Chagas Disease and Domestic Medical Screening Guidance for Newly Arrived Individuals Under a Humanitarian-Based Immigration Status: A Call for Action.

Chagas disease is considered one of the most important neglected tropical diseases in the Western Hemisphere, given its morbidity, mortality, and societal and economic burden. The United States has the fifth highest global burden of Chagas disease. Every year, thousands of migrant people from Latin America and throughout the globe travel to the U.S.- Mexico border searching for asylum. The U.S. CDC's Guidance for the U.S. Domestic Medical Examination for Newly Arriving Refugees provides recommendations to safeguard the health of individuals who enter the United States with a humanitarian-based immigration status as defined by the CDC's guidance under Key Considerations and Best Practices. We encourage the inclusion of Trypanosoma cruzi infection screening recommendations in this guidance as an important step toward understanding the risk and burden of Chagas disease in this vulnerable population, strengthening their access to care and contributing to the 2030 objectives of the WHO's neglected tropical diseases road map.

Burden of serious fungal infections in Honduras.

BACKGROUND: The burden of serious fungal infections in Honduras is unknown. The diagnosis of fungal diseases relies on almost exclusively on microscopy and culture limiting an accurate estimate of the burden of disease. OBJECTIVES: The primary objective of the study was to estimate the burden of serious fungal infections in Honduras using previously described methods. METHODS: National and international demographic data on population, HIV, tuberculosis, asthma, COPD and cancer were obtained. A thorough literature search was done for all epidemiological studies and case series of serious fungal diseases. Using these risk populations and whatever incidence and prevalence could be found that was most pertinent to Honduras, a burden estimate was derived. RESULTS: The estimated number of serious fungal infection was estimated to be between 178,772 and 179,624 with nearly 2300 cases of these representing opportunistic infections in people living with HIV. The incidence of histoplasmosis and cryptococcosis in people living with HIV is high and estimated to be 4.3 and 4.6 cases per 100,000 population respectively. Approximately 12,247-13,099 cases of aspergillosis and 164,227 of other serious fungal infections were estimated to occur each year. CONCLUSION: An accurate estimate of the burden of serious fungal infections in Honduras is unknown but based on our results, likely significant. Serious fungal infections represent an important public health problem in Honduras affecting approximately 1.8% of the population. There is a clear need for better access to diagnostic tools and antifungals to conduct research to better understand the impact of fungal diseases in Honduras.