Chagas Disease at the U.S. Southern Frontier: Florida’s Emerging Risk and Women’s Health Imperatives

Chagas disease (CD), caused by Trypanosoma cruzi and primarily transmitted by triatomine “kissing bugs,” remains a neglected tropical disease with substantial global burden and growing significance in nonendemic regions through migration, congenital transmission, transfusion, and transplantation.^1,2 Florida presents a unique risk landscape given established vector presence, infected wildlife reservoirs, and a large population with ties to Latin America.^3,4

This article synthesizes epidemiology, transmission, clinical outcomes, and prevention across primary, secondary, and tertiary levels with focused attention on women of reproductive age and congenital Chagas, while highlighting programmatic lessons from Latin America and practical recommendations for US infection prevention programs.

Why Florida Matters

CD is an emerging concern in Florida due to the presence of Triatoma sanguisuga and evidence of T cruzi in local vectors and wildlife.^3,4 Florida is estimated to have one of the highest numbers of people living with chronic Chagas in the US (more than 18,000), yet CD is not reportable in the state, complicating surveillance and burden estimation.³ Kissing bugs have been documented in at least 30 states, including Florida.⁵ Community-science and entomologic investigations detected T cruzi in approximately 30% of tested Florida triatomines and documented home invasion behavior; bloodmeal analyses indicate human feeding, underscoring potential exposure.^6,7,8 Beyond parasitic transmission, kissing bug bites can provoke anaphylaxis.⁹

Global Burden and Migration

Globally, 6 to more than 8 million people are infected, with the greatest burden in Latin America and millions more at risk.^2,10,11 Migration and mobility export risk to nonendemic countries, where underdiagnosis persists.^12,13 In US metropolitan areas with large Latin American communities, prevalence studies confirm ongoing needs for screening and care.¹⁴

Transmission and Clinical Spectrum

Primary transmission occurs via infected triatomines; additional routes include congenital, transfusion, transplantation, and (less often) foodborne exposure.^1,5 Acute infection is frequently oligosymptomatic [having few symptoms]; chronic infection may remain indeterminate for years before cardiac and gastrointestinal sequelae emerge.^15,16,17 Chronic Chagas cardiomyopathy drives excess mortality.¹⁸

Women’s Health and Congenital Chagas

An estimated 1 million or more women of reproductive age in Latin America live with CD,¹ with congenital transmission a key pathway outside endemic settings. Systematic evidence shows notable congenital prevalence and adverse perinatal outcomes when infection remains untreated.¹⁹ Antiparasitic treatment of girls and women of childbearing age is an underused but cost-effective strategy to prevent congenital transmission.^20,21Early detection in infants enables timely therapy with high cure potential.

Determinants and At-Risk Populations

Risk clusters with poverty, rural residence, substandard housing, and limited health care access; peridomestic animal reservoirs and vector ecology intensify exposure.^22,23 In Florida, wildlife reservoirs are notable: T cruzi was detected in approximately 51% of opossums and approximately 42% of raccoons sampled, indicating a robust sylvatic cycle.⁴

Prevention Across the Continuum

Primary prevention. Vector control (insecticide spraying, environmental management, durable housing improvements) and blood and organ donor screening reduce incident infections.^{2, 24, 25} In endemic regions, community-based vector surveillance is pivotal.²⁴

Secondary prevention. Early detection and treatment, especially in children and reproductive-age women, interrupts progression and congenital transmission.²¹ In at-risk settings, periodic child screening and proactive maternal testing are recommended.^21,26

Tertiary prevention. For chronic disease, benznidazole or nifurtimox may slow progression; advanced cardiac disease requires guideline-based care, occasionally transplant.^{16, 21} Lifelong clinical follow-up is essential.

Surveillance and Secular Trends

Vector control campaigns have reduced incidence in parts of Latin America, though seasonality and ecological variability persist.^11,27 In the US, CD remains underrecognized; jurisdictional reportability, diagnostic capacity, and clinician awareness vary widely.²⁵ Florida’s nonreportable status hinders trend detection and targeted interventions.⁴

Evidence Snapshots (What Recent Studies Add)

• Mortality and regional heterogeneity (Brazil). Declines in mortality correlate with improved control and care, but CD remains a significant cause of death in vulnerable regions.²⁸
• Preventing congenital transmission. Treating girls and women of childbearing age is effective and economically attractive; it should complement vector control and blood screening.^19,20
• Child risk factors (case-control, Brazil). Insecticide use and better housing reduce infection risk; underscores integrated vector management.²⁹
• Florida vectors and reservoirs. High T cruzi infection in T sanguisuga and wildlife, human bloodmeals documented, which is evidence for human exposure potential.^4,6,8

Program Lens: Lessons from the Bolivian Chagas Network

Bolivia’s network integrated prevention, diagnosis, and treatment into the national system, decentralizing services, training clinicians, and standardizing protocols. The initiative expanded access, improved diagnostic yields, and increased treatment uptake, though resources, training, and evaluation capacity remained constraints.³⁰ For US health systems, this model argues for: (1) embedding CD screening into routine care for at-risk populations; (2) centralized clinical expertise with decentralized testing; (3) robust data systems to track outcomes.

Practice Recommendations for Florida and Similar Settings

1. Make CD notifiable at the state level or develop sentinel surveillance to estimate burden and detect congenital cases.²⁵
2. Risk-based screening:

• Latin America–born adults; women of reproductive age; pregnant patients with epidemiologic risk; infants of seropositive mothers.^21,26
• Blood and organ donor screening per national guidance.²²

1. Clinical pathways in health systems: testing algorithms (2-assay serology with confirmatory methods), The polymerase chain reaction for acute and infant cases; timely linkage to benznidazole and nifurtimox.
2. Vector-aware counseling: housing repairs, pest management, safe animal housing; clinician education about anaphylaxis risk from bites.⁹
3. Women’s health focus: preconception and prenatal screening in at-risk patients; test and treat women before pregnancy when feasible; neonatal testing and follow-up.^19,20
4. Community partnerships: leverage community health workers and trusted organizations for culturally responsive outreach and navigation.³¹

Conclusion

Florida’s ecological context and demographics align to create a credible exposure landscape for Chagas disease. While definitive evidence of widespread autochthonous human transmission remains limited, the convergence of infected vectors, wildlife reservoirs, and human–vector contact, along with persistent underdiagnosis, demands a proactive strategy. Priorities include risk-based screening (especially for women of reproductive age), standardized clinical pathways, strengthened surveillance, and community-engaged vector control. Programs that integrate these elements, as demonstrated in Bolivia, can reduce morbidity, prevent congenital cases, and improve long-term outcomes.

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