Report on the Emergence of Chagas Disease in the United States and its Implications for Sustainable Development Goal 3

Executive Summary

A recent study published by the Centers for Disease Control (CDC) presents evidence supporting the classification of Chagas disease as an endemic condition within the United States. The documentation of locally acquired human and animal infections across multiple states poses a direct challenge to the achievement of Sustainable Development Goal 3 (Good Health and Well-being), specifically Target 3.3, which calls for an end to the epidemics of neglected tropical diseases (NTDs) by 2030. This report outlines the current situation, public health implications, and the critical need for an enhanced response aligned with global health objectives.

Disease Profile and Vector Information

Etiology and Transmission

Chagas disease is a parasitic illness caused by Trypanosoma cruzi. The parasite is primarily transmitted to humans and animals by blood-feeding insects known as triatomine bugs (“kissing bugs”).

• Approximately 55% of triatomine bugs in affected regions are estimated to carry the T. cruzi parasite.
• The presence of these vectors within human dwellings, particularly common in the southern United States, highlights a public health risk linked to housing quality and environmental management, touching upon objectives within SDG 11 (Sustainable Cities and Communities).

Geographic Distribution and Public Health Surveillance

Reported Human Cases

Since 2013, triatomine bugs have been identified in 31 states. More critically, locally acquired human cases of Chagas disease have been confirmed in eight states, indicating that domestic transmission is occurring. Addressing this domestic spread is fundamental to meeting the targets of SDG 3. The states with confirmed local human transmission are:

• Arizona
• Arkansas
• California
• Louisiana
• Mississippi
• Missouri
• Tennessee
• Texas

Reported Animal Cases

The parasite is widespread in animal populations, serving as a reservoir for human infection. This zoonotic dimension underscores the need for a “One Health” approach, which is integral to the holistic framework of the SDGs, particularly SDG 15 (Life on Land). Cases in animals, especially dogs, have been reported in the following states:

• Alabama
• Arizona
• California
• Florida
• Georgia
• Kansas
• Kentucky
• Louisiana
• Maryland
• Mississippi
• Missouri
• New Mexico
• North Carolina
• Oklahoma
• South Carolina
• Tennessee
• Texas
• Virginia

Surveillance Gaps and SDG Alignment

A significant barrier to an effective public health response is that Chagas disease is not a nationally notifiable disease in the United States. This lack of mandatory reporting creates critical data gaps, preventing accurate assessment of disease burden and hindering progress toward SDG Target 3.3. Establishing robust surveillance systems, a key component of resilient health infrastructure, is essential for targeted interventions.

Clinical Manifestations and Health Outcomes

Chagas disease progresses in two phases, with early diagnosis and treatment being critical to preventing severe long-term health consequences and ensuring progress toward universal health coverage as envisioned in SDG 3.

Acute Phase Symptoms

The initial phase occurs within the first few weeks of infection and may include the following symptoms:

• Fever
• Fatigue and body aches
• Headache
• Rash
• Loss of appetite, diarrhea, and vomiting
• Swelling of an eyelid (Romaña’s sign)

Chronic Phase Complications

If untreated, 20% to 30% of infected individuals may develop serious, life-threatening conditions over many years. These complications represent a significant health burden that undermines the goal of ensuring healthy lives.

• Cardiac Problems: Enlarged heart, heart failure, altered heart rate, and risk of sudden death.
• Digestive Problems: Enlarged esophagus or colon, leading to difficulties with eating and elimination.

Conclusion and Path Forward for SDG Attainment

The evidence of established T. cruzi transmission cycles in the U.S. warrants official recognition of Chagas disease as an endemic health issue. Such a declaration would strengthen public health infrastructure by improving surveillance, raising clinical awareness, and promoting early diagnosis and treatment. These actions are indispensable for the United States to meet its commitments under Sustainable Development Goal 3. Fostering collaboration between public health agencies, academic institutions, and healthcare providers, in the spirit of SDG 17 (Partnerships for the Goals), is imperative to effectively combat this neglected tropical disease.

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

  This goal aims to ensure healthy lives and promote well-being for all at all ages. The article directly addresses this by focusing on Chagas disease, a parasitic illness affecting both humans and animals in the United States. It discusses the disease’s causes, symptoms, transmission, and the public health challenge posed by its spread. The call for the Centers for Disease Control (CDC) to declare it an endemic disease underscores the need for a formal public health response to protect and improve the well-being of affected populations.

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

Based on the article’s focus on Chagas disease, the following specific 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.

  Chagas disease is widely recognized as a neglected tropical disease (NTD). The article highlights its emergence and local transmission in the U.S., stating that “humans were reported to have locally-contracted Chagas disease in eight states.” The discussion about its spread and the call for it to be declared endemic directly relate to the effort to combat and manage communicable and neglected diseases.

• 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.

  The article points to a significant gap in the U.S. public health surveillance system. It explicitly states, “There is no federal data on the number of Chagas cases in the United States because the disease is not a nationally notifiable disease, meaning healthcare providers are not required to report cases to local and state health departments.” This lack of mandatory reporting hinders early warning, risk assessment, and effective management of the disease, which is precisely the capacity that Target 3.d aims to strengthen.

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

Yes, the article mentions or implies several indicators that can be used to measure the status and progress related to the identified targets.

• Indicators for Target 3.3 (Combatting communicable diseases):
  • Geographical spread of the vector: The article notes that “‘kissing bugs’ have been reported in 31 states,” providing a baseline measure of the vector’s presence.
  • Incidence and location of human cases: The report of “locally-contracted Chagas disease in eight states” serves as a direct indicator of the disease’s incidence and endemic nature. Tracking this number over time would measure progress in controlling the disease.
  • Prevalence in animal reservoirs: The mention that “16 states have reported cases of animals contracting Chagas disease” is an indicator of the parasite’s prevalence in the environment, which poses a risk to humans.
• Indicators for Target 3.d (Strengthening health risk management):
  • National Notifiable Disease Status: The article states that Chagas “is not a nationally notifiable disease.” The status of this classification serves as a key indicator. Changing its status to “notifiable” would represent a significant strengthening of national capacity for disease surveillance.
  • Availability of Federal Data: The fact that “There is no federal data on the number of Chagas cases” is a clear indicator of a weakness in the health information system. The establishment of a federal database to track cases would be a measure of progress toward this target.

4. Summary Table of SDGs, Targets, and Indicators

Source: usatoday.com