Volume 79, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


The first U.S. ELISA test for antibodies was licensed by the Food and Drug Administration (FDA) on December 13, 2006. Blood banks have begun screening in absence of FDA recommendations for best implementation methods. We surveyed 2,029 blood donors at five California sites with three risk-based Chagas risk-screening questions. Semi-Markov models compared the cost-effectiveness of three testing strategies. 30% of donors screened positively. Screening all dominated doing nothing, being less costly, and saving more lives. The choice to “screen and test” compared with “testing all” varied by Chagas prevalence, “screening and testing” being cost-effective for high (0.004) and low (0.00004) prevalences, and “testing all” cost-effective for moderate risk (0.0004). It is cost-effective to screen by ELISA rather than do nothing. The best strategy depends on site-specific risk. Census estimates of Hispanics do not predict donor risk well. We suggest using our screening questions to determine risk level and most cost-effective testing strategy.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Organizacion Panamericana de la Salud, 2006. Estimacion cuantitativa de la enfermedad de Chagas en las Americas. Organizacion Panamericana de la Salud POS/.HDM/CD/425-06.
  2. Schmunis Gabriel A, 2007. Epidemiology of Chagas disease in non endemic countries: the role of international migration. Mem Inst Oswaldo Cruz 102 : 1–16. [Google Scholar]
  3. Guzman-Bracho C, 2001. Epidemiology of Chagas disease in Mexico: an update. Trends Parasitol 17 : 372–376. [Google Scholar]
  4. Moncayo A, 2003. Chagas disease: current epidemiological trends after the interruption of vectoral and transfusional transmission in the Southern Cone countries. Mem Inst Oswaldo Cruz, Rio de Janeiro 98 : 577–591. [Google Scholar]
  5. Murray CHL, Lopez AD, 1996. Global Health Statistics. Geneva.
  6. Punukollu G, Gowda RM, Khan IA, Nararro VS, Vasavada BC, 2007. Clinical aspects of the Chagas’ heart disease. Int J Cardiol 115 : 279–283. [Google Scholar]
  7. Torrico F, Alonso-Vega C, Suarez E, Rodriguez P, Torrico MC, Dramaix M, Truyens C, Carlier Y, 2004. Maternal trypanosome cruzi infection, pregnancy outcome, morbidity and mortality of congenitally infected and non-infected newborns in Bolivia. Am J Trop Med Hyg 70 : 201–209. [Google Scholar]
  8. WHO, 1997. Elimination of Chagas disease as a public health problem, projected costs 1997–2010. World Health Organization Division of Control of Tropical Diseases Geneva: 27.
  9. Cruz-Reyes A, Pickering-Lopez JM, 2005. Sobre la enfermedad de Chagas in Mexico, con un enfoque biologico geografico y socioeconomico. Available at: http://www.ibiologia.unam.mx/pdf/noticias/CHAGMEX.pdf.
  10. Cruz JR, Perez Rosales MD, 2003. Availability, safety, and quality of blood for transfusion in the Americas. Panam J Pub Health 13 : 103–109. [Google Scholar]
  11. Rizzo Nidia R, Arana Byron A, Diaz A, Cordon-Rosales C, Klein RERPM, 2003. Seroprevalence of Trypanosoma cruzi infection among school-age children in the endemic area of Guatemala. J Am J Trop Med Hyg 68 : 678–682. [Google Scholar]
  12. Kirchhoff Louis V, Gam Albert A, Gilliam Flora C, 1987. American trypanosomiasis (Chagas’ disease) in Central American immigrants. Am J Med 82 : 915–920. [Google Scholar]
  13. Kirchhoff LV, Paredes P, Lomeli-Guerrero A, Paredes-Espinoza M, Rib-Guerrero CS, Delgado-Mejia M, Pena-Munoz JG, 2006. Transfusion-associated Chagas disease (American trypanosomiasis) in Mexico: implications for transfusion medicine in the United States. Transfusion 46 : 298–304. [Google Scholar]
  14. Grant IH, Gold JW, Wittner M, Tanowitz HB, Nathan C, Reich MK, Wollner N, Steinherz L, Gharimi F, 1989. Transfusion-associated acute Chagas disease acquired in the United States. Ann Intern Med 111 : 849–851. [Google Scholar]
  15. Nickerson P, Orr P, Schroeder ML, Sekla L, Johnston SB, 1989. Transfusion-associated Trypanosoma cruzi infection in a non-endemic area. Ann Intern Med 111 : 851–853. [Google Scholar]
  16. Leiby DA, Lenes BA, Tibbals MA, T-O TM, 1999. Prospective evaluation of a patient with Trypanosoma cruzi infection transmitted by transfusion. N Engl J Med 341 : 1237–1239. [Google Scholar]
  17. Lane DJ, Sher G, Ward B, Ndao M, Leiby DBH, 2000. Presented at 42nd Annual Meeting of American Society of Hematology. San Francisco, CA: Dec 1–5.
  18. Cimo PL, Luper WE, Ma S, 1993. Transfusion-associated Chagas’ disease in Texas: report of a case. Tex Med 89 : 48–50. [Google Scholar]
  19. Leiby David A, 2004. Medical and scientific updates: Number 99–1: Present status of studies on Trypanosoma cruzi in U.S. blood donors. Oakland, CA: Holland Laboratory, American Red Cross, 1–5.
  20. Tobler Leslie H, Contestable P, Pitina L, Groth HSS, Blackburn GR, Warren H, Lee SR, Busch MP, 2007. Evaluation of a new enzyme-linked immunosorbent assay for detection of Chagas antibody in US blood donors. Transfusion 47 : 90–96. [Google Scholar]
  21. Elliott VS, 2008. Health experts seek more awareness about Chagas. Health Science 7 : 1–4. [Google Scholar]
  22. Leiby David A, Herron Jr Ross M, Read Elizabeth J, Lenes Bruce A, Stumpf Robert J, 2002. Trypanosoma cruzi in Los Angeles and Miami blood donors: impact of evolving donor demographics on seroprevalence and implications for transfusion transmission. Transfusion 42 : 549–555. [Google Scholar]
  23. Viotti R, Vigliano C, Lococo B, Bertocchi G, Petti M, Alvarez MG, Postan MA, 2006. Long-term cardiac outcomes of treating chronic Chagas disease with Benznidazole versus no treatment: a nonrandomized trial. Ann Intern Med 144 : 724–734. [Google Scholar]
  24. Carlier Y, Luquetti AO, 2003. Chagas Disease (American Trypanosomiasis). EMedicine Journal: http://www.emedicine.com/med/topic327.htm 4: 1–24. [Google Scholar]
  25. Wilson L, Strosberg AM, Barrio K, 2005. Cost-effectiveness of Chagas disease interventions in Latin America and the Caribbean: Markov Models. Am J Trop Med Hyg 73 : 901–910. [Google Scholar]
  26. Ortho T. Cruzi ELISA Test System, 2006. Ortho-Clinical Diagnostics Inc, Raritan, NJ.
  27. Stramer SL, Dodd RY, Leiby DA, Herron RM, 2007. Blood donor screening for Chagas disease—United States, 2006–2007. JAMA 297 : 1424–1426. [Google Scholar]
  28. Tree-Age Software Inc., 1988–2001. Decision Analysis by TreeAge, DATAPro. Williamstown, MA 01267: TreeAge Software, Inc.
  29. Leiby DA, Read EJ, Lenes BA, Yund JA, Stumpf RJ, Kirchhoff LV, Dodd RY, 1997. Seroepidemiology of Trypanosoma cruzi, etiologic agent of Chagas’ disease in U.S. blood donors. J Infect Dis 176 : 1047–1052. [Google Scholar]
  30. Guzman-Bracho C, Garcia GL, Floriani VJ, Guerrero MS, Torres CM, Ramirez MC, Co V, 1998. Risk of Trypanosoma cruzi transmission by blood transfusion in Mexico. Revista Pan Salud 4 : 94–99. [Google Scholar]
  31. Hernandez-Becerril N, Mejia AM, Ballinas-Verdugo MA, Garza-Murillo V, Manilla-Toquero E, Lopez R, Trevethan S, Cardenas M, Reyes PA, Hirayama K, Monteon VM, 2005. Blood transfusion and iatrogenic risks in Mexico city. Anti-Trypanosoma cruzi seroprevalence in 43,048 blood donors, evaluation of parasitemia, and electrocardiogram findings in seropositive. Mem Inst Oswaldo Cruz, Rio de Janeiro 100 : 111–116. [Google Scholar]
  32. Cardenas JL, Bravo FEG, Schettino PMS, Salorzano JCG, Barba ER, Mendez JM, Sanchez-Cordero V, Peterson AT, Ramsey JM, 2005. Fine-scale predictions of distributions of Chagas disease vectors in the state of Guanajuato Mexico. J Med Entomol 42 : 1068–1081. [Google Scholar]
  33. Ramsey JM, Alvear AL, Ordonez R, Munoz G, Garcia A, Lopez R, Leyva R, 2005a. Risk factors associated with house infestation by the Chagas disease vector Triatoma pallidipennis in Cuernavaca metropolitan area, Mexico. Med Vet Entomol 19 : 219–228. [Google Scholar]
  34. Ramsey Willoquet Janine M, 2007. Chagas disease transmission in Mexico: a case for translational research while waiting to take disease burden seriously. Salud Publica Mex 49 : 291–295. [Google Scholar]
  35. Ramsey Willoquet Janine M, Ordonez R, Tello-Lopez A, Pohls JL, Sanchez V, Peterson AT, 2003. Actualidades Sobre la Epidemiologia de la Emfer, edad de Chagas en Mexico. Morelos, Mexico: Instituto Nacional de Salus Publica.
  36. Schmunis Gabriel A, 1999. Prevention of transfusional Trypanosoma cruzi infection in Latin America. Mem Inst Oswaldo Cruz, Rio de Janeiro 94 : 93–101. [Google Scholar]
  37. Schmunis GA, Zicker F, Cruz JR, Cuchi P, 2001. Safety of the blood supply for infectious diseases in Latin American countries. Am J Trop Med Hyg 65 : 924–930. [Google Scholar]
  38. Schmunis G, 1998. Risk for transfusion transmitted infectious diseases. Emerging Infectious Disease 4 : 5–11. [Google Scholar]
  39. Strosberg AM, Barrio K, Stinger VH, Tashker J, Wilbur JC, Wilson L, Woo K, 2007. Chagas Disesase: A Latin American Nemesis. San Francisco, CA: Institute for OneWorldHealth, 1–96.
  40. Schmunis GA, 2007. The globalization of Chagas disease. ISBT Science Series 2 : 6–11. [Google Scholar]
  41. Cohen Joel E, Gurtler Ricardo E, 2001. Modeling household transmission of American Trypanosomiasis. Science 293 : 694–698. [Google Scholar]
  42. Catala SS, Crocco LB, Munoz A, 2004. Entomological aspects of Chagas’ disease transmission in the domestic habitat, Argentina. Rev Saude Publica 38 : 216–222. [Google Scholar]
  43. Zicker F, Smith PG, Almeida JC, Oliveira RM, Zicker EMS, 1990. Physical activity, opportunity of reinfection and sibling history of heart disease as risk factors for Chagas cardiomyopathy. Am J Trop Med Hyg 43 : 498–505. [Google Scholar]
  44. Monteon-Padilla V, Hernandez-Becerril N, Ballinas-Verdugo M, Aranda-Fraustro A, Pa R, 2001. Persistence of Trypanosoma cruzi in chronic Chagasic cardiopathy patients. Arch Med Res 32 : 39–43. [Google Scholar]
  45. MMWR, 2007. Blood donor screening for Chagas disease, 2006–2007. MMWR 56 : 141–143. [Google Scholar]
  46. Williams Alan E, Thompson RA, Watanabe BSG, Bethel James K, Lo A, Kleinman SH, Hollingsworth CG, Nemo GJ, 1997. Estimates of infectious disease risk factors in US blood donors. Retrovirus epidemiology donor study. JAMA 277 : 967–972. [Google Scholar]
  47. Sellors John W, Hayward R, Swanson G, Ali A, Haynes RB, Bourque R, Moore K-A, Lohfeld L, Dalby D, Howard M, 2002. Comparison of deferral rates using a computerized versus written blood donor questionnaire: a randomized, crossover study. BMC Public Health 2 : 1–9. [Google Scholar]
  48. Sanchez Anna M, Schreiber George B, Bethel J, McCurdy PR, Glynn SA, Williams AE, Gilcher R, 2001. Prevalence, donation practices, and risk assessment of blood donors with hemochromatosis. JAMA 286 : 1475–1481. [Google Scholar]
  49. Sanchez Anna M, Schreiber George B, Glynn Simone A, Bethel J, Kessler D, Chang D, Zuck TF, 2003. Blood-donor perceptions of health history screening with a computer-assisted self-administered interview. Transfusion 43 : 165–172. [Google Scholar]
  50. Leiby David A, Rentas Francisco J, Nelson Kenrad E, Stambolis Veronica A, Ness Paul M, Parnis C, McAllister HA, Yawn DH Jr, Stumpf Robert J, Kirchhoff Louis V, 2000. Evidence of Trypanosoma cruzi infection (Chagas’ Disease) among patients undergoing cardiac surgery. Circulation 102 : 2978–2982. [Google Scholar]
  51. Custer B, Busch MP, Marfin AA, Petersen LR, 2005. The cost-effectiveness of screening the US blood supply for West Nile virus. Ann Intern Med 143 : 486–492. [Google Scholar]
  52. Sonnenberg FA, Beck JR, 1993. Markov models in medical decision making: a practical guide. Med Decis Making 13 : 322–338. [Google Scholar]
  53. Halilovic J, Kenna GA, 2006. Immunosuppressants used in solid organ transplantation. US Pharm 31 : HS8–HS30. [Google Scholar]
  54. Organ Procurement and Transplantation Network, 2007. Transplants in the U.S. by recipient age: January 1, 1988–October 31, 2006. Available at: http://www.optn.org/latestData/rptData.asp.
  55. MMWR, 2002. Chagas disease after organ transplantation—United States, 2001. CDC MMWR Weekly 51: 210–212. [Google Scholar]
  56. Miyoshi C, 1995. The Cost-effectiveness of Blood Donor Screening Programs to Identify Transfusion Transmitted Chagas’ Disease in Bolivia. Boston, MA: Bureau of International Cooperation, International Medical Center of Japan, Takemi Program in International Health, Harvard School of Public Health, 1–34.
  57. WHO, 2002. Control of Chagas disease: Second report of the WHO expert committee. Geneva: WHO technical report series #905.
  58. Arias E, 2006. United States Life Tables, 2003. Hyattsville, MD: National Centre for Health Statistics.
  59. Rassi A Jr, Rasi SG, Rassi A, 2001. Sudden death in Chagas’ disease. Arq Bras Cardol 76 : 86–96. [Google Scholar]
  60. Espinosa R, Carrasco HA, Belandria F, Fuenmayor AM, Molina C, Gonzalez R, Martinez O, 1985. Life expectancy analysis in patients with Chagas’ disease: prognosis after one decade (1973–1983). Int J Cardiol 8 : 45–56. [Google Scholar]
  61. Wendel S, Brener Z, Camargo ME, Rassi A, eds., 1992. Chagas disease (American trypanosomiasis): its impact on transfusion and clinical medicine. ISBT. San Paulo, Brazil: SBHH, 103–133.
  62. Wendel S, Dias JCP, 1992. Transfusion transmitted Chagas disease. Wendel S, Brener Z, Camargo ME, Rassi A, eds. Chagas Disease (American trypanosomiasis): its impact on transfusion and clinical medicine. Sao Paulo, Brazil: International Society of Blood Transfusion Brazil ‘92—Sociedade Brasileira Hemalologia E Hemoterapia, 103–133.
  63. Netinho JG, Teixeira FV, 2003. Surgical treatment of chagasic megacolon: Duhamel-Haddad procedure is also a good option. Dis Colon Rectum 46 : 1576–1578. [Google Scholar]
  64. Dietz K, Raddatz G, Wallis J, Muller N, Zerr I, Duerr H-P, Lefevre H, Seifried E, Lower J, 2007. Blood transfusion and spread of variant Creutzfeldt-Jacob Disease. Emerg Infect Dis 13 : 89–96. [Google Scholar]
  65. Vamvakas EC, Taswell HF, 1994. Long-term survival after blood transfusion. Transfusion 34 : 471–477. [Google Scholar]
  66. Wallis J, Wells AW, Matthews JN, Chapman CE, 2004. Long-term survival after blood transfusion: a population based study in the north of England. Transfusion 44 : 1025–1032. [Google Scholar]
  67. Kobayasi S, Mendes EF, Rodrigues MA, Mf F, 1992. Toxic dilatation of the colon in Chagas’ disease. Br J Surg 79 : 1202–1203. [Google Scholar]
  68. Pinotti HW, Habr-Gama A, Cecconello I, Felix VN, Zilberstein B, 1993. The surgical treatment of megaesophagus and mega-colon. Dig Dis 11 : 206–215. [Google Scholar]
  69. Sales GB, Chiocca JC, Mazure PA, 1987. Esophageal achalasia: review of the results after 15 years’ experience. Acta Gastroenterol Latinoam 17 : 7–13. [Google Scholar]
  70. Dantas RO, 1998. Dysphagia in patients with Chagas’ disease. Dysphagia 13 : 53–57. [Google Scholar]
  71. Dantas RO, 2003. Comparison between idiopathic achalasia and achalasia caused by Chagas disease: a review on the publications about the subject. Arq Gastroenterol 40: 126–130. [Google Scholar]
  72. Briggs Andrew H, O’Brien Bernie J, Blackhouse G, 2002.Thinking outside the box: recent advances in the analysis and presentation of uncertainty in cost-effectiveness studies. Annu Rev Public Health 22 : 377–401. [Google Scholar]
  73. Fenwick E, Claxton K, Schulpher M, 2001. Representing uncertainty: the role of cost-effectiveness acceptability curves. Health Ecomics 10 : 779–787. [Google Scholar]
  74. Akhavan D, 1996. Analise de Custoefetivadade do Programa de Controle da Doenca de Chagas no Brasil. Monographic paper. Brasilia, Brazil. National Health Foundation (Ministry of Health): 44.
  75. Gold MR, Siegel JE, Russell LB, Weinstein MC, eds., 1996. Cost-effectiveness in health and medicine. New York: Oxford University Press.
  76. Briggs Andrew H, 2001. A Bayesian approach to stochastic cost-effectiveness analysis. Int J Technol Assess Health Care 17 : 69–82. [Google Scholar]
  77. Briggs Andrew H, 2004. Statistical approaches to handling uncertainty in health economic evaluation. Eur J Gastroenterol Hepatol 16 : 551–561. [Google Scholar]
  78. Heitjan Daniel F, 2000. Fieller’s method and net health benefits. Economic Evaluation 9 : 327–335. [Google Scholar]
  79. Laska Eugene M, Meisner M, Siegel C, Wanderling J, 2002. Statistical determination of cost-effectiveness frontier based on net health benefits. Health Econ 11 : 249–264. [Google Scholar]
  80. Briggs Andrew H, 1999. A Bayesian approach to stochastic cost-effectiveness analysis. Health Econ 8 : 257–261. [Google Scholar]
  81. Stinnett A, Mullahy J, 1998. Net health benefits: a new framework for the analysis of uncertainty in cost-effectiveness analysis. MDM 18 : S68–S80. [Google Scholar]
  82. Basombrio MA, Schofield CJ, Rojas CL, del Rey EC, 1998. A cost-benefit analysis of Chagas disease control in northwestern Argentina. Trans R Soc Trop Med Hyg 92 : 137–143. [Google Scholar]
  83. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl KOJA, Rahko PS, Silver MA, Stevenson LW, 2005. Guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation 112 : 154–235. [Google Scholar]
  84. Report NPR, 2007. Blood system screening for Chagas disease. NPR, San Francisco 1/29/2007.
  85. Salary Wizard, 2007. Median expected salary for a typical phlebotomist in the United States. My Salary.com. Available at: http://swz.salary.com/salarywizard/layoutscripts/swzl_compresult.asp?jobcode=HC070001. Accessed February 23, 2007.
  86. American Red Cross, 2006. Medicare 2006 Hospital Outpatient Payment Rates. APC payment rates for common blood and blood product items effective April 1, 2002 HM2-8: 1–6.
  87. Pirard M, Iihoshi N, Boelaert M, Basanta P, Lopez F, Vds P, 2005. The validity of serologic tests for Trypanosoma cruzi and the effectiveness of transfusional screening strategies in a hyperendemic region. Transfusion 45 : 554–561. [Google Scholar]
  88. Becerril-Flores Marco A, Rangel-Flores E, Impert-Palafox JL, Gomez-Gomez JV, Figueroa-Gutierrez AH, 2007. Human infection and risk of transmission of Chagas disease in hidalgo state, Mexico. Am J Trop Med Hyg 76 : 318–323. [Google Scholar]
  89. California Department of Social Services, 2002. The regions of California: Recommended grouping of the counties for regional studies. Sacramento: Health and Human Services: Research and Development Division, Data Analysis & Publications Branch, 1–7.
  90. Cheng Kevin Y, Chang C-D, Salbilla VA, Kirchhoff LV, Leiby DA, Schochetman G, Shjah DO, 2007. Immunoblot assay using recombinant antigens as a supplemental test to confirm the presence of antibodies to Trypanosoma cruzi. Clinical and Vaccine Immunology 14 : 355–361. [Google Scholar]
  91. Lopez-Cardenas J, Gonzalez E, Salazar M, Carlos J, Ramirez E, Artomez K, Sanchez-Cordero V, Peterson A, Townsend RJM, 2005. Fine-scale predictions of distributions of Chagas disease vectors in the state of Guanajuato, Mexico. J Med Entomol 42 : 1068–1081. [Google Scholar]
  92. Schofield CJ, 2000. Challenges of Chagas disease vector control in Central America. Global Collaboration for Development of Pesticides for Public Health (GCDPP): WHO/CDS/WHOPES/ GCDPP/2000.1, 1–36.
  93. Tabaru Y, Monroy C, Rodas A, Mejia M, Rosales R, 1999. The geographic distribution of vectors of Chagas disease and populations at risk of infection in Guatemala. Medical Entomology and Zoology 50 : 9–17. [Google Scholar]
  94. PAHO, 2002. Country Profile, Panama. Available at: www.paho.org/English/DD/AIS/cp_591.htm. Accessed October 31, 2004.
  95. Ponce C, 1999. Elimination of the vectorial transmission of Chagas disease in Central American Countries: Honduras. Mem Inst Oswaldo Cruz 94 (Suppl 1): 417–418. [Google Scholar]
  96. Medici A, Bravo J, 2000. Indirect estimation of the prevalence and mortality by Chagas, Malaria and tuberculosis in Bolivia: Two applications to program evaluation. Bolivian Epidemiological Shield and Support to the Reform of the Sector Health Program.
  97. Moncayo A, Guhl F, Stein C, 2000. Global Burden of Chagas Disease in the Year 2000. WHO. Available at: http://www.who.int/healthinfo/statistics/bod_chagas.pdf.
  98. Chuit R, 2000. La Enfermedad de Chagas en el Siglo XXI—Argentina. 1er Congreso virtual de Cardiologia. UNER CB, ed. 1er Congreso Virtual de Cardiologia, May 14. Funmdaci on Mundo Sano, Buenos Aires, Argentina. Available at: http://www.epidemiologia.anm.edu.ar/pdf/publicaciones_cie/2000/Enfermedad_Chagas_Siglo_XXI_2000.pdf.
  99. Diaz JCP, Schofield CJ, 1999. The evolution of Chagas disease (American Trypanosomiasis) control after 90 years since Carlos Chagas’ discovery. Mem Inst Oswaldo Cruz, Rio de Janeiro 94 (Suppl 1) 103–121. [Google Scholar]
  100. Guhl F, Vallejo GA, 1999. Interruption of Chagas disease transmission in the Andean Countries: Colombia. Mem Inst Oswaldo Cruz, Rio de Janeiro 94 : 413–415. [Google Scholar]
  101. Ache A, Matos AJ, 2001. Interrupting Chagas disease transmission in Venezuela. Review Inst Med Trop S Paulo 43 : 37–43. [Google Scholar]
  102. PAHO, 1998. Venezuela. PAHO, ed. Health in the Americas, 1998. Washington DC: PAHO Publications Center, 530–544.
  103. PAHO, 2002. Country Health Profile, Peru. PAHO, WHO, Basic Health Indicator Data Base. Available at: http://www.paho.org/English/DD/AIS/cp-604.htm.
  104. Aguilar H, Abad-Franch RF, Raucar A, 1999. Epidemiology of Chagas disease in Ecuador: a brief overview. Mem Inst Oswaldo Cruz, Rio de Janeiro 94 : 387–393. [Google Scholar]
  105. Schmunis G, 2002. Presentation. Brazil, Chagas Control Program: 1975–1995. Ministry of Health, National Health Foundation, Brazil (CCDTV/DEOPE). Available at: ftp://ftp.cdc.gov/pub/infectious_diseases/iceid/2002/pdf/schmunis.pdf.
  106. Ramsey JM, Alvear AL, Ordonez R, Munoz G, Garcia A, Lopez R, Leyva R, 2005. Risk factors associated with house infestation by the Chagas disease vector Triatoma pallidipennis in Cuernavaca metropolitan area, Mexico. Med Vet Entomol 19 : 219–228. [Google Scholar]
  107. Ramsey JM, Ordonez R, Cruz-Celis A, Alvear L, Chavez V, Lopez R, Pintor JR, Gama F, Carrillo S, 2000. Distribution of domestic Triatominae and stratification of Chagas disease transmission in Oazaca, Mexico. Med Vet Entomol 14 : 19–30. [Google Scholar]
  108. Cobain Trevor J, Vamvakas EC, Wells A, Titlestad K, 2007. A survey of the demographics of blood use. Transfus Med 17 : 1–15. [Google Scholar]
  109. US Census Bureau. Residents & armed forces, 2007.
  110. Micromedex, 2006. Drugdex evaluations. Micromedex health-care series. Available at: http://lrs.lendac.ie/guides/micromedex/micromedex.html. Accessed 11/25/2006.
  111. PAHO, 2005. Strategic drug products Excel spreadsheet. WHO.
  112. AMA, 2006. Current Procedural Terminology, Fourth Edition. Available at: http://catalogue.ama-assn.org/Catalog/cpt/cpt_search.jsp. Accessed November 25, 2006. Atlanta, Georgia: AMA.
  113. Cohen Harold E, ed., 2005. Redbook. Montvale, NJ: Thomson Medical Economics.
  114. Davis James BP, 2006. Medical Fees in the United States. Nationwide charges for medicine, surgery, laboratory, radiology and allied health services. Practice Management Information Corporation, AMA: Los Angeles, CA 90010.
  115. Gopikrishna P, Gowda RM, Khan IA, Navarro VS, Vasavada BC, 2007. Clinical aspects of Chagas’ heart disease. Int J Cardiol 115 : 279–283. [Google Scholar]
  116. H-CUPnet, 2002. National and regional estimates on hospital use for all patient from the HCUP nationwide inpatient sample: principal procedure and principal diagnosis. http//hcup.ahrq.gov/HCUPnet.asp. Accessed 1/24/2005: 1–94 and 1–112.
  117. Chinese Society of Gastroenterology & Chinese Medical Association, 2004. Consensus on the guidelines for diagnosis and treatment of chronic constipation. Chin J Dig Dis 5 : 134–137. [Google Scholar]
  118. Manuel David M, Piper Michael H, Gamarra Roberto M, Ko Clifford Y, 2007. Megacolon, Chronic. emedicine Journal from WebMD last updated Aug 3, 2007.
  119. Oliveira RB, Troncon LEA, Dantas RO, Meneghelli UG, 1998. Gastrointestinal manifestations of Chagas’ disease. Am J Gastroenterol 93 : 884–889. [Google Scholar]
  120. U.S. Department of Labor BoLS, CPI, 2004. Health, United States, 2004 with chartbook on trends in the health of Americans. National Center for Health Statistics Table 17 Consumer price index and average annual percent change for all items, selected items, and medical care components: United States, selected years 1960–2003.
  121. Umezawa Eufrosina S, Simonsen SAM, Corbett CEP, Shikanai-Yasuda MA, 2001. Chagas’ disease. Lancet 357 : 797–799. [Google Scholar]
  122. Janssen Martin P, van der Poel CL, Buskens E, Bonneux L, Bonsel GJ, van Hout BA, 2006. Costs & benefits of bacterial culturing and pathogen reduction in the Netherlands. Transfusion 46 : 956–965. [Google Scholar]

Data & Media loading...

  • Received : 01 Oct 2007
  • Accepted : 08 Apr 2008

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error