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The United States Trypanosoma cruzi Infection Study: evidence for vector-borne transmission of the parasite that causes Chagas disease among United States blood donors

Authors

  • Paul T. Cantey,

    Corresponding author
    1. From the Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, and the Division of Parasitic Diseases and Malaria, Center for Global Health, CDC, Atlanta, Georgia; the Scientific Support Office, American Red Cross, Gaithersburg, Maryland; Blood Systems, Inc., Scottsdale, Arizona; the Mississippi State Department of Health, Jackson, Mississippi; the Biology Department, Berry College, Mount Berry, Georgia; and Mississippi Blood Services, Flowood, Mississippi.
      Paul T. Cantey, MD, MPH, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, MS A-06, Atlanta, GA 30333; e-mail pcantey@cdc.gov.
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  • Susan L. Stramer,

    1. From the Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, and the Division of Parasitic Diseases and Malaria, Center for Global Health, CDC, Atlanta, Georgia; the Scientific Support Office, American Red Cross, Gaithersburg, Maryland; Blood Systems, Inc., Scottsdale, Arizona; the Mississippi State Department of Health, Jackson, Mississippi; the Biology Department, Berry College, Mount Berry, Georgia; and Mississippi Blood Services, Flowood, Mississippi.
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  • Rebecca L. Townsend,

    1. From the Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, and the Division of Parasitic Diseases and Malaria, Center for Global Health, CDC, Atlanta, Georgia; the Scientific Support Office, American Red Cross, Gaithersburg, Maryland; Blood Systems, Inc., Scottsdale, Arizona; the Mississippi State Department of Health, Jackson, Mississippi; the Biology Department, Berry College, Mount Berry, Georgia; and Mississippi Blood Services, Flowood, Mississippi.
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  • Hany Kamel,

    1. From the Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, and the Division of Parasitic Diseases and Malaria, Center for Global Health, CDC, Atlanta, Georgia; the Scientific Support Office, American Red Cross, Gaithersburg, Maryland; Blood Systems, Inc., Scottsdale, Arizona; the Mississippi State Department of Health, Jackson, Mississippi; the Biology Department, Berry College, Mount Berry, Georgia; and Mississippi Blood Services, Flowood, Mississippi.
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  • Karen Ofafa,

    1. From the Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, and the Division of Parasitic Diseases and Malaria, Center for Global Health, CDC, Atlanta, Georgia; the Scientific Support Office, American Red Cross, Gaithersburg, Maryland; Blood Systems, Inc., Scottsdale, Arizona; the Mississippi State Department of Health, Jackson, Mississippi; the Biology Department, Berry College, Mount Berry, Georgia; and Mississippi Blood Services, Flowood, Mississippi.
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  • Charles W. Todd,

    1. From the Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, and the Division of Parasitic Diseases and Malaria, Center for Global Health, CDC, Atlanta, Georgia; the Scientific Support Office, American Red Cross, Gaithersburg, Maryland; Blood Systems, Inc., Scottsdale, Arizona; the Mississippi State Department of Health, Jackson, Mississippi; the Biology Department, Berry College, Mount Berry, Georgia; and Mississippi Blood Services, Flowood, Mississippi.
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  • Mary Currier,

    1. From the Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, and the Division of Parasitic Diseases and Malaria, Center for Global Health, CDC, Atlanta, Georgia; the Scientific Support Office, American Red Cross, Gaithersburg, Maryland; Blood Systems, Inc., Scottsdale, Arizona; the Mississippi State Department of Health, Jackson, Mississippi; the Biology Department, Berry College, Mount Berry, Georgia; and Mississippi Blood Services, Flowood, Mississippi.
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  • Sheryl Hand,

    1. From the Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, and the Division of Parasitic Diseases and Malaria, Center for Global Health, CDC, Atlanta, Georgia; the Scientific Support Office, American Red Cross, Gaithersburg, Maryland; Blood Systems, Inc., Scottsdale, Arizona; the Mississippi State Department of Health, Jackson, Mississippi; the Biology Department, Berry College, Mount Berry, Georgia; and Mississippi Blood Services, Flowood, Mississippi.
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  • Wendy Varnado,

    1. From the Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, and the Division of Parasitic Diseases and Malaria, Center for Global Health, CDC, Atlanta, Georgia; the Scientific Support Office, American Red Cross, Gaithersburg, Maryland; Blood Systems, Inc., Scottsdale, Arizona; the Mississippi State Department of Health, Jackson, Mississippi; the Biology Department, Berry College, Mount Berry, Georgia; and Mississippi Blood Services, Flowood, Mississippi.
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  • Ellen Dotson,

    1. From the Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, and the Division of Parasitic Diseases and Malaria, Center for Global Health, CDC, Atlanta, Georgia; the Scientific Support Office, American Red Cross, Gaithersburg, Maryland; Blood Systems, Inc., Scottsdale, Arizona; the Mississippi State Department of Health, Jackson, Mississippi; the Biology Department, Berry College, Mount Berry, Georgia; and Mississippi Blood Services, Flowood, Mississippi.
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  • Chris Hall,

    1. From the Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, and the Division of Parasitic Diseases and Malaria, Center for Global Health, CDC, Atlanta, Georgia; the Scientific Support Office, American Red Cross, Gaithersburg, Maryland; Blood Systems, Inc., Scottsdale, Arizona; the Mississippi State Department of Health, Jackson, Mississippi; the Biology Department, Berry College, Mount Berry, Georgia; and Mississippi Blood Services, Flowood, Mississippi.
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  • Pamela L. Jett,

    1. From the Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, and the Division of Parasitic Diseases and Malaria, Center for Global Health, CDC, Atlanta, Georgia; the Scientific Support Office, American Red Cross, Gaithersburg, Maryland; Blood Systems, Inc., Scottsdale, Arizona; the Mississippi State Department of Health, Jackson, Mississippi; the Biology Department, Berry College, Mount Berry, Georgia; and Mississippi Blood Services, Flowood, Mississippi.
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  • Susan P. Montgomery

    1. From the Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, and the Division of Parasitic Diseases and Malaria, Center for Global Health, CDC, Atlanta, Georgia; the Scientific Support Office, American Red Cross, Gaithersburg, Maryland; Blood Systems, Inc., Scottsdale, Arizona; the Mississippi State Department of Health, Jackson, Mississippi; the Biology Department, Berry College, Mount Berry, Georgia; and Mississippi Blood Services, Flowood, Mississippi.
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  • The opinions expressed in this manuscript are those of the authors and do not represent the opinions of the Centers for Disease Control and Prevention, the American Red Cross, or Blood Systems, Inc.

Paul T. Cantey, MD, MPH, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, MS A-06, Atlanta, GA 30333; e-mail pcantey@cdc.gov.

Abstract

BACKGROUND: Screening US blood donors for Trypanosoma cruzi infection is identifying autochthonous, chronic infections. Two donors in Mississippi were identified through screening and investigated as probable domestically acquired vector-borne infections, and the US T. cruzi Infection Study was conducted to evaluate the burden of and describe putative risk factors for vector-borne infection in the United States.

STUDY DESIGN AND METHODS: Blood donors who tested enzyme-linked immunosorbent assay repeat reactive and positive by radioimmunoprecipitation assay, and whose mode of infection could not be identified, were evaluated with a questionnaire to identify possible sources of infection and by additional serologic and hemoculture testing for T. cruzi infection.

RESULTS: Of 54 eligible donors, 37 (69%) enrolled in the study. Fifteen (41%) enrollees had four or more positive serologic tests and were considered positive for T. cruzi infection; one was hemoculture positive. Of the 15, three (20%) donors had visited a rural area of an endemic country, although none had stayed for 2 or more weeks. All had lived in a state with documented T. cruzi vector(s) or infected mammalian reservoir(s), 13 (87%) reported outdoor leisure or work activities, and 11 (73%) reported seeing wild reservoir animals on their property.

CONCLUSION: This report adds 16 cases, including one from the Mississippi investigation, of chronic T. cruzi infection presumably acquired via vector-borne transmission in the United States to the previously reported seven cases. The estimated prevalence of autochthonous infections based on this study is 1 in 354,000 donors. Determining US foci of vector-borne transmission is needed to better assess risk for infection.

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