Skip to main content

Advertisement

Log in

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

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Rassi Jr A, Rassi A, Marin-Neto JA. Chagas disease. Lancet. 2010;375(9723):1388–402.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  4. Lazzari CR, Pereira MH, Lorenzo MG. Behavioural biology of Chagas disease vectors. Memorias do Instituto Oswaldo Cruz. 2013;108(Suppl 1):34–47.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Rassi Jr A, Rassi A, Marcondes de Rezende J. American trypanosomiasis (Chagas disease). Infect Dis Clin N Am. 2012;26(2):275–91.

    Article  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Brouqui P, Raoult D. Arthropod-borne diseases in homeless. 2006.

  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.

  11. Gunter SM, Brown EO, Murray KO, Garcia MN. Historical perspectives on sylvatic transmission among wildlife reservoirs in Texas. 2016.

  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.

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Partnership GH. Age distribution 2016 [12/1/2016]. Available from: http://www.houston.org/newgen/09_Demography/09F%20W001%20Age%20Distribution.pdf.

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Brouqui P. Arthropod-borne diseases associated with political and social disorder. Annu Rev Entomol. 2011;56:357–74.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  24. Rassi Jr A, Rassi A, Little WC. Chagas’ heart disease. Clin Cardiol. 2000;23(12):883–9.

    Article  PubMed  Google Scholar 

  25. Bor DH, Epstein PR. Pathogenesis of respiratory infection in the disadvantaged. Semin Respir Infect. 1991;6(4):194–203.

    CAS  PubMed  Google Scholar 

  26. Stimpert KK, Montgomery SP. Physician awareness of Chagas disease, USA. Emerg Infect Dis. 2010;16(5):871–2.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kristy O Murray.

Ethics declarations

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ingber, A., Garcia, M.N., Leon, J. et al. Chagas Disease Knowledge and Risk Behaviors of the Homeless Population in Houston, TX. J. Racial and Ethnic Health Disparities 5, 229–234 (2018). https://doi.org/10.1007/s40615-017-0362-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-017-0362-0

Keywords

Navigation