SAN CRISTÓBAL DE LAS CASAS, MEXICO — It’s called the “kissing bug,” but over time its bite can prove to be the kiss of death.
Triatomine bugs, or chinches, transmit Chagas’ disease, a potentially fatal illness that afflicts more than a million Mexicans nearly a decade after global health experts pledged to wipe out so-called neglected tropical diseases.
“When I started hearing about Chagas in ’85, my teacher said that it only existed in the jungle,” says Dolores Guadalupe Vidal-López, a public health researcher at the Biological Sciences Institute at the University of Sciences and Arts of Chiapas. “And now, in 2020, it’s 20 minutes outside of Tuxtla Gutiérrez, the state capital.”
Chagas is one of 19 neglected tropical diseases that collectively affect more than 1.5 billion people and cost economies worldwide billions of dollars annually. The illnesses, which include river blindness, leprosy, intestinal worms and trachoma, deepen poverty by keeping millions out of work and school. They kill hundreds of thousands each year.
Though countries have eradicated some of these tropical diseases, the coronavirus pandemic has only made more stark the lack of attention given to such diseases. Research related to Chagas was already lagging. The pandemic has pushed that work further behind.
“These diseases, when there is an emergency, in this case by COVID-19, are still marginalized, especially in the diagnosis,” says Daniel Velázquez, a researcher and doctoral student at the Colegio de la Frontera Sur, a scientific research institution.
The World Health Organization reports that Chagas has infected 6 to 7 million people globally, a majority of them in South America, Central America and Mexico. The disease has struck more than a million people in Mexico.
Chiapas, along with Veracruz, Yucatán, Oaxaca and Morelos, is among the Mexican states with the most cases of Chagas. They are also among the country’s most impoverished regions.
Medical authorities say 32 Chiapas residents had the illness in 2019 and another 17 by mid-October, but they say that’s likely a vast undercount, given such challenges as limited health service coverage, unreported cases and mistaken diagnoses.
“Official figures are too low because they only take into account the cases that make it to the health centers,” Velázquez says.
Only eight years ago, in what became known as the London Declaration on Neglected Tropical Diseases, some of the world’s foremost medical experts, development organizations, foundations, drug companies and governments promised a full-fledged attack on these illnesses.
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Since then, some countries have had successes. The WHO has confirmed, for example, that Mexico, Oman, Morocco, Laos and Cambodia have all vanquished trachoma as a public health problem.
But in Mexico, Chagas hangs on.
Its stubborn presence highlights the country’s larger battle against poverty. From 2008 to 2018, the number of Chiapas residents who live below the poverty line grew by about 15%, to roughly 4.3 million.
In the same period, those without basic housing services leaped by nearly 23%, to more than 3.1 million.
This has a direct bearing on Chagas cases in Chiapas, Mexico’s southernmost state and one of its poorest, as many residents live in dirt-floor homes built with mud or palm thatch – materials that allow the kissing bug to flourish.
“If a home provides the right conditions,” Vidal-López says, “they will hide in piles of materials or burrow in dirt floors.”
Chinches attack while people sleep. They bite the sleeper’s face and leave behind feces that carry the parasite that causes Chagas. When the sleeper rubs their face, they inadvertently allow the parasite to enter the body through the nose or breaks in the skin.
Less common methods of transmission include blood transfusions, organ transplants, eating wild foods contaminated with the bug’s feces, and from an infected pregnant woman to the fetus.
Chagas can cause fevers, swollen lymph nodes, headaches or swelling at the site of the bite. The disease may take 10 to 15 years to develop and can lead to kidney disease and heart failure.
That’s what happened in Miguel Hernández’s family. The resident of Ocosingo in Chiapas saw heart failure kill his mother in 2001, and two years ago kidney damage took his father. For years, Hernández says, they did not know they had Chagas.
Hernández’s brother has Chagas too. The brother, 49, felt weak and listless, but he wanted to donate blood to help his sick father. That’s when he learned he was ill.
“I almost became a specialist in knowing the procedure,” Hernández says. “I downloaded pictures, I sent them to the networks in the region where I am. At my dad’s funeral I gave a talk. I showed the pictures of the bug and people started to worry.” They hadn’t heard about the disease.
While working on his father’s case, Hernández met Vidal-López and they went to a remote jungle community called Chapultepec to take samples from about 60 people, one of whom tested positive. They planned to take more samples this year, but the coronavirus pandemic stopped them.
Hernández says three people in his community have died from COVID-19, the disease caused by the coronavirus. With the pandemic, he says, “it seems that Chagas is not the main thing now.”
As of Nov. 23, Ocosingo had seen 98 cases of COVID-19 and 22 deaths, while Chiapas had 7,676 cases and 1,172 deaths.
Velázquez says he hopes the urgency around the coronavirus will spill over to diseases such as Chagas.
“If we take care of the diseases that are lagging behind as we do COVID-19,” he says, “many of [them] would already be controlled or eliminated.”
Marissa Revilla is a Global Press Journal reporter based in San Cristóbal de Las Casas, Mexico. She specializes in reporting on child rights and conflict in indigenous communities throughout Chiapas.
Shannon Kirby, GPJ, translated this story from Spanish. Click here to learn more about our translation policy.