U.S.: Increasing Prevalence, Continued Neglect
Chagas disease has traditionally been characterised as a Latin American phenomenon, endemic only to the 21 countries south of the United States border. However, recent studies have shown that the prevalence of Chagas disease outside of Latin America is increasing, in large part due to population flows, and Chagas disease is becoming an important global health issue.(1) Caryn Bern and Sue Montgomery of Centres for Disease Control (CDC) estimate that in 2005 there were 300,167 individuals infected with Chagas disease living in the U.S.(2) This is more than six times the estimated prevalence of Chagas in Spain (47,743)(3) – the country with the next highest population of Latin American immigrants.
Modes of transmission in the U.S.
A case of neglect
Health practitioners unfamiliar
with Chagas disease
U.S. global health policies neglect Chagas
(1) Tarleton RL, Reithinger R, Urbina JA, Kitron U, Gürtler RE, 2007 The Challenges of Chagas Disease - Grim Outlook or Glimmer of Hope?. PLoS Med 4(12): e332. doi:10.1371/journal.pmed.0040332.
(2) Bern C, Montgomery SP, An Estimate of the Burden of Chagas Disease in the United States, CID 2009; 49 e52-54 DOI: 10.1086/609509.
(3) Gascon, J., et al., Chagas disease in Spain, the United States and other non-endemic countries. Acta Trop. (2009), doi:10.1016/j.actatropica.2009.07.019.
(4) Bern & Montgomery, 2009.
(5) Based on 147 confirmed positives since screening began in 2007 divided by the total estimated number of Latino Blood donors (40 000 – 50 000) in that period. Information provided by Cliff Numark and Ross Herron of the American Red Cross Blood Services.
(6) Centres for Disease Control and Prevention (CDC). (2007). Blood donor screening for Chagas disease-United States, 2006-2007. Morbidity and Mortality Weekly Report, 56, 141-143.
(7) Bern C, Montgomery SP, Herwaldt BL, Rassi A, Jr, Marin-Neto JA, et al. Evaluation and treatment of Chagas disease in the United States: A systematic review. JAMA. 2007;298:2171–81. [PubMed].
(8) Bern & Montgomery, 2009.
(9) This includes Centre for Disease Control, Department of Defense, National Institutes of Health and United States Agency for International Development.
(10) Families USA, “The World Can’t Wait: More Funding Needed for Research on Neglected Infectious Diseases.” December 2008.
Maira Gutierrez, an El Salvador native and an U.S. resident of 29 years, was diagnosed with Chagas disease by the Red Cross in 1997 after donating blood. At the time, the Red Cross was conducting exploratory screening of the disease (routine blood screening for Chagas was not implemented in the U.S. until 2007).(6) In the following years, Gutierrez repeatedly sought treatment without success – the doctors she contacted either did not know of Chagas disease or did not know how to treat it. Despite suffering from heart palpitations, Gutierrez gave up her search. In 2007, a decade later, her sister called to tell her that there was a story on the evening news about the opening of the Centre of Excellence for Chagas Disease, at Olive View-UCLA Medical Centre in Los Angeles County. Gutierrez subsequently underwent treatment for Chagas disease at the Centre, but she still doesn’t know if she’s cured, because no definitive “test of cure” currently exists. The American Red Cross now refers blood donors who test positive for Chagas to the Olive View-UCLA Centre of Excellence for Chagas Disease for treatment – still the only centre of its kind in the US. The Centre has implemented one of the only programmes in the country that proactively screens at-risk individuals for Chagas disease through outreach programmes in Hispanic communities in the Los Angeles area.
Treatment access in the U.S.
In the U.S., nifurtimox is available to physicians through special Centres for Disease Control (CDC) protocols, but benznidazole is more difficult to obtain and is rarely used. According to Dr Sheba Meymandi, director of the Centre of Excellence for Chagas Disease, “We can get [benznidazole], but it is a very laborious process through the FDA. Hopefully the CDC will have access to benznidazole soon.” Dr. Meymandi adds, “The difference, in terms of the treatments, is that benznidazole is a shorter course - two months - with a better side effect profile. Nifurtimox, which we have easier access to in the U.S., is a three-month course, and the side effect profile is pretty abysmal. It is like giving chemotherapy. Major side effects are nausea, vomiting, memory loss, neuropathies, and the list goes on.”
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