Chagas disease in the context of the 2030 agenda: global warming and vectors

Souza, Rita de Cássia Moreira de; Gorla, David E; Chame, Marcia; Jaramillo, Nicolas; Monroy, Carlota; Diotaiuti, Lileia

doi:10.1590/0074-02760200479

The 2030 Agenda for Sustainable Development is a plan of action for people, planet and prosperity. Thousands of years and centuries of colonisation have passed the precarious housing conditions, food insecurity, lack of sanitation, the limitation of surveillance, health care programs and climate change. Chagas disease continues to be a public health problem. The control programs have been successful in many countries in reducing transmission by T. cruzi; but the results have been variable. WHO makes recommendations for prevention and control with the aim of eliminating Chagas disease as a public health problem. Climate change, deforestation, migration, urbanisation, sylvatic vectors and oral transmission require integrating the economic, social, and environmental dimensions of sustainable development, as well as the links within and between objectives and sectors. While the environment scenarios change around the world, native vector species pose a significant public health threat. The man-made atmosphere change is related to the increase of triatomines’ dispersal range, or an increase of the mobility of the vectors from their sylvatic environment to man-made constructions, or humans getting into sylvatic scenarios, leading to an increase of Chagas disease infection. Innovations with the communities and collaborations among municipalities, International cooperation agencies, local governmental agencies, academic partners, developmental agencies, or environmental institutions may present promising solutions, but sustained partnerships, long-term commitment, and strong regional leadership are required. A new world has just opened up for the renewal of surveillance practices, but the lessons learned in the past should be the basis for solutions in the future.

Key words:
Chagas disease; triatomines; global warming; 2030 Agenda

[1] + Corresponding author: lileia.diotaiuti@fiocruz.br

SDGs can affect Chagas disease?		How	Why	References
SDG 1	End poverty in all its forms everywhere	↑	Chagas disease mostly affects poor and unassisted people. According WHO “Chagas disease is a proxy for poverty and disadvantage: it affects populations with low visibility and little political voice, causes stigma and discrimination, is relatively neglected by researchers, and has a considerable impact on morbidity and mortality”.	¹²⁶126. Franco-Paredes C, Von A, Hidron A, Rodríguez-Morales AJ, Tellez I, Barragán M, et al. Chagas disease: an impediment in achieving the millennium development goals in Latin America. BMC Int Health Hum Rights. 2007; 7: 7. doi: 10.1186/1472-698X-7-7. https://doi.org/10.1186/1472-698X-7-7... ¹²12. Gürtler RE, Diotaiuti L, Kitron U. Commentary: Chagas disease: 100 years since discovery and lessons for the future. Int J Epid. 2008; 37(4): 698-701. ¹³13. Bhutta ZA, Sommerfeld J, Lassi ZS, Salam RA, Das JK. Global burden, distribution, and interventions for infectious diseases of poverty. Infect Dis Poverty. 2014; 3: 21. ²2. Dias JCP. Globalization, inequity and Chagas disease. Cad Saude Publica. 2007; 23(Suppl.1): S13-22. ¹²⁷127. Finkelman J. Innovative community-based ecosystem management for dengue and Chagas disease prevention in low and middle income countries in Latin America and the Caribbean. Trans R Soc Trop Med Hyg. 2015; 109(2): 89-90.
SDG 2	End hunger, achieve food security and improved nutrition and promote sustainable agriculture	↑	Oral transmission of Trypanosoma cruzi associated with food / beverage consumption is an important path of infection in South America that from 2000-2010 recorded 70% of the cases in the Amazon region. This type of transmission is basically related to improper handling by extractive communities and trade of regionals fruits such as açaí and bacaba. Other cases have also been reported for the consumption of sugar cane. The production of goats and sheep represents an expressive part of the economic activity of rural communities in South America, as well as the raising of pigs. Usually these animals are in corrals in the peridomicile and are food source of the triatomines, vectors of Chagas disease. The infestation of these insects is an impact factor on production.	¹²⁸128. Silva-dos-Santos D, Barreto-de-Albuquerque J, Guerra B, Moreira OC, Berbert LR, Ramos MT, et al. Unraveling Chagas disease transmission through the oral route: gateways to Trypanosoma cruzi infection and target tissues. PLoS Negl Trop Dis. 2017; 11(4): e0005507. doi.org/10.1371/journal.pntd.0005507. ¹²⁹129. Toso MA, Vial UF, Galanti N. Transmisión de la enfermedad de Chagas por vía oral [Oral transmission of Chagas' disease]. Rev Med Chil. 2011; 139(2): 258-66. ¹³⁰130. Gorla DE, Abrahan L, Hernandez ML, Porcasi X, Hrellac HÁ, Carrizo H, et al. New structures for goat corrals to control peridomestic populations of Triatoma infestans (Hemiptera: Reduviidae) in the Gran Chaco of Argentina. Mem Inst Oswaldo Cruz. 2013; 108(3): 352-8.
SDG 3	Ensure healthy lives and promote well-being for all at all ages	↑	Chagas disease significantly affects the countries of South America where premature death leads to the loss of thousands of working days and a billion dollar impact on productivity. Health care costs reach more than half a billion a year and the migration of infected people to non-endemic areas, such as Europe, requires specific resources for this disease in these areas. Chagas’ disease is highly prevalent in rural areas. A study in Brazil from 2000 to 2010, with 54,236 patients, indicates greater involvement and mortality rate among men. Most patients were over 60 years old (Nóbrega et al.). The improvement of housing in some areas and lower fertility may be one of the causes of the aging of the disease, which translates into low infection among young people and an increase in the cause of death in the elderly in these areas.	¹³¹131. Pérez-Molina JA, Molina I. Chagas disease. Lancet. 2018; 391(10115): 82-94. doi: 10.1016/S0140-6736(17)31612-4. https://doi.org/10.1016/S0140-6736(17)31... ¹³²132. Mendes FSNS, Mediano MFF, Souza FCC, Silva OS, Carneiro FM, Holanda MT, et al. Effect of physical exercise training in patients with Chagas heart disease (from the PEACH STUDY). Am J Cardiol. 2020; 125(9): 1413-20. doi: 10.1016/j.amjcard.2020.01.035. https://doi.org/10.1016/j.amjcard.2020.0... ¹³³133. Nóbrega AA, Araújo WN, Vasconcelos AMV. Mortality due to Chagas disease in Brazil according to a specific cause. Am J Trop Med Hyg. 2014; 91(3): 528-33. ¹³⁴134. Santos Filho JCL, Vieira MX, Xavier IGG, Maciel ER, Rodrigues Jr LF, Curvo EOV, et al. Quality of life and associated factors in patients with chronic Chagas disease. Trop Med Int Health. 2018; 23(11): 1213-22.
SDG 4	Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all	↑	Little or incorrect information is one of the fundamental aspects that compromise health promotion and actions for the prevention and control of zoonoses. In the case of Chagas’ disease, the knowledge of the vector species, their behavior, habitat and form of transmission of T. cruzi are essential for people to recognise the risk of infection and assist in entomological surveillance. Likewise, decision makers need to have the same knowledge to implement public policies and effective and efficient actions. The use of videos and films, iconographic atlases and vector albums and the collaboration of society are useful tools for everyone to become responsible in controlling the disease.	¹³⁵135. Bianchi TF, Santos CV, Jeske S, Grala AP, Moura MQ, Madia DS, et al. Health education in Chagas disease control: making an educational video. Rev Patol Trop. 2018; 47(2): 116-24. ¹³⁶136. Curtis-Robles R, Wozniak EJ, Auckland LD, Hamer GL, Hamer SA. Combining public health education and disease ecology research: using citizen science to assess Chagas disease entomological risk in Texas. PLoS Negl Trop Dis. 2015; 9(12): e0004235. ¹³⁷137. Yevstigneyeva V, Camara-Mejia J, Dumonteil E. Analysis of children's perception of triatomine vectors of Chagas disease through drawings: opportunities for targeted health education. PLoS Negl Trop Dis. 2014; 8(10): e3217.
SDG 5	Achieve gender equality and empower all women and girls	↑	Chagas disease can be a congenital disease. The WHO points out that the elimination of congenital transmission depends on early diagnosis in infected pregnant women, newborns and immediate treatment. As the effectiveness of antiparasitic treatment is more frequent, faster and with fewer adverse reactions in girls under 19 years of age, it is important to promote the diagnosis before pregnancy, especially in non-endemic areas. The adoption of positive attitudes is one of the objectives of intervention programs for Chagas’ diseases, which must adopt different communication strategies between the sexes. Those that increase women’s knowledge about prevention and control of Chagas’ disease can contribute to increase the levels of adoption of good practices. For men, on the other hand, a strategy must involve practical and collaborative activities, differences that must be used in planning programs.	¹³⁸138. WHO - World Health Organization. Preventing mother-to-child transmission of Chagas disease: from control to elimination. 2018 [cited 2020 September 3]. Available from: https://www.who.int/neglected_diseases/news/Chagas-Preventing-mother-to-child-transmission/en/. https://www.who.int/neglected_diseases/n... ¹³⁹139. Carlier Y, Sosa-Estani S, Luquetti AO, Buekens P. Congenital Chagas disease: an update. Mem Inst Oswaldo Cruz. 2015; 110(3): 363-68. doi: 10.1590/0074-02760140405. https://doi.org/10.1590/0074-02760140405... ¹⁴⁰140. Triana DRR, Mertens F, Zúniga CV, Mendoza Y, Nakano EY, Monroy MC. The role of gender in Chagas disease prevention and control in Honduras: an analysis of communication and collaboration networks. EcoHealth. 2016; 13: 535-48. doi: 10.1007/s10393-016-1141-9. https://doi.org/10.1007/s10393-016-1141-...
SDG 6	Ensure availability and sustainable management of water and sanitation for all	→	Good practices in food preparation, transportation, storage and consumptiom are recommended as a supporting actions to prevent the risk of oral T. cruzi infection.	¹⁴¹141. WHO - World Health Organization. Water sanitation and hygiene for accelerating and sustaining progress on neglected tropical diseases. A global strategy 2015-2020. 2015. Available from: https://apps.who.int/iris/bitstream/handle/10665/182735/WHO_FWC_WSH_15.12_eng.pdf?sequence=1. https://apps.who.int/iris/bitstream/hand... ¹⁴²142. Bustamante DM, Monroy C, Pineda S, Rodas A, Castro X, Ayala V, et al. Risk factors for intradomiciliary infestation by the Chagas disease vector Triatoma dimidiata in Jutiapa, Guatemala. Cad Saude Publica. 2009; 25(Suppl. 1): S83-92.
SDG 7	Ensure access to affordable, reliable, sustainable and modern energy for all	→	Access to energy allows the maintenance of food and production of perishables, promotes comfort, quality of life and reduces manual labor, conditions that benefit extractive communities and rural producers in areas at risk of Chagas disease. Energy also promotes access to information through television and the internet that contribute to health education. On the other hand, home and street lighting can be an attraction factor for Chagas disease vectors and could increase the contact rates between vectors, humans and domestic animals.	¹⁴³143. Erazo D, Cordovez J. The role of light in Chagas disease infection risk in Colombia. Parasit Vectors. 2016; 9: 9. ¹⁴⁴144. Pacheco-Tucuch FS, Ramirez-Sierra MJ, Gourbière S, Dumonteil E. Public street lights increase house infestation by the Chagas disease vector Triatoma dimidiata. PLoS One. 2012; 7(4): e36207. ¹⁴⁵145. Lazzari CR, Pereira MH, Lorenzo MG. Behavioural biology of Chagas disease vectors. Mem Inst Oswaldo Cruz. 2013; 108(Suppl. 1): 34-47.
SDG 8	Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all	↑	Food production, extractivism and changes in land use should include in their business plans the assessment of the impact of the activity on health and in Latin America in Chagas disease. They must consider the exposure and protection of the worker to the vector and the pathogen, environmental changes and biological communities that alter the natural cycle, the increase in the population density of humans and domestic animals attracted by economic growth, a scenario usually accompanied by precarious housing and conditions. Sanitary conditions, low capacity for surveillance and health care, factors that open alternative routes for infection by T. cruzi. The neglect in considering these factors led to outbreaks of Chagas disease due to oral infection.	¹⁴⁶146. Souza-Lima RC, Barbosa MGV, Coura JR, Arcanjo ARL, Nascimento AS, Ferreira JMBB, et al. Outbreak of acute Chagas disease associated with oral transmission in the Rio Negro region, Brazilian Amazon. Rev Soc Bras Med Trop. 2013; 46(4): 510-4. ¹⁴⁷147. Morocoimaa A, Chiquea J, Zavala-Jaspeb R, Díaz-Bellob Z, Ferrerc E, Urdaneta-Moralesd S, et al. Commercial coconut palm as an ecotope of Chagas disease vectors in north-eastern Venezuela. J Vector Borne Dis. 2010; 47: 76-84. ¹⁴⁸148. Santos VRC, Meis J, Savino W, Andrade JAA, Vieira JRS, Coura JR, et al. Acute Chagas disease in the State of Pará, Amazon Region: is it increasing? Mem Inst Oswaldo Cruz. 2018; 113(5): e170298.
SDG 9	Build resilient infrastructure, promote inclusive and sustainable industrialisation and foster innovation	↑	Efforts around the world to ensure food quality can be seen in advancing health standards and regulatory frameworks in several countries to prevent foodborne diseases. These advances include the control of oral transmission and expansion of Chagas disease. However, there is an urgent need for the sanitary surveillance system to be broad and efficient to identify potential risks, maintain risk analyses and control outbreaks of foodborne diseases worldwide.	¹⁴⁹149. Feltes MMC, Arisseto-Bragotto AP, Block JM. Food quality, food-borne diseases, and food safety in the Brazilian food industry. FQS. 2017; 1(1): 13-27. doi: 10.1093/fqsafe/fyx004. https://doi.org/10.1093/fqsafe/fyx004...
SDG 10	Reduce inequality within and among countries	↑	Chagas disease is a social disease traditionally installed in poor communities with low assistance and political and economic inequalities. In the last 30 years it has expanded to the Amazon region with agricultural, urban, mining, livestock and timber extraction. The loss of territory by traditional and indigenous populations and the prospect of improving the quality of life and job offers in urban centers, inside and outside Latin American countries, stimulated the mobility of infected people coming from these areas, to other non-endemics. Migration to Europe and the United States (more than 300,000 legal immigrants) expanded the distribution of the disease. Although in many of these areas there is no possibility of maintaining transmission, the disease becomes a problem due to its morbidity and other forms of non-vector transmission.	¹⁵⁰150. Briceño-León R. Chagas disease and globalization of the Amazon. Cad Saude Publica. 2007; 23(Suppl. 1): S33-40. ²2. Dias JCP. Globalization, inequity and Chagas disease. Cad Saude Publica. 2007; 23(Suppl.1): S13-22. ¹⁵¹151. Fernández MD, Gaspe MS, Gürtler RE. Inequalities in the social determinants of health and Chagas disease transmission risk in indigenous and creole households in the Argentine Chaco. Parasit Vectors. 2019; 12: 184. ¹¹⁸118. Coura JR, Albajar Viñas P, Junqueira ACV. Ecoepidemiology, short history and control of Chagas disease in the endemic countries and the new challenge for non-endemic countries. Mem Inst Oswaldo Cruz. 2014; 109(7): 856-62. ¹⁵²152. Schmunis GA, Yadon ZE. Chagas disease: a Latin American health problem becoming a world health problem. Acta Trop. 2009; 115(2010): 14-21.
SDG 11	Make cities and human settlements inclusive, safe, resilient and sustainable	↑	The maintenance of vector transmission of Chagas disease is closely related to human settements that provide habitat for several species of insect vectors. Adobe wall homes and corrugated metal roofing shelter triatomines vectors and subsistence living without drinking water sources contribute to the occurrence of Chagas disease. Although this scenario is still common in rural areas, colonisation and adaptation of vectors to urban constructions is increasing.	¹⁵³153. Delgado S, Ernst KC, Pumahuanca ML, Yool SR, Comrie AC, Sterling CR, et al. A country bug in the city: urban infestation by the Chagas disease vector Triatoma infestans in Arequipa, Peru. Int J Health Geogr. 2013; 12: 48. ¹⁴²142. Bustamante DM, Monroy C, Pineda S, Rodas A, Castro X, Ayala V, et al. Risk factors for intradomiciliary infestation by the Chagas disease vector Triatoma dimidiata in Jutiapa, Guatemala. Cad Saude Publica. 2009; 25(Suppl. 1): S83-92. ¹⁵⁴154. Urdaneta-Morales S. Chagas' disease: an emergent urban zoonosis. The Caracas Valley (Venezuela) as an epidemiological model. Front Public Health. 2014; 2: e00265.
SDG 12	Ensure sustainable consumption and production patterns	↑	The consumption of açaí and other fruits and plants can lead to the risk of oral infection by T. cruzi if adequate sanitary measures are not observed and implemented in the production chain. This risk is low in traditional management in native areas and high in inadequate management in monocultures that expand the scale of production and degrade the forest structure.	¹⁵⁵155. Veloz P. Value chains and soft commodities in Amazonia. Regulatory prospects for commodified biodiversity according to the glocal production chain of açaí. J Land Use Sci. 2020; 15: 389-405.
SDG 13	Take urgent action to combat climate change and its impacts	↑	Triatominae, vectors of Chagas disease, occur in tropical and subtropical regions. For the establishment and population stability, these vectors need protection from climatic extremes, environments whose relative humidity does not exceed the annual average of 60% and a regular source of food (blood). Global climate and environmental changes can alter these parameters, increase temperature and expand the geographic distribution of these insects and make new habitats available.	¹⁵⁶156. Mischler P, Kearney M, McCarroll JC, Scholte, Ronaldo GC, Vounatsou P, et al. Environmental and socio-economic risk modelling for Chagas disease in Bolivia. Geospatial Health. 2012; 6(3): S59-66. ¹¹⁸118. Coura JR, Albajar Viñas P, Junqueira ACV. Ecoepidemiology, short history and control of Chagas disease in the endemic countries and the new challenge for non-endemic countries. Mem Inst Oswaldo Cruz. 2014; 109(7): 856-62. ¹¹⁶116. Eberhard FE, Cunze S, Kochmann J, Klimpel S. Modelling the climatic suitability of Chagas disease vectors on a global scale. Elife. 2020; 9: e52072. doi: 10.7554/eLife.52072. https://doi.org/10.7554/eLife.52072... ¹⁵⁷157. Tamayo LD, Guhl F, Vallejo GA, Ramírez JD. The effect of temperature increase on the development of Rhodnius prolixus and the course of Trypanosoma cruzi metacyclogenesis. PLoS Negl Trop Dis. 2018; 12(8): e0006735. ¹¹⁷117. Graves BN. Climate change and Chagas disease in the Americas: a qualitative systematic review [monograph] [Internet]. UT School of Public Health Dissertations. Press; 2019. [cited 2020 Aug]. Available from: https://digitalcommons.library.tmc.edu/uthsph_dissertsopen/87. https://digitalcommons.library.tmc.edu/u... ¹⁰⁶106. Garrido R, Bacigalupo A, Peña-Gómez F, Bustamente RO, Cattan PE, Gorla D, et al. Potential impact of climate change on the geographical distribution of two wild vectors of Chagas disease in Chile: Mepraia spinolai and Mepraia gajardoi. Parasit Vectors. 2019; 12: 478. doi: 10.1186/s13071-019-3744-9. https://doi.org/10.1186/s13071-019-3744-...
SDG 14	Conserve and sustainably use the oceans, seas and marine resources for sustainable development	×	no impact identified
SDG 15	Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss	↑	Studies point out the impact of biodiversity loss on Chagas disease transmission and relate the lower richness of small mammals and the high infection in domestic dogs as a risk factor to Chagas disease transmission. This scenario seems to be consolidated after the human invasion of forest systems because the presence of domestic animals and synanthropic mammals, competent hosts of T. cruzi, promotes an increase in the abundance of vectors. In intact environments, the high diversity of species balances the distribution of the protozoan between competent and incompetent hosts (dillution effect).	¹²¹121. Xavier SCC, Roque ALR, Lima VS, Monteiro KJL, Otaviano JCR, Ferreira da Silva LFC, et al. Lower richness of small wild mammal species and Chagas disease risk. PLoS Negl Trop Dis. 2012; 6(5): e1647. ¹²⁰120. Gottdenker NL. Effects of anthropogenic land use change on the ecology of the Chagas disease agent Trypanosoma cruzi [PhD Thesis]. Seropédica: University of Georgia; 2009. 147 pp. ¹¹⁹119. Gottdenker NL, Calzada JE, Saldaña A, Carrol CR. Association of anthropogenic land use change and increased abundance of the Chagas disease vector Rhodnius pallescens in a rural landscape of Panama. Am J Trop Med Hyg. 2011; 84(1): 7077.
SDG 16	Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels	↑	In South America and the Caribbean, many populations live in areas of armed conflict or social instability that hinder or even prevent vector control, the diagnosis and treatment of Chagas disease, among others. In these locations, the persistence of violence instills fear and abandonment of public power, leading thousands to cities and countries in search of security and quality of life.	¹⁵⁸158. Beyer C, Villar JC, Suwanvanichkij V, Singh S, Baral S, Mills J. Neglected diseases, civil conflicts, and the right to health. Lancet. 2007; 370(9587): 619-27. https://doi.org/10.1016/S0140-6736(07)61301-4. https://doi.org/10.1016/S0140-6736(07)61... ¹⁵⁹159. Mills RM. Chagas disease: epidemiology and barriers to treatment [published online ahead of print, 2020 Jun 24]. Am J Med. 2020; S0002-9343(20)30520-9. doi:10.1016/j.amjmed.2020.05.022. ¹⁶⁰160. Hotez PJ, Basáñez M-G, Acosta-Serrano A, Grillet ME. Venezuela and its rising vector-borne neglected diseases. PLoS Negl Trop Dis. 2017: 11(6): e0005423.
SDG 17	Strengthen the means of implementation and revitalise the global partnership for sustainable development		Chagas disease is a tropical and subtropical disease that affects millions of people in several countries, especially poor and migrant people. Improving research and knowledge, sustainable economy, social justice, public policies, biodiversity conservation and surveillance and assistance and health actions can only be achieved with intersectoral partners and joint efforts.	¹⁶¹161. Boischio A, Sánchez A, Orosz Z, Charron D. Health and sustainable development: challenges and opportunities of ecosystem approaches in the prevention and control of dengue and Chagas disease. Cad Saude Publica. 2009; 25(Suppl. 1): S149-154. ¹⁶²162. Bruce YL, Bacon KM, Bottazzi ME, Hotez PJ. Global economic burden of Chagas disease: a computational simulation model. Lancet Infect Dis. 2013; 13(4): 342-8.

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Chagas disease in the context of the 2030 agenda: global warming and vectors