Andean subregional Chagas disease area and the Andean initiative of Chagas disease.

The Andean subregional Chagas disease area and theAndean initiative of Chagas disease consist of the asso-ciation of Peru, Ecuador, Colombia, and Venezuela withtheir own and particular characteristics:1. extensive area distributed in a broad latitude;2. important echo-biological diversity;3. biogeographically variables due to diverse alti-tude and latitude;4. different epidemiological situations of Chagasendemic disease;5. socioeconomic-cultural diversity;6. ethnic diversity;7. different structures and characteristics of peri andintradomiciliary areas;8. different vectors implied in the transmission ofTrypanosoma cruzi;9. various degrees of development and continuity ofthe control/surveillance of Chagas disease.The initiative, created in 1997, has gotten around dis-continuity periods but has served as a support of develop-ment of the prevention, control, surveillance, and care ofChagas disease, that the member countries have fulfilled.The proposed control against the vector of Chagasdisease has been based on a proposal that countries de-veloped in the Initiative, centered in actions that priori-tize the concept of “risk”. Some species of triatomines of the subregion, poin-ted out as vectors of the greatest epidemiological im-portance, are prone of “elimination”, such as:Rhodnius prolixus: Colombia and VenezuelaTriatoma dimidiata and Rhodnius ecuadoriensis:Ecuador.Rhodnius ecuadoriensis and Triatoma infestans: Peru.This may be possible to their condition of speciesclosely associated to anthropic constructions.Other species of vector importance, given their “indig-enous” condition with presence in nature, only makes itpossible to assume a control of its household presence.Wild populations of R. prolixus, R. ecuadoriensis,and T. dimidiata correspond to studies in specific areasand should be subject to entomological surveillance.With regard to medical care – with diagnosis, man-agement, and treatment of the infected/Chagas disease –, itshould be worked a great deal so that national health sys-tems fortify theirs capabilities, departing as an exampleof a better quantification of their prevalences, morbid-ity, and mortality, and of a clear development of the as-pects of treatment with regard to indication, opportu-nity, access, and availability.The objectives of the Andean Initiative of ChagasDisease are the control of the vector-borne transmis-sion of Chagas disease and the control of the transfu-sion transmission of Chagas disease.It seems to be a subject to consider in the future theoutlining of more specific objectives in order.The Andean Initiative of Chagas disease and/or someof its members have counted up to date with technicalcooperation of major interest, such as: CDIA/EC; ECLAT;CIDA (Canada); TDR/WHO; and the Technical Secre-tariat of PAHO.A characteristic of significance in the four membercountries is their double membership to endemic op-portunities geo-epidemiologist of Chagas disease:Andean and Amazon.There exists potential for groups and institutions ofimportance in the area of research, that are capable offormulating contributions to the prevention, control,surveillance, and care of Chagas disease, as effectivelyhave carried them out.This subregional space is acquiescent of a greaterdevelopment of actions on Chagas disease and of tech-nical and horizontal international cooperation amongmember countries, better organized and coordinated, inorder to strengthen the control measures.The technical cooperation possibilities are timely andrelevant appropriate as they may possible the following:(1) training applied to the control and care; (2) techno-logical transfer of validated schemes of prevention, con-trol, and surveillance; (3) practical research and appliedin field for the purpose of control; (4) the developmentof mass communication, in favor of installing in betterform to Chagas disease, among the subjects of the healthagenda of the countries; (5) the utilization of the Websportal suitable for: (a) dissemination of regular meetingreports; (b) dissemination of reports on workshops andtechnical forums; (c) dissemination of work manuals incontrol and attention; (d) rendering operational coursesvirtual in control and attention; (6) promote horizontaltechnical cooperation among services and institutes ofthe member countries; (7) increase international evalu-ation systems of land, through visits of commissions ofindependent specialists; (8) the development of tests ofquality control in diagnosis among the countries and cen-ters of excellence; (9) standardize criteria for the treat-ment and follow-up of the infected patient.