Donating blood has always been a habit for Flávio Mendes, a 34-year-old native of Brasilia. But when he moved to Dublin, the capital of Ireland, he found he could no longer be a donor.
This is because, in the country, South Americans are not eligible for blood donation. And the reason is the risk of Chagas disease.
The measure of the Irish government has existed for 25 years and is based on the guidelines of the World Health Organization (WHO) on blood donation, which say that, “if the individual, his mother or maternal grandmother was born in South or Central America, he should be permanently excluded from blood donation unless a certified T. cruzi antibody test is available”.
“It was quite surprising as I have always donated, have regular blood tests and it has never been detected. [a doença de Chagas]. It seems very inflexible and in a way discriminatory, since there are tests to detect the disease”, says Flávio.
In addition to Ireland, Australia and Singapore also consider South Americans ineligible for blood donation.
The rule applies to both public and private blood donation programs in these countries. In Sydney, Australia, Brazilian Priscilla Lopes, 37, also complains about the Australian government’s justification.
“I feel excluded. There are tests that rule out the disease. Not to mention that it is a disease practically eradicated in Brazil”, says Priscilla.
Although transmission of the pathogen behind Chagas disease has greatly declined in recent years, it still happens in Brazil.
Furthermore, the parasite remains in the body for several years — therefore, a person who was infected decades ago can still carry the infectious agent and transmit it through blood donation.
Blood donation services in other countries told BBC News Brasil that they test candidates to exclude only those at risk of Chagas disease.
This is the case in Germany, France, the United Kingdom, Spain, Portugal, South Africa, Canada and the United States. This testing option is also present in the WHO blood donation guidelines.
Chagas disease gets its name because it was discovered by Brazilian physician and researcher Carlos Chagas in 1909.
It is caused by the protozoan Trypanosoma cruzi (or T. cruzi), which is transmitted from the bite and contact with the feces of an insect popularly known as the kissing bug.
The pathogen can remain in the body for years, or even decades, and cause problems in the heart or other organs, such as the intestine.
In 2006, Brazil even received a certificate of elimination of T. cruzi transmission. But the disease reappeared in mid-2018, when cases were detected in Pará due to consumption of açaí contaminated by barber feces.
Contact with the pathogen occurs through the mucous membranes (such as when a person ingests contaminated açaí, for example), but also when the insect’s feces are deposited on a person’s skin after being bitten by a kissing bug.
The bite causes itching, facilitating the entry of the parasite, which is in the feces, into the human body.
Contagion can also occur through blood transfusion from a donor carrying the protozoan.
A final form of transmission occurs during pregnancy, from mother to child, via the placenta.
The most common symptoms of the infection are fever, appearance of ganglia and growth of the spleen, liver and heart.
In the acute phase of the disease, symptoms last from three to eight weeks. There is still no vaccine against Chagas disease and its incidence is directly related to housing conditions such as wattle and daub houses, thatch and wood, very common in the poorest regions of South America.
The barber lives in cracks in these types of houses and even in tree leaves. That is why care for house conservation, the regular use of insecticides and the installation of screens on doors and windows are some of the preventive measures that must be adopted, especially in rural environments.
According to the Ministry of Health, around 4,500 people die each year in Brazil from Chagas disease, mainly in Minas Gerais, São Paulo, Goiás and Bahia.
Immunologist Jaime Santana, who has been studying the saliva of kissing bugs at the University of Brasília (UnB) for decades, says that official government data are underestimated. According to him, there is underreporting of cases of the disease, since not all patients seek medical help.
“It is necessary to intensify the educational process in schools and municipalities, teach people to identify the barber and always notify authorities. This is the best way to fight the disease”, he says.
In addition to educational campaigns, the immunologist believes that it is up to the Brazilian government to disseminate updated data on the disease in Brazil to the world and reinforce the reliability of the tests that are approved by the WHO.
“The test is cheap and this would be a way of predicting needs and preparing the health system of these countries that today exclude these donors. Denying testing is denying care for the immigrant.”
According to the immunologist, the test unit costs just over US$ 1 (about R$ 5.15).
According to data from Brazilian Embassies, at least 150,000 Brazilians live in Ireland, Australia and Singapore today — but the number of immigrants not tested by these countries is much higher, considering that they are also part of the permanent exclusion list. born in 13 countries in South America and 20 countries in Central America.
“If there were testing, these countries could benefit from the blood of Brazilians and South Americans and contributed to mapping Chagas disease in the world. Everyone would win”, completes the immunologist.
Restrictions in Brazil
Brazil also has restrictions on foreign donors and even on Brazilians who have lived in Europe for a certain period.
The reason is the Mad Cow disease, which became known in the 1980s and 90s, after an outbreak registered in the United Kingdom.
Brazilian legislation determines that people who have lived for five years or more in Europe between 1980 and the present day are prevented from donating blood in Brazil due to the risks of exposure to the prion of mad cow disease.
Anyone who has received a blood transfusion in the United Kingdom after 1980 cannot donate blood in Brazil either.
Mad Cow Disease is lethal and is linked to the consumption of contaminated meat that carries the protein called prion, which causes brain damage by killing neurons and creating “holes” in the brain.
According to the Blood Center of Brasilia, the disease is not detectable in serological tests and can remain inactive in the body of the infected person for many years.
Therefore, the restriction exists for an epidemiological surveillance criterion.