Advertisement

Chagas Disease Knowledge and Risk Behaviors of the Homeless Population in Houston, TX

  • Alexandra Ingber
  • Melissa N Garcia
  • Juan Leon
  • Kristy O MurrayEmail author
Article

Abstract

Chagas disease is a parasitic infection, caused by Trypanosoma cruzi, endemic in Latin America. Sylvatic T. cruzi-infected triatomine vectors are present in rural and urban areas in the southern USA and may transmit T. cruzi infection to at-risk populations, such as homeless individuals. Our study aimed to evaluate Chagas disease knowledge and behaviors potentially associated with transmission risk of Chagas disease among Houston, Texas’ homeless population by performing interviews with 212 homeless individuals. The majority of the 212 surveyed homeless individuals were male (79%), African-American (43%), American-born individuals (96%). About 30% of the individuals reported having seen triatomines in Houston, and 25% had evidence of blood-borne transmission risk (IV drug use and/or unregulated tattoos). The median total time homeless was significantly associated with recognition of the triatomine vector. Our survey responses indicate that the homeless populations may exhibit potential risks for Chagas disease, due to increased vector exposure, and participation in blood-borne pathogen risk behaviors. Our findings warrant additional research to quantify the prevalence of Chagas disease among homeless populations.

Keywords

Chagas disease Trypanosoma cruzi Homeless Texas Vulnerable populations 92C60, 92D30 

Notes

Acknowledgements

The authors would like to thank Mandy Chapman Semple with the Homeless Initiatives in Houston, the team at Houston Police Department Homeless Outreach Team, and Charity Dominguez and Jess DiManno with SEARCH Homeless Services for their combined help in administering surveys. In addition, thank you to Dr. Solveig Cunningham for her guidance in the quantitative survey creation.

Compliance with Ethical Standards

Human subject approval and waiver of written consent were granted from Emory University’s Institutional Review Board (study number IRB00066083). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Funding

The authors received no funding for this research study.

References

  1. 1.
    Rassi Jr A, Rassi A, Marin-Neto JA. Chagas disease. Lancet. 2010;375(9723):1388–402.CrossRefPubMedGoogle Scholar
  2. 2.
    Coura JR, Dias JC. Epidemiology, control and surveillance of Chagas disease: 100 years after its discovery. Memorias do Instituto Oswaldo Cruz. 2009;104(Suppl 1):31–40.CrossRefPubMedGoogle Scholar
  3. 3.
    Teixeira AR, Gomes C, Lozzi SP, Hecht MM, Rosa Ade C, Monteiro PS, et al. Environment, interactions between Trypanosoma cruzi and its host, and health. Cadernos de saude publica. 2009;25(Suppl 1):S32–44.CrossRefPubMedGoogle Scholar
  4. 4.
    Lazzari CR, Pereira MH, Lorenzo MG. Behavioural biology of Chagas disease vectors. Memorias do Instituto Oswaldo Cruz. 2013;108(Suppl 1):34–47.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Rassi Jr A, Rassi A, Marcondes de Rezende J. American trypanosomiasis (Chagas disease). Infect Dis Clin N Am. 2012;26(2):275–91.CrossRefGoogle Scholar
  6. 6.
    Lee BY, Bacon KM, Bottazzi ME, Hotez PJ. Global economic burden of Chagas disease: a computational simulation model. Lancet Infect Dis. 2013;13(4):342–8.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Hotez PJ, Bottazzi ME, Franco-Paredes C, Ault SK, Periago MR. The neglected tropical diseases of Latin America and the Caribbean: a review of disease burden and distribution and a roadmap for control and elimination. PLoS Negl Trop Dis. 2008;2(9):e300.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Bern C, Kjos S, Yabsley MJ, Montgomery SP. Trypanosoma cruzi and Chagas’ disease in the United States. Clin Microbiol Rev. 2011;24(4):655–81.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Brouqui P, Raoult D. Arthropod-borne diseases in homeless. 2006.Google Scholar
  10. 10.
    Gunter SM, Murray KO, Gorchakov R, Beddard R, Montgomery SP, Rivera H, et al. Likely autochthonous transmission of Trypanosoma cruzi to humans, South Central Texas, USA. Emerging infectious diseases. 2017.Google Scholar
  11. 11.
    Gunter SM, Brown EO, Murray KO, Garcia MN. Historical perspectives on sylvatic transmission among wildlife reservoirs in Texas. 2016.Google Scholar
  12. 12.
    Garcia M, Woc-Colburn L, Aguilar D, Hotez P, Murray K. Historical perspectives on the epidemiology of human Chagas disease in Texas and recommendations for enhanced understanding of clinical chagas disease in the southern United States. PLoS NTDs. 2015.Google Scholar
  13. 13.
    Kjos SA, Snowden KF, Olson JK. Biogeography and Trypanosoma cruzi infection prevalence of Chagas disease vectors in Texas, USA. Vector Borne Zoonotic Dis. 2009;9(1):41–50.CrossRefPubMedGoogle Scholar
  14. 14.
    Kim NJ, Jin H, McFarland W, Raymond HF. Trends in sources and sharing of needles among people who inject drugs, San Francisco, 2005–2012. Int J Drug Policy. 2015;26(12):1238–43.CrossRefPubMedGoogle Scholar
  15. 15.
    Imaz-Iglesia I, Miguel LG, Ayala-Morillas LE, Garcia-Perez L, Gonzalez-Enriquez J, Blasco-Hernandez T, et al. Economic evaluation of Chagas disease screening in Spain. Acta Trop. 2015;148:77–88.CrossRefPubMedGoogle Scholar
  16. 16.
    Sanchez-Gonzalez G, Figueroa-Lara A, Elizondo-Cano M, Wilson L, Novelo-Garza B, Valiente-Banuet L, et al. Cost-effectiveness of blood donation screening for Trypanosoma cruzi in Mexico. PLoS Negl Trop Dis. 2016;10(3):e0004528.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Garcia MN, Woc-Colburn L, Aguilar D, Hotez PJ, Murray KO. Historical perspectives on the epidemiology of human Chagas disease in Texas and recommendations for enhanced understanding of clinical Chagas disease in the southern United States. PLoS Negl Trop Dis. 2015;9(11):e0003981.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Partnership GH. Age distribution 2016 [12/1/2016]. Available from: http://www.houston.org/newgen/09_Demography/09F%20W001%20Age%20Distribution.pdf.
  19. 19.
    Bonilla DL, Kabeya H, Henn J, Kramer VL, Kosoy MY. Bartonella quintana in body lice and head lice from homeless persons, San Francisco, California, USA. Emerg Infect Dis. 2009;15(6):912–5.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Brouqui P. Arthropod-borne diseases associated with political and social disorder. Annu Rev Entomol. 2011;56:357–74.CrossRefPubMedGoogle Scholar
  21. 21.
    Sadowski LS, Kee RA, VanderWeele TJ, Buchanan D. Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: a randomized trial. JAMA. 2009;301(17):1771–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Breland JY, Chee CP, Zulman DM. Racial differences in chronic conditions and sociodemographic characteristics among high-utilizing veterans. J Racial Ethn Health Disparities. 2015;2(2):167–75.CrossRefPubMedGoogle Scholar
  23. 23.
    Leibler JH, Zakhour CM, Gadhoke P, Gaeta JM. Zoonotic and vector-borne infections among urban homeless and marginalized people in the United States and Europe, 1990–2014. Vector Borne Zoonotic Dis. 2016;16(7):435–44.CrossRefPubMedGoogle Scholar
  24. 24.
    Rassi Jr A, Rassi A, Little WC. Chagas’ heart disease. Clin Cardiol. 2000;23(12):883–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Bor DH, Epstein PR. Pathogenesis of respiratory infection in the disadvantaged. Semin Respir Infect. 1991;6(4):194–203.PubMedGoogle Scholar
  26. 26.
    Stimpert KK, Montgomery SP. Physician awareness of Chagas disease, USA. Emerg Infect Dis. 2010;16(5):871–2.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Verani JR, Montgomery SP, Schulkin J, Anderson B, Jones JL. Survey of obstetrician-gynecologists in the United States about Chagas disease. AmJTrop Med Hyg. 2010;83(4):891–5.CrossRefGoogle Scholar
  28. 28.
    Hernandez C, Cucunuba Z, Florez C, Olivera M, Valencia C, Zambrano P, et al. Molecular diagnosis of Chagas disease in Colombia: parasitic loads and discrete typing units in patients from acute and chronic phases. PLoS Negl Trop Dis. 2016;10(9):e0004997.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2017

Authors and Affiliations

  • Alexandra Ingber
    • 1
  • Melissa N Garcia
    • 2
  • Juan Leon
    • 1
  • Kristy O Murray
    • 2
    Email author
  1. 1.Rollins School of Public HealthEmory UniversityAtlantaUSA
  2. 2.National School of Tropical MedicineBaylor College of MedicineHoustonUSA

Personalised recommendations