Report on Chagas Disease in the United States: A Public Health Challenge for Sustainable Development Goals

Introduction: An Emerging Threat to SDG 3

Chagas disease, a parasitic infection caused by Trypanosoma cruzi, has transitioned from a geographically confined illness in Latin America to an endemic public health concern in the United States. This development poses a significant challenge to the achievement of **Sustainable Development Goal 3 (SDG 3): Good Health and Well-being)**. A September 2025 report from the U.S. Centers for Disease Control and Prevention (CDC) highlighted the rise in cases, underscoring the urgency of addressing this silent health crisis affecting both human and animal populations.

Transmission Cycle and Pathophysiology

The primary vector for T. cruzi is the triatomine bug, colloquially known as the “kissing bug,” which is present in 32 U.S. states. The parasite’s transmission cycle presents a complex challenge that intersects with environmental and animal health, touching upon **SDG 15 (Life on Land)**.

Modes of Transmission

• Vector-borne: The most common method occurs when an infected triatomine bug bites an individual and defecates near the wound. The parasite in the feces enters the body when the person scratches the bite.
• Oral: Ingestion of food or beverages contaminated with the parasite.
• Congenital: Transmission from an infected mother to her baby during pregnancy or childbirth.
• Other: Transmission via blood transfusions or organ transplants from infected donors.

Once inside a host, T. cruzi invades cells, particularly in the heart and gastrointestinal (GI) tract. The parasite replicates until the host cells rupture, releasing more parasites into the bloodstream and causing progressive tissue damage and inflammation. This pathology directly undermines public health objectives central to **SDG 3**.

Clinical Manifestations and Impact on Human and Animal Health

Chagas disease progresses through two distinct phases, with severe long-term consequences that impede the goal of ensuring healthy lives.

Acute Phase

This initial phase is often asymptomatic or presents with mild, non-specific symptoms such as fever and fatigue, leading to under-diagnosis. In both humans and canines, the subclinical nature of this stage allows the infection to become established without intervention.

Chronic Phase

If left untreated, the infection enters a chronic phase that can remain dormant for decades. However, in approximately 20-30% of human cases, it leads to severe and life-threatening conditions.

1. Indeterminate Stage: The host is asymptomatic, but the parasite persists within body tissues.
2. Chronic Symptomatic Stage: Progressive organ damage becomes evident, primarily affecting the heart (cardiomyopathy, arrhythmias, heart failure) and, in some human cases, the GI tract (megacolon, megaesophagus).

In dogs, which serve as significant domestic reservoirs, the chronic phase often progresses more rapidly, leading to fatal cardiac complications. The health of these animals is intrinsically linked to human health and the surrounding environment, a core tenet of the One Health approach relevant to **SDG 15**.

Diagnostic Challenges and the Need for Integrated Health Systems

The silent nature of Chagas disease creates significant diagnostic hurdles, complicating efforts to meet **SDG 3** targets for disease control. Diagnosis in the acute phase relies on detecting the parasite in the blood, which becomes difficult in the chronic phase as parasite levels drop. Chronic infections are typically identified through serological tests for antibodies.

Advances in veterinary diagnostics, such as advanced PCR-based screening panels, offer a pathway for earlier detection in canine populations. Identifying the disease in pets can serve as a crucial sentinel for local human risk, highlighting the need for integrated surveillance systems that align with **SDG 17 (Partnerships for the Goals)**.

A One Health Approach: A Strategy for Achieving Multiple SDGs

Addressing Chagas disease effectively requires a “One Health” approach, which recognizes the interconnection between human health, animal health, and the environment. This collaborative framework is essential for building the partnerships required by **SDG 17**.

Key Components of a One Health Strategy

• Interdisciplinary Collaboration: Fostering dialogue and joint initiatives between physicians, veterinarians, and public health officials to create a comprehensive response.
• Public and Professional Education: Raising awareness among the general public and healthcare providers about the risks, symptoms, and presence of Chagas disease to promote early diagnosis and treatment, directly supporting **SDG 3**.
• Integrated Surveillance: Monitoring the disease in human, domestic animal, and wildlife populations to understand transmission dynamics and inform targeted interventions. This approach respects the integrity of ecosystems as outlined in **SDG 15**.

By viewing Chagas disease through a One Health lens, stakeholders can develop more resilient and sustainable health systems capable of managing complex zoonotic diseases, thereby contributing to the broader 2030 Agenda for Sustainable Development.

Analysis of Sustainable Development Goals in the Article

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

The primary Sustainable Development Goal (SDG) addressed in the article is SDG 3: Good Health and Well-being. The entire article focuses on a significant public health issue, Chagas disease, and its impact on both human and animal populations.

• SDG 3: Good Health and Well-being: The article details the emergence of Chagas disease as a “silent public health crisis” in the United States. It discusses the disease’s transmission, symptoms, health complications (such as cardiomyopathy and congestive heart failure), and the challenges in diagnosis and treatment. The call for greater awareness, improved diagnostics, and a collaborative “One Health” approach directly aligns with the goal of ensuring healthy lives and promoting well-being for all.

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

Based on the article’s focus on combating a specific communicable disease and strengthening health systems, the following targets under SDG 3 are relevant:

• Target 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.
  • Explanation: Chagas disease is classified as a neglected tropical disease (NTD). The article explicitly addresses the spread of this disease, noting that it is “now endemic in the United States” and that the CDC has “raised concerns about a rise in cases.” The discussion about its transmission, diagnosis, and the need for awareness is directly related to efforts to combat and control this communicable disease.
• Target 3.d: Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks.
  • Explanation: The article highlights significant gaps in the management of Chagas disease in the US. Dr. Brad Ryan’s emphasis on the need for “education and to raise awareness” among doctors, veterinarians, and the public is a call to strengthen the capacity for early warning and risk reduction. The mention of advanced diagnostics, such as “Antech Diagnostics’ advanced vector-borne disease (VBD) screening panel,” points to the tools needed to improve this capacity. Furthermore, the promotion of a “One Health approach” is a strategy for managing a health risk that spans human, animal, and environmental domains.

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

The article implies several indicators that can be used to measure progress towards the identified targets:

• Indicators for Target 3.3:
  • Incidence and prevalence of Chagas disease: While the article does not provide specific numbers, it refers to a “rise in cases” and the disease becoming “endemic.” Tracking the number of new and existing cases in both humans and animals (particularly dogs, as mentioned) would be a direct indicator of progress in combating the disease. This relates to Indicator 3.3.5 (Number of people requiring interventions against neglected tropical diseases).
• Indicators for Target 3.d:
  • Availability and use of advanced diagnostic tests: The article mentions the availability of a “PCR-based testing capable of detecting T. cruzi DNA even at low levels.” The rate of adoption and utilization of such advanced screening panels by veterinarians and physicians can serve as an indicator of strengthened diagnostic capacity.
  • Public and professional awareness levels: Dr. Ryan states, “We want doctors to be informed, we want veterinarians to be informed, and we also want the general public to be informed.” Progress could be measured through surveys assessing the knowledge of Chagas disease symptoms, transmission, and risks among healthcare professionals and the general population in affected areas.
  • Implementation of “One Health” initiatives: The article strongly advocates for a “One Health approach to medicine.” The establishment of collaborative programs between human public health agencies (like the CDC) and veterinary medicine professionals to monitor and manage Chagas disease would be a key indicator of improved capacity for managing this zoonotic health risk.

4. Summary Table of SDGs, Targets, and Indicators

Source: newatlas.com