Abstract
Chagas disease, caused by Trypanosoma cruzi parasites, is considered endemic to 21 countries in the Americas, excluding the United States. However, increasing evidence of T. cruzi parasites in the United States in triatomine insects, domestic animals, wildlife, and humans challenges that nonendemic label. Several triatomine species are common in the southern United States, where they transmit T. cruzi and invade human dwellings. Wildlife, captive animals, and companion animals, especially dogs, are commonly infected with T. cruzi parasites in this region and serve as reservoirs. Autochthonous human cases have been reported in 8 states, most notably in Texas. Labeling the United States as non-Chagas disease-endemic perpetuates low awareness and underreporting. Classification of Chagas disease as endemic, in particular as hypoendemic, to the United States could improve surveillance, research, and public health responses. Acknowledging the endemicity of Chagas disease in the United States is crucial for achieving global health goals.