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Review
, 136 (9), 1153-64

The Elimination of Chagas' Disease From Brazil

Affiliations
Review

The Elimination of Chagas' Disease From Brazil

E Massad. Epidemiol Infect.

Abstract

On 9 June 2006 the Pan American Health Organization (PAHO) presented the Minister of Health of Brazil with the International Elimination of Transmission of Chagas' Disease Certificate. This act was the culmination of an intensive process that began in 1991 with the Southern Cone Initiative, a joint agreement between the governments of Argentina, Bolivia, Brazil, Chile, Paraguay, Uruguay and Peru, to control Chagas' disease by the elimination of the main vector, Triatoma infestans. This initiative has been highly successful and the prevalence area of the vector diminished rapidly in the last years. As a consequence, the current seroprevalence in children aged between 0 and 5 years is of the order of 10(-5), a clear indication that transmission, if it is occurring, is only accidental. In this review I calculate the basic reproduction number, R0, for Chagas' disease and demonstrate that its relatively low value (1.25) explains why vectorial transmission was interrupted relatively easily. In addition, I used a mathematical model to forecast how long the remaining cases of the disease, as well as the additional vertically transmitted cases will last.

Figures

Fig. 1
Fig. 1
Geographical distribution of Triatoma infestans in South America (from [23]).
Fig. 2
Fig. 2
Impact of a control strategy on the value of R0.
Fig. 3
Fig. 3
Triatoma infestans and its life cycle in the wall of a typical house in the endemic area. (1) Eggs, (2) first-stage nymphs, (3) fifth-stage nymph, (4) adult (from [39]).
Fig. 4
Fig. 4
Geographical distribution of Triatoma infestans in South America as a result of the control programme (from [23]).
Fig. 5
Fig. 5
Age distribution of half-life of number of cases in each age group.
Fig. 6
Fig. 6
Forecast of Chagas' disease assuming infected mothers and congenitally infected children for the next 50 years. The proportion of treated children is 0% (upper curve), 20%, 40%, 60% and 80% (lowest curve).

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