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December 7, 2019

Chagas Disease in the United States

This semester I’ve had the opportunity to work with Dr. Claire Standley on a projected related to Chagas disease—specifically, we have been gathering data on the current burden of Chagas disease within the United States and the ways in which surveillance of the disease can be improved. Chagas disease is caused by the parasite Trypanosoma cruzi, predominantly spread by a T. cruzi-infected triatomine bug endemic in Latin America. Transmission can also occur via blood transfusions, organ transplants and congenitally from a mother to her baby. It is estimated roughly 300,000 individuals with T. cruzi livein the United States.

While treatment for those who are infected is available and highly-effective, many of these individuals have not been diagnosed as no national screening program exists. Furthermore, those who are not diagnosed are at risk of developing Chagas cardiomyopathy, which is life-threatening.

Currently, incidence cases of Chagas disease are predominantly diagnosed by blood donor screening which was implemented in 2007. Given the limitations of this in diagnosing and subsequently treating those with the disease, our team has been focused on advocating for screening on behalf of at-risk pregnant women and their offspring for potential infection. It is estimated that 300 congenital infections occur each year. While congenital screening has been proven to be both cost-effective and successful, Chagas disease in the United States is rarely screened for in this setting and many obstetrician-gynecologists are unfamiliar with the disease.

In contrast, this screening is being widely conducted in other countries. For example, in a rural community in Guatemala, neonatal screening is performed at the primary health care level to diagnose infants with Chagas disease. This screening is both simple and low-cost, consisting of microscopic examination of an infant’s blood, and supplemented with educational programs for physicians and community members to increase their awareness of the disease. Screening for pregnant women from Latin America has also been mandated in two autonomous communities in Spain—Valencia and Catalonia. Through these programs, pregnant women and their newborns are screened and, if necessary, treated for T. cruzi infection. If the mother is found to be infected, screening and treatment is extended to her other children who might also have the disease.

Implementing similar programs in the United States could be done by establishing perinatal screening for Chagas disease in women at risk of infection, with screening for infection in their newborns integrated into existing postnatal follow-up. This might be challenging to develop on a national scale due to differences between states and the multistep nature of this process.

However, the impact of doing so has the potential to be substantial, including improving data on the burden of Chagas disease within the United States, reducing morbidity from congenital Chagas disease and addressing health disparities in vulnerable populations.

Jennifer Ayres (NHS ’22) is an undergraduate studying Global Health and a student fellow with the Global Health Initiative.