RESUMO
BACKGROUND: The elimination of Triatoma infestans, the main domestic vector of Trypanosoma cruzi, is lagging behind expectations in the Gran Chaco region. We implemented an insecticide-based intervention program and assessed its long-term effects on house infestation and bug abundance in a resource-constrained municipality (Pampa del Indio, northeastern Argentina) inhabited by creole and the Qom indigenous people (2007-2016). Key questions were whether district-wide data integration revealed patterns concealed at lower spatial levels; to what extent preintervention infestation and pyrethroid resistance challenged the effectiveness of insecticide-based control efforts, and how much control effort was needed to meet defined targets. METHODS: Supervised vector control teams i) georeferenced every housing unit at baseline (1,546); ii) evaluated house infestation using timed-manual searches with a dislodging aerosol across four rural areas designated for district-wide scaling up; iii) sprayed with pyrethroid insecticide 92.7% of all houses; iv) periodically monitored infestation and promoted householder-based surveillance, and v) selectively sprayed the infested houses, totaling 1,823 insecticide treatments throughout the program. RESULTS: Baseline house infestation (mean, 26.8%; range, 14.4-41.4%) and bug abundance plummeted over the first year postintervention (YPI). Timed searches at baseline detected 61.4-88.0% of apparent infestations revealed by any of the methods used. Housing dynamics varied widely among areas and between Qom and creole households. Preintervention triatomine abundance and the cumulative frequency of insecticide treatments were spatially aggregated in three large clusters overlapping with pyrethroid resistance, which ranged from susceptible to high. Persistent foci were suppressed with malathion. Aggregation occurred mainly at house compound or village levels. Preintervention domestic infestation and abundance were much greater in Qom than in creole households, whereas the reverse was recorded in peridomestic habitats. House infestation, rare (1.9-3.7%) over 2-6 YPI, averaged 0.66% (95% confidence interval, 0.28-1.29%) at endpoint. CONCLUSIONS: Upscale integration revealed multiple coupled heterogeneities (spatial, sociodemographic and biological) that reflect large inequalities, hamper control efforts, and provide opportunities for targeted, sustainable disease control. High-coverage, professional insecticide spraying combined with systematic surveillance-and-response were essential ingredients to achieve the quasi-elimination of T. infestans within 5 YPI and concomitant transmission blockage despite various structural threats and constraints.
Assuntos
Doença de Chagas , Inseticidas , Piretrinas , Triatoma , Animais , Humanos , Triatoma/fisiologia , Inseticidas/farmacologia , Controle de Insetos/métodos , Doença de Chagas/epidemiologia , Piretrinas/farmacologia , Argentina/epidemiologiaRESUMO
BACKGROUND: The distribution of parasite load across hosts may modify the transmission dynamics of infectious diseases. Chagas disease is caused by a multi-host protozoan, Trypanosoma cruzi, but the association between host parasitemia and infectiousness to the vector has not been studied in sylvatic mammalian hosts. We quantified T. cruzi parasite load in sylvatic mammals, modeled the association of the parasite load with infectiousness to the vector and compared these results with previous ones for local domestic hosts. METHODS: The bloodstream parasite load in each of 28 naturally infected sylvatic mammals from six species captured in northern Argentina was assessed by quantitative PCR, and its association with infectiousness to the triatomine Triatoma infestans was evaluated, as determined by natural or artificial xenodiagnosis. These results were compared with our previous results for 88 humans, 70 dogs and 13 cats, and the degree of parasite over-dispersion was quantified and non-linear models fitted to data on host infectiousness and bloodstream parasite load. RESULTS: The parasite loads of Didelphis albiventris (white-eared opossum) and Dasypus novemcinctus (nine-banded armadillo) were directly and significantly associated with infectiousness of the host and were up to 190-fold higher than those in domestic hosts. Parasite load was aggregated across host species, as measured by the negative binomial parameter, k, and found to be substantially higher in white-eared opossums, cats, dogs and nine-banded armadillos (range: k = 0.3-0.5) than in humans (k = 5.1). The distribution of bloodstream parasite load closely followed the "80-20 rule" in every host species examined. However, the 20% of human hosts, domestic mammals or sylvatic mammals exhibiting the highest parasite load accounted for 49, 25 and 33% of the infected triatomines, respectively. CONCLUSIONS: Our results support the use of bloodstream parasite load as a proxy of reservoir host competence and individual transmissibility. The over-dispersed distribution of T. cruzi bloodstream load implies the existence of a fraction of highly infectious hosts that could be targeted to improve vector-borne transmission control efforts toward interruption transmission. Combined strategies that decrease the parasitemia and/or host-vector contact with these hosts would disproportionally contribute to T. cruzi transmission control.
Assuntos
Doença de Chagas/transmissão , Mamíferos/parasitologia , Triatoma/parasitologia , Trypanosoma cruzi , Animais , Animais Selvagens/parasitologia , Argentina/epidemiologia , Tatus/parasitologia , Gatos , Doença de Chagas/diagnóstico , Doença de Chagas/prevenção & controle , Didelphis/parasitologia , Reservatórios de Doenças/parasitologia , Vetores de Doenças , Cães , Florestas , Genes de Protozoários , Humanos , Insetos Vetores/parasitologia , Carga Parasitária/estatística & dados numéricos , Parasitemia/parasitologia , Reação em Cadeia da Polimerase em Tempo Real , Trypanosoma cruzi/genética , Trypanosoma cruzi/isolamento & purificação , Doenças Transmitidas por Vetores/diagnóstico , Doenças Transmitidas por Vetores/prevenção & controle , Doenças Transmitidas por Vetores/transmissão , XenodiagnósticoRESUMO
BACKGROUND: The sustainable elimination of Triatoma infestans in the Gran Chaco region represents an enduring challenge. Following the limited effects of a routine pyrethroid insecticide spraying campaign conducted over 2011-2013 (first period) in Avia Terai, an endemic municipality with approximately 2300 houses, we implemented a rapid-impact intervention package to suppress house infestation across the urban-to-rural gradient over 2015-2019 (second period). Here, we assess their impacts and whether persisting infestations were associated with pyrethroid resistance. METHODS: The 2011-2013 campaign achieved a limited detection and spray coverage across settings (< 68%), more so during the surveillance phase. Following community mobilization and school-based interventions, the 2015-2019 program assessed baseline house infestation using a stratified sampling strategy; sprayed all rural houses with suspension concentrate beta-cypermethrin, and selectively sprayed infested and adjacent houses in urban and peri-urban settings; and monitored house infestation and performed selective treatments over the follow-up. RESULTS: Over the first period, house infestation returned to pre-intervention levels within 3-4 years. The adjusted relative odds of house infestation between 2011-2013 and 2015-2016 differed very little (adj. OR: 1.17, 95% CI 0.91-1.51). Over the second period, infestation decreased significantly between 0 and 1 year post-spraying (YPS) (adj. OR: 0.36, 95% CI 0.28-0.46), with heterogeneous effects across the gradient. Mean bug abundance also dropped between 0 and 1 YPS and thereafter remained stable in rural and peri-urban areas. Using multiple regression models, house infestation and bug abundance at 1 YPS were 3-4 times higher if the house had been infested before treatment, or was scored as high-risk or non-participating. No low-risk house was ever infested. Persistent foci over two successive surveys increased from 30.0 to 59.3% across the gradient. Infestation was more concentrated in peridomestic rather than domestic habitats. Discriminating-dose bioassays showed incipient or moderate pyrethroid resistance in 7% of 28 triatomine populations collected over 2015-2016 and in 83% of 52 post-spraying populations. CONCLUSIONS: The intervention package was substantially more effective than the routine insecticide spraying campaign, though the effects were lower than predicted due to unexpected incipient or moderate pyrethroid resistance. Increased awareness and diagnosis of vector control failures in the Gran Chaco, including appropriate remedial actions, are greatly needed.
Assuntos
Doença de Chagas/transmissão , Controle de Insetos/normas , Insetos Vetores/efeitos dos fármacos , Resistência a Inseticidas , Inseticidas/farmacologia , Piretrinas/farmacologia , Triatoma/parasitologia , Animais , Argentina/epidemiologia , Doença de Chagas/parasitologia , Cidades/estatística & dados numéricos , Ecossistema , Habitação/estatística & dados numéricos , Humanos , Controle de Insetos/métodos , Insetos Vetores/parasitologia , População Rural/estatística & dados numéricosRESUMO
Vector-borne transmission of Chagas disease in urban areas of Argentina has been an overlooked phenomena. We conducted the first comprehensive cross-sectional study of domestic infestation with Triatoma infestans and vector infection with Trypanosoma cruzi in a metropolitan area of San Juan, Argentina. Our results document the occurrence of T. infestans infected with T. cruzi in human sleeping quarters. In this urban setting, we also show that infestation was associated with construction materials, the presence of chickens, cats and a large number of dogs that can provide blood meals for the vector. Our findings reveal new challenges for vectorial control agencies.
Assuntos
Doença de Chagas , Triatoma , Trypanosoma cruzi , Animais , Argentina , Gatos , Galinhas , Estudos Transversais , Cães , Insetos VetoresRESUMO
BACKGROUND: Interruption of domestic vector-borne transmission of Trypanosoma cruzi is still an unmet goal in several American countries. In 2007 we launched a long-term intervention program aimed to suppress house infestation with the main domestic vector in southern South America (Triatoma infestans) and domestic transmission in Pampa del Indio, a resource-constrained, hyperendemic municipality with 1446 rural houses inhabited by Creole and indigenous people, in the Argentine Chaco ecoregion. Here, we assessed whether the 10-year insecticide-based program combined with community mobilization blocked vector-borne domestic transmission of T. cruzi to humans and dogs. METHODS: We carried out two municipality-wide, cross-sectional serosurveys of humans and dogs (considered sentinel animals) during 2016-2017 to compare with baseline data. We used a risk-stratified random sampling design to select 273 study houses; 410 people from 180 households and 492 dogs from 151 houses were examined for antibodies to T. cruzi using at least two serological methods. RESULTS: The seroprevalence of T. cruzi in children aged <16 years was 2.5% in 2017 (i.e., 4- to 11-fold lower than before interventions). The mean annual force of child infection (λ) sharply decreased from 2.18 to 0.34 per 100 person-years in 2017. One of 102 children born after interventions was seropositive for T. cruzi; he had lifetime residence in an apparently uninfested house, no outside travel history, and his mother was T. cruzi-seropositive. No incident case was detected among 114 seronegative people of all ages re-examined serologically. Dog seroprevalence was 3.05%. Among native dogs, λ in 2016 (1.21 per 100 dog-years) was 5 times lower than at program onset. Six native adult dogs born after interventions and with stable lifetime residence were T. cruzi-seropositive: three had exposure to T. infestans at their houses and one was an incident case. CONCLUSIONS: These results support the interruption of vector-borne transmission of T. cruzi to humans in rural Pampa del Indio. Congenital transmission was the most likely source of the only seropositive child born after interventions. Residual transmission to dogs was likely related to transient infestations and other transmission routes. Sustained vector control supplemented with human chemotherapy can lead to a substantial reduction of Chagas disease transmission in the Argentine Chaco.
Assuntos
Doença de Chagas/prevenção & controle , Doenças do Cão/parasitologia , Trypanosoma cruzi/imunologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Anticorpos Antiprotozoários/sangue , Argentina , Doença de Chagas/transmissão , Doença de Chagas/veterinária , Criança , Pré-Escolar , Estudos Transversais , Doenças do Cão/prevenção & controle , Cães , Feminino , Humanos , Lactente , Controle de Insetos , Insetos Vetores , Masculino , Pessoa de Meia-Idade , Estudos Soroepidemiológicos , TriatomaRESUMO
Vector-borne transmission of Chagas disease in urban areas of Argentina has been an overlooked phenomena. We conducted the first comprehensive cross-sectional study of domestic infestation with Triatoma infestans and vector infection with Trypanosoma cruzi in a metropolitan area of San Juan, Argentina. Our results document the occurrence of T. infestans infected with T. cruzi in human sleeping quarters. In this urban setting, we also show that infestation was associated with construction materials, the presence of chickens, cats and a large number of dogs that can provide blood meals for the vector. Our findings reveal new challenges for vectorial control agencies.
Assuntos
Animais , Gatos , Cães , Triatoma , Trypanosoma cruzi , Doença de Chagas , Argentina , Galinhas , Estudos Transversais , Insetos VetoresRESUMO
Background: The sustainable elimination of Triatoma infestans in the Gran Chaco region represents an enduring challenge. Following the limited effects of a routine pyrethroid insecticide spraying campaign conducted over 20112013 (first period) in Avia Terai, an endemic municipality with approximately 2300 houses, we implemented a rapid-impact intervention package to suppress house infestation across the urban-to-rural gradient over 20152019 (second period). Here, we assess their impacts and whether persisting infestations were associated with pyrethroid resistance. Methods: The 20112013 campaign achieved a limited detection and spray coverage across settings (< 68%), more so during the surveillance phase. Following community mobilization and school-based interventions, the 20152019 program assessed baseline house infestation using a stratified sampling strategy; sprayed all rural houses with suspension concentrate beta-cypermethrin, and selectively sprayed infested and adjacent houses in urban and peri-urban settings; and monitored house infestation and performed selective treatments over the follow-up. Results: Over the first period, house infestation returned to pre-intervention levels within 34 years. The adjusted relative odds of house infestation between 20112013 and 20152016 differed very little (adj. OR: 1.17, 95% CI 0.911.51). Over the second period, infestation decreased significantly between 0 and 1 year post-spraying (YPS) (adj. OR: 0.36, 95% CI 0.280.46), with heterogeneous effects across the gradient. Mean bug abundance also dropped between 0 and 1 YPS and thereafter remained stable in rural and peri-urban areas. Using multiple regression models, house infestation and bug abundance at 1 YPS were 34 times higher if the house had been infested before treatment, or was scored as high-risk or non-participating. No low-risk house was ever infested. Persistent foci over two successive surveys increased from 30.0 to 59.3% across the gradient. Infestation was more concentrated in peridomestic rather than domestic habitats. Discriminating-dose bioassays showed incipient or moderate pyrethroid resistance in 7% of 28 triatomine populations collected over 20152016 and in 83% of 52 post-spraying populations. Conclusions: The intervention package was substantially more effective than the routine insecticide spraying campaign, though the effects were lower than predicted due to unexpected incipient or moderate pyrethroid resistance. Increased awareness and diagnosis of vector control failures in the Gran Chaco, including appropriate remedial actions, are greatly needed.
Assuntos
Doença de Chagas , Inseticidas , Resistência a Inseticidas , Doença , TriatominaeRESUMO
BACKGROUND: The occurrence of the major vectors of Chagas disease has historically been linked to poor rural housing, but urban or peri-urban infestations are increasingly being reported. We evaluated a simple risk index to detect houses infested with Triatoma infestans and tested whether house infestation and vector abundance increased across the urban-to-rural gradient in Avia Terai, an endemic municipality of the Argentine Chaco; whether the association between infestation and selected ecological determinants varied across the gradient; and whether urban and peri-urban infestations were associated with population settlement history. METHODS: We conducted a screening survey of house infestation in 2296 urban, peri-urban and rural dwellings to identify high-risk houses based on a simple index, and then searched for triatomines in all high-risk houses and in a systematic sample of low-risk houses. RESULTS: The risk index had maximum sensitivity and negative predictive value, and low specificity. The combined number of infested houses in peri-urban and urban areas equalled that in rural areas. House infestation prevalence was 4.5%, 22.7% and 42.4% across the gradient, and paralleled the increasing trend in the frequency of domestic animals and peridomestic structures. Multiple logistic regression analysis showed that house infestation was positively and significantly associated with the availability of poultry and bug refuges in walls, and was negatively associated with domestic insecticide use. Several pieces of evidence, including absence of spatial aggregation of house infestation, support that T. infestans has been a long-established occupant of urban, peri-urban and rural settings in Avia Terai. CONCLUSIONS: An integrated vector management strategy targeting chicken coops and good husbandry practices may provide more cost-effective returns to insecticide-based vector elimination efforts.
Assuntos
Doença de Chagas/transmissão , Habitação/estatística & dados numéricos , Insetos Vetores/fisiologia , Triatoma/fisiologia , Urbanização , Animais , Argentina/epidemiologia , Doença de Chagas/epidemiologia , Cidades/epidemiologia , Características da Família , Humanos , Controle de Insetos/estatística & dados numéricos , Dinâmica Populacional , Medição de Risco , Trypanosoma cruziRESUMO
The transmission of Trypanosoma cruzi to humans is determined by multiple ecological, socio-economic and cultural factors acting at different scales. Their effects on human infection with T. cruzi have often been examined separately or using a limited set of ecological and socio-demographic variables. Herein, we integrated the ecological and social dimensions of human infection risk with the spatial distribution patterns of human and vector (Triatoma infestans) infection in rural communities of the Argentine Chaco composed of indigenous people (90% Qom) and a creole minority. We conducted serosurveys in 470 households aiming at complete population enumeration over 2012-2015. The estimated seroprevalence of T. cruzi prior to the implementation of an insecticide spraying campaign (2008) was 29.0% (N = 1,373 in 301 households), and was twice as large in Qom than creoles. Using generalized linear mixed models, human seropositive cases significantly increased with infected triatomine abundance, having a seropositive household co-inhabitant and household social vulnerability (a multidimensional index of poverty), and significantly decreased with increasing host availability in sleeping quarters (an index summarizing the number of domestic hosts for T. infestans). Vulnerable household residents were exposed to a higher risk of infection even at low infected-vector abundances. The risk of being seropositive increased significantly with house infestation among children from stable households, whereas both variables were not significantly associated among children from households exhibiting high mobility within the communities, possibly owing to less consistent exposures. Human infection was clustered by household and at a larger spatial scale, with hotspots of human and vector infection matching areas of higher social vulnerability. These results were integrated in a risk map that shows high-priority areas for targeted interventions oriented to suppress house (re)infestations, detect and treat infected children, and thus reduce the burden of future disease.
Assuntos
Doença de Chagas/epidemiologia , Doença de Chagas/transmissão , Transmissão de Doença Infecciosa , Relações Interpessoais , População Rural , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Argentina/epidemiologia , Criança , Pré-Escolar , Economia , Etnicidade , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Soroepidemiológicos , Topografia Médica , Triatominae/crescimento & desenvolvimento , Adulto JovemRESUMO
The eco-epidemiology of Triatominae and Trypanosoma cruzi transmission has been little studied in the Argentinean Monte ecoregion. Herein, we provide a comprehensive description of domestic and intrusive triatomines to evaluate the risk of reinfestation of rural dwellings. Triatoma infestans, T. patagonica, T. garciabesi and T. eratyrusiformis were collected by active searches or light traps. None were infected with T. cruzi. One T. infestans male was collected at 1.3 km from the nearest infested house. The finding of intrusive and domestic triatomines in sylvatic foci emphasizes the need of implementing an effective vector surveillance system.