The long-term impact of an Ecohealth intervention: Entomological data suggest the interruption of Chagas disease transmission in southeastern Guatemala.

Triatoma dimidiata is the main vector of Chagas disease in southern Mexico, Central America and northern South America. As a native vector, it moves readily among domestic, peri­domestic and sylvatic environments, making it difficult to control only using insecticide as this requires regular application, and re-infestation frequently occurs. Other social innovation alternatives such as those based on Ecohealth principles can be used to tackle the dynamics of the disease in an integral way. We asked whether an Ecohealth intervention, implemented beginning in 2001 in a highly infested village, 41.8%, in southeastern Guatemala, was sustainable in the long term. This intervention included initial insecticide treatments, followed by making low-cost house improvements to eliminate transmission risk factors such as repairing cracked walls, covering dirt floors with a cement-like substance and moving domestic animals outside. We assessed the long-term sustainability through entomological and house condition surveys, as well as an analysis of community satisfaction. We found over a 19-year period, infestation with T. dimidiata was reduced to 2.2% and maintained at a level below the level (8%) where vector transmission is unlikely. This long-term maintenance of low infestation coincided with a large proportion of villagers (88.6%) improving their houses and completing other aspects of the Ecohealth approach to maintain the village at low risk for Chagas transmission. There was unanimous satisfaction among the villagers with their houses, following improvements using the Ecohealth method, which likely played a role in the long-term persistence of the modifications. Although the infestation has remained low, 11 years following the last intervention and as the population grew there has been an increase in the proportion of "at-risk" houses, to 33%, pointing out the necessity of maintaining vigilance. The Ecohealth approach is a low-cost, sustainable approach for the long-term control of vector-borne Chagas disease. We recommend this approach including ongoing community monitoring and institutional response for the long-term, integrated control of Chagas disease.

Spatial epidemiology and adaptive targeted sampling to manage the Chagas disease vector Triatoma dimidiata.

Widespread application of insecticide remains the primary form of control for Chagas disease in Central America, despite only temporarily reducing domestic levels of the endemic vector Triatoma dimidiata and having little long-term impact. Recently, an approach emphasizing community feedback and housing improvements has been shown to yield lasting results. However, the additional resources and personnel required by such an intervention likely hinders its widespread adoption. One solution to this problem would be to target only a subset of houses in a community while still eliminating enough infestations to interrupt disease transfer. Here we develop a sequential sampling framework that adapts to information specific to a community as more houses are visited, thereby allowing us to efficiently find homes with domiciliary vectors while minimizing sampling bias. The method fits Bayesian geostatistical models to make spatially informed predictions, while gradually transitioning from prioritizing houses based on prediction uncertainty to targeting houses with a high risk of infestation. A key feature of the method is the use of a single exploration parameter, α, to control the rate of transition between these two design targets. In a simulation study using empirical data from five villages in southeastern Guatemala, we test our method using a range of values for α, and find it can consistently select fewer homes than random sampling, while still bringing the village infestation rate below a given threshold. We further find that when additional socioeconomic information is available, much larger savings are possible, but that meeting the target infestation rate is less consistent, particularly among the less exploratory strategies. Our results suggest new options for implementing long-term T. dimidiata control.

Assessing risk of vector transmission of Chagas disease through blood source analysis using LC-MS/MS for hemoglobin sequence identification.

Chagas disease is mainly transmitted by triatomine insect vectors that feed on vertebrate blood. The disease has complex domiciliary infestation patterns and parasite transmission dynamics, influenced by biological, ecological, and socioeconomic factors. In this context, feeding patterns have been used to understand vector movement and transmission risk. Recently, a new technique using Liquid chromatography tandem mass spectrometry (LC-MS/MS) targeting hemoglobin peptides has showed excellent results for understanding triatomines' feeding patterns. The aim of this study was to further develop the automated computational analysis pipeline for peptide sequence taxonomic identification, enhancing the ability to analyze large datasets data. We then used the enhanced pipeline to evaluate the feeding patterns of Triatoma dimidiata, along with domiciliary infestation risk variables, such as unkempt piles of firewood or construction material, cracks in bajareque and adobe walls and intradomiciliary animals. Our new python scripts were able to detect blood meal sources in 100% of the bugs analyzed and identified nine different species of blood meal sources. Human, chicken, and dog were the main blood sources found in 78.7%, 50.4% and 44.8% of the bugs, respectively. In addition, 14% of the bugs feeding on chicken and 15% of those feeding on dogs were captured in houses with no evidence of those animals being present. This suggests a high mobility among ecotopes and houses. Two of the three main blood sources, dog and chicken, were significantly (p < 0.05) affected by domiciliary infestation risk variables, including cracks in walls, construction material and birds sleeping in the intradomicile. This suggests that these variables are important for maintaining reproducing Triatoma dimidiata populations and that it is critical to mitigate these variables in all the houses of a village for effective control of these mobile vectors.

A multidisciplinary, collaborative, inter-agency and comprehensive approach for the control of Chagas Disease as a public health problem in Guatemala.

The Pan American Health Organization (PAHO) has defined Chagas Disease hotspots in Central America associated with the vector Triatoma spp. Triatoma dimidiata is a native vector adapted to multiple environments, including intra-domestic and peri-domestic habitats. A multi-institutional project named "Alliances for the elimination of Chagas in Central America" was created to help reduce the incidence of the disease in the region. Activities performed in the field as part of the project included aspects of vector surveillance and control, improvement of houses, diagnosis and treatment of individuals, health promotion, training of human resources and identification of access barriers to diagnosis and treatment. As a base line study, eleven villages, comprised of 1,572 households, were entomologically evaluated (83.4% overall participation); five were found to have very high infestation rates (>20%), three had high infestation rates (8-20%) and three had low-infestation rates (<8%), coinciding with the category of infestation-risk of the houses within each village. Serological tests were carried out in 812 people (>80% participation) in two of the 11 villages and none of the 128 children tested, less than 5 years of age, were positive for Trypanosoma cruzi infection. Community participation in all the activities was high (>70%). The collaboration between several subnational, national, and international institutions, each with specific roles, promoted community participation in the activities of vector control and patient care, thus, establishing a baseline to continue implementing and monitoring project progress.

Infestation dynamics of Triatoma dimidiata in highly deforested tropical dry forest regions of Guatemala.

BACKGROUND: Deforestation, driven by anthropogenic change in land use, influences the behaviour and abundance of vector-borne diseases. For various species of Chagas disease vectors, there is evidence that change in land use affects population density and abundance. Triatoma dimidiata is the most important Chagas vector in Guatemala, and at least one million people live in T. dimidiata endemic areas; however, infestation dynamics vary among regions, from high infestation with all life stages to low seasonal infestation by sylvatic adults. OBJECTIVES: The aim of this study was to evaluate how land-use, combined with domiciliary risk factors, influences the infestation dynamics of T. dimidiata for four villages in a dry forest region with a strong deforestation history. METHODS: Land use, measured with drone and satellite images, was classified into four categories (houses, monocultures and pastures, woodland and shrubland, and bare soil). Domiciliary risk factors and infestation were assessed through entomological surveys. Statistical analyses compared infestation indices and the ability of land use and domiciliary risk factors to explain infestation. FINDINGS: Two villages had significantly higher infestation (26 and 30% vs. 5 and 6%), yet all villages had high colonisation (71-100% of infested houses had immature insects), with no significant difference among them. Because of the high level of deforestation across the study area, land use was not related to infestation; however, domiciliary risk factors were. A model based on four weighted domiciliary risk factors (adobe or bajareque walls, intradomicile animals, intradomicile clutter, and dirt floors) explains the infestation risk. MAIN CONCLUSIONS: Because almost all infested houses have reproducing populations in this deforested dry forest region and statistical analysis identified the domiciliary risk factors for infestation, intermediate and long-term control of Chagas disease vectors in this region requires management of these risk factors.

Infestation dynamics of Triatoma dimidiata in highly deforested tropical dry forest regions of Guatemala

BACKGROUND Deforestation, driven by anthropogenic change in land use, influences the behaviour and abundance of vector-borne diseases. For various species of Chagas disease vectors, there is evidence that change in land use affects population density and abundance. Triatoma dimidiata is the most important Chagas vector in Guatemala, and at least one million people live in T. dimidiata endemic areas; however, infestation dynamics vary among regions, from high infestation with all life stages to low seasonal infestation by sylvatic adults. OBJECTIVES The aim of this study was to evaluate how land-use, combined with domiciliary risk factors, influences the infestation dynamics of T. dimidiata for four villages in a dry forest region with a strong deforestation history. METHODS Land use, measured with drone and satellite images, was classified into four categories (houses, monocultures and pastures, woodland and shrubland, and bare soil). Domiciliary risk factors and infestation were assessed through entomological surveys. Statistical analyses compared infestation indices and the ability of land use and domiciliary risk factors to explain infestation. FINDINGS Two villages had significantly higher infestation (26 and 30% vs. 5 and 6%), yet all villages had high colonisation (71-100% of infested houses had immature insects), with no significant difference among them. Because of the high level of deforestation across the study area, land use was not related to infestation; however, domiciliary risk factors were. A model based on four weighted domiciliary risk factors (adobe or bajareque walls, intradomicile animals, intradomicile clutter, and dirt floors) explains the infestation risk. MAIN CONCLUSIONS Because almost all infested houses have reproducing populations in this deforested dry forest region and statistical analysis identified the domiciliary risk factors for infestation, intermediate and long-term control of Chagas disease vectors in this region requires management of these risk factors.