Federal University of Jequitinhonha and Mucuri Valleys, Campus JK, Diamantina, MG, Brazil.
Middlesex University, The Burroughs Hendon, Town Hall Extension Building, London NW4 4BT. UK.
Perspect Public Health. 2017 Sep;137(5):289-295. doi: 10.1177/1757913916671160. Epub 2016 Oct 10.
This article aimed to provide a critical review of the evolution of Chagas' disease (ChD) in Brazil, its magnitude, historical development and management, and challenges for the future.
A literature search was performed using PubMed, SciELO and Google Scholar and throughout collected articles' references. Narrative analysis was structured around five main themes identified: vector transmission, control programme, transfusion, oral and congenital transmission.
In Brazil, the Chagas' Disease Control Programme was fully implemented in the 1980s, when it reached practically all the endemic areas, and in 1991, the Southern Cone Initiative was created, aiming to control the disease transmission through eliminating the Triatoma infestans and controlling blood banks. As a result, the prevalence of chagasic donors in blood banks reduced from 4.4% in the 1980s to 0.2% in 2005. In 2006, Pan American Health Organization (PAHO) certified the interruption of transmission of ChD through this vector in Brazil. However, there are still challenges, such as the domiciliation of new vector species, the need for medical care of the infected individuals, the prevention of alternative mechanisms of transmission, the loss of political concern regarding the disease and the weakening of the control programme.
Despite the progress towards control, there are still many challenges ahead to maintain and expand such control and minimise the risk of re-emergence.
本文旨在对巴西恰加斯病（Chagas' disease，ChD）的演变、规模、历史发展和管理进行批判性回顾，并探讨未来面临的挑战。
使用 PubMed、SciELO 和 Google Scholar 进行文献检索，并查阅了整篇文章的参考文献。叙述性分析围绕五个主要主题展开：媒介传播、控制规划、输血、口服和先天性传播。
在巴西，恰加斯病控制规划于 20 世纪 80 年代全面实施，当时该规划几乎覆盖了所有流行地区。1991 年，创建了南锥体倡议，旨在通过消灭传播疾病的锥蝽和控制血库来控制疾病传播。结果，血库中携带恰加斯病的供体比例从 20 世纪 80 年代的 4.4%降至 2005 年的 0.2%。2006 年，泛美卫生组织（PAHO）认证巴西通过这种媒介中断了 ChD 的传播。然而，仍存在挑战，如新型媒介物种的定殖、感染个体的医疗需求、预防替代传播途径、对疾病的政治关注减弱以及控制规划的削弱。
尽管在控制方面取得了进展，但仍面临许多挑战，需要维持和扩大控制范围，以尽量减少再次出现的风险。
