Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110 -Santa Efigênia, Belo Horizonte -MG, 30130-100, BR.
Department of Family Medicine, Mental and Collective Health, Universidade Federal de Ouro Preto, Ouro Preto, Brazil.
Glob Heart. 2024 Jan 8;19(1):2. doi: 10.5334/gh.1280. eCollection 2024.
Chagas disease (ChD), a Neglected Tropical Disease, has witnessed a transformative epidemiological landscape characterized by a trend of reduction in prevalence, shifting modes of transmission, urbanization, and globalization. Historically a vector-borne disease in rural areas of Latin America, effective control measures have reduced the incidence in many countries, leading to a demographic shift where most affected individuals are now adults. However, challenges persist in regions like the Gran Chaco, and emerging oral transmission in the Amazon basin adds complexity. Urbanization and migration from rural to urban areas and to non-endemic countries, especially in Europe and the US, have redefined the disease's reach. These changing patterns contribute to uncertainties in estimating ChD prevalence, exacerbated by the lack of recent data, scarcity of surveys, and reliance on outdated models. Besides, ChD's lifelong natural history, marked by acute and chronic phases, introduces complexities in diagnosis, particularly in non-endemic regions where healthcare provider awareness is low. The temporal dissociation of infection and clinical manifestations, coupled with underreporting, has rendered ChD invisible in health statistics. Deaths attributed to ChD cardiomyopathy often go unrecognized, camouflaged under alternative causes. Understanding these challenges, the RAISE project aims to reassess the burden of ChD and ChD cardiomyopathy. The project is a collaborative effort of the World Heart Federation, Novartis Global Health, the University of Washington's Institute for Health Metrics and Evaluation, and a team of specialists coordinated by Brazil's Federal University of Minas Gerais. Employing a multidimensional strategy, the project seeks to refine estimates of ChD-related deaths, conduct systematic reviews on seroprevalence and prevalence of clinical forms, enhance existing modeling frameworks, and calculate the global economic burden, considering healthcare expenditures and service access. The RAISE project aspires to bridge knowledge gaps, raise awareness, and inform evidence-based health policies and research initiatives, positioning ChD prominently on the global health agenda.
恰加斯病（Chagas disease，ChD）是一种被忽视的热带病，其流行病学特征发生了重大转变，包括流行率下降、传播方式转变、城市化和全球化等。历史上，恰加斯病是拉丁美洲农村地区的一种媒介传播疾病，但有效的控制措施已使许多国家的发病率降低，导致受影响的大多数个体现在为成年人。然而，在格兰查科等地区仍存在挑战，亚马逊流域出现的新的口服传播方式增加了复杂性。从农村到城市以及从非流行地区到欧洲和美国等非流行国家的城市化和移民，重新定义了该疾病的传播范围。这些变化的模式加剧了恰加斯病流行率估计的不确定性，缺乏近期数据、调查稀缺以及依赖过时模型都使得情况更加复杂。此外，恰加斯病的终身自然史，具有急性和慢性阶段，给诊断带来了复杂性，尤其是在医疗保健提供者意识较低的非流行地区。感染和临床表现之间的时间分离以及漏报现象，使得恰加斯病在卫生统计数据中无法被察觉。由于替代原因，恰加斯病心肌病导致的死亡往往未被识别。为了应对这些挑战，RAISE 项目旨在重新评估恰加斯病和恰加斯病心肌病的负担。该项目是世界心脏联合会、诺华全球健康、华盛顿大学健康计量与评估研究所与巴西联邦米纳斯吉拉斯联邦大学协调的专家团队的合作项目。该项目采用多维策略，旨在完善与恰加斯病相关的死亡估计，对血清流行率和临床形式的流行率进行系统评价，改进现有的建模框架，并计算全球经济负担，考虑医疗保健支出和服务获取情况。RAISE 项目旨在缩小知识差距、提高认识，并为循证卫生政策和研究计划提供信息，使恰加斯病在全球卫生议程中占据重要位置。
