169402 Chagas: A forgotten but deadly disease in Bolivia

Tuesday, October 28, 2008

Karina Gamarra , Chagas control program, Plan International Inc. Bolivia, Tarija, Bolivia
Silvia Nole , Plan Bolivia, La Paz, Bolivia
Gustavo Tapia, MD MPH , Plan Bolivia, La Paz, Bolivia
Carlos Salinas , Plan Bolivia, La Paz, Bolivia
Luis Tam, MD DrPH , Plan USA, Arlington, VA
Background: Chagas is a deadly disease caused by a protozoan called Trypanosoma cruci and is transmitted to human by a blood-sucking insect known as Vinchuca or assassin bug. Chagas is the most important parasite disease in Latin America and is closely related to poverty. The disease is endemic in Bolivia and causes 15% of deaths aged among 15-75, affecting the economy and life expectancy of the country.

Chagas control efforts: Since year 2002, Plan in Bolivia has implemented the “Chagas diagnosis and treatment” project for children below 12 years of age; the project operates in 66 rural communities from highly endemic areas of Tarija. Once the vector was controlled, screening tests were applied at the community level and infected children received ambulatory treatment with standard doses of Benznidazole.

Results: A study revealed that although children who had completed the treatment presented a significant decrease in their serologic titers; frequent adverse reactions were observed. From 6,364 screened children, 1,137 were found infected (21 %), and 1145 were treated by the project. Treated children were studied to measure the frequency and severity of adverse reactions; 22.1% of these children presented adverse reactions distributed as follow: low (45.9%), moderate (48.9%) and serious (5.2%) reactions, these last ones required hospitalization. Frequency of adverse reactions is directly related to the age of treated children. Due to these reactions, 9.9% of children did not conclude the treatment and 7.7% suspended it temporarily.

Discussion: The high frequency of adverse reactions caused by Benznidazole hinders the effectiveness of the project by reducing adherence to Chagas treatment, and put children in unnecessary death risk. Even though Chagas is the most devastating parasite infection in the region no significant support has been given for the development of new cost-effective drugs with fewer side effects. Apparently the pharmaceutical industry is not interested in developing new drugs for the poor.

Recommendations: There is an urgent need to promote commitment in the international community to stimulate research and development of new cheaper and more effective drugs to treat Chagas with fewer adverse reactions among the scientists and pharmaceutical industries.

Learning Objectives:
To assess the importance of the side effects of benznidazole treatment as a major cause of its discontinuation among Trypanosoma-infected patients

Keywords: Infectious Diseases, Treatment Efficacy

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I developed the work described in this abstract
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.