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The elimination of Chagas' disease from Brazil

  • E. MASSAD (a1)

On 9 June 2006 the Pan American Health Organization (PAHO) presented the Minister of Health of Brazil with the International Elimination of Transmission of Chagas' Disease Certificate. This act was the culmination of an intensive process that began in 1991 with the Southern Cone Initiative, a joint agreement between the governments of Argentina, Bolivia, Brazil, Chile, Paraguay, Uruguay and Peru, to control Chagas' disease by the elimination of the main vector, Triatoma infestans. This initiative has been highly successful and the prevalence area of the vector diminished rapidly in the last years. As a consequence, the current seroprevalence in children aged between 0 and 5 years is of the order of 10−5, a clear indication that transmission, if it is occurring, is only accidental. In this review I calculate the basic reproduction number, R0, for Chagas' disease and demonstrate that its relatively low value (1·25) explains why vectorial transmission was interrupted relatively easily. In addition, I used a mathematical model to forecast how long the remaining cases of the disease, as well as the additional vertically transmitted cases will last.

Corresponding author
*Address for correspondence: Dr E. Massad, Rua Teodoro Sampaio 115, São Paulo, CEP 05405-000, SP, Brazil. (Email:
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1. Scliar, M. Oswaldo Cruz and Carlos Chagas: the Birth of Science in Brazil [in Portuguese]. São Paulo: Odysseus, 2002.
2. Perleth, M. The discovery of Chagas' disease and the formation of the early Chagas disease concept. History and Philosophy of the Life Sciences 1997; 19: 211236.
3. Punukollu, G, Gowda, RM, Khan, IA. Early twentieth century descriptions of Chagas heart disease. International Journal of Cardiology 2004; 95: 347349.
4. PAHO. The Newsletter of the Pan American Health Organization ( Accessed 2 March 2007.
5. Ministério de Saúde ( Accessed 2 March 2007.
6. Kirchhoff, LV. American trypanosomiasis (Chagas' Disease). In: Guerrant, RL, Walker, DH, Weller, PF eds. Tropical Infectious Diseases. Principles, Pathogens and Practice. New York: Churchill Livingstone, 2000.
7. Rassi, A, Rassi, A Jr., Rassi, GG. Acute Chagas' disease [in Portuguese]. In: Brener, Z, Andrade, ZA, Barral-Neto, M eds. Trypanosoma cruzi e Doença de Chagas. Rio de Janeiro: Guanabara Koogan, 2000.
8. Kirchhoff, LV. Trypanosoma species (American Trypanosomiasis, Chagas' Disease): Biology of Trypanosomes. In: Mandell, GL, Bennet, JE, Dolin, R eds. Principles and Practice of Infectious Disease. Philadelphia: Elsevier, Churchill Livingstone.
9. Rey, L. Parasitologia, 3rd edn [in Portuguese]. Rio de Janeiro: Guanabara Koogan, 2001.
10. Beaty, B, Marquardt, WC. The Biology of Disease Vectors. Niwot: University Press of Colorado, 1996.
11. Marsden, PD. American Trypanosomiasis. In: Cook, GC ed. Manson's Tropical Diseases, 20th edn. London: W. B. Saunders Company Ltd, 1996.
12. Prata, A, Lopes, ER, Chapadeiro, E. Characteristics of non-expected sudden death in Chagas' disease [in Portuguese]. Revista Brasileira de Medicina Tropical 1986; 19: 912.
13. Junqueira, LF. On the possible role of autonomous cardiac dysfunction on sudden death associated with Chagas' disease [in Portuguese]. Arquivos Brasileiros de Cardiologia 1991; 56: 420434.
14. Resende, J. Digestive manifestations [in Portuguese]. In: Brener, Z, Andrade, ZA, Barral-Neto, M eds. Trypanosoma cruzi e Doença de Chagas. Rio de Janeiro: Guanabara Koogan, 2000.
16. Schofield, CJ. Biosystematics and evolution of the Triatominae. Cadernos de Saúde Pública 2000; 16 (Suppl. 2): 8992.
17. Lent, H, Jurberg, J, Galvão, C. Revalidation of genus Mepraia Mazza, Gajardo & Jorg, 1940 (Hemiptera Reduviidae) [in Portuguese]. Memórias do Instituto Oswaldo Cruz 1994; 89: 347352.
18. Schofield, CJ. Triatominae – Biology and Control. West Sussex: Eurocomunica Publications, 1994.
19. Allison, MJ. 1993. Chagas' Disease, chapter 25. In: Kiple, KF ed. The Cambridge World History of Human Disease. Cambridge: Cambridge University Press, 1993, pp. 636638.
20. Moncayo, A. Chagas disease: current epidemiological trends after the interruption of vectorial and transfusional transmission in the Southern Cone countries. Memórias do Instituto Oswaldo Cruz 2003; 98: 577591.
21. Kropf, SP, Azevedo, N, Ferreira, LO. Biomedical research and public health in Brazil: the case of Chagas' Disease (1909–1950). Journal of the Society for the Social History of Medicine 2003; 16: 111129.
22. WHO ( Accessed 2 March 2007.
23. Schofield, CJ, Jannin, J, Salvatella, R. The future of Chagas disease control. Trends in Parasitology 2006; 22: 583588.
24. Burnet, FM. Natural History of Infectious Disease, 3rd edn. Cambridge: Cambridge University Press, 1962.
25. Philip, CB, Rozenboom, LE. Medico-veterinary entomology: a generation of progress. In: Smith, RF, Mitler, TE, Smith, CN eds. History of Entomology, Palo Alto: Annual Reviews Inc., 1973.
26. Gubler, DJ. Resurgent vector-borne diseases as a global health problem. Emerging Infectious Diseases 1998; 4: 442450.
27. Macdonald, G. The analysis of equilibrium in malaria. Tropical Disease Bulletin 1952; 49: 813828.
28. Dietz, K. The estimation of the basic reproduction number for infectious diseases. Statistical Methods in Medicine 1993; 2: 2341.
29. Lopez, LF, et al. Threshold conditions for infection persistence in complex host-vectors interactions. Comptes Rendus Biologies Académie des Sciences Paris 2002; 325: 10731084.
30. Burattini, MN, et al. Modelling the control strategies against dengue in Singapore. Epidemiology and Infection. Published online: 31 May 2007. doi: 10.1017/S0950268807008667
31. Coutinho, FAB, et al. Threshold conditions for an non-autonomous epidemic system describing the population dynamics of dengue. Bulletin of Mathematical Biology 2006; 68: 22632282.
32. Luz, PM, et al. Uncertainties regarding dengue modeling in Rio de Janeiro, Brazil. Memórias do Instituto Oswaldo Cruz 2003; 98: 871878.
33. Massad, E, et al. Dengue and the risk of urban Yellow Fever reintroduction in São Paulo, Brazil. Revista de Saúde Pública 2003; 37: 477484.
34. Massad, E, et al. The risk of Yellow Fever in a dengue infested area. Transactions of the Royal Society of Tropical Medicine, 2001; 95: 370374.
35. Marques, CA, Forattini, OP, Massad, E. The basic reproduction number for dengue fever in São Paulo state, Brazil: 1990–1991 epidemics. Transactions of the Royal Society of Tropical Medicine and Hygiene 1994; 88: 5859.
36. Molineaux, L. The epidemiology of human malaria as an explanation of its distribution, including some implications for its control. In: Wernsdorfer, WH, McGregor, I eds. Malaria. Edinburgh: Churchill Livingstone, 1988.
37. WHO. Control of Chagas Disease. WHO Technical Report Series 811. Geneva: World Health Organization, 1991.
38. Dias, JCP, Silveira, AC, Schofield, CJ. The impact of Chagas disease control in Latin América – a review. Memórias do Instituto Oswaldo Cruz 2002; 97: 603612.
39. Geigy, E, Herbig, K. Erreger um Ubertrager tropischer Krankheiten, 1955. Cited in Rey L. Parasitologia, 3rd edn, Rio de Janeiro: Guanabara Koogan, 2001.
40. Silveira, AC. Current situation with Chagas disease vector control in the Americas. Cadernos de Saúde Pública 2000; 16: 3542.
41. Busvine, JR, Barnes, S. Observations on mortality among insects exposed to insecticidal films. Bulletin of Entomological Research 1947; 38: 8081.
42. Dias, E, Pellegrino, J. Some assays with ‘Gamexanne’ in the fight against the transmissors of Chagas' disease [in Portuguese]. Brazil Médico 1948; 62: 185190.
43. Schmunis, GA. American trypanosomiasis and its impact on Public Health in the Americas. In: Brener, Z, Andrade, ZA, Barral-Neto, M eds. Trypanosoma cruzi e Doença de Chagas. Rio de Janeiro: Guanabara Koogan, 1999.
44. Wendell, S. Doença de Chagas transfusional. In: Dias, JCP, Coura, JR eds. Clínica e terapêutica da Doença de Chagas: uma Abordagem Prática para o Clínico Geral. Rio de Janeiro: Fiocruz, 1997.
45. Dias, JCP, Schofield, CJ. The control of transfusional transmission of Chagas' disease in the South Cone initiative [in Portuguese]. Revista da Sociedade Brasileira de Medicina Tropical 1998; 31: 373383.
46. Massad, E. The basic reproduction ratio of HIV among intravenous drug users. Mathematical Bioscience 1994; 123: 227247.
47. Bittencourt, AL. Vertical transmission in Chagas' disease [in Portuguese]. Revista de Patologia Tropical 2000; 29 (Suppl.): 101115.
48. Mortara, G. Studies on the use of demographic census for reconstitution of birth statistics of Brazilian population [in Portuguese]. Revista Brasileira de Estatística 1941; 3: 4143.
49. Reis, EJ. A Economia do Brasil no Século XX, 2004 ( Accessed 12 March 2007.
50. Romaña, C, Abalos, JW. Action of ‘Gammexane’ on triatomidea. Domiciliary ‘Control’. Anals del Instituto de Medicina Regional, Tucuman 1948; 2: 95106.
51. Vinhaes, MC, Dias, JCP. Chagas' Disease in Brazil [in Portuguese]. Cadernos de Saúde Pública 2000; 16 (Suppl. 2): 712.
52. Organización Panamericana de la Salud. Manual de Procedimientos de control de calidad para los laboratórios de serologia de los bancos de sangre. PAHO/HPC/HCT 94.21. Washington, 1994.
53. Informe Nacional sobre la Enfermedad de Chagas en Uruguay. Apresentado à Comissão Intergovernamental de Avaliação. Mimeo, 1997, 17 pp.
54. Souza, HM, Ramirez, LE, Bordin, JO. Doença de Chagas Transfusional: medidas de controle. In: Dias, JCP, Coura, JR eds. Clínica e terapêutica da Doença de Chagas: uma Abordagem Prática para o Clínico Geral. Rio de Janeiro: Fiocruz, 1997.
55. Dias, JCP. Mecanismos de transmissão. In: Brener, Z, Andrade, ZA eds. Trypanosoma cruzi e doença de Chagas. Rio de Janeiro: Guanabara Koogan Editora, 1979.
56. Schijman, AG. Congenital Chagas Disease. Perspectives in Medical Virology 2006; 13: 223258.
57. Gorla, DE. Environmental variables recorded by remote sensors as indicators of geographical distribution of Triatoma infestans. Ecologia Austral 2002; 12: 117127.
58. Murray, CJL, Lopez, AD. The Global Burden of Disease. Harvard: Harvard University Press, 1996.
59. World, Bank. World Development Report 1993: Investing in Health. New York: Oxford University Press, 1993.
60. Mathers, CD, Lopez, A, Murray, C. The burden of disease and mortality by condition: data, methods, and results for the year 2001. In: Lopez, A, Mathers, C, Ezzati, M, Jamison, D, Murray, C eds. Global Burden of Disease and Risk Factor. New York: Oxford University Press, 2006.
61. Dias, JC. Control of Chagas' Disease in Brazil. Parasitology Today 1987; 3: 336341.
62. Schofield, CJ, Dias, JC. A cost-benefit analysis of Chagas' Disease control. Memorias do Instituto Oswaldo Cruz 1991; 86: 285295.
63. Dias, JCP. Doença de Chagas em Bambuí, Minas Gerais, Brasil. Estudo Clínico-Epidemiológico a Partir da Fase Aguda entre 1940 e 1982 (Thesis). Universidade Federal de Minas Gerais, Belo Horizonte, 1982.
64. Souza, AG, et al. Consolidation of the control of Chagas disease vectors in the State of São Paulo. Memórias do Instituto Oswaldo Cruz 1984; 79 (Suppl.): 125132.
65. Camargo, M, et al. Seroprevalence survey of chagasic infection in Brazil 1975/80 [in Portuguese]. Revista do Instituto de Medicina Tropical de São Paulo 1984; 26: 192204.
66. WHO. Chagas disease, interruption of transmission in Brazil. Weekly Epidemiologic Records 2000; 19: 153155.
67. Dias, E. Effects of superinfection on the evolution of chagasic chronic cardiopathy [in Portuguese]. Revista Goiana de Medicina 1962; 9 (Suppl.): 233239.
68. Macedo, VO. Influence of exposition to reinfection on the evolution of Chagas' disease. A cohort study of 5 years. Revista de Patologia Tropical 1976; 5: 33115.
69. Moraes-Souza, H. Transmissão transfusional da doença de Chagas. Revista de Patologia Tropical 2000; 29 (Suppl.): 91100.
70. Dias, JCP, Coura, JR. Epidemiologia. In: Dias, JCP, Coura, JR eds. Clínica e terapêutica da Doença de Chagas: uma Abordagem Prática para o Clínico Geral. Rio de Janeiro: Fiocruz, 1997.
71. WHO. Department of Measurement and Health Information ( Accessed 14 March 2007.
73. Smith, D, Keyfitz, N. Mathematical Demography. Berlin: Springer-Verlag, 1977.
74. Massad, E, et al. Forecasting versus projection models in epidemiology: the case of the SARS epidemics. Medical Hypotheses 2005; 65: 1722.
75. Ministério do Planejamento, Orçamento e Gestão ( Accessed 14 March 2007.
77. Schofield, CJ, Dias, JCP. The Southern Cone Initiative against Chagas disease. Advances in Parasitology 1999; 42: 127.
78. Dias, JCP. Chagas disease control and the natural history of human Chagas disease: a possible interaction? Memórias do Instituto Oswaldo Cruz 2000; 95 (Suppl. 11): 1420.
79. Vinhaes, MC. The situation of Southern Cone Initiative. XI Meeting of the Intergovernmental Commission of the Southern Cone Initiative for the elimination of Triatoma infestans and the control of transfusion transmission of Chagas disease. Asunción, Paraguay, 2002.
80. Coura, JR, et al. Emerging Chagas disease in Amazonian Brazil. Trends in Parasitology 2002; 18: 171176.
81. El'sgol'ts, EL. Introduction to the Theory of Differential Equations with Deviating Arguments. San Francisco: Holden-Day Inc., 1966.
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