Public Health Interventions
The Southern Cone Initiative
The Southern Cone Initiative to Control/Eliminate Chagas (INCOSUR) was created in 1991 by the Ministers of Health of Argentina, Bolivia, Brazil, Chile, Paraguay, and Uruguay with the goal of fighting Chagas' disease in the southern cone region of South America by eliminating the main vector and screening blood donors. PAHO is the the Pan American Health Organization, and is the umbrella organization under which INCOSUR operates. Transmission of Chagas' disease by vectors and by blood transfusion has been interrupted in Uruguay in 1997, in Chile in 1999, and in 8 of the 12 endemic states of Brazil in 2000. An update from 2001 of the initiative showed the vectorial transmission had been stopped in 13 of the 19 endemic provinces of Argentina. The incidence of new infections by T. cruzi in the whole continent has decreased by 70%. A cost-benefit analysis of the investments of the vector control program in Brazil indicate that for each dollar spent on prevention, there is US$17 in savings in medical care and disabilities.
Similar multi-country control initiatives have been launched in the Andean countries and in Central America and rapid progress has been made to ensure the interruption of the transmission of Chagas' disease by 2005 as requested by a resolution of the World Health Assembly approved in 1998. (Mem Inst Oswaldo Cruz. 2003 Jul; 98(5): 577-91)
Control of the reduviid bug vector is very important in decreasing the spread of the disease, but this alone cannot control the spread due to the "infinite resilience" of the vector population. Vector control has proved to be very effective in Oaxaca, Mexico, where the use of DDT to control malaria has alos resulted in the virtual elimination of household reduviid bugs and a decrease in the transmission of Chagas' disease. Education of the population in endemic areas is important, as well as working to build houses that do not harbor reduviid bugs. Periodic inseciticide spraying programs are of value as well.