Hanford Elaine Jennifer, Zhan F Benjamin, Lu Yongmei, Giordano Alberto
Department of Geography, Texas Center for Geographic Information Science, Texas State University, Texas, San Marcos, TX 78666, USA.
Soc Sci Med. 2007 Jul;65(1):60-79. doi: 10.1016/j.socscimed.2007.02.041. Epub 2007 Apr 16.
Chagas disease is endemic and is recognized as a major health problem in many Latin American countries. Despite the parallels between socio-economic and environmental conditions in Texas and much of Latin America, Chagas disease is not a notifiable human disease in Texas. Based on extensive review of related literature, this paper seeks to recognize the evidence that Chagas Disease is endemic to Texas but the epidemiological, parasitological and entomological patterns of Chagas disease in Texas are both different from and parallel to other endemic regions. We find that with a growing immigrant human reservoir, the epidemiological differences may be reduced and result in increasing incidence of the disease. Chagas disease should be recognized as an emerging disease among both immigrant and indigenous populations. Without proper actions, Chagas disease will place increasing burden on the health care system. Current medical treatments consist of chemotherapies that carry the risk of serious side effects; curing the potentially fatal disease remains equivocal. Therefore, as shown in South America, prevention is paramount and can be successfully achieved through intervention and education. We conclude that biogeographical research is needed to (1) distinguish the dynamic evolution of the agent-vector-host system, (2) document locations with greater risk and identify mechanisms responsible for observed changes in risk, and (3) assist in developing a model for Triatomid vector-borne disease in states like Texas where the disease is both endemic and may be carried by a sizeable immigrant population. Tracking of Chagas disease and planning for appropriate health care services would also be aided by including Chagas disease on the list of reportable diseases for humans.
恰加斯病在许多拉丁美洲国家呈地方性流行，被视为一个重大的健康问题。尽管得克萨斯州与拉丁美洲许多地区在社会经济和环境条件方面存在相似之处，但恰加斯病在得克萨斯州并非须上报的人类疾病。基于对相关文献的广泛综述，本文旨在确认有证据表明恰加斯病在得克萨斯州呈地方性流行，但得克萨斯州恰加斯病的流行病学、寄生虫学和昆虫学模式既不同于其他流行地区，又与之平行。我们发现，随着移民人群作为疾病宿主的增加，流行病学差异可能会缩小，从而导致该病发病率上升。恰加斯病应被视为移民和原住民中的一种新发疾病。若不采取适当行动，恰加斯病将给医疗保健系统带来越来越大的负担。目前的药物治疗包括化疗，存在严重副作用的风险；治愈这种潜在致命疾病的效果仍不明确。因此，正如在南美洲所显示的那样，预防至关重要，通过干预和教育可以成功实现预防目标。我们得出结论，需要进行生物地理学研究，以（1）区分病原体 - 媒介 - 宿主系统的动态演变，（2）记录风险较高的地点并确定导致观察到的风险变化的机制，以及（3）协助为得克萨斯州等州开发一种锥蝽媒介传播疾病模型，在这些州该病既呈地方性流行，又可能由大量移民人群携带。将恰加斯病列入人类应报告疾病清单也将有助于追踪恰加斯病并规划适当的医疗服务。
