Chagas disease outbreaks in South America from 2000 to 2022: A systematic review

Chagas disease (CD), an emerging neglected tropical disease endemic to Latin America, causes 12,000 deaths annually. Its ecological and epidemiological complexities, including rural-urban shifts in disease distribution, have complicated outbreak control. Further understanding of the conditions that promote outbreaks will support improved public health response design. Outbreak investigations of CD in South America were reviewed and the investigative methods used across outbreaks were assessed to provide important insight into the disease epidemiology. Primary and secondary database searches resulted in 77 and 83 articles describing outbreaks of CD in South America, respectively. This review included articles that provided an extensive description of the outbreak investigation and the use of appropriate epidemiological methods. Outbreaks primarily occurred in urban areas (62.5%), some linked to rural-based food production and handling facilities. They resulted in 186 cases of CD and five deaths. Oral transmission was identified in all outbreaks. Non-specific symptoms common in endemic diseases (malaria and dengue) led to initial misdiagnosis and delayed treatment. The considerable impact of CD on morbidity and mortality, shifting ecology, and diagnostic difficulties demands improvements in disease surveillance, training in the health sector, development of new diagnostic tools, and public education on prevention measures.