Bolivia fairs much worse than other Latin American countries, as the Triatoma infestans vector (“vinchuca”) is still present in 84% of the national territory (PAHO “Salud in the Americas 2007: Bolivia”), and Bolivians have the highest prevalence of Chagas in the world (around 10%). In fact, preliminary data from our study group working in the Gran Chaco area, suggests 100% seropositivity for Chagas among Bolivians over the age of 40 years old. That means, by the age of 40, everyone has been infected with Chagas during their lifetime and 30-40% of them will eventually suffer from cardiac and/or gastrointestinal consequences of this disease.
Though the reduviid bug has historically been the major route of disease transmission, congenital transmission (from mother to child), transfusions of infected blood products (especially platelets), bone marrow/solid organ transplantations from infected donors, laboratory accidents, and, rarely, ingestion of food/liquid contaminated with T. cruzi (case reports from jungle settings) are also routes of transmission. Over the past 2 decades, though, public health efforts have drastically diminished the incidence of Chagas disease through blood-bank screenings for Chagas, vector control, and neonatal screenings. In South America, the largest portion of this impact has come from vector control programs, like the Southern Cone Initiative, which sprays pesticides to kill the reduviid bugs. Now, every South American country is vector-free, with the exception of one: Bolivia (Doctors Without Borders: Chagas in Bolivia).