spent on research
and development of new drugs to treat Chagas.

Research and development must be boosted in order to develop new
rapid diagnostic tests, better medicines, and new cure tests to address
this disease more effectively.

"The lack of commercial incentives has pushed Chagas into oblivion,"
said Gemma Ortiz, head of the MSF Chagas campaign. "New ways to boost
research and development and better tools to care for patients need to
be found."

In the coming months, MSF will campaign for greater awareness and
commitment to the fight against Chagas. For more information on Chagas
disease and the enormous gap between the number of people living with
Chagas and those who receive treatment, go to: www.chagas-break-the-silence.com.
Visitors can participate in the MSF campaign and "break the silence" by
sending information about this silent disease to their friends.

Doctors Without Borders/Medecins Sans Frontieres has been
working in projects fighting Chagas disease since 1999. Currently, the
organization is working in three districts on the outskirts of
Cochabamba, in Bolivia, the country with the highest prevalence of
Chagas in the world. Activities are carried out in collaboration with
the Bolivian Ministry of Health and integrated into five primary health
care centers, where children and adults up to 50 years of age are
diagnosed and treated. Using the same approach, the organization is
currently setting up a new project in the rural zone of Cochabamba
region, where it is working to involve the community in all aspects of
the strategy (prevention, diagnosis and treatment), in an area where
the vector is much more prevalent.

At the end of 2008, MSF had tested over 60,000 people for
Chagas, treating 3,100 patients, of whom 2,800 successfully completed
their treatment. This shows that, even though the current means are not
ideal, diagnosing and treating Chagas in limited resource settings and
remote areas is feasible.