Estimating the Burden of Chagas Disease in the United States.
BACKGROUND
In recent years, there has been growing awareness of the significant burden of Chagas disease in the United States (US). However, epidemiological data on both prevalence and access to care for this disease are limited. The objective of this study is to provide an updated national estimate of Chagas disease prevalence, the first state-level estimates of cases of T. cruzi infection in the US and to analyze these estimates in the context of data on confirmed cases of infection in the US blood supply.


METHODS
In this study, we calculated estimates of the state and national prevalence of Chagas disease. The number of residents originally from Chagas disease endemic countries were computed using data on Foreign-Born Hispanic populations from the American Community Survey, along with recent prevalence estimates for Chagas disease in Latin America from the World Health Organization that were published in 2006 and updated in 2015. We then describe the distribution of estimated cases in each state in relation to the number of infections identified in the donated blood supply per data from the AABB (formerly American Association of Blood Banks).


RESULTS
The results of this analysis offer an updated national estimate of 238,091 cases of T. cruzi infection in the United States as of 2012, using the same method as was used by Bern and Montgomery to estimate cases in 2005. This estimate indicates that there are 62,070 cases less than the most recent prior estimate, though it does not include undocumented immigrants who may account for as many as 109,000 additional cases. The state level results show that four states (California, Texas, Florida and New York) have over 10,000 cases and an additional seven states have over 5,000 cases. Moreover, since 2007, the AABB has reported 1,908 confirmed cases of T. cruzi infection identified through screening of blood donations.


CONCLUSIONS
This study demonstrates a substantial burden of Chagas disease in the US, with state variation that reflects the distribution of at risk Latin American immigrant populations. The study lends important new insight into the distribution of this disease in the US and highlights the need for further research quantifying prevalence and incidence to guide interventions for control of Chagas disease across the US.
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America.
Jennifer
J
Manne-Goehler
Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America.
Chukwuemeka A
CA
Umeh
United States Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
Susan P
SP
Montgomery
Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America.
Veronika J
VJ
Wirtz
D000328:Adult; D001782:Blood Donors; D002140:California / Q000453:epidemiology; D014355:Chagas Disease / Q000453:epidemiology* / Q000208:ethnology / Q000469:parasitology / Q000517:prevention & control; D017281:Cost of Illness; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D019353:Endemic Diseases; D005431:Florida / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007843:Latin America / Q000453:epidemiology; D008297:Male; D009518:New York / Q000453:epidemiology; D015995:Prevalence; D013781:Texas / Q000453:epidemiology / Q000208:ethnology; D014349:Trypanosoma cruzi / Q000302:isolation & purification; D014481:United States / Q000453:epidemiology / Q000208:ethnology