%0 Journal Article
%T Chagas Disease Risk in Texas
%A Sahotra Sarkar
%A Stavana E. Strutz
%A David M. Frank
%A Chissa每Louise Rivaldi
%A Blake Sissel
%A Victor S芍nchez每Cordero
%J PLOS Neglected Tropical Diseases
%D 2010
%I Public Library of Science (PLoS)
%R 10.1371/journal.pntd.0000836
%X Background Chagas disease, caused by Trypanosoma cruzi, remains a serious public health concern in many areas of Latin America, including M谷xico. It is also endemic in Texas with an autochthonous canine cycle, abundant vectors (Triatoma species) in many counties, and established domestic and peridomestic cycles which make competent reservoirs available throughout the state. Yet, Chagas disease is not reportable in Texas, blood donor screening is not mandatory, and the serological profiles of human and canine populations remain unknown. The purpose of this analysis was to provide a formal risk assessment, including risk maps, which recommends the removal of these lacunae. Methods and Findings The spatial relative risk of the establishment of autochthonous Chagas disease cycles in Texas was assessed using a five每stage analysis. 1. Ecological risk for Chagas disease was established at a fine spatial resolution using a maximum entropy algorithm that takes as input occurrence points of vectors and environmental layers. The analysis was restricted to triatomine vector species for which new data were generated through field collection and through collation of post每1960 museum records in both M谷xico and the United States with sufficiently low georeferenced error to be admissible given the spatial resolution of the analysis (1 arc每minute). The new data extended the distribution of vector species to 10 new Texas counties. The models predicted that Triatoma gerstaeckeri has a large region of contiguous suitable habitat in the southern United States and M谷xico, T. lecticularia has a diffuse suitable habitat distribution along both coasts of the same region, and T. sanguisuga has a disjoint suitable habitat distribution along the coasts of the United States. The ecological risk is highest in south Texas. 2. Incidence每based relative risk was computed at the county level using the Bayesian Besag每York每Molli谷 model and post每1960 T. cruzi incidence data. This risk is concentrated in south Texas. 3. The ecological and incidence每based risks were analyzed together in a multi每criteria dominance analysis of all counties and those counties in which there were as yet no reports of parasite incidence. Both analyses picked out counties in south Texas as those at highest risk. 4. As an alternative to the multi每criteria analysis, the ecological and incidence每based risks were compounded in a multiplicative composite risk model. Counties in south Texas emerged as those with the highest risk. 5. Risk as the relative expected exposure rate was computed using a multiplicative model for
%U http://www.plosntds.org/article/info%3Adoi%2F10.1371%2Fjournal.pntd.0000836