{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T17:45:14Z","timestamp":1787161514212,"version":"build-2736575974"},"reference-count":71,"publisher":"BMJ","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Heart"],"published-print":{"date-parts":[[2009,4]]},"abstract":"<jats:p>\n                    A century after its discovery, Chagas\u2019 disease still represents a major public health challenge in Latin America. Moreover, because of growing population movements, an increasing number of cases of imported Chagas\u2019 disease have now been detected in non-endemic areas, such as North America and some European countries. This parasitic zoonosis, caused by\n                    <jats:italic>Trypanosoma cruzi<\/jats:italic>\n                    , is transmitted to humans by infected Triatominae insects, or occasionally by non-vectorial mechanisms, such as blood transfusion, mother to fetus, or oral ingestion of materials contaminated with parasites. Following the acute phase of the infection, untreated individuals enter a chronic phase that is initially asymptomatic or clinically unapparent. Usually, a few decades later, 40\u201350% of patients develop progressive cardiomyopathy and\/or motility disturbances of the oesophagus and colon. In the last decades several interventions targeting primary, secondary and tertiary prevention of Chagas\u2019 disease have been attempted. While control of both vectorial and blood transfusion transmission of\n                    <jats:italic>T cruzi<\/jats:italic>\n                    (primary prevention) has been successful in many regions of Latin America, early detection and aetiological treatment of asymptomatic subjects with Chagas\u2019 disease (secondary prevention) have been largely underutilised. At the same time, in patients with established chronic disease, several pharmacological and non-pharmacological interventions are currently available and have been increasingly used with the intention of preventing or delaying complications of the disease (tertiary prevention). In this review we discuss in detail each of these issues.\n                  <\/jats:p>","DOI":"10.1136\/hrt.2008.159624","type":"journal-article","created":{"date-parts":[[2009,1,8]],"date-time":"2009-01-08T20:55:29Z","timestamp":1231448129000},"page":"524-534","source":"Crossref","is-referenced-by-count":98,"title":["Challenges and opportunities for primary, secondary, and tertiary prevention of Chagas\u2019 disease"],"prefix":"10.1136","volume":"95","author":[{"suffix":"Jr","given":"A","family":"Rassi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J C P","family":"Dias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J A","family":"Marin-Neto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Rassi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2009,1,8]]},"reference":[{"key":"2025092004271470000_95.7.524.1","unstructured":"Wendel S Dias JCP . Transfusion transmitted Chagas disease. In: Wendel S Brener Z Camargo M E , eds. Chagas disease (American trypanosomiasis): its impact on transfusion and clinical medicine. S\u00e3o Paulo, Brazil: ISBT, 1992:103\u201334."},{"key":"2025092004271470000_95.7.524.2","unstructured":"World Health Organization . Control of Chagas disease. Second report of the WHO Expert Committee. WHO Technical Report Series 905. Geneva: WHO, 2002."},{"key":"2025092004271470000_95.7.524.3","doi-asserted-by":"crossref","unstructured":"World Bank . World Development Report 1993. Investing in health. New York: Oxford University Press, 1993.","DOI":"10.1596\/978-0-1952-0890-0"},{"key":"2025092004271470000_95.7.524.4","doi-asserted-by":"publisher","DOI":"10.1590\/S0074-02762003000500001"},{"key":"2025092004271470000_95.7.524.5","unstructured":"Organizacion Panamericana de la Salud . Estimacion cuantitativa de la enfermedad de Chagas en l\u00e3s Americas. Montevideo, Uruguay: Organizacion Panamericana de la Salud, 2006."},{"key":"2025092004271470000_95.7.524.6","doi-asserted-by":"crossref","unstructured":"Remme JHF Feenstra P Lever PR . Tropical diseases targeted for elimination: Chagas disease, lymphatic filariasis, onchocerciasis, and leprosy. In: Jamison D T Breman J G Measham A R , eds. Disease control priorities in developing countries. New York: The World Bank and Oxford University Press, 2006:433\u201349.","DOI":"10.1596\/978-0-8213-6179-5\/Chpt-22"},{"key":"2025092004271470000_95.7.524.7","unstructured":"World Health Organization . Control of Chagas disease. Report of a WHO Expert Committee. WHO Technical Report Series 811. Geneva: WHO, 1991."},{"key":"2025092004271470000_95.7.524.8","doi-asserted-by":"publisher","DOI":"10.1590\/S0074-02762007005000093"},{"key":"2025092004271470000_95.7.524.9","first-page":"505","article-title":"Trypanosomiase am\u00e9ricaine ou maladie de Chagas.","volume":"8","author":"Carlier","year":"2002","journal-title":"Enciclop\u00e9die M\u00e9dico-Chirurgicale"},{"key":"2025092004271470000_95.7.524.10","unstructured":"Dias JCP Schofield CJ . Control of Chagas disease. In: Maudlin I Holmes P H Miles M A , eds. The trypanosomes. London: CABI Publishing, 2004:547\u201364."},{"key":"2025092004271470000_95.7.524.11","doi-asserted-by":"publisher","DOI":"10.1586\/14760584.4.6.867"},{"key":"2025092004271470000_95.7.524.12","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1590\/S0074-02761999000700011","article-title":"The evolution of Chagas disease (American trypanosomiasis) control after 90 years since Carlos Chagas discovery.","volume":"94","author":"Dias","year":"1999","journal-title":"Mem Inst Oswaldo Cruz"},{"key":"2025092004271470000_95.7.524.13","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1590\/S0036-46652001000100008","article-title":"Interrupting Chagas disease transmission in Venezuela.","volume":"43","author":"Ach\u00e9","year":"2001","journal-title":"Rev Inst Med Trop Sao Paulo"},{"key":"2025092004271470000_95.7.524.14","unstructured":"Dias JCP Macedo VO . Doen\u00e7a de Chagas. In: Coura J R , ed. Din\u00e2mica das doen\u00e7as infecciosas e parasit\u00e1rias. Rio de Janeiro: Guanabara Koogan, 2005:557\u201394."},{"key":"2025092004271470000_95.7.524.15","doi-asserted-by":"publisher","DOI":"10.1590\/S0037-86822005000100002"},{"key":"2025092004271470000_95.7.524.16","doi-asserted-by":"publisher","DOI":"10.1002\/clc.4960231205"},{"key":"2025092004271470000_95.7.524.17","doi-asserted-by":"publisher","DOI":"10.1590\/S0074-02762002000900001"},{"key":"2025092004271470000_95.7.524.18","unstructured":"Rassi A Rassi A Jr Rassi GG . Fase Aguda. In: Brener Z Andrade Z A Barral Neto M , eds. Trypanosoma cruzi e doen\u00e7a de Chagas. 2nd ed. Rio de Janeiro, Brazil: Guanabara Koogan, 2000:231\u201345."},{"key":"2025092004271470000_95.7.524.19","doi-asserted-by":"publisher","DOI":"10.2307\/3281592"},{"key":"2025092004271470000_95.7.524.20","doi-asserted-by":"publisher","DOI":"10.1590\/S0074-02761984000500026"},{"key":"2025092004271470000_95.7.524.21","doi-asserted-by":"publisher","DOI":"10.1016\/S0169-4758(99)01398-8"},{"key":"2025092004271470000_95.7.524.22","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)04128-1"},{"key":"2025092004271470000_95.7.524.23","doi-asserted-by":"crossref","first-page":"526","DOI":"10.4269\/ajtmh.1998.59.526","article-title":"Efficacy of chemotherapy with benznidazole in children in the indeterminate phase of Chagas\u2019 disease.","volume":"59","author":"Sosa Estani","year":"1998","journal-title":"Am J Trop Med Hyg"},{"key":"2025092004271470000_95.7.524.24","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-144-10-200605160-00006"},{"key":"2025092004271470000_95.7.524.25","doi-asserted-by":"publisher","DOI":"10.1590\/S0037-86822007000100001"},{"key":"2025092004271470000_95.7.524.26","doi-asserted-by":"crossref","unstructured":"Rassi A Luquetti AO . Specific treatment for Trypanosoma cruzi infection (Chagas disease). In: Tyler K M Miles M A , eds. American trypanosomiasis. Boston, MA: Kluwer Academic Publishers, 2003:117\u201325.","DOI":"10.1007\/978-1-4419-9206-2_11"},{"key":"2025092004271470000_95.7.524.27","unstructured":"Can\u00e7ado JR . Tratamento espec\u00edfico da doen\u00e7a de Chagas nas fases aguda e cr\u00f4nica. In: Coura J R , ed. Din\u00e2mica das doen\u00e7as infecciosas e parasit\u00e1rias. Rio de Janeiro, Brazil: Guanabara Koogan, 2005:667\u201376."},{"key":"2025092004271470000_95.7.524.28","doi-asserted-by":"publisher","DOI":"10.1001\/jama.298.18.2171"},{"key":"2025092004271470000_95.7.524.29","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0040332"},{"key":"2025092004271470000_95.7.524.30","doi-asserted-by":"publisher","DOI":"10.1590\/S0074-02762007005000106"},{"key":"2025092004271470000_95.7.524.31","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/S0021-9975(08)80133-8","article-title":"Malignant, non-Hodgkin\u2019s lymphomas in Trypanosoma cruzi-infected rabbits treated with nitroarenes.","volume":"103","author":"Teixeira","year":"1990","journal-title":"J Comp Pathol"},{"key":"2025092004271470000_95.7.524.32","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/S0891-5520(20)30539-0","article-title":"Chagas disease. American trypanosomiasis.","volume":"7","author":"Kirchhoff","year":"1993","journal-title":"Infect Dis Clin North Am"},{"key":"2025092004271470000_95.7.524.33","doi-asserted-by":"crossref","unstructured":"Villar JC Marin-Neto JA Ebrahim S . Trypanocidal drugs for chronic asymptomatic Trypanosoma cruzi infection. Cochrane Database Syst Rev 2002;(1):CD003463.","DOI":"10.1002\/14651858.CD003463"},{"key":"2025092004271470000_95.7.524.34","doi-asserted-by":"crossref","first-page":"58","DOI":"10.4269\/ajtmh.2007.76.58","article-title":"Specific treatment for Trypanosoma cruzi: lack of efficacy of allopurinol in the human chronic phase of Chagas disease.","volume":"76","author":"Rassi","year":"2007","journal-title":"Am J Trop Med Hyg"},{"key":"2025092004271470000_95.7.524.35","doi-asserted-by":"publisher","DOI":"10.1179\/136485905X75403"},{"key":"2025092004271470000_95.7.524.36","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01170-06"},{"key":"2025092004271470000_95.7.524.37","doi-asserted-by":"publisher","DOI":"10.1016\/S0924-8579(02)00273-X"},{"key":"2025092004271470000_95.7.524.38","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.49.4.1556-1560.2005"},{"key":"2025092004271470000_95.7.524.39","doi-asserted-by":"publisher","DOI":"10.1590\/S0074-02762002000500002"},{"key":"2025092004271470000_95.7.524.40","doi-asserted-by":"publisher","DOI":"10.1586\/14787210.5.4.717"},{"key":"2025092004271470000_95.7.524.41","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(07)70194-9"},{"key":"2025092004271470000_95.7.524.42","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1590\/S0066-782X1999000300001","article-title":"Chagas heart disease.","volume":"72","author":"Marin Neto","year":"1999","journal-title":"Arq Bras Cardiol"},{"key":"2025092004271470000_95.7.524.43","unstructured":"Marin-Neto JA Rassi A Jr Maciel BC . Chagas heart disease. In: Yusuf S Cairns J A Camm A J , eds. Evidence-based cardiology. 3rd ed. London: BMJ Books (in press)."},{"key":"2025092004271470000_95.7.524.44","first-page":"231","article-title":"Radionuclide angiographic evidence for early predominant right ventricular involvement in patients with Chagas disease.","volume":"4","author":"Marin-Neto","year":"1988","journal-title":"Can J Cardiol"},{"key":"2025092004271470000_95.7.524.45","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-5273(98)00132-6"},{"key":"2025092004271470000_95.7.524.46","doi-asserted-by":"crossref","unstructured":"Hiss FC Lascala TF Maciel BC . Changes in myocardial perfusion correlate with deterioration of left ventricular systolic function in chronic Chagas cardiomyopathy. Braz J Med Biol Res 2009 (in press).","DOI":"10.1016\/j.jcmg.2008.09.012"},{"key":"2025092004271470000_95.7.524.47","first-page":"377","article-title":"[Ventricular arrhythmia in Chagas disease. Diagnostic, prognostic, and therapeutic features].","volume":"65","author":"Rassi J\u00fanior","year":"1995","journal-title":"Arq Bras Cardiol"},{"key":"2025092004271470000_95.7.524.48","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(86)90765-4"},{"key":"2025092004271470000_95.7.524.49","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.1998.tb00907.x"},{"key":"2025092004271470000_95.7.524.50","doi-asserted-by":"crossref","unstructured":"D\u2019Avila A Splinter R Svenson RH . New perspectives on catheter-based ablation of ventricular tachycardia complicating Chagas disease: experimental evidence of the efficacy of near infrared lasers for catheter ablation of Chagas VT J Interv Card Electrophysiol 2002;7:23\u201338.","DOI":"10.1023\/A:1020811915133"},{"key":"2025092004271470000_95.7.524.51","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2004.05.025"},{"key":"2025092004271470000_95.7.524.52","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(83)90085-1"},{"key":"2025092004271470000_95.7.524.53","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000163104.92943.50"},{"key":"2025092004271470000_95.7.524.54","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1590\/S0066-782X2001000100008","article-title":"Sudden death in Chagas disease.","volume":"76","author":"Rassi","year":"2001","journal-title":"Arq Bras Cardiol"},{"key":"2025092004271470000_95.7.524.55","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa053241"},{"key":"2025092004271470000_95.7.524.56","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc062580"},{"key":"2025092004271470000_95.7.524.57","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.627265"},{"key":"2025092004271470000_95.7.524.58","first-page":"367","article-title":"[Empiric therapy with amiodarone in patients with chronic Chagas cardiomyopathy and sustained ventricular tachycardia].","volume":"54","author":"Scanavacca","year":"1990","journal-title":"Arq Bras Cardiol"},{"key":"2025092004271470000_95.7.524.59","doi-asserted-by":"publisher","DOI":"10.1590\/S0066-782X2002001700001"},{"key":"2025092004271470000_95.7.524.60","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2007.01011.x"},{"key":"2025092004271470000_95.7.524.61","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.1999.tb00311.x"},{"key":"2025092004271470000_95.7.524.62","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.167586"},{"key":"2025092004271470000_95.7.524.63","doi-asserted-by":"publisher","DOI":"10.1186\/1745-6215-7-21"},{"key":"2025092004271470000_95.7.524.64","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199909023411001"},{"key":"2025092004271470000_95.7.524.65","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(01)02587-5"},{"key":"2025092004271470000_95.7.524.66","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2008.02.017"},{"key":"2025092004271470000_95.7.524.67","doi-asserted-by":"publisher","DOI":"10.1186\/1745-6215-8-2"},{"key":"2025092004271470000_95.7.524.68","doi-asserted-by":"publisher","DOI":"10.1590\/S0074-02761991000200008"},{"key":"2025092004271470000_95.7.524.69","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.49.4.1521-1528.2005"},{"key":"2025092004271470000_95.7.524.70","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2008.04.001"},{"key":"2025092004271470000_95.7.524.71","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1590\/S0037-86822008000200012","article-title":"Problems and perspectives for Chagas disease control: in search of a realistic analysis.","volume":"41","author":"Dias","year":"2008","journal-title":"Rev Soc Bras Med Trop"}],"container-title":["Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/hrt.2008.159624","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T11:27:29Z","timestamp":1758367649000},"score":1,"resource":{"primary":{"URL":"https:\/\/heart.bmj.com\/lookup\/doi\/10.1136\/hrt.2008.159624"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,1,8]]},"references-count":71,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2009,3,13]]},"published-print":{"date-parts":[[2009,4]]}},"alternative-id":["10.1136\/hrt.2008.159624"],"URL":"https:\/\/doi.org\/10.1136\/hrt.2008.159624","relation":{},"ISSN":["1355-6037","1468-201X"],"issn-type":[{"value":"1355-6037","type":"print"},{"value":"1468-201X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,1,8]]}}}