Health Experts Urge U.S. to Declare Chagas Disease Endemic as Kissing Bugs Spread to 32 States

Health experts are urging U.S. public health authorities to recognize Chagas disease as endemic in the United States, saying that vector-borne infections tied to triatomine "kissing bugs" are now established in at least 32 states.

Chagas disease, caused by the parasite Trypanosoma cruzi, is most commonly transmitted when people inadvertently ingest the feces of infected triatomine insects. The bugs are known to bite humans and animals, and infections can go undetected for years. Scientists estimate that at least 300,000 Americans have been infected, though the true number may be higher because the disease is often underdiagnosed and is not nationally reportable.

Public health leaders say reclassifying Chagas as endemic would align with the Centers for Disease Control and Prevention’s definition of endemicity — the constant presence or usual prevalence of a disease in a population within a geographic area — and could prompt more systematic surveillance, screening and public education. Because Chagas is not uniformly reported to national health authorities, available case counts and prevalence estimates rely on limited surveillance data and modeling.

The first documented U.S. case of locally acquired Chagas disease occurred in 1955 in Corpus Christi, Texas, when an infant contracted the infection in a home infested with triatomine bugs. Since then, entomological surveys and public reports have documented the presence of kissing bugs across a widening range of states. Researchers and clinicians now report detections in 32 states, and warn that expanding vector habitats and increased awareness may reveal additional cases.

Clinicians and infectious-disease specialists have long cautioned that many infections remain unrecognized because early symptoms can be mild or nonspecific, and chronic infection may not be identified until more serious complications arise. The lack of a national reporting requirement complicates efforts to quantify the burden and to identify areas for targeted interventions.

Supporters of an endemic designation say it could lead to standardized case reporting, more routine screening in at-risk populations, and greater investment in diagnostic and treatment resources. They also argue it would help inform public guidance on reducing contact with triatomine bugs and managing environments where the insects are found.

Federal health agencies have acknowledged the presence of triatomine species in the continental United States and provide guidance on preventing bites and reducing exposure to bug feces, the principal route of transmission. However, a formal move to relabel Chagas disease as endemic would hinge on policy decisions at the national level and coordination among state and local health departments.

Public health experts stress that better surveillance and awareness are essential to addressing the disease burden. Until reporting and screening are expanded, scientists say, existing estimates — including the commonly cited figure of about 300,000 infected Americans — will remain provisional and likely understate the true scope of infections nationwide.