By Agustin Caceres
At the end of last year, I attended the conference “Lives in the Balance”, organized by DNDi and Doctors Without Borders in New York City. Specialists from all over the world debated the situation of NTDs, particularly TB and Chagas disease: the existing challenges in research and development, the creation of new drugs and the need for better coordination among governments, donors, academia and NGOs.
The surprise for me was hearing Dr. Peter J. Hotez, dean of the National School of Tropical Medicine at Baylor College and president of the Sabin Vaccine Institute, talk about the situation of NTDs in a country that would not come to my mind when I think about Chagas disease: the United States.
According to his research, Texas has an increasing number of cases of Chagas. You might think that these statistics could be due to the high volume of immigrants that reside in the State, but research shows that in many cases, patients infected with the parasite that causes the disease were born and raised in Texas.
Image: A composite risk map for Chagas disease in Texas. Source: University of Texas in Austin
These cases are, like in many other countries, usually neglected. Chagas remains invisible to the public eye, since cases are found mostly in the poorest and most vulnerable populations of Southern Texas and the metropolitan area of Houston, particularly among African Americans.
The situation of Chagas in Texas has drawn the attention of institutions like the Centers for Disease Control and Prevention (CDC). After three dogs died from acute Chagas cardiomyopathy in one location, an investigation was conducted in the home, garage and grounds of the owner of these pets. A serologic study was conducted on stray dogs, and an ecologic niche model was developed to predict areas where the vector Triatoma gerstaeckeri might be expected.
This study demonstrated the existence of a domestic transmission cycle for an insect species that is typically considered a zoonotic vector. However, according to CDC it is not clear whether this observation represents an isolated case or whether it actually indicates an emerging public health problem.
Some estimate that 300,000 people live with Chagas disease in the United States, and in many cases they do not have access to testing or free treatment. The research conducted in Texas is a good reminder that we must remain vigilant –NTDs are not just a problem of the developing world. These diseases affect the neglected everywhere.
Agustin Caceres is Communications and Outreach Officer at the Social Protection and Health Division of the Inter-American Development Bank (IDB) in Washington DC.