Disease Prevention and Control / Communicable Diseases / Chagas Disease

PAHO Consultation on Congenital Chagas Disease, Its Epidemiology and Management

(Montevideo, Uruguay, 24–25 June 2004,
in collaboration with the Latin American Center for Perinatology and Human Development, CLAP)
T. infestans

Full text (material to the right plus agenda and list of participants; 8 pp, PDF, 354 KB)

- PAHO Chagas Page
- PAHO Child Health Page
- CLAP Website

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- Institute of Research for Development (IRD) (in French)
- Free University of Brussels, Research (in French)

Objectives: To consult with researchers, clinicians, and program managers dealing with Congenital Chagas Disease, for the following purposes:

  • To arrive at and update a situational diagnosis of the disease and its management.
  • To develop guidelines for a management guide.
  • To establish a risk and impact projection on the disease in the Region.
  • To generate guidelines to regularly and sustainably implement the necessary actions in the countries.

Participants: A select group of researchers, clinicians, program managers, and program operators working with Congenital Chagas Disease in the Region of the Americas, with subregional emphasis on the Southern Cone and with the participation of the Université Libre de Bruxelles/ULB (Free University of Brussels), Belgium.

Recommendations: After due consideration, the Advisory Group recommends the following:

  1. The Advisory Group considers it indispensable to carry out intervention and control activities to prevent and control congenital infection by Trypanosoma cruzi, due to the importance that the latter has on children's health and the epidemiology of the parasitosis.
  2. In consideration of the historic time that Chagas disease control is now going through throughout the Region of the Americas, the Advisory Group wishes to express the need to consolidate successful actions and to increase efforts to control vectoral and transfusional transmission of T. cruzi.
  3. The Advisory Group points out that, in those regions where achievements or advancements have been made in controlling vectoral and transfusional T. cruzi transmission, congenital transmission constitutes the main and most persistent form of the parasitosis among the human population.
  4. The Advisory Group considers that the document Congenital Infection from T. cruzi: From Mechanisms of Transmission to Strategies for Diagnosis and Control (Rev. Soc. Bras. Med. Trop., 2003, 36 (6): 767-771), resulting from the International Colloquium at Cochabamba, Bolivia (6–8 November 2002), reflects the main orientations and provides fundamental guidelines on which to base the necessary screening, diagnosis, treatment and monitoring in order to deal with individual cases completely and correctly, as well as with the public-health problem that Congenital Chagas Disease represents.
  5. The Advisory Group recommends that basic data on Congenital Chagas Disease be integrated into the PAHO/CLAP Perinatal Information System. In addition, it recommends that that the problems of this parasitosis be incorporated into technical-cooperation activities in the area of maternal and child health that the Center promotes in the Region of the Americas.
  6. The Advisory Group insists on the need for greater coordination of activities and interventions in the area of maternal and child health, in such a way that the activities aimed at screening, diagnosis, treatment, and monitoring of Congenital Chagas Disease be given preference both through routine vaccinations and/or clinical controls in each country, in order to achieve greater operational effectiveness, efficiency, and sustainability.
  7. The Advisory Group proposes the following as a basic scheme for screening and diagnosis procedures, so that the countries can implement adequate, feasible, effective, efficient, and sustainable program activities actions against Congenital Chagas Disease:
    • Universal maternal serological testing, first during pregnancy or upon admission to hospital for childbirth.
    • For children with positive Chagas serology:
      1. Direct neonatal parasitological testing.
      2. Conventional serological testing differed between 9 and 12 months of age.

    In communities with a high incidence of vectoral transmission and acute infection during pregnancy, regardless of relevance, the possibility should be explored to provide universal testing for T. cruzi infection among all newborns.

    In countries with a high frequency of home deliveries, newborns should be tested during their first contact with the health system.

  8. With regard to treatment, the Advisory Group considers the following indispensable:
    • That the countries allocate resources for the procurement of specific drugs (nifurtimox and benznidazole) and recommends a purchasing system managed with PAHO cooperation.
    • That the countries make pediatric presentations of these drugs available for the etiological treatment; for this reason, the Advisory Group exhorts governments, NGOs, international organizations, and industry to implement the corresponding actions.
  9. With regard to the family health, the Advisory Group recommends the following:
    • To expand testing to all children whose mother has a positive serology.
    • To provide medical care for the infected mother.
  10. The Advisory Group reaffirms the need for developing programs and control measures for Congenital Chagas Disease throughout the entire country (in both endemic and non-endemic areas), due to the demographic and migratory realities that surpass all past and present limits in these areas to control vectoral transmission.
  11. The Advisory Group considers it fundamental that the plans and operations developed for screening, diagnosis, treatment, and monitoring of Congenital Chagas Disease be incorporated definitively into the national health system at all levels of complexity, and integrated into Primary Health Care (PHC).
  12. The Advisory Group considers it necessary to implement processes to educate and continually train human resources, so that they might carry out the recommended actions.
  13. The Advisory Group invites the countries to make compulsory and to regulate screening, diagnosis, treatment, and monitoring of Congenital Chagas Disease, within its legal and/or health regulatory system.
  14. The Advisory Group deems it of the greatest importance and interest to promote interagency technical cooperation between PAHO/WHO, the Belgian Cooperation agency, and the French Institute for Research in Development (Institut de Recherche en Développement / IRD), to support the organization, development, scientific research, and human-resources training required to strengthen control measures against Congenital Chagas Disease in the Region of the Americas.