Chagas disease in Trinidad and Tobago - a call to action.

Chagas disease, caused by the protozoan parasite Trypanosoma cruzi, is a vector-borne disease that can lead to serious cardiac alterations. The Caribbean nation of Trinidad and Tobago (TT) is not considered Chagas endemic by major public health organizations, but Trinidad is home to six T. cruzi vector species as well as T. cruzi-infected vertebrate hosts, including humans. Here we present the most comprehensive assessment to date of Chagas disease in TT based on information from published literature, museum specimens, hospital and veterinary records and archival documents. Panstrongylus geniculatus is the most abundant and well-studied T. cruzi vector species in TT, where it is found in and around human homes with human blood meals and with T. cruzi infection prevalences >83%. Wildlife reservoirs of T. cruzi in TT include commonly hunted species, which may pose a risk of T. cruzi transmission during preparation or consumption of infected carcasses. Blood bank data from 2020 showed a 0.5% seropositivity rate for T. cruzi, which is higher than that reported for 13 Chagas-endemic countries. By presenting the entomological, ecological, epidemiological and clinical evidence in a single report, we aim to present what is known about Chagas disease on the island, identify knowledge gaps and pinpoint areas of future research and public health focus, with the goal of sending a call to action for increased attention to Chagas disease in TT.