Policy and Complex Systems
America ( de Silva et al ., 2003 ), with an estimated 3,000,000 people infected ( Hotez et al ., 2008 ). Given that the cost of hookworm infection in the Americas is ~$ 447 ( range $ 40 –$ 1,693 ) ( Bartsch et al ., 2016 ) and the annual total cost to society for each chronic Chagas disease patient is ~$ 4,059 ( range $ 3,569 –$ 4,434 ) ( Lee et al ., 2013 ), the cost of replacing dirt floors with cement-like floors is a fraction of the annual total cost to society . The hope is that researchers will use this new statistical tool as just one means of performing an unbiased statistical analysis of complex datasets often found in epidemiology .
While vectorial transmission of Trypanosoma cruzi is primarily limited to Latin America , Trypanosoma cruzi does exist in the United States . Researchers have identified 24 natural wildlife hosts of Trypanosoma cruzi in the southern portion of the United States ranging from Maryland to Florida and every state that borders Mexico ( Bern , Kjos , Yabsley , & Montgomery , 2011 ). In addition to wildlife hosts , Trypanosoma cruzi has been identified in domestic dogs throughout the southern portion of the United States ( Bern et al ., 2011 ). Vectors infected with Trypanosoma cruzi endemic to the United States have been shown to feed on human blood , thus highlighting the risk of autochthonous human Trypanosoma cruzi infection ( Waleckx , Suarez , Richards , & Dorn , 2014 ). In addition , there is evidence of limited autochthonous human Trypanosoma cruzi infection occurring in the southern portion of the United States ( Bern et al ., 2011 ; Cantey et al ., 2012 ). In addition to the threat posed by triatomine transmission of Trypanosoma cruzi , recent laboratory research has shown that bed bugs ( Cimex lectularius ) can become infected with Trypanosoma cruzi after feeding on an infected host ( i . e ., mouse ) and can serve as a competent vector of Trypanosoma cruzi ( Salazar et al ., 2015 ). Therefore , vectorial transmission of Trypanosoma cruzi in the United States has the potential to become a higher risk in the future ; and if that were to occur , the CCEA could be used to mine Big Datasets for the most important risk factors .
Acknowledgements
We thank Laboratory for Applied Entomology and Parasitology ( LENAP ) at La Universidad de San Carlos Guatemala , especially Carlota Monroy , Antonieta Rodas , Lucia Orantes , Gabriela Rodas , Raquel Asuncion Lima , Elizabeth Solórzano , and Dulce Bustamante , for their help in collecting and managing the Chagas infestation dataset . We also thank the Guatemalan Ministry of Health for their help with collecting the data . This work was supported , in part , by Vermont EPSCoR with funds from the National Science Foundation Grant DBC- EID-1216193 ( J . P . H .) and EPS-1101317 ( D . M . R .).
References
Acevedo , F ., Godoy , E ., & Schofield , C . ( 2000 ). Comparison of intervention strategies for control of Triatoma dimidiata in Nicaragua . Memórias Do Instituto Oswaldo Cruz , 95 ( 6 ), 867 – 871 .
Bartsch , S . M ., Hotez , P . J ., Asti , L ., Zapf , K . M ., Bottazzi , M . E ., Diemert , D . J ., & Lee , B . Y . ( 2016 ). The global economic and health burden of human hookworm infection . PLoS Neglected Tropical Diseases , 10 ( 9 ), e0004922 .
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