Chagas Disease Knowledge and Estimates of Trypanosoma cruzi Prevalence Among Latin American Children Living in New York City

Background

Chagas disease, caused by the protozoa Trypanosoma cruzi (Tc), is the leading cause of parasitic death in Latin America (LA). Humans are infected when a Triatomine bug defecates while feeding and the feces are scratched into the bite; other modes include vertical transmission, ingestion of contaminated food, transplantation, and blood transfusion. Acute Tc infection is usually asymptomatic and, consequently, underdiagnosed. If untreated, nearly 30% of individuals progress to debilitating chronic Chagas disease decades after initial infection. In 2023, an estimated 37,500 migrants younger than 18 years of age arrived in New York City (NYC), a majority from Tc endemic countries in LA. To date, there has not been a large-scale pediatric prevalence study of Tc in NYC. Tc infection in NYC’s LA pediatric migrant population is highly variable and dependent of socio-demographic factors, country of origin and built environment.

Methods

The research findings aim to elucidate the overall health literacy of pediatric Tc infections and identify those at risk in NYC. This is accomplished as a two-part project.

Part one includes distribution of a Chagas educational video assessment to two participant populations: pediatric healthcare providers and parents/guardians of eligible patients. Providers within the Mount Sinai health system (MSH) will be asked to complete a pre-test survey to determine baseline knowledge of Chagas disease. They will subsequently watch an educational video to increase awareness of appropriate screening implementation in at-risk patients. Lastly, a post-test survey will be administered to determine understanding of the educational video. Parents/guardians of eligible children, defined as those born in LA or have lived in LA for more than six months, will be given a similarly structured pre-test, educational video and post test survey. Parents/guardians have an additional opportunity to answer demographic questions highlighting the child’s risk factors for acquiring Tc infection.

Part two includes a retrospective chart review from MSH. LA children <19 years of age and first-generation immigrants, regardless of years living in the US, will be included. Researchers will identify all charts of patients seen between April 1, 2022, through April 30, 2025, based on target samples met. Data extracted include country of origin, prior history of Chagas testing, if testing resulted positive and if patient developed concerning symptoms for Tc infection.

Results

We aim to survey 200 healthcare providers, 250 parent/guardians and review 500 patient charts with the expectation of an average of 2-4 positive Chagas cases based on prior pediatric studies conducted in Northeastern US and the global burden of disease estimates. However, this number may be higher as prevalence is expected to vary depending on country of origin and environmental exposure risks during childhood.

Conclusions

This work will build upon pediatric risk profiles for Tc infection with creation of a statistical model to extrapolate prevalence estimates within the five boroughs of NYC using geo-located information on migrant age structure and origin. This work represents an initial step in developing a cost-effective pediatric Tc screening protocol for NYC.