Ever heard of chagas disease? Well, you're not alone. There may be as many as 10 million people, including an estimated 1 million in the United States, who have it.

Chagas is a disease caused by a parasite, Trypanosoma cruzi, which lives inside a certain insect native to Central and South America. This insect, the Triatomabug, thrives in tropical areas, especially poor housing conditions where they come out and infect their victims at night.

While it may seem that the impoverished conditions where these insects reside would confine it to certain areas, or even countries, immigration and the lack of familiarity of most physicians with the disease has exacerbated its spread.

Another complicating feature of chagas disease are its two stages: acute and chronic. The early "acute" stage may be asymptomatic and last for a few weeks or months. During the "chronic" stage, most infected people "enter into a prolonged asymptomatic form of disease (called 'chronic indeterminate') during which few or no parasites are found in the blood" (Centers for Disease Control). While most people will remain asymptomatic for life, up to one-third of those infected, 3 million, are at risk of chagas' worst complications, enlarging of the colon, esophagus and heart, cardiomyopathy and heart failure.

Chagas disease is treatable, but clearly the longer its goes undetected, the more difficult it is to treat. Which leads me to the public health implications. A recent paper in PLoS Neglected Tropical Diseases by Sarkar and Strutz entitled "Chagas Disease Risk in Texas" stated that chagas is "endemic in the southern United States, especially in Texas" where, curiously enough, it has not been designated as reportable. Of course the state of Texas has never been a leader in public health, evidenced by its failure to adequately screen its own blood supply.

If we have learned anything from HIV/AIDS, it's that we generally have a short window in which to prevent these types of diseases from becoming epidemic. Well, that window may have closed. However, the authors of the above article note that chagas has so many ways of being transmitted including blood transfusions, organ donations, ingestion of tainted food and a variety of animals, from dogs to raccoons to rodents. It's time for an aggressive campaign to produce a vaccine for humans and animals. Moreover, we need more research so that we have a better idea of how many people are infected, how tainted the blood supply may be and how widespread it has become in various animal species. Finally, we need to disseminate "INFORMATION," e.g., a social awareness campaign to educate the public. The horse may already be "out of the barn," but let's get him back before he runs too far away.

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This year marks Bell's 14th as the executive director of the Philadelphia-based BEBASHI (Blacks Educating Blacks About Sexual Health), founded in 1985 as the nation's first AIDS organization serving African Americans with HIV. Bell has been widely praised, not only for increasing funding and accountability at a time when HIV donations have plummeted, but also for launching such innovative programs as a women's initiative, prison-discharge planning, and, most recently, a diabetes intervention.

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