title: Evolution of Chagas' disease in Brazil. Epidemiological perspective and challenges for the future: a critical review.
abstract: OBJECTIVE
  This article aimed to provide a critical review of the evolution of Chagas' disease (ChD) in Brazil, its magnitude, historical development and management, and challenges for the future.
  
  
  METHODS
  A literature search was performed using PubMed, SciELO and Google Scholar and throughout collected articles' references. Narrative analysis was structured around five main themes identified: vector transmission, control programme, transfusion, oral and congenital transmission.
  
  
  RESULTS
  In Brazil, the Chagas' Disease Control Programme was fully implemented in the 1980s, when it reached practically all the endemic areas, and in 1991, the Southern Cone Initiative was created, aiming to control the disease transmission through eliminating the Triatoma infestans and controlling blood banks. As a result, the prevalence of chagasic donors in blood banks reduced from 4.4% in the 1980s to 0.2% in 2005. In 2006, Pan American Health Organization (PAHO) certified the interruption of transmission of ChD through this vector in Brazil. However, there are still challenges, such as the domiciliation of new vector species, the need for medical care of the infected individuals, the prevention of alternative mechanisms of transmission, the loss of political concern regarding the disease and the weakening of the control programme.
  
  
  CONCLUSIONS
  Despite the progress towards control, there are still many challenges ahead to maintain and expand such control and minimise the risk of re-emergence.
authors.affiliation: Federal University of Jequitinhonha and Mucuri Valleys, Campus JK, Diamantina, MG, Brazil.
authors.forename: Rafael
authors.initials: R
authors.lastname: Bello Corassa
authors.affiliation: Middlesex University, The Burroughs Hendon, Town Hall Extension Building, London NW4 4BT. UK.
authors.forename: Carmen
authors.initials: C
authors.lastname: Aceijas
authors.affiliation: Federal University of Jequitinhonha and Mucuri Valleys, Campus JK, Diamantina, MG, Brazil.
authors.forename: Paula Aryane Brito
authors.initials: PAB
authors.lastname: Alves
authors.affiliation: Middlesex University, London, UK.
authors.forename: Hemda
authors.initials: H
authors.lastname: Garelick
mesh_terms: D017677:Age Distribution; D000818:Animals; D001938:Brazil / Q000453:epidemiology; D014355:Chagas Disease / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D003140:Communicable Disease Control / Q000266:history; D019353:Endemic Diseases; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D007300:Insect Control; D007303:Insect Vectors; D015995:Prevalence; D014224:Triatoma
keywords: Brazil epidemiology; Chagas disease; Trypanosoma cruzi; epidemiologic surveillance; neglected tropical diseases; public health