Chagas Disease Shifts: Declining Overall, But Rising Risks in Unexpected Places
While global prevalence of Chagas disease has decreased by roughly 18% between 1990 and 2023, a new analysis reveals a concerning trend: a significant rise in cases outside of traditionally endemic regions, coupled with an aging population now bearing the brunt of the illness. This isn’t simply a story of progress; it’s a signal that the fight against this parasitic disease is evolving, demanding a recalibration of global health strategies.
The Global Picture: A Declining Burden, But Not a Victory
Published in The Lancet Infectious Diseases, research from the University of Washington’s Institute for Health Metrics and Evaluation (IHME) paints a complex picture. The total estimated global prevalence of Chagas disease fell from 12.6 million in 1990 to 10.5 million in 2023, with a corresponding decrease in reported deaths (from 13,400 to 8,420). This decline is largely attributed to improved control efforts in Latin America, where the disease is historically concentrated. However, this positive trend masks a critical shift in where and who is affected.
An Aging Epidemic
Perhaps the most striking finding is the demographic shift. In 1990, the peak prevalence of Chagas disease was among individuals aged 30-45. Now, that peak has moved to the 45-65 age range. As explained by Ewerton Cousin, PhD, MS, and Jonathan F. Moss, MD, MPH, of IHME, this shift “highlights the importance of preparing and funding health systems for caring for older individuals living with advanced sequela,” – the chronic cardiac and digestive complications that can develop years, even decades, after initial infection. The long latency period of Chagas disease means that individuals infected in their youth are now reaching the age where these complications manifest, placing a growing strain on healthcare resources.
The Unexpected Spread: Chagas Disease Beyond Borders
While cases are decreasing in endemic areas, the study reveals a nearly 46.2% increase in Chagas disease prevalence in nonendemic locations between 1990 and 2023. North America and Western Europe are seeing the most significant increases, with approximately 232,000 and 126,000 cases respectively in 2023. This rise is primarily linked to migration patterns, particularly from Latin American countries where the disease is prevalent. The parasite, Trypanosoma cruzi, is transmitted to humans through contact with triatomine bugs (often called “kissing bugs”), but can also be spread through blood transfusions, organ transplantation, and from mother to child during pregnancy.
Why the Increase in Nonendemic Regions?
Several factors contribute to this spread. Increased international travel and migration, coupled with a lack of awareness among healthcare professionals in nonendemic areas, contribute to underdiagnosis. Furthermore, screening protocols for blood and organ donations are not universally implemented, creating potential transmission pathways. The IHME researchers emphasize the need for increased awareness among healthcare professionals and targeted screening of high-risk populations, including Latin American immigrants. The Centers for Disease Control and Prevention (CDC) provides comprehensive information on Chagas disease, its transmission, and prevention.
Looking Ahead: A Call for Proactive Strategies
The changing landscape of Chagas disease demands a proactive and multifaceted approach. Continued investment in control efforts within endemic countries remains crucial, but equal attention must be paid to preventing and managing the disease in nonendemic regions. This includes strengthening screening programs, raising awareness among healthcare providers, and improving access to diagnosis and treatment. The shift towards an aging population with chronic complications underscores the urgent need for long-term care strategies and dedicated funding to support those living with this often-overlooked disease. What steps will global health organizations take to address this evolving threat and ensure equitable access to care for all affected individuals?
