Chagas Disease Declared Endemic in the U.S.

Experts now assert that Chagas disease, which is caused by a parasite found in kissing bugs, needs to be seen as endemic in the United States. They believe that without recognizing its persistent presence in certain areas, many individuals will experience unnecessary suffering.

A report published last week in the CDC’s journal, Emerging Infectious Diseases, highlighted this issue. The authors express hope that the increasing global attention will lead to better surveillance, prevention, and funding for research on Chagas in the U.S.

Dr. Norman Beatty, a coauthor of the report and a clinical associate professor at the University of Florida, noted, “We’ve been waiting forever; all of us Chagas people have been waiting for people to recognize this disease is in our communities.” He has dedicated the last decade studying Chagas.

The World Health Organization labels Chagas as a neglected tropical disease. Meanwhile, the Pan American Health Organization points out that it is endemic in 21 other countries in the Americas but not in the U.S. In Latin America, Chagas is a leading cause of heart disease and causes more disabilities than other insect-borne diseases, including malaria and Zika.

Chagas mainly spreads when kissing bugs bite individuals during sleep. These bugs defecate at the site of the bite or on the person’s face, and if the feces are rubbed into the mouth, eyes, or nose, they can transmit the parasite Trypanosoma cruzi.

Additionally, Chagas can be transmitted through contaminated food, blood, organ transplants, and during pregnancy.

Initial symptoms of the disease can include fever, body aches, headaches, and fatigue, which may last for weeks or even months. It’s concerning that about 20% to 30% of those infected go on to develop severe long-term issues, such as heart failure or stroke, according to the CDC.

If diagnosed early, treatment with medicines like benznidazole or nifurtimox can eliminate the parasite. However, these drugs lose effectiveness the longer the infection remains undetected. Unfortunately, many people may not even realize they have the disease. The report mentions that most medical professionals in the U.S. do not tend to consider it.

Interestingly, some individuals discover their infection when donating blood, as testing for Chagas has been mandatory in the U.S. since 2007.

While surveillance is limited, the CDC estimates around 280,000 people in the U.S. have Chagas at any one time. It’s not quite clear how many experience severe symptoms or how many fatalities are attributed to the disease each year.

Scientists have found kissing bugs in 32 states; these pesky insects tend to thrive in warmer Southern regions. Climate change may allow them to spread even further.

Infected mammals have been identified in at least 17 states, including opossums and raccoons, among others. Reports of Chagas cases in humans have emerged in eight states, but most infections do not get reported, making it likely the actual numbers are higher.

Dr. Mario J. Grijalva, a director at the Infectious and Tropical Disease Institute, called it “momentous” if Chagas were formally recognized as endemic in the U.S. He believes acknowledging it as a domestic issue can change public health policy and raise awareness.

Grijalva shared his experiences promoting awareness about Chagas during a motorcycle journey through Latin America and noted significant differences in public awareness between countries with solid health campaigns versus those without.

Beatty hopes that the growing recognition of Chagas in the U.S. leads to more effective surveillance, similar to efforts in other countries. He expresses a wish for healthcare providers to diagnose it more quickly, and he points out the lack of control measures for kissing bugs compared to mosquitoes.

For now, people can seal their homes better, use window screens, and spray for other bugs, although there’s no specific spray approved for kissing bugs in the U.S.

In Florida, about 30% of kissing bugs are reportedly positive for the parasites. Beatty shared that many locals send him bug photos or even drop off the insects at his hospital for testing.

“They’re scared,” he said, “and they have a right to be.”

He strives to assist his community as much as possible, pointing out, “There’s not another doctor around here walking around with bugs in their pockets.” He hopes that increased awareness will inspire others to contribute as well.

“I’m just one person,” he concluded. “It’s a small team, and we have limited resources.”