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Chagas Disease Transmission

1:03:30 recording · AUTO · 3 speakers

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Brief overview

A new global study shows Chagas burden falling sharply, while doxycycline still outperforms rifampicin against onchocerciasis.

  1. Chagas is falling, except outside endemic countriesAge-standardised prevalence, deaths and DALYs dropped everywhere endemic, but the US, Spain, Portugal and Italy show rising cases driven by migration.
  2. Stigma keeps the true burden hiddenGriffin describes being told there is no Chagas in Panama, and deaths recorded only as heart failure because nobody looked.
  3. Six weeks of doxycycline, and 100 mg may doDoxycycline sterilises adult females and kills about 70% of them; the trial suggests 100 mg is as good as 200 mg.
Executive Summary AI
  • Christina Naula opens paper week with a paywalled Lancet Infectious Diseases GBD analysis, corresponded by Dr. Jonathan F. Mosser at the Institute for Health Metrics and Evaluation, estimating Chagas deaths, prevalence and DALYs for 204 countries from 1990 to 2023.2:26
  • In 2023 there were 10.5 million people living with Chagas globally, a 16% decrease on 1990, with the age-standardised incidence rate down 55% and roughly 38% of cases in Brazil and 17% in Argentina.27:11
  • The same year saw 8,420 Chagas deaths, a 37% reduction on 1990 that becomes about 72% once age-standardised, alongside 285,000 DALYs, down almost 43%, with Bolivia carrying the highest death rates.29:58
  • Daniel Griffin then presents an Open Forum Infectious Diseases phase 2A randomised placebo-controlled trial comparing six weeks of doxycycline, six weeks of rifampicin and three weeks of both for onchocerciasis, scored on onchocercomata with normally embryogenic worms at 20 months.42:19
  • Doxycycline at 200 mg or 100 mg for six weeks performed best, the three-week doxycycline-rifampicin combination was weaker, and rifampicin alone was no different from placebo, possibly because it was dosed about four times too low.54:01
Key Quote
“And I think that systematic underreporting actually obscure the actual burden of the disease and maybe kind of makes it a bit hidden away in the health statistic.”
— Christina Naula19:08
Key Quote
“People don't really want it identified in their country.”
— Daniel Griffin25:38
Key Quote
“So doxycycline has a long-term permanent sterilizing effect on adult female worms.”
— Daniel Griffin48:50