Click Lambert Rebecca, Kolivras Korine N, Resler Lynn M, Brewster Carlyle C, Paulson Sally L
Department of Geography, Virginia Polytechnic Institute and State University (Virginia Tech), 115 Major Williams Hall, Blacksburg, VA 24061, USA.
Geospat Health. 2008 May;2(2):227-39. doi: 10.4081/gh.2008.246.
To determine the risk for Chagas disease (American trypanosomiasis) in the United States, the characteristics that make the triatomine vector effective and the areas most at risk for transmission were delineated. In addition, the status of Chagas disease awareness among physicians in areas with a potential risk for the disease was determined. A geographical information system (GIS) was used to analyze three triatomine species within the United States known to harbor Trypanosoma cruzi and that exhibit qualities of domesticity. An analysis of the minimum temperature threshold for increased triatomine activity delineates the current population at increased risk, and by incorporating temperature predictions for 2030, the population at risk under a future climate scenario was also delineated. Considering both environmental and social factors, a vignette-based physician survey, based on the results of the GIS analysis, was used to gauge the level of awareness of Chagas disease within the delineated higher risk range. The current area at increased risk for Chagas disease includes much of the southern United States, and the higher risk range is expected to expand into the central United States based upon the 1 degrees C (1.8 degrees F) increase in temperature predicted by the Intergovernmental Panel on Climate Change (IPCC) by the year 2030. Survey results indicate a limited consideration of Chagas disease during differential diagnosis, illustrating that the low number of Chagas disease cases discovered in the United States may be attributable to a lack of disease awareness as opposed to a lack of disease threat. This study combines GIS and survey analyses to evaluate the role that temperature variability and disease awareness among physicians play in the potential emergence of Chagas disease in the United States. This approach indicates that there is a potential for Chagas disease to emerge in the United States.
为确定美国恰加斯病（美洲锥虫病）的风险，明确了使锥猎蝽媒介发挥作用的特征以及传播风险最高的地区。此外，还确定了该病潜在风险地区医生对恰加斯病的认知状况。利用地理信息系统（GIS）分析了美国境内已知携带克氏锥虫且具有居家习性的三种锥猎蝽。对锥猎蝽活动增加的最低温度阈值进行分析，确定了当前风险增加的人群，并通过纳入2030年的温度预测，划定了未来气候情景下的风险人群。综合考虑环境和社会因素，基于GIS分析结果开展了一项基于病例 vignette 的医生调查，以评估在划定的高风险范围内对恰加斯病的认知水平。目前美国恰加斯病风险增加的地区包括美国南部大部分地区，根据政府间气候变化专门委员会（IPCC）预测，到2030年气温将升高1摄氏度（1.8华氏度），高风险范围预计将扩展到美国中部。调查结果表明，在鉴别诊断过程中对恰加斯病的考虑有限，这说明在美国发现的恰加斯病病例数量较少可能是由于缺乏疾病认知，而非缺乏疾病威胁。本研究结合GIS和调查分析，评估温度变异性和医生疾病认知在美国恰加斯病潜在出现中所起的作用。这种方法表明美国存在恰加斯病出现的可能性。
