An expert guide through the epidemiological, ecological, and clinical complexities of Chagas disease, emphasizing recent advances that have created new tools for diagnosis, treatment, prevention and control. The report marks the first time that a WHO expert committee has assessed the public health importance of this disease and issued practical guidelines for its control. Information is specific to geographic area, parasite strain, and species of animal reservoir host. Basic information is provided in the opening section, which discusses the clinical features, pathology, and pathogenesis of the disease as seen in its different stages and in its cardiac, digestive, and neurological forms. The special features of congenital infection are also described. Subsequent sections offer detailed information on the different parasite strains and criteria for their identification and incrimination, the biology and behaviour of the six principal vectors, and the main animal reservoir hosts involved in domestic, peridomestic, and sylvatic transmission cycles. A section devoted to epidemiology profiles characteristics of the disease and factors favouring transmission in each of seventeen Latin American countries where the disease is endemic. Particular attention is given to the increasing problem of transfusion-acquired infection. The second and most extensive part of the book offers practical and technical guidelines for clinical management, prevention, and control. Clinical management is covered first, with detailed advice on various diagnostic methods, recommended drugs for trypanosomicidal treatment, and techniques for the symptomatic management of the various clinical forms. Advice on vector control covers modification of housing for long-term control, conventional spraying campaigns, nd a number of promising new chemical tools, including a fumigant canister and a range of slow-release insecticide paints. The final main section responds to the urgent need to develop national programmes for control and to establish mandatory serological screening for T. cruzi infections in blood banks. Practical advice includes an outline of the steps involved in programme development, a six-point budget frame, and a list of factors to consider when assessing the cost-effectiveness of a control programme. A primary health care approach is singled out as the most cost-effective route towards the achievement of long-term control. Additional practical information is presented in a series of six annexes. Three of these are lists presenting the 105 Triatominae found in the Americas, the sylvan and domestic mammal hosts of the parasite, and the codes to be used when labelling T. cruzi isolates according to a proposed international standard classification. Other annexes set out standard data required for identification and incrimination of hosts and parasite strains, describe laboratory safety precautions, and outline the sequential steps to follow in cost-effectiveness analysis.

eng fre spa.

WHODOC

WHO monograph

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