‘Kissing bug’ disease is here to stay in the US, experts say. Here’s why it’s spreading – CNN

Report on the Endemic Status of Chagas Disease in the United States and Implications for Sustainable Development Goals

Executive Summary

A recent report published in the U.S. Centers for Disease Control and Prevention’s (CDC) journal, Emerging Infectious Diseases, posits that Chagas disease should now be considered endemic in the United States. This parasitic illness, traditionally viewed as a neglected tropical disease prevalent in Latin America, poses a significant and under-recognized public health threat within the U.S. Addressing this challenge is crucial for meeting key United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), which includes the target of ending epidemics of neglected tropical diseases by 2030.

Chagas Disease: A Public Health Overview

Disease Profile and Transmission

Chagas disease is caused by the parasite Trypanosoma cruzi. Its persistence and spread directly impact public health systems and community well-being, challenging the achievement of SDG 3.

• Primary Vector: The disease is primarily transmitted by triatomine bugs, also known as “kissing bugs,” which defecate near their bite, allowing the parasite to enter the human body.
• Other Transmission Routes:
  • Contaminated food or beverages
  • Blood transfusions
  • Organ transplants
  • Congenital transmission (from mother to baby)

Clinical Manifestations and Health Impact

The health consequences of Chagas disease underscore the urgency of its recognition and management to ensure healthy lives for all, a core principle of SDG 3.

• Acute Phase Symptoms: Initial symptoms can be mild and include fever, body aches, rash, and fatigue, often leading to a lack of diagnosis.
• Chronic Phase Complications: An estimated 20% to 30% of infected individuals develop severe, life-threatening conditions, including:
  • Heart failure and other cardiac complications
  • Long-term digestive and nervous system problems
  • Stroke
  • Death
• Treatment: Early detection allows for effective treatment with antiparasitic drugs (benznidazole or nifurtimox). However, efficacy decreases significantly the longer a person has been infected, highlighting the critical need for improved screening and awareness.

Endemic Status in the United States: A Growing Concern

Prevalence and Surveillance Deficiencies

The lack of robust data and surveillance systems in the U.S. is a major barrier to controlling Chagas disease and achieving SDG Target 3.3. The CDC estimates that approximately 280,000 people in the U.S. are currently infected, yet awareness among both the public and medical professionals remains low. Since 2007, the primary method of detection for many asymptomatic individuals has been through blood donation screening, indicating a significant gap in proactive public health surveillance.

Geographic Spread and Environmental Factors

The expanding presence of the disease vector and parasite is linked to environmental and climatic factors, connecting this health issue to broader sustainability challenges outlined in SDG 11 (Sustainable Cities and Communities) and SDG 13 (Climate Action).

• Vector Presence: Kissing bugs have been identified in 32 states, predominantly in the warmer southern U.S., with their range potentially expanding due to climate change.
• Infected Wildlife: The parasite has been found in mammals across at least 17 states, including common species like raccoons, opossums, and coyotes.
• Confirmed Human Cases: Locally acquired human cases have been documented in Arkansas, Arizona, California, Louisiana, Missouri, Mississippi, Tennessee, and Texas. The lack of mandatory reporting in most states suggests the true number of cases is likely higher.

Recommendations for a Sustainable Public Health Response

Policy and Awareness Imperatives

Recognizing Chagas as an endemic U.S. disease is a critical first step. A concerted effort, reflecting the principles of SDG 17 (Partnerships for the Goals), is required to build a comprehensive response. Drawing lessons from successful public awareness and management campaigns in countries like Chile, Bolivia, and Argentina, the U.S. must take decisive action.

1. Enhance Surveillance: Establish robust surveillance systems and mandate the reporting of Chagas disease cases to accurately assess its prevalence and guide public health interventions.
2. Increase Awareness: Launch targeted public and healthcare provider education campaigns to improve recognition of symptoms, risk factors, and the importance of early diagnosis and treatment.
3. Implement Vector Control: Develop and implement vector control programs analogous to existing mosquito abatement efforts. This includes public guidance on sealing homes, using window screens, and appropriate pest control measures, contributing to SDG 11’s goal of safe and resilient human settlements.
4. Allocate Research Funding: Increase funding for research into Chagas disease diagnostics, treatments, and vector control strategies specific to the U.S. context.

Conclusion

The classification of Chagas disease as endemic to the United States marks a pivotal moment for domestic public health policy. Addressing this neglected disease is not only a national health imperative but also a commitment to the global Sustainable Development Goals. By increasing surveillance, promoting awareness, and implementing control measures, the U.S. can mitigate the serious health impacts of Chagas disease, protect its communities, and align its public health efforts with the global agenda for a sustainable and healthy future for all.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being

  The article is centered on Chagas disease, a significant health issue. It discusses the disease’s prevalence, symptoms, transmission, and severe long-term health consequences like heart failure and stroke. The text explicitly refers to Chagas as a “neglected tropical disease,” directly linking it to the core concerns of SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages.

• SDG 13: Climate Action

  The article establishes a direct link between climate change and the spread of Chagas disease. It states, “with climate change causing more bug-friendly temperatures, there’s a good chance they [kissing bugs] have spread farther.” This connection highlights how climate change is exacerbating a public health threat, making SDG 13 relevant to understanding and combating the disease’s expansion.

• SDG 11: Sustainable Cities and Communities

  The article touches upon housing and community-level prevention measures. It mentions that people can protect themselves by “better seal[ing] their homes, use window screens and spray for bugs.” It also points out the lack of vector control programs for kissing bugs compared to mosquitoes. These points relate to creating safe and resilient human settlements, a key aspect of SDG 11.

2. What specific targets under those SDGs can be identified based on the article’s content?

• SDG 3: Good Health and Well-being

  • Target 3.3: End the epidemics of… neglected tropical diseases… and other communicable diseases. The article explicitly identifies Chagas as a “neglected tropical disease” that the World Health Organization is concerned about. The entire discussion about its endemic status in the US and the need for greater attention is aimed at controlling and ultimately ending this communicable disease.
  • Target 3.4: Reduce by one third premature mortality from non-communicable diseases through prevention and treatment. The article notes that 20% to 30% of those infected develop serious chronic conditions, including “heart failure, stroke or death.” These are non-communicable diseases resulting from the initial infection. The call for early detection and treatment, which can cure the disease and prevent these outcomes, directly supports this target.
  • Target 3.d: Strengthen the capacity of all countries… for early warning, risk reduction and management of national and global health risks. The article argues for improved “surveillance, prevention and testing efforts” in the US. It points out that doctors are not required to report Chagas in most states and that surveillance is limited, highlighting a weakness in the national capacity to manage this health risk.

• SDG 13: Climate Action

  • Target 13.1: Strengthen resilience and adaptive capacity to climate-related hazards and natural disasters in all countries. The spread of the kissing bug vector due to “climate change causing more bug-friendly temperatures” is a climate-related hazard. The call for better surveillance and control of the bug population is a measure to strengthen resilience and adapt to the health impacts of a changing climate.

• SDG 11: Sustainable Cities and Communities

  • Target 11.1: Ensure access for all to adequate, safe and affordable housing. The article suggests that structural improvements to homes, such as being well-sealed and having window screens, are a key method of prevention. This connects the quality and safety of housing directly to the prevention of vector-borne diseases like Chagas.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• For Target 3.3 (End epidemics of neglected tropical diseases)

  • Indicator (Implied): Number of people requiring interventions against neglected tropical diseases. The article provides a direct figure for this, stating that “the CDC estimates that about 280,000 people in the US have Chagas at any given time.” Tracking this number would measure progress in controlling the disease.

• For Target 3.4 (Reduce premature mortality from NCDs)

  • Indicator (Implied): Mortality rate attributed to Chagas-related complications. The article states that Chagas can lead to “heart failure, stroke or death” and is a “leading cause of heart disease in Latin America.” While it notes it’s “unclear how many deaths are caused by Chagas each year” in the US, establishing and tracking this mortality rate would be a key indicator of progress.

• For Target 3.d (Strengthen early warning and health risk management)

  • Indicator (Implied): Existence and scope of national surveillance and reporting systems. The article highlights a major gap by stating, “doctors are not required to report Chagas infections in most states.” Therefore, an indicator of progress would be the number of states that make Chagas a reportable disease.
  • Indicator (Implied): Existence of vector control programs. The article points out a deficiency: “We have mosquito control programs around the country, but we’re essentially doing nothing about kissing bugs.” Establishing and measuring the coverage of control programs for kissing bugs would be a clear indicator of strengthened capacity.

• For Target 13.1 (Strengthen resilience to climate-related hazards)

  • Indicator (Implied): Geographical distribution and prevalence of the disease vector. The article mentions that “Scientists have found kissing bugs in 32 states” and that their range is expanding due to climate change. Monitoring the geographical spread of these insects over time would be an indicator of the increasing climate-related health hazard.

4. SDGs, Targets, and Indicators Table

Source: cnn.com