Category Archives: International

The Spread of Chagas Disease in Latin America

By Francisca Bermudez

Although Chagas disease has only recently emerged as a possible public health concern in some southern states of the U.S., this infectious disease has been a major threat of high priority for health officials throughout many nations of Latin America for many years.

Prevalent in countries such as Mexico and Brazil, Chagas disease, also known as American trypanosomiasis, is a potentially life-threatening tropical parasitic infection caused by the protozoan parasite Trypanosoma cruzi (T. cruzi) found mostly in endemic areas of Central and South America. According to the Center for Disease Control and Prevention (CDC), it is estimated that as many as 8 million people suffer from this disease worldwide, many of whom are unaware of their condition.

Most victims are infected by this parasite in the same way: through contact with the feces of triatomine bugs, also known as “kissing bugs”. As described by the CDC, they are known as “kissing bugs” because they tend to feed on people’s faces; after they ingest blood, they defecate on the person, infecting them with the T. cruzi parasite. While usually transmitted to animals and people by insect vectors, Chagas disease can also spread through congenital transmissions, contaminated blood transfusions, infected organ transplants, or even laboratory accidents.

Chagas disease has spread quickly over the years and has recently become so widespread in areas of Latin America that many now feel it has become a “public health emergency”6.This is because Chagas disease, in its later stages, can often result in chronic diseases and even death.

In an interview, Dr. Juan Mejia, Secretary General of the Latin American Society of Cardiovascular and Thoracic Surgery, explains that besides causing gastrointestinal disease such as “megacolon” or “megaesophagus,” Chagas disease can also lead to severe cardiac disease and can “cause acute myopericarditis as well as chronic fibrosing myocarditis”.

According to Dr. Mejia, “Chagas myocarditis is the most common cause of non-ischemic cardiomyopathy in Latin America”. In fact, of the people suffering from Chagas disease, according to the World Health Organization, approximately 30% of chronically infected people develop cardiac abnormalities7.

These cardiac abnormalities, Dr. Mejia states, can often include “cardiac arrhythmia, left ventricular enlargement, and chronic heart insufficiency”. In addition, Chagas disease often leads to cardiomyopathy as a result of “chronic myocardial aggression” along with “chronic inflammation and fibrosis of the heart,” he adds.

Due to these mentioned cardiac complications, Chagas disease, throughout the Americas in recent years, has emerged as one of the leading causes of heart disease in the region.

According to Dr. Mejia, this epidemic of Chagas disease – one of the leading causes of heart failure in Central and South America – has quickly spread throughout Latin America and is “typical of Andean, semi, and tropical countries”. Noting that “the transmission of Chagas disease is related to the insect family of Triatominae,” he explains that these insects usually “live in hovels where they are able to multiply without the risk of predators.” For this reason, we commonly see the spread of Chagas disease in places where “kissing bugs” thrive, which is mostly in mud dwellings in undeveloped areas in Latin America.

While this epidemic has mainly affected those living in Central and South America, the CDC has recently reported that Chagas disease is now progressively spreading to other areas of the world9. As a result, due the mentioned serious cardiac complications, it appears that Chagas disease will continue to be a major public health concern in the long run. However, it is possible that it will now have an impact not only in the lives of people in Latin America, but also in the lives of people in many other parts of the world as well.

Lessons from Polio in Nigeria

By: Tristan Lim

At the end of the twenty-fifth year of the Global Polio Eradication Initiative, only three polio-endemic countries remain in the world – a drastic difference from the more than 125 countries struggling to control polio in 1988. One of these remaining countries is one of the most populous in the world: Nigeria.

Located in West Africa, Nigeria has made ongoing efforts to eradicate polio since 1988 as part of the Global Polio Eradication Initiative. As of 2014, the Nigeria Polio Eradication Emergency Plan (NPEEP) has identified six strategic priorities in eradicating polio: enhancing the quality of supplemental immunization activities, implementation of special strategies to reach underserved populations, adoption of special approaches for security challenges areas, improving outbreak responses, enhancing routine immunization and in-between round activities, and enhancing surveillance.

The NPEEP’s efforts have brought about important achievements in the ongoing battle to eradicate polio. In 2013 alone, Nigeria saw a marked reduction of at least 56% in Type 1 wild polio virus cases compared to those in 2012 and witnessed the disappearance of Type 3 wild polio virus with no cases in 2013. However, Nigeria’s six-pronged plan has led to an unexpected outcome in regards to another nearby epidemic.

In recent months, the Ebola epidemic has ravaged countries in West Africa such as Sierra Leone, Liberia, and Nigeria. On July 20th, Nigeria’s Ebola outbreak began when Liberian-American Patrick Sawyer flew into Lagos. Nineteen confirmed cases and one probable case stem from Sawyer’s case, the most recent of which was detected August 31. As of October 20th, the World Health Organization has officially declared Nigeria Ebola-free after having passed the mandatory period of forty-two days after the last confirmed case of the virus being discharged from the hospital.

The World Health Organization Country Representative, Dr. Rui Gama Vaz, highlighted the importance of having an established public health infrastructure system by observing that, “As the most populous country in Africa and its newest economic powerhouse, Nigeria stands at a high risk for the spread of the Ebola virus disease”.

With the construction of public health infrastructure to battle polio, Nigeria has developed a more centralized approach to handling health crises that provided the country a head start over other West African countries. The NPEEP’s strategies such as instituting a centralized National Polio Eradication Emergency Operations Center and improving strategies to reach underserved populations have effectively created a surveillance system that was easily implemented to monitor new Ebola cases.

Many lessons concerning emergency responses and decision-making can be learned from Nigeria’s success in containing Ebola. As the world continues to watch the Ebola health crisis take place in West Africa, Nigeria is a prime example of the importance of public health infrastructure. Development of emergency operations centers and surveillance systems in the rest of the West African countries may lend themselves to further preventing the spread of Ebola. While these lessons from Nigeria may be late to the war on Ebola, they still provide a resounding model of centralized public health infrastructure that may prevent future epidemics from occurring.

Lessons from Polio in Nigeria

At the end of the twenty-fifth year of the Global Polio Eradication Initiative, only three polio-endemic countries remain in the world – a drastic difference from the more than 125 countries struggling to control polio in 1988. One of these remaining countries is one of the most populous in the world: Nigeria.

Located in West Africa, Nigeria has made ongoing efforts to eradicate polio since 1988 as part of the Global Polio Eradication Initiative. Continue reading Lessons from Polio in Nigeria

Ebola and Cultural Misunderstandings

The spread of the Ebola virus in West Africa has generated fear over the possible global spread of the disease due to traveling, improper health care, and the potential transmission of disease through bodily fluid exchange or, less likely, airborne contamination.

Experts generally trace the origins of Ebola to fruit bats which can carry the disease without being affected themselves. Continue reading Ebola and Cultural Misunderstandings