Twenty years ago, even doctors in Spain knew nothing about Chagas, a disease caused by infection with the Trypanosoma cruzi parasite. It was not so much a forgotten disease as one that had never existed. Endemic in parts of Latin America, Chagas disease was basically considered to be a problem “over there”. Over the last two decades, however, we have started to see cases of local transmission in Spain.
Following the arrival of large numbers of people from the parts of the world where the disease is endemic, doctors in Spain are now faced with a new challenge: the diagnosis and treatment of a condition that the World Health Organisation classifies as being a neglected disease. Our health system has discovered that the absence in Spain of the kissing bug— the insect vector that transmits the parasite—is not an insurmountable obstacle to local transmission of the infection: T cruzi can also pass from an infected woman to her child or hitch a ride as an unwelcome stowaway in blood transfusions and organ transplants from infected donors.
The warning first served by Chagas disease, and reinforced by the current Ebola outbreak, is that when it comes to health the problems are no longer “ours” or “theirs”. Health has, for once and for all, become globalized. It is estimated that between 8 and 10 million people worldwide are currently infected with T cruzi and between 75,000 and 80,000 of those affected live in Spain. The figures available are only estimates because a number of factors make it difficult to obtain more precise statistics: Chagas disease is a silent process that produces symptoms in only 4 out of 10 cases; most of those affected live in rural areas; and the symptoms can be confused with those of other conditions.
Chagas is still a neglected disease to which insufficient resources are allocated. The only two drugs on the market today are the same ones that have been used since the 1970s. The disease is still associated with the stigma of poverty and, for many people, this makes it a taboo subject—a wretched condition which is better not mentioned. As a result, fewer than 1% of those affected are receiving treatment. In order to combat this stigma and address the lack of accessible information, the Chagas Initiative of the Barcelona Institute for Global Health (ISGlobal) has created InfoChagas.org, a website in Spanish and English that provides straightforward answers to the questions people have about this infection.
Among other resources, the site offers a test that allows the anonymous user to get a answer to a disturbing question: Could I have Chagas disease? The tool, which is also available as a Facebook app, advises users on whether or not they are in the population at risk. We should not forget that, left untreated, Chagas disease can damage the digestive system or cause heart disease, with fatal consequences in some cases.
The time has come to ensure that Chagas disease receives the attention it deserves given the seriousness of the global health threat it poses.
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