Chagas Disease in Latin America and the United States: Factors Influencing Differences in Transmission Rates Among Differing Populations and Vectors †

Autochthonous Chagas disease remains a health risk for humans in Latin American countries but is rarely found among residents of the United States (US), despite the presence of competent insect vectors and small mammal reservoirs of Trypanosoma cruzi in the lower two-thirds of the US. This report discusses the differences in the rates of autochthonous Chagas disease in Latin America and the US. The key to the differences may lie in the mode (or means) of transmission of parasites to humans. In both Latin America and the US, the so-called vectorial transmission of Chagas disease to humans is the mode of acquisition accepted by most authorities. This mode involves the improbable combination of an infected kissing bug defecating near the mouth or eyes or the site of the bite, followed by the bite victim rubbing infected feces into the wound site or mucous membranes. Outbreaks of Chagas disease due to fecal–oral contamination, known as oral Chagas, have been recorded in Latin America for decades, and at present, oral Chagas is the predominant mode of infection recognized in Brazil. It is perhaps time to consider fecal–oral transmission in its many manifestations as a risk factor for Chagas disease in the US rather than reflexively invoking vectorial transmission. Fecal–oral transmission includes contamination of food and drink by triatomine feces and infection via contaminated fomites and surfaces at home and at worksites, as well as transmission from infected small mammals and other routes discussed in this report.