Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 28, Number 7—July 2022

Updated Estimates and Mapping for Prevalence of Chagas Disease among Adults, United States

Amanda Irish, Jeffrey D. Whitman, Eva H. Clark, Rachel Marcus, and Caryn BernComments to Author 
Author affiliations: University of California–San Francisco, San Francisco, California, USA (A. Irish, J.D. Whitman, C. Bern); Baylor College of Medicine, Houston, Texas, USA (E.H. Clark); Medstar Union Memorial Hospital and Latin American Society of Chagas, Washington, DC, USA (R. Marcus)

Cite This Article


CME Logo


In support of improving patient care, this activity has been planned and implemented by Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Medscape, LLC designates this Journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit(s). Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 75% minimum passing score and complete the evaluation at; and (4) view/print certificate.

Release date: June 17, 2022; Expiration date: June 17, 2023
Learning Objectives

Upon completion of this activity, participants will be able to:

  • Evaluate the prognosis of Chagas disease

  • Analyze the epidemiology of Chagas disease in the United States

  • Distinguish US metropolitan areas with the highest rates of Chagas disease

  • Analyze the prevalence of Chagas disease based on country of origin in Latin America.

CME Editor

Dana C. Dolan, BS, Technical Writer/Editor, Emerging Infectious Diseases. Disclosure: Dana C. Dolan, BS, has disclosed no relevant financial relationships.

CME Author

Charles P. Vega, MD, Health Sciences Clinical Professor of Family Medicine, University of California, Irvine School of Medicine, Irvine, California. Disclosure: Charles P. Vega, MD, has disclosed the following relevant financial relationships: served as an advisor or consultant for GlaxoSmithKline; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.


Amanda Irish, DVM; Jeffrey D. Whitman, MD; Eva H. Clark, MD; Rachel Marcus, MD; and Caryn Bern, MD.



We combined American Community Survey data with age-specific Trypanosoma cruzi prevalence derived from US surveys and World Health Organization reports to yield estimates of Chagas disease in the United States, which we mapped at the local level. In addition, we used blood donor data to estimate the relative prevalence of autochthonous T. cruzi infection. Our estimates indicate that 288,000 infected persons, including 57,000 Chagas cardiomyopathy patients and 43,000 infected reproductive-age women, currently live in the United States; 22–108 congenital infections occur annually. We estimated ≈10,000 prevalent cases of locally acquired T. cruzi infection. Mapping shows marked geographic heterogeneity of T. cruzi prevalence and illness. Reliable demographic and geographic data are key to guiding prevention and management of Chagas disease. Population-based surveys in high prevalence areas could improve the evidence base for future estimates. Knowledge of the demographics and geographic distribution of affected persons may aid practitioners in recognizing Chagas disease.

Six million persons are estimated to have Chagas disease in the Americas; 20%–30% of those cases will progress to cardiac or gastrointestinal disease (1). Early treatment of infection with the causative parasite, Trypanosoma cruzi, provides the best chance to decrease progression risk; cure rates are >60% in those treated as children (2,3). Cure rates among adults are unclear; the accepted test of cure is reversion to negative serologic test results, which requires years to decades, and the time to negative serologic results is inversely proportional to the duration of infection (4). Because the date of T. cruzi infection is nearly always unknown, age is commonly used as a proxy for duration. Infected persons are typically asymptomatic for decades. In those with established Chagas cardiomyopathy, antiparasitic treatment is unlikely to alter heart disease progression (5). Thus, early, active screening during the asymptomatic period is essential to achieve timely diagnosis and effective treatment. Since the establishment of regional control programs in the 1990s, many Latin America countries have mounted community- and facility-based programs, most commonly focused on screening of children and pregnant women (6,7). No such large-scale programs exist in the United States.

Enzootic transmission by local triatomine species occurs across the southern United States from coast to coast; Lynn et al. summarized 76 suspected or confirmed autochthonous human T. cruzi infections (8). However, locally acquired infections are vastly outnumbered by those acquired by immigrants from Latin America in their countries of origin before arrival in the United States. No nationally representative T. cruzi prevalence data exist for the United States; disease burden estimates have been based on reported national prevalence figures from Latin America countries. These estimates suggest that 240,000–350,000 US residents of Latin America origin may have T. cruzi infection (9). However, infection rates are heterogeneous within countries, so national-level prevalence estimates may not reflect prevalence among US immigrants.

Calls for more widespread screening and diagnostic testing for Chagas disease in the United States are growing (1012). Finer-scale geographic data would be of great help in the targeting of such efforts. Local screening of at-risk populations in Los Angeles, California; the District of Columbia; and the Boston, Massachusetts, metropolitan areas provide a more accurate reflection of prevalence in some US populations (1315). Using data from the American Community Survey (ACS) (16), we developed new age-structured estimates and interactive maps of Chagas disease prevalence at the local level. We present these data to support geographic targeting of screening efforts and setting priorities for healthcare providers and public health outreach to address Chagas disease in the United States.


Prevalence by Age and Country of Origin

Because T. cruzi infection is lifelong in the absence of effective antiparasitic treatment, the prevalence of infection tends to rise as age increases (17). Those patterns may also reflect improved vector control for patients who grew up more recently in endemic settings compared with those in older age cohorts (17); also, age is used as a determinant for treatment recommendations (1). Together, these issues make age-structured estimates crucial to public health efforts. Past estimates have relied on aggregate prevalence figures derived from data provided by member countries and published by the World Health Organization (18). For our estimates, we used T. cruzi seroprevalence data from US populations to the greatest extent possible (1315). Data are available for immigrants from the most frequent Chagas disease–endemic countries of origin: Mexico, El Salvador, Guatemala, Honduras, and Colombia. In addition, data are available from a metropolitan area with a high number of immigrants from Bolivia, a group that contributes disproportionately to the Chagas disease burden because of very high prevalence in some regions of Bolivia (13). Data for children <18 years of age are extremely sparse. One of the screening studies that underpin our assumptions included 225 children, of whom none were infected (14). Those data were insufficient to obtain a reliable estimate for children; for that reason, our estimates are for adults only.

We used the age-specific pattern for El Salvador in US survey data to model prevalence patterns for immigrants from other countries of origin. Although more immigrants to the United States are from Mexico than El Salvador, T. cruzi prevalence is substantially higher among those from El Salvador (13,14,19,20); for this reason, the patterns were clearer and the age-stratified estimates more stable for immigrants from El Salvador. The general finding of prevalence increasing with age holds true in data from immigrants from Latin America in the United States (1315), as well as in surveys from urban and rural areas of Latin America (2123). We then calculated the ratio of the overall prevalence in persons from a given country to the prevalence for immigrants from El Salvador. We multiplied this country-level correction factor by the El Salvador estimates to yield estimated age-specific prevalence for immigrants from each country (Appendix 1 Table 1). For Mexico, Guatemala, Honduras, Colombia and Bolivia, we derived the correction factor from the mean of estimated prevalence from US surveys plus the WHO estimate; for all other countries of origin, we used WHO estimates (18).

Estimates of Foreign-Born Population by Age Group and Public Use Micro-Area

The ACS is an annual survey conducted to supplement the decennial census (16). We used the 5-year data, based on a 5% sample of the US population, because they provide the most statistically reliable estimates, a particular concern for this study because we calculated estimates for small population subgroups at the public use micro-area (PUMA) level for mapping. PUMAs partition states into areas containing >100,000 residents and are the smallest geographic area for which complete microdata are available. Because not all counties can be characterized using PUMA data, we could not map at the county level. Estimates are interpreted as period estimates (e.g., the Chagas disease prevalence in 2014–2018).

We extracted relevant microdata for 2014–2018 from IPUMS-USA, which collects and harmonizes data from the census and ACS (Appendix 1). Using these data, we estimated the overall adult population and population of adult Latin America–born US residents by country of origin and age group (Appendix 1 Table 2).

Estimates of the Clinical Burden of Chagas Disease in the United States

We used the infection prevalence and population figures to calculate the prevalence of Chagas disease at the PUMA level for mapping and national level for summary estimates. We produced estimates of the number of patients with Chagas cardiomyopathy in the United States by applying age-specific cardiomyopathy prevalence rates among T. cruzi–infected persons in population-based studies from disease-endemic countries to our US infection estimates by age group (2426).

We estimated the risk for congenital transmission in the United States using age-specific infection prevalence and birth rate statistics. To estimate age-specific birth rates among foreign-born women from Latin America, we started with the reported number of live births per 1,000 Hispanic women by age group in 2017 (27). That figure includes women of Hispanic origin born in the US as well as women born in Latin America. We therefore multiplied by a correction factor of 1.22 to adjust for the higher birth rate among US resident women born in Latin America (82.3) compared with all Hispanic women (67.6) (27,28). We then applied a range of vertical transmission rates of 1%–5% to estimate a likely range for the number of congenitally infected infants born in 2017. In a recent meta-analysis, the estimated vertical transmission rate for T. cruzi–infected women in nonendemic countries was 2.7%, falling within the range we used (29). However, most of the data in the meta-analysis came from immigrants from Bolivia in Spain. Data for women from Mexico and Central America are extremely sparse, and we felt the uncertainty expressed by the range was more appropriate than a single point estimate.

Finally, we calculated the relative number of locally acquired autochthonous T. cruzi infections in the United States, based on estimates that 5.5%–7.5% of blood donor infections were locally acquired (30). We corrected for underrepresentation of Hispanic populations in donor data (31).

Statistical Analysis and Mapping

We performed analyses in R version 4.0.4 ( We obtained point estimates and 95% CIs using person-level replicate weights. We generated interactive, web-based maps to display estimates for the total number of infected adults and the prevalence of Chagas disease in the total population and in the Latin America–born population at the PUMA level (Appendix 1).


We estimated that 287,711 adult Latin America–born US residents were living with Chagas disease during the period 2014–2018 (Table 1). Of those, 68% (196,907) were >50 years of age; case numbers were low in younger age groups. The marked age dependence of both T. cruzi infection prevalence and Chagas cardiomyopathy indicates that >85% of the estimated 57,000 Chagas cardiomyopathy cases occur in those >50 years of age (Table 2). Because prevalence among women of childbearing age is relatively low, we estimate relatively few congenital infections (Table 3). On the basis of blood donor data, we estimated as many as 10,000 locally acquired T. cruzi infections in the United States (Appendix Table 3).

The PUMA-level maps illustrate the marked geographic heterogeneity of estimated T. cruzi infection prevalence and the burden of Chagas disease in the United States ( Foci of high disease burden vary substantially in demography, geography and healthcare access, as we saw in the Houston, Texas, metropolitan area (Appendix 2); in southern California (Appendix 3); and in the Washington, DC, metropolitan area (Appendix 4). The metropolitan areas with the highest number of estimated Chagas disease cases reflect major population centers, whereas areas with the highest percentage of infected residents include midsized cities in states with a high proportion of Latin America–born residents (Table 4).


To address Chagas disease in the United States, public health practitioners and healthcare providers need to know where and among whom to target their efforts. Our updated estimates define the demographics and provide a detailed geography of Chagas disease. In data from both the United States (1315) and Chagas disease–endemic countries (2123), the infection prevalence increases with increasing age. The use of prevalence and age structure assumptions based on data from several US populations of interest make these new estimates a more accurate reflection of T. cruzi infection and illness than previous calculations (9,32). By mapping the resulting data at the most local level possible, we have constructed interactive maps that enable providers to assess risk in their catchment area (16). Such maps could be developed to target screening efforts for other conditions for which migrants bear a disproportionate risk (33).

These new estimates add nuance to the already complex landscape of efforts to address Chagas disease (1,34). Our updated estimate of ≈288,000 T. cruzi–infected US residents is consistent with earlier figures of ≈240,000 to ≈350,000 (9,32). However, our new age-structured estimates indicate that two thirds of persons with Chagas disease in the United States are >50 years of age. This finding substantially increases the estimate of patients with Chagas cardiomyopathy (57,000 in our estimates vs. 30,000–45,000 in the 2009 estimates) and decreases the projected number of annual congenital T. cruzi infections (22–108 in our data vs. 63–315 in 2009 data) (32).

Antitrypanosomal treatment recommendations are strongest for younger age groups, based on the more robust data for benefit among children than adults (35,36). In the United States, as in Latin America, at-risk women of reproductive age should be screened for Chagas disease, to offer them treatment and detect infected infants early in life (36,37). Treatment of women before pregnancy is associated with an estimated 95% decrease in risk for subsequent congenital transmission (4,38). We were unable to make a disease burden estimate for children <18 years of age; 1 of the 3 US studies used to underpin the estimates included children, none of whom was infected (14). Children in the United States are also at risk if they were born to women with Chagas disease; hundreds of US-born children <18 are probably living with undetected T. cruzi infection acquired at birth. Maternal birthplace is, therefore, a crucial piece of information to assess risk among US-born persons with roots in Latin America.

Persons with Chagas cardiomyopathy also benefit from accurate and timely diagnosis. Clinical trial data have failed to show substantial effects of antitrypanosomal therapy on progression of established Chagas cardiomyopathy, reinforcing the urgency to institute active screening to detect infections before cardiac damage occurs (5,39). Nevertheless, good cardiac management substantially improves survival and quality of life, and the United States has the resources to appropriately evaluate and manage every infected patient (40). Patients who receive cardiac transplants for end-stage Chagas cardiomyopathy have a survival rate equivalent to or better than that of patients who receive transplants for other etiologies, as long as the infection is recognized and the patient actively monitored for reactivation (4143). Pretransplant diagnosis of T. cruzi infection is crucial to ensure good outcomes (41).

Our estimates improve on previous efforts (9,32) but suffer from some of the same limitations in the empirical data underpinning their assumptions. US data were available from 3 metropolitan areas (1315), and data for children were extremely sparse. The US data were based on clinical screening and community convenience samples, not population-based sampling. The results may be affected by differences in access to care, catchment areas, and awareness among participants. ACS datasets lack the data needed to make estimates for some counties, including several of those comprising the highest-burden PUMAs. Thus, we were unable to show a county-level map, which might have been useful for public health targeting. We have no direct data for the incidence of congenital T. cruzi transmission in the United States. Only 2 congenital infections have been reported, both with moderately severe manifestations (44,45). In the absence of screening, most infected infants with minimal or no symptoms were undoubtedly missed. Because of the indirect calculation method, and because foreign-born donors may have been less likely than US-born donors to participate in the donor follow-up study (30), our estimate for locally acquired Chagas disease provides an indication of the relative order of magnitude of this problem and may represent an overestimate.

Effectively addressing Chagas disease is complicated by the heterogeneity of healthcare systems in the United States. States play a major role in determining services for the indigent, uninsured, and undocumented persons who are at highest risk for Chagas disease, so there is no universal pathway for these persons to receive affordable healthcare (46). Nevertheless, most states have programs to cover uninsured pregnant women, infants, and young children. Thus, prenatal testing and evaluation of newborns and older children of infected women constitute high-priority, cost-effective aspects of Chagas disease control that should be within our immediate reach (11,12). Managing the chronic sequelae of Chagas disease is complex and costly, and access to such care for uninsured patients varies widely from state to state. Federally qualified health centers may lack the capacity to provide access to specialty services such as infectious diseases, cardiology, and gastroenterology (47). Strategies to enhance awareness among relevant providers, including primary care physicians, obstetricians, cardiologists and gastroenterologists, are urgently needed. Targeting locations with the highest Chagas disease burden will improve screening, management and health care access (48).

Early treatment has the potential to prevent congenital transmission and decrease the future burden of cardiomyopathy and other chronic sequelae of Chagas disease. Screening of asymptomatic persons at epidemiologic risk will be essential to achieve these goals (12). Population-based surveys in high-prevalence areas could identify those eligible for treatment, and at the same time, greatly improve the evidence base for future estimates. However, such surveys would be much more resource intensive than screening in primary-healthcare settings. Early recognition of Chagas cardiomyopathy is equally necessary to guide accurate medical and surgical management to improve quality of life and survival. Many of those at highest risk for COVID-19 include the target populations identified in our Chagas disease estimates, and the outreach methods and community partnerships crucial to the response to the pandemic provide a potential template for addressing Chagas disease (49).



We thank Yagahira Castro-Sesquen, Jennifer Manne-Goehler, and Julia Koehler for sharing age- and country-specific prevalence figures from their screening studies.

C.B. receives royalties for UpToDate topics related to Chagas disease. E.H.C. was supported by National Institutes of Health NIAID K23AI168583-01.

A.I. conducted the data analysis, generated the maps, drafted part of the manuscript, and reviewed and revised the manuscript. J.D.W. contributed to interpretation of the study findings, drafted part of the manuscript, and reviewed and revised the manuscript. E.H.C. contributed to interpretation of the study findings, drafted part of the manuscript, and reviewed and revised the manuscript. R.M. contributed to interpretation of the study findings, drafted part of the manuscript, and reviewed and revised the manuscript. C.B. conceptualized and designed the study, assisted with data analysis, contributed to interpretation of the study findings, drafted part of the manuscript, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.



  1. Bern  C, Messenger  LA, Whitman  JD, Maguire  JH. Chagas disease in the United States: a public health approach. Clin Microbiol Rev. 2019;33:e0002319. DOIPubMedGoogle Scholar
  2. de Andrade  AL, Zicker  F, de Oliveira  RM, Almeida Silva  S, Luquetti  A, Travassos  LR, et al. Randomised trial of efficacy of benznidazole in treatment of early Trypanosoma cruzi infection. Lancet. 1996;348:140713. DOIPubMedGoogle Scholar
  3. Sosa Estani  S, Segura  EL, Ruiz  AM, Velazquez  E, Porcel  BM, Yampotis  C. Efficacy of chemotherapy with benznidazole in children in the indeterminate phase of Chagas’ disease. Am J Trop Med Hyg. 1998;59:5269. DOIPubMedGoogle Scholar
  4. Fabbro  DL, Danesi  E, Olivera  V, Codebó  MO, Denner  S, Heredia  C, et al. Trypanocide treatment of women infected with Trypanosoma cruzi and its effect on preventing congenital Chagas. PLoS Negl Trop Dis. 2014;8:e3312. DOIPubMedGoogle Scholar
  5. Morillo  CA, Marin-Neto  JA, Avezum  A, Sosa-Estani  S, Rassi  A Jr, Rosas  F, et al.; BENEFIT Investigators. BENEFIT Investigators. Randomized trial of benznidazole for chronic Chagas’ cardiomyopathy. N Engl J Med. 2015;373:1295306. DOIPubMedGoogle Scholar
  6. Alonso-Vega  C, Billot  C, Torrico  F. Achievements and challenges upon the implementation of a program for national control of congenital Chagas in Bolivia: results 2004-2009. PLoS Negl Trop Dis. 2013;7:e2304. DOIPubMedGoogle Scholar
  7. Yun  O, Lima  MA, Ellman  T, Chambi  W, Castillo  S, Flevaud  L, et al. Feasibility, drug safety, and effectiveness of etiological treatment programs for Chagas disease in Honduras, Guatemala, and Bolivia: 10-year experience of Médecins Sans Frontières. PLoS Negl Trop Dis. 2009;3:e488. DOIPubMedGoogle Scholar
  8. Lynn  MK, Bossak  BH, Sandifer  PA, Watson  A, Nolan  MS. Contemporary autochthonous human Chagas disease in the USA. Acta Trop. 2020;205:105361. DOIPubMedGoogle Scholar
  9. Manne-Goehler  J, Umeh  CA, Montgomery  SP, Wirtz  VJ. Estimating the burden of Chagas disease in the United States. PLoS Negl Trop Dis. 2016;10:e0005033. DOIPubMedGoogle Scholar
  10. Montgomery  SP, Starr  MC, Cantey  PT, Edwards  MS, Meymandi  SK. Neglected parasitic infections in the United States: Chagas disease. Am J Trop Med Hyg. 2014;90:8148. DOIPubMedGoogle Scholar
  11. Stillwaggon  E, Perez-Zetune  V, Bialek  SR, Montgomery  SP. Congenital Chagas disease in the United States: cost savings through maternal screening. Am J Trop Med Hyg. 2018;98:173342. DOIPubMedGoogle Scholar
  12. Forsyth  CJ, Manne-Goehler  J, Bern  C, Whitman  J, Hochberg  NS, Edwards  M, et al. Recommendations for screening and diagnosis of Chagas disease in the United States. J Infect Dis. 2021;•••: Epub ahead of print. DOIPubMedGoogle Scholar
  13. Castro-Sesquen  YE, Saldaña  A, Patino Nava  D, Bayangos  T, Paulette Evans  D, DeToy  K, et al. Use of a latent class analysis in the diagnosis of chronic Chagas disease in the Washington Metropolitan area. Clin Infect Dis. 2020; [Epub ahead of print].PubMedGoogle Scholar
  14. Manne-Goehler  J, Davis  J, Perez  JH, Collins  K, Harakawa  H, Hochberg  N, et al. The results of a primary care-based screening program for Trypanosoma cruzi in East Boston, Massachusetts. IDWeek: Infectious Diseases Society of America; San Francisco, CA, USA: 2018 October 3–7.
  15. Meymandi  SK, Forsyth  CJ, Soverow  J, Hernandez  S, Sanchez  D, Montgomery  SP, et al. Prevalence of Chagas disease in the Latin American-born population of Los Angeles. Clin Infect Dis. 2017;64:11828. DOIPubMedGoogle Scholar
  16. United States Census Bureau. About the American Community Survey (ACS). 2021 Jan 4 [cited 2021 Aug 5].
  17. Cucunubá  ZM, Nouvellet  P, Conteh  L, Vera  MJ, Angulo  VM, Dib  JC, et al. Modelling historical changes in the force-of-infection of Chagas disease to inform control and elimination programmes: application in Colombia. BMJ Glob Health. 2017;2:e000345. DOIPubMedGoogle Scholar
  18. World Health Organization. Chagas disease in Latin America: an epidemiological update based on 2010 estimates. Wkly Epidemiol Rec. 2015;90:3343.PubMedGoogle Scholar
  19. Meymandi  SK, Hernandez  S, Forsyth  CJ. A community-based screening program for Chagas disease in the USA. Trends Parasitol. 2017;33:82831. DOIPubMedGoogle Scholar
  20. Edwards  MS, Rench  MA, Todd  CW, Czaicki  N, Steurer  FJ, Bern  C, et al. Perinatal screening for Chagas disease in southern Texas. J Pediatric Infect Dis Soc. 2015;4:6770. DOIPubMedGoogle Scholar
  21. Cedillos  R, Francia  H, Soundy  C, Ascencio  G, Valcarcel  N. Epidemiological study of Trypanosoma cruzi infection in El Salvador, Central America [in Spanish]. Minerva Revista en Línea CIC-UES. 2011;2:3546.
  22. González-Guzmán  S, Pichardo-Ávila  S, Mimbrera-Rodríguez  E, Crescencio-Trujillo  JA, Gasca-Leyva  ML, Martínez-Hernández  F, et al. Seroprevalence of human Trypanosoma cruzi infection in the North of Estado de Mexico. Rev Soc Bras Med Trop. 2017;50:83942. DOIPubMedGoogle Scholar
  23. Paz-Bailey  G, Monroy  C, Rodas  A, Rosales  R, Tabaru  R, Davies  C, et al. Incidence of Trypanosoma cruzi infection in two Guatemalan communities. Trans R Soc Trop Med Hyg. 2002;96:4852. DOIPubMedGoogle Scholar
  24. Fernandez  AB, Nunes  MC, Clark  EH, Samuels  A, Menacho  S, Gomez  J, et al. Electrocardiographic and echocardiographic abnormalities in Chagas disease: findings in residents of rural Bolivian communities hyperendemic for Chagas disease. Glob Heart. 2015;10:15966. DOIPubMedGoogle Scholar
  25. Maguire  JH, Mott  KE, Lehman  JS, Hoff  R, Muniz  TM, Guimarães  AC, et al. Relationship of electrocardiographic abnormalities and seropositivity to Trypanosoma cruzi within a rural community in northeast Brazil. Am Heart J. 1983;105:28794. DOIPubMedGoogle Scholar
  26. Williams-Blangero  S, Magalhaes  T, Rainwater  E, Blangero  J, Corrêa-Oliveira  R, Vandeberg  JL. Electrocardiographic characteristics in a population with high rates of seropositivity for Trypanosoma cruzi infection. Am J Trop Med Hyg. 2007;77:4959. DOIPubMedGoogle Scholar
  27. Martin  JA, Hamilton  BE, Osterman  MJK, Driscoll  AK, Drake  P. Births: Final Data for 2017. Natl Vital Stat Rep. 2018;67:150.PubMedGoogle Scholar
  28. Livingston  G. Hispanic women no longer account for the majority of immigrant births in the U.S. 2019 [cited 2021 Jul 23].
  29. Howard  EJ, Xiong  X, Carlier  Y, Sosa-Estani  S, Buekens  P. Frequency of the congenital transmission of Trypanosoma cruzi: a systematic review and meta-analysis. BJOG. 2014;121:2233. DOIPubMedGoogle Scholar
  30. Cantey  PT, Stramer  SL, Townsend  RL, Kamel  H, Ofafa  K, Todd  CW, et al. The United States Trypanosoma cruzi Infection Study: evidence for vector-borne transmission of the parasite that causes Chagas disease among United States blood donors. Transfusion. 2012;52:192230. DOIPubMedGoogle Scholar
  31. Murphy  EL, Shaz  B, Hillyer  CD, Carey  P, Custer  BS, Hirschler  N, et al.; NHLBI Retrovirus Epidemiology in Blood Donors Study-II (REDS-II). Minority and foreign-born representation among US blood donors: demographics and donation frequency for 2006. Transfusion. 2009;49:22218. DOIPubMedGoogle Scholar
  32. Bern  C, Montgomery  SP. An estimate of the burden of Chagas disease in the United States. Clin Infect Dis. 2009;49:e524. DOIPubMedGoogle Scholar
  33. Berto  CG, Coyle  CM, Friedman  L, Walker  PF. Where was my patient born? The Intersection of tropical medicine and migrant health. Curr Opin Infect Dis. 2021;34:44754. DOIPubMedGoogle Scholar
  34. Montgomery  SP, Parise  ME, Dotson  EM, Bialek  SR. What do we know about Chagas disease in the United States? Am J Trop Med Hyg. 2016;95:12257. DOIPubMedGoogle Scholar
  35. Bern  C, Montgomery  SP, Herwaldt  BL, Rassi  A Jr, Marin-Neto  JA, Dantas  RO, et al. Evaluation and treatment of chagas disease in the United States: a systematic review. JAMA. 2007;298:217181. DOIPubMedGoogle Scholar
  36. Dias  JC, Ramos  AN Jr, Gontijo  ED, Luquetti  A, Shikanai-Yasuda  MA, Coura  JR, et al. 2 nd Brazilian Consensus on Chagas Disease, 2015. Rev Soc Bras Med Trop. 2016;49(Suppl 1):360. DOIPubMedGoogle Scholar
  37. Edwards  MS, Stimpert  KK, Bialek  SR, Montgomery  SP. Evaluation and management of congenital Chagas disease in the United States. J Pediatric Infect Dis Soc. 2019;8:4619. DOIPubMedGoogle Scholar
  38. Álvarez  MG, Vigliano  C, Lococo  B, Bertocchi  G, Viotti  R. Prevention of congenital Chagas disease by Benznidazole treatment in reproductive-age women. An observational study. Acta Trop. 2017;174:14952. DOIPubMedGoogle Scholar
  39. Maguire  JH. Treatment of Chagas’ disease—time is running out. N Engl J Med. 2015;373:136970. DOIPubMedGoogle Scholar
  40. Nunes  MCP, Beaton  A, Acquatella  H, Bern  C, Bolger  AF, Echeverría  LE, et al.; American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; and Stroke Council. Council on Cardiovascular and Stroke Nursing; and Stroke Council. Chagas cardiomyopathy: an update of current clinical knowledge and management: a scientific statement from the American Heart Association. Circulation. 2018;138:e169209. DOIPubMedGoogle Scholar
  41. Gray  EB, La Hoz  RM, Green  JS, Vikram  HR, Benedict  T, Rivera  H, et al. Reactivation of Chagas disease among heart transplant recipients in the United States, 2012-2016. Transpl Infect Dis. 2018;20:e12996. DOIPubMedGoogle Scholar
  42. Kransdorf  EP, Zakowski  PC, Kobashigawa  JA. Chagas disease in solid organ and heart transplantation. Curr Opin Infect Dis. 2014;27:41824. DOIPubMedGoogle Scholar
  43. Bocchi  EA, Fiorelli  A; First Guidelines Group for Heart Transplantation of the Brazilian Society of Cardiology. The paradox of survival results after heart transplantation for cardiomyopathy caused by Trypanosoma cruzi. Ann Thorac Surg. 2001;71:18338. DOIPubMedGoogle Scholar
  44. Alarcón  A, Morgan  M, Montgomery  SP, Scavo  L, Wong  EC, Hahn  A, et al. Diagnosis and treatment of congenital Chagas disease in a premature infant. J Pediatric Infect Dis Soc. 2016;5:e2831. DOIPubMedGoogle Scholar
  45. Centers for Disease Control and Prevention (CDC). Congenital transmission of Chagas disease - Virginia, 2010. MMWR Morb Mortal Wkly Rep. 2012;61:4779.PubMedGoogle Scholar
  46. Forsyth  C, Meymandi  S, Moss  I, Cone  J, Cohen  R, Batista  C. Proposed multidimensional framework for understanding Chagas disease healthcare barriers in the United States. PLoS Negl Trop Dis. 2019;13:e0007447. DOIPubMedGoogle Scholar
  47. Manne-Goehler  J, Reich  MR, Wirtz  VJ. Access to care for Chagas disease in the United States: a health systems analysis. Am J Trop Med Hyg. 2015;93:10813. DOIPubMedGoogle Scholar
  48. Stimpert  KK, Montgomery  SP. Physician awareness of Chagas disease, USA. Emerg Infect Dis. 2010;16:8712. DOIPubMedGoogle Scholar
  49. Chamie  G, Marquez  C, Crawford  E, Peng  J, Petersen  M, Schwab  D, et al.; CLIAhub Consortium. CLIAhub Consortium. Community transmission of severe acute respiratory syndrome coronavirus 2 disproportionately affects the Latinx population during shelter-in-place in San Francisco. Clin Infect Dis. 2021;73(Suppl 2):S12735. DOIPubMedGoogle Scholar




Follow Up

Earning CME Credit

To obtain credit, you should first read the journal article. After reading the article, you should be able to answer the following, related, multiple-choice questions. To complete the questions (with a minimum 75% passing score) and earn continuing medical education (CME) credit, please go to Credit cannot be obtained for tests completed on paper, although you may use the worksheet below to keep a record of your answers.

You must be a registered user on If you are not registered on, please click on the “Register” link on the right hand side of the website.

Only one answer is correct for each question. Once you successfully answer all post-test questions, you will be able to view and/or print your certificate. For questions regarding this activity, contact the accredited provider, For technical assistance, contact American Medical Association’s Physician’s Recognition Award (AMA PRA) credits are accepted in the US as evidence of participation in CME activities. For further information on this award, please go to The AMA has determined that physicians not licensed in the US who participate in this CME activity are eligible for AMA PRA Category 1 Credits™. Through agreements that the AMA has made with agencies in some countries, AMA PRA credit may be acceptable as evidence of participation in CME activities. If you are not licensed in the US, please complete the questions online, print the AMA PRA CME credit certificate, and present it to your national medical association for review.

Article Title: 
Updated Estimates and Prevalence of Chagas Disease among Adults, United States
CME Questions
  • Which of the following statements regarding Chagas disease in the United States is most accurate?

    • 70% to 80% of adults eventually develop cardiac or gastrointestinal disease

    • Serology against Trypanosoma cruzi becomes negative about 4 weeks after treatment among adults

    • Autochthonous infections with T. cruzi occurs in southern states from coast to coast

    • Survival rates for end-stage cardiomyopathy associated with Chagas disease are lower compared with other indications for transplant

  • What does the current study find regarding the epidemiology of Chagas’ disease in the United States?

    • Nearly 29,000 US residents born in Latin America had Chagas disease from 2014 to 2018

    • Chagas disease was most prevalent among adolescents and young adults

    • There were approximately 1000 congenital T. cruzi infections annually

    • The number of annual locally acquired infections may be 10,000

  • Which metropolitan area had the highest prevalence rate of Chagas disease in the current study?

    • New York

    • Houston

    • Washington, DC

    • Los Angeles

  • Persons from which of the following countries of origin had the highest prevalence of Chagas disease in the current study?

    • Mexico

    • Guatemala

    • Venezuela

    • Bolivia


Cite This Article

DOI: 10.3201/eid2807.212221

Original Publication Date: June 17, 2022

Related Links

Table of Contents – Volume 28, Number 7—July 2022

EID Search Options
presentation_01 Advanced Article Search – Search articles by author and/or keyword.
presentation_01 Articles by Country Search – Search articles by the topic country.
presentation_01 Article Type Search – Search articles by article type and issue.



Please use the form below to submit correspondence to the authors or contact them at the following address:

Caryn Bern, Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, 550 16th St, San Francisco, CA 94158, USA

Send To

10000 character(s) remaining.


Page created: May 21, 2022
Page updated: June 17, 2022
Page reviewed: June 17, 2022
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.