RESUMEN
BACKGROUND: Chagas disease, caused by Trypanosoma cruzi, is still a public health problem in Latin America and in the Southern Cone countries, where Triatoma infestans is the main vector. We evaluated the relationships among the density of green vegetation around rural houses, sociodemographic characteristics, and domestic (re)infestation with T. infestans while accounting for their spatial dependence in the municipality of Pampa del Indio between 2007 and 2016. METHODS: The study comprised sociodemographic and ecological variables from 734 rural houses with no missing data. Green vegetation density surrounding houses was estimated by the normalized difference vegetation index (NDVI). We used a hierarchical Bayesian logistic regression composed of fixed effects and spatial random effects to estimate domestic infestation risk and quantile regressions to evaluate the association between surrounding NDVI and selected sociodemographic variables. RESULTS: Qom ethnicity and the number of poultry were negatively associated with surrounding NDVI, whereas overcrowding was positively associated with surrounding NDVI. Hierarchical Bayesian models identified that domestic infestation was positively associated with surrounding NDVI, suitable walls for triatomines, and overcrowding over both intervention periods. Preintervention domestic infestation also was positively associated with Qom ethnicity. Models with spatial random effects performed better than models without spatial effects. The former identified geographic areas with a domestic infestation risk not accounted for by fixed-effect variables. CONCLUSIONS: Domestic infestation with T. infestans was associated with the density of green vegetation surrounding rural houses and social vulnerability over a decade of sustained vector control interventions. High density of green vegetation surrounding rural houses was associated with households with more vulnerable social conditions. Evaluation of domestic infestation risk should simultaneously consider social, landscape and spatial effects to control for their mutual dependency. Hierarchical Bayesian models provided a proficient methodology to identify areas for targeted triatomine and disease surveillance and control.
Asunto(s)
Enfermedad de Chagas , Insectos Vectores , Triatoma , Triatoma/fisiología , Triatoma/parasitología , Animales , Enfermedad de Chagas/transmisión , Enfermedad de Chagas/epidemiología , Humanos , Argentina/epidemiología , Insectos Vectores/fisiología , Teorema de Bayes , Población Rural , Trypanosoma cruzi , Vivienda , Factores Socioeconómicos , Factores de RiesgoRESUMEN
BACKGROUND: Chagas disease is a neglected tropical disease (NTD). Cost-effective strategies for large-scale implementation of diagnosis and etiological treatment are urgently needed to comply with NTD control goals. We determined the seroprevalence of Trypanosoma cruzi infection and associated risk factors in a well-defined rural population of Pampa del Indio municipality including creole and indigenous (Qom) households and developed two indices to identify houses harboring infected children. METHODS: We serodiagnosed and administered a questionnaire to 1337 residents (48.2% of the listed population) in two sections of the municipality (named Areas II and IV) 6-9 years after deploying sustained vector control interventions. Multiple logistic regression models were used to evaluate the relationship between human infection and a priori selected predictors. Two risk indices were constructed based on environmental and serostatus variables, and we used spatial analysis to test whether households harboring T. cruzi-seropositive children were randomly distributed. RESULTS: The global seroprevalence of T. cruzi infection was 24.8%. Human infection was positively and significantly associated with exposure time to triatomines, the household number of seropositive co-inhabitants, maternal seropositivity for T. cruzi, recent residence at the current house and the presence of suitable walls for triatomine colonization in the domicile. The pre-intervention mean annual force of infection (FOI) was 1.23 per 100 person-years. Creoles from Area IV exhibited the highest seroprevalence and FOI; Qom people from both areas displayed intermediate ones and creoles from Area II the lowest. Three hotspots of infected children were spatially associated with hotspots of triatomine abundance at baseline and persistent house infestation. No child born after vector control interventions was T. cruzi seropositive except for one putative transplacental case. Two simple risk indices (based on self-reported inhabiting an infested house and suitable walls for triatomines or maternal serostatus) identified 97.3-98.6% of the households with at least one T. cruzi-seropositive child. CONCLUSIONS: We showed strong heterogeneity in the seroprevalence of T. cruzi infection within and between ethnic groups inhabiting neighboring rural areas. Developed indices can be used for household risk stratification and to improve access of rural residents to serodiagnosis and treatment and may be easily transferred to primary healthcare personnel.
Asunto(s)
Enfermedad de Chagas , Trypanosoma cruzi , Animales , Niño , Humanos , Enfermedad de Chagas/epidemiología , Factores de Riesgo , Estudios Seroepidemiológicos , Triatoma , Pueblos Indígenas , ArgentinaRESUMEN
Genetic and morphological structure of vector populations are useful to identify panmictic groups, reinfestation sources and minimal units for control interventions. Currently, no studies have integrated genetic and morphometric data in Triatoma infestans (Hemiptera: Reduviidae), one of the main vectors of Trypanosoma cruzi. We characterized the genetic and phenotypic structure of T. infestans at a small spatial scale (2-8 km), identified potential migrants and compared flight-related traits among genetic groups and between migrant and non-migrant insects in a well-defined area without insecticide spraying in the previous 12 years. We obtained microsatellite genotypes (N = 303), wing shape and size (N = 164) and body weight-to-length ratios (N = 188) in T. infestans from 11 houses in Pampa del Indio, Argentine Chaco. The uppermost level of genetic structuring partially agreed with the morphological groups, showing high degrees of substructuring. The genetic structure showed a clear spatial pattern around Route 3 and one genetic group overlapped with an area of persistent infestation and insecticide resistance. Females harboured more microsatellite alleles than males, which showed signs of isolation-by-distance. Wing shape discriminant analyses of genetic groups revealed low reclassification scores whereas wing size differed among genetic groups for both sexes. Potential migrants (8%) did not differ from non-migrants in sex, ecotope, wing shape and size. However, male migrants had lower W/L than non-migrants suggesting poorer nutritional state. Our findings may contribute to the understanding of population characteristics, dispersal dynamics and ongoing elimination efforts of T. infestans.
Asunto(s)
Triatoma , Femenino , Animales , Masculino , Triatoma/genética , Alelos , Análisis Discriminante , Genotipo , Resistencia a los InsecticidasRESUMEN
Exposure to sublethal doses of insecticide may affect biological traits in triatomines. We investigated the effects of toxicological phenotype (pyrethroid resistance status) and exposure to sublethal doses of deltamethrin on two traits of Triatoma infestans Klug (Heteroptera: Reduviidae) using a phenotypic plasticity experimental design. First-instar nymphs from 14 and 10 full-sib families from pyrethroid-susceptible and pyrethroid-resistant populations, respectively, were used. For the susceptible population, we treated first instars topically with acetone (control) or deltamethrin (treatment) once. For the resistant population, instars were treated once, twice and three times as first, third or fifth-instar nymphs, respectively. We measured cuticle thickness, wing size and wing shape of 484 emerging adults, and tested for treatment effects using mixed ANOVA and MANOVA models. Toxicological phenotype, exposure to deltamethrin and full-sib family exerted significant effects on cuticle thickness, wing size and wing shape. Adult triatomines previously treated with deltamethrin developed significantly thicker cuticles than control triatomines only in the resistant population and significantly bigger wings in both populations. Mean cuticle thickness and wing size increased with increasing exposures to deltamethrin. Exposure to sublethal doses of deltamethrin generated morphological modifications that may affect insect survival and flight dispersal, and hence may have evolutionary and epidemiological consequences.
Asunto(s)
Insecticidas , Piretrinas , Triatoma , Animales , Insecticidas/farmacología , Resistencia a los Insecticidas , Piretrinas/farmacología , Nitrilos/farmacología , Ninfa , Insectos VectoresRESUMEN
We assessed whether fluralaner administered to outbred healthy dogs reduced or supressed site infestation and abundance of pyrethroid-resistant populations of Triatoma infestans Klug (Heteroptera: Reduviidae). We conducted a placebo-controlled before-and-after efficacy trial in 28 infested sites in Castelli (Argentine Chaco) over 10 months. All 72 dogs initially present received either an oral dose of fluralaner (treated group) or placebo (control group) at month 0 posttreatment (MPT). Preliminary results justified treating all 38 control-house dogs with fluralaner 1 month later, and 71 of 78 existing dogs at 7 MPT. Site-level infestation and triatomine abundance were evaluated using timed manual searches with a dislodging aerosol. In the fluralaner-treated group, infestation dropped significantly from 100% at baseline to 19% over 6-10 MPT whereas mean abundance fell highly significantly from 5.5 to 0.8-0.9 triatomines per unit effort. In the placebo group, site infestation and mean abundance remained stable between 0 and 1 MPT, and strongly declined after fluralaner administration from 13.0-14.7 - triatomines at 0-1 MPT to 4.0-4.2 over 6-10 MPT. Only one of 81 noninfested sites before fluralaner treatment became infested subsequently. Fluralaner significantly reduced the site-level infestation and abundance of pyrethroid-resistant T. infestans and should be tested more widely in Phase III efficacy trials.
Asunto(s)
Enfermedad de Chagas , Enfermedades de los Perros , Insecticidas , Piretrinas , Triatoma , Trypanosoma cruzi , Animales , Argentina , Enfermedad de Chagas/prevención & control , Enfermedad de Chagas/veterinaria , Enfermedades de los Perros/prevención & control , Perros , Insectos Vectores , Insecticidas/farmacología , Isoxazoles , Piretrinas/farmacologíaRESUMEN
BACKGROUND: Chagas disease remains a significant public health problem in Latin America. There are only two chemotherapy drugs, nifurtimox and benznidazole, and both may have severe side effects. After complete chemotherapy of acute cases, seropositive diagnosis may revert to negative. However, there are no definitive parasitological or serological biomarkers of cure. METHODS: Following a pilot study with seven Bolivian migrants to Spain, we tested 71 serum samples from chronic patients (mean age 12.6 years) inhabiting the Argentine Chaco region. Benznidazole chemotherapy (5-8 mg/kg day, twice daily for 60 days) was administered during 2011-2016. Subsequently, pre-and post-chemotherapy serum samples were analysed in pairs by IgG1 and IgG ELISA using two different antigens and Chagas Sero K-SeT rapid diagnostic tests (RDT). Molecular diagnosis by kDNA-PCR was applied to post-treatment samples. RESULTS: Pilot data demonstrated IgG1 antibody decline in three of seven patients from Bolivia 1 year post-treatment. All Argentine patients in 2017 (averaging 5 years post-treatment), except one, were positive by conventional serology. All were kDNA-PCR-negative. Most (91.5%) pre-treatment samples were positive by the Chagas Sero K-SeT RDT, confirming the predominance of TcII/V/VI. IgG1 and IgG of Argentine patients showed significant decline in antibody titres post-chemotherapy, with either lysate (IgG, P = 0.0001, IgG1, P = 0.0001) or TcII/V/VI peptide antigen (IgG, P = 0.0001, IgG1, P = 0.0001). IgG1 decline was more discriminative than IgG. Antibody decline after treatment was also detected by the RDT. Incomplete treatment was associated with high IgG1 post-treatment titres against lysate (P = 0.013), as were IgG post-treatment titres to TcII/V/VI peptide (P = 0.0001). High pre-treatment IgG1 with lysate was associated with Qom ethnicity (P = 0.045). No associations were found between gender, age, body mass index and pre- or post-treatment antibody titres. CONCLUSIONS: We show that following chemotherapy of early chronic Chagas disease, significant decline in IgG1 antibody suggests cure, whereas sustained or increased IgG1 is a potential indicator of treatment failure. Due to restricted sensitivity, IgG1 should not be used as a diagnostic marker but has promise, with further development, as a biomarker of cure. We show that following chemotherapy of early chronic Chagas disease, a significant decline in IgG1 antibody suggests cure, whereas sustained or increased IgG1 is a potential indicator of treatment failure. Due to restricted sensitivity, IgG1 should not be used as a diagnostic marker but has promise, with further development, as a biomarker of cure.
Asunto(s)
Anticuerpos Antiprotozoarios/sangre , Enfermedad de Chagas/tratamiento farmacológico , Enfermedad de Chagas/inmunología , Nifurtimox/uso terapéutico , Nitroimidazoles/uso terapéutico , Tripanocidas/uso terapéutico , Trypanosoma cruzi/inmunología , Adolescente , Anticuerpos Antiprotozoarios/inmunología , Enfermedad de Chagas/sangre , Enfermedad Crónica/tratamiento farmacológico , Estudios de Cohortes , Femenino , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina G/inmunología , Pruebas Inmunológicas , Masculino , Técnicas de Diagnóstico Molecular , Nifurtimox/efectos adversos , Nitroimidazoles/efectos adversos , Proyectos Piloto , Factores de Tiempo , Tripanocidas/efectos adversos , Trypanosoma cruzi/efectos de los fármacos , Trypanosoma cruzi/genéticaRESUMEN
BACKGROUND: Triatomine control campaigns have traditionally consisted of spraying the inside of houses with pyrethroid insecticides. However, exposure to sublethal insecticide doses after the initial application is a common occurrence and may have phenotypic consequences for survivors. Here, using Triatoma infestans (the main vector of Chagas disease in the Southern Cone of South America) as a model species, we quantified the effects of exposure to a sublethal dose of pyrethroid insecticide on wing morphology. We tested if the treatment (i) induced a plastic effect (change in the character mean); (ii) altered environmental canalisation (higher individual variation within genotypes); (iii) altered genetic canalisation (higher variation among genotypes); and (iv) altered developmental stability (higher fluctuating asymmetry [FA]). METHODS: Each of 25 full-sib families known to be susceptible to pyrethroid insecticides were split in two groups: one to be treated with a sublethal dose of deltamethrin (insecticide-treated group) and the other to be treated with pure acetone (control group). Wings of the emerging adults were used in a landmark-based geometric morphometry analysis to extract size and shape measurements. Average differences among treatments were measured. Levels of variation among families, among individuals within families and among sides within individuals were computed and compared among treatments. RESULTS: Wing size and shape were affected by a sublethal dose of deltamethrin. The treated insects had larger wings and a more variable wing size and shape than control insects. For both wing size and shape, genetic variation was higher in treated individuals. Individual variations and variations in FA were also greater in deltamethrin-treated insects than in control ones for all full-sib families; however, the patterns of shape variation associated with genetic variation, individual variation and FA were different. CONCLUSIONS: Insects exposed to a sublethal dose of deltamethrin presented larger, less symmetrical and less canalised wings. The insecticide treatment jointly impaired developmental stability and genetic and environmental canalisation. The divergent patterns of shape variation suggest that the related developmental buffering processes differed at least partially. The morphological modifications induced by a single sublethal exposure to pyrethroids early in life may impinge on subsequent flight performance and consequently affect the dynamics of house invasion and reinfestation, and the effectiveness of triatomine control operations.
Asunto(s)
Adaptación Fisiológica , Piretrinas/farmacología , Triatoma/efectos de los fármacos , Triatoma/fisiología , Alas de Animales/efectos de los fármacos , Alas de Animales/fisiología , Animales , Enfermedad de Chagas/prevención & control , Enfermedad de Chagas/transmisión , Estudios Transversales , Relación Dosis-Respuesta a Droga , Femenino , Control de Insectos/métodos , Insectos Vectores/efectos de los fármacos , Resistencia a los Insecticidas , Triatoma/genética , Alas de Animales/anatomía & histologíaRESUMEN
A key parameter in the transmission of vector-borne infections, including Chagas disease, is the ability of the different host species to transmit the parasite to the vector (infectiousness). Here, we determined infectiousness to the vector of Trypanosoma cruzi-seropositive humans examined by artificial xenodiagnosis (XD), established its relationship with T. cruzi DNA levels (a surrogate of intensity of parasitemia) quantified by real-time PCR (qPCR), and assessed whether infectiousness was associated with the body mass index (BMI), age, ethnic background and parasite genotype. XD was performed to 117â¯T. cruzi-seropositive residents from Pampa del Indio and parasite load was quantified in 81 of them. Using optical microscopy (OM) 33.6% of the seropositive people tested were infectious and this fraction nearly doubled (66.0%) when XD triatomines were examined by kDNA-PCR. The mean infectiousness (defined as the percentage of all infected triatomines detected by OM at any time point among the total number of insects examined by OM 30â¯days post-feeding) was 5.2%, and the mean parasite load was 0.51 parasite equivalents per ml. Infectiousness to the vector was associated negatively with age and BMI, and positively with the detection of parasitemia by kDNA-PCR, and parasite load by qPCR in bivariate analysis. Patients with a positive XD by OM exhibited a significantly higher mean parasite load. Using multiple regression, infectiousness was associated with parasite load (positively) and with the household presence of T. infestans and Qom ethnic group (negatively); no significant association was observed with age or its interaction with ethnicity. We did not find significant associations between identified DTUs and infectiousness or parasite load. Infectiousness was aggregated: 18% of the people examined by XD generated 80% of the infected triatomines. Detecting and treating the super-infectious fraction of the infected human would disproportionally impact on domestic transmission risks. Nonetheless, treatment of all eligible infected people who meet the inclusion criteria regardless of their parasitemia should be ensured to improve their prognosis.
Asunto(s)
Enfermedad de Chagas/transmisión , ADN de Cinetoplasto/genética , Triatominae/parasitología , Trypanosoma cruzi/patogenicidad , Adolescente , Adulto , Anciano , Animales , Anticuerpos Antiprotozoarios/metabolismo , Argentina , Índice de Masa Corporal , Enfermedad de Chagas/inmunología , Niño , Genotipo , Humanos , Persona de Mediana Edad , Carga de Parásitos , Reacción en Cadena en Tiempo Real de la Polimerasa , Población Rural , Trypanosoma cruzi/genética , Trypanosoma cruzi/inmunología , Xenodiagnóstico , Adulto JovenRESUMEN
Triatoma infestans, the main vector in the Gran Chaco region, may competitively displace other sympatric species such as Triatoma sordida. We conducted a three-year longitudinal study of site- and house-level infestation and abundance of triatomine bugs before and after an area-wide insecticide spraying campaign followed by sustained vector surveillance in a well-defined rural section of the Argentine Chaco encompassing 368-411 houses. Here, we tested whether insecticide applications targeting and virtually suppressing T. infestans reduced the abundance of T. sordida and modified its habitat occupancies, and whether their joint spatial distribution was random, aggregated or uniform, and varied over time. Systematic timed-manual searches of 18,031 sites yielded 2,226 T. sordida over seven postintervention surveys. Triatoma sordida failed to colonize human sleeping quarters after interventions, and its prime and secondary habitats remained virtually unmodified. Residual insecticide spraying and seasonality best described variations in the house-level abundance of T. sordida as determined using a generalized estimating equation model. Two-species foci occurred in 3.2% of sites ever positive for any species. The habitat-adjusted relative odds of catching one species was 10.8 times greater when the other species was present, with no evidence of heterogeneity among ORs, suggesting no antagonistic interactions throughout the follow-up. The spatial occurrence of both species was significantly aggregated within 300-500â¯m before and after interventions, and was random at broader spatial scales. The habitat occupancies of T. sordida may be used as a proxy for potential infestation with T. infestans and to guide targeted vector control actions.
Asunto(s)
Control de Insectos/métodos , Insecticidas/farmacología , Triatoma/efectos de los fármacos , Animales , Argentina/epidemiología , Enfermedad de Chagas/prevención & control , Enfermedad de Chagas/transmisión , Vectores de Enfermedades , Ecosistema , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Población RuralRESUMEN
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.
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Enfermedad de Chagas/epidemiología , Enfermedad de Chagas/transmisión , Transmisión de Enfermedad Infecciosa , Relaciones Interpersonales , Población Rural , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Argentina/epidemiología , Niño , Preescolar , Economía , Etnicidad , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Estudios Seroepidemiológicos , Topografía Médica , Triatominae/crecimiento & desarrollo , Adulto JovenRESUMEN
BACKGROUND: Trypanosoma cruzi, the protozoan agent of Chagas disease, is comprised of at least 6 genetic lineages (TcI-TcVI). Their geographical distribution, clinical associations and reservoir hosts are not fully elucidated, as genotyping is hampered due to the difficulty in isolating representative populations of organisms. Lineage-specific serological techniques may address these issues. METHODS: Trypanosoma cruzi lineage-specific serological assays were performed on human, canine, feline and armadillo sera from the Gran Chaco in northern Argentina, a region of ongoing transmission. Synthetic peptides representing lineage-specific epitopes of the trypomastigote small surface antigen (TSSA) were used in ELISA, and the TcII/V/VI shared epitope peptide (TSSApep-II/V/VI) was used in the Chagas Sero K-SeT rapid diagnostic test (RDT). RESULTS: Chagas Sero K-SeT RDT, using Protein G to detect human and canine IgG, was at least as sensitive as TSSApep-II/V/VI ELISA using specific secondary antibodies. For sera from humans TSSApep-II/V/VI seroprevalence by Chagas Sero K-SeT was 273/393 (69.5%), for dogs 48/73 (65.8%) and for armadillos 1/7 (14.3%); by ELISA for cats 5/19 (26.3%). The seroprevalence for humans was similar to that for Bolivian patients, amongst whom we previously observed an association of TSSApep-II/V/VI seropositivity with severity of cardiomyopathy. In humans, prevalence of TSSApep-II/V/VI recognition was associated with locality, and with increasing and decreasing age within the Qom and Creole populations, respectively. For dogs TSSApep-II/V/VI recognition was associated with being born before community-wide insecticide spraying (P = 0.05) and with Qom household (P < 0.001). CONCLUSIONS: We show here that Chagas Sero K-SeT RDT can replace ELISA for TSSApep-II/V/VI serology of humans and dogs; for humans there were statistically significant associations between a positive Chagas Sero K-SeT RDT and being resident in Area IV, and for dogs association with Qom household or with being born before the mass spraying campaign; we also show that with cats the TcII/V/VI epitope can be detected by ELISA. We assessed the lineage distribution in an unprecedented 83% of the human T. cruzi-seropositive population. These results form the basis for more detailed studies, enabling rapid in-the-field surveillance of the distribution and clustering of these lineages among humans and mammalian reservoirs of T. cruzi infection.
Asunto(s)
Anticuerpos Antiprotozoarios/sangre , Enfermedad de Chagas/epidemiología , Enfermedad de Chagas/veterinaria , Pruebas Diagnósticas de Rutina/métodos , Serogrupo , Pruebas Serológicas/métodos , Trypanosoma cruzi/clasificación , Animales , Argentina/epidemiología , Armadillos , Gatos , Enfermedad de Chagas/parasitología , Estudios Transversales , Perros , Ensayo de Inmunoadsorción Enzimática/métodos , Humanos , Estudios Seroepidemiológicos , Trypanosoma cruzi/genética , Trypanosoma cruzi/aislamiento & purificaciónRESUMEN
BACKGROUND: The social determinants of health (SDHs) condition disease distribution and the ways they are handled. Socio-economic inequalities are closely linked to the occurrence of neglected tropical diseases, but empirical support is limited in the case of Chagas disease, caused by the protozoan Trypanosoma cruzi. Herein we assessed the relationship between key structural SDHs and the risk of T. cruzi vector-borne transmission in rural communities of the Argentine Chaco occupied by creoles and an indigenous group (Qom). We used multiple correspondence analysis to quantify the household-level socio-economic position (social vulnerability and assets indices), access to health and sanitation services, and domestic host availability. We identified the most vulnerable population subgroups by comparing their demographic profiles, mobility patterns and distribution of these summary indices, then assessed their spatial correlation and household-level effects on vector domiciliary indices as transmission risk surrogates. RESULTS: Qom households had higher social vulnerability and fewer assets than creoles, as did local movers and migrant households compared with non-movers. We found significantly positive effects of social vulnerability and domestic host availability on infected Triatoma infestans abundance, after adjusting for ethnicity. Access to health and sanitation services had no effect on transmission risk. Only social vulnerability displayed significant global spatial autocorrelation up to 1 km. A hotspot of infected vectors overlapped with an aggregation of most vulnerable households. CONCLUSIONS: This synthetic approach to assess socio-economic related inequalities in transmission risk provides key information to guide targeted vector control actions, case detection and treatment of Chagas disease, towards sustainability of interventions and greater reduction of health inequalities.
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Enfermedad de Chagas/transmisión , Grupos de Población , Determinantes Sociales de la Salud/etnología , Factores Socioeconómicos , Adolescente , Adulto , Anciano , Animales , Argentina , Enfermedad de Chagas/etnología , Niño , Preescolar , Composición Familiar , Femenino , Humanos , Control de Insectos , Insectos Vectores/parasitología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Población Rural , Encuestas y Cuestionarios , Triatoma/parasitología , Trypanosoma cruzi , Adulto JovenRESUMEN
Prevention of Chagas disease vector-borne transmission mostly relies on the residual application of pyrethroid insecticide. Persistent or recurrent house infestation after insecticide spraying remains a serious challenge in remote, resource-poor rural areas where public health services face substantial constraints. Here we use generalized estimating equations and multimodel inference to model the fine-scale, time-lagged effects of a community-based vector surveillance-and-response strategy on house infestation and abundance of Triatoma infestans in four rural communities of the Argentine Chaco over a five-year period. Householders and community leaders were trained to detect triatomines and spray with insecticides their premises if infested. House infestation and vector abundance were consistently higher in peridomestic habitats than in human habitations (domiciles). Householders supplemented with sensor boxes detected infested domiciles (67%) more frequently than timed-manual searches (49%). Of all houses ever found to be infested by timed-manual searches, 76% were sprayed within six months upon detection. Domestic triatomine abundance was significantly related to house-level insecticide spraying during the previous year (inversely) and current peridomestic abundance (positively). Peridomestic triatomine abundance significantly increased with current domestic bug abundance and maximum peridomestic abundance during the previous year, and was unaffected by insecticide spraying. Our study provides new empirical evidence of the interconnection and flow between domestic and peridomestic populations of T. infestans under recurrent insecticide treatments, and supports targeting both habitats with appropriate tactics for longer-lasting, improved vector control. Community-directed efforts succeeded in controlling domestic infestations and interrupting domestic transmission, whereas persistent peridomestic infestations demand sustained control efforts to address domestic reinvasions.
Asunto(s)
Animales Domésticos/parasitología , Enfermedad de Chagas/prevención & control , Enfermedad de Chagas/transmisión , Control de Insectos/métodos , Insectos Vectores/efectos de los fármacos , Insecticidas/farmacología , Piretrinas/farmacología , Animales , Estudios de Seguimiento , Humanos , Vigilancia de la Población , Población RuralRESUMEN
BACKGROUND: Rapid reinfestation of insecticide-treated dwellings hamper the sustained elimination of Triatoma infestans, the main vector of Chagas disease in the Gran Chaco region. We conducted a seven-year longitudinal study including community-wide spraying with pyrethroid insecticides combined with periodic vector surveillance to investigate the house reinfestation process in connection with baseline pyrethroid resistance, housing quality and household mobility in a rural section of Pampa del Indio mainly inhabited by deprived indigenous people (Qom). METHODOLOGY/PRINCIPAL FINDINGS: Despite evidence of moderate pyrethroid resistance in local T. infestans populations, house infestation dropped from 31.9% at baseline to 0.7% at 10 months post-spraying (MPS), with no triatomine found at 59 and 78 MPS. Household-based surveillance corroborated the rare occurrence of T. infestans and the house invasion of other four triatomine species. The annual rates of loss of initially occupied houses and of household mobility were high (4.6-8.0%). Housing improvements did not translate into a significant reduction of mud-walled houses and refuges for triatomines because most households kept the former dwelling or built new ones with mud walls. CONCLUSIONS/SIGNIFICANCE: Our results refute the assumption that vector control actions performed in marginalized communities of the Gran Chaco are doomed to fail. The larger-than-expected impacts of the intervention program were likely associated with the combined effects of high-coverage, professional insecticide spraying followed by systematic vector surveillance-and-response, broad geographic coverage creating a buffer zone, frequent housing replacement and residential mobility. The dynamical interactions among housing quality, mobility and insecticide-based control largely affect the chances of vector elimination.
Asunto(s)
Enfermedad de Chagas/prevención & control , Transmisión de Enfermedad Infecciosa/prevención & control , Control de Insectos/métodos , Grupos de Población , Adolescente , Adulto , Aerosoles/administración & dosificación , Anciano , Anciano de 80 o más Años , Animales , Argentina , Composición Familiar , Femenino , Humanos , Insecticidas/administración & dosificación , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Piretrinas/administración & dosificación , Encuestas y Cuestionarios , Triatoma/efectos de los fármacos , Triatoma/crecimiento & desarrollo , Adulto JovenRESUMEN
Prevention of vector-borne transmission of Chagas disease mainly relies on residual insecticide spraying. Despite significant success at a regional scale, house infestation with Triatoma infestans (Klug) (Hemiptera: Reduviidae) still persists in the Gran Chaco ecoregion. One key aspect is the identification of the sources of reinfestant triatomines. After detecting fine-scale genetic structure in two rural villages of Pampa del Indio, Argentine Chaco, we tested hypotheses on the putative origins of the triatomines collected at 4, 8, and 12 mo after insecticide house spraying. We genotyped 10 microsatellite loci in 262 baseline and 83 postspraying triatomines from different houses. Genetic variability was similar between baseline and postspraying populations, but 13 low-frequency alleles were not detected at postspraying. FSTs were not significant between insects collected before and after insecticide spraying at the same house in all but one case, and they clustered together in a neighbor-joining tree. A clustering algorithm detected seven genetic groups, four of them mainly composed of baseline and postspraying insects from the same house. Assignment tests suggested multiple putative sources (including the house of collection) for most postspraying insects but excluded a house located more than 9 km from the study area. The origin of three triatomines was attributed to immigration from other unaccounted sources. Our study is compatible with the hypothesis that house reinfestations in the Argentine Chaco are mostly related to residual foci (i.e., survival of insects within the same community), in agreement with field observations, spatial analysis, and morphometric studies previously published.
Asunto(s)
Distribución Animal , Control de Insectos , Repeticiones de Microsatélite , Triatoma/fisiología , Animales , Argentina , Insecticidas/administración & dosificación , Dinámica Poblacional , Triatoma/genéticaRESUMEN
Triatoma sordida Stål (Hemiptera: Reduviidae), a secondary vector of Trypanosoma cruzi Chagas (Kinetoplastida: Trypanosomatidae), occasionally colonizes human sleeping quarters in Paraguay, Bolivia, and Brazil, whereas only sylvatic and peridomestic populations are found in Argentina. We carried out a cross-sectional survey of house infestation in a well-defined rural area of northeastern Argentina to identify the key habitats of T. sordida; describe its spatial distribution in an apparently undisturbed setting under no recent insecticide treatment and use metapopulation theory to investigate these spatially structured populations. Timed-manual searches in 2,177 georeferenced sites from 368 houses yielded T. sordida in 78 sites (house infestation prevalence, 19.9%). Most triatomines occurred in chicken nests, chicken coops, and trees where chickens roosted (prime habitats). Goat or sheep corrals and pig corrals had a lower fraction of occupied sites (occupancies) and abundance. Both occupancy and catch increased with increasing refuge availability according to multimodel inference with model averaging. The majority of suitable habitats were unoccupied despite their proximity to occupied sites. The site-specific occurrence of T. sordida and Triatoma infestans Klug (Hemiptera: Reduviidae) was positively and homogeneously associated over ecotopes, showing no evidence of interspecific interference. An incidence function metapopulation model (including intersite distances and vector carrying capacity) predicted a fivefold greater occupancy relative to the observed pattern, suggesting the latter represented a transient state. T. sordida failed to colonize human sleeping quarters, thrived in peridomestic habitats occupied by chickens, and had a limited occupancy likely related to a poor colonizing ability and the relative instability of its prime habitats.
Asunto(s)
Distribución Animal , Ecosistema , Insectos Vectores/fisiología , Triatoma/fisiología , Animales , Argentina , Enfermedad de Chagas/transmisión , Estudios Transversales , Modelos Biológicos , Dinámica PoblacionalRESUMEN
BACKGROUND: Large spatial and temporal fluctuations in the population density of living organisms have profound consequences for biodiversity conservation, food production, pest control and disease control, especially vector-borne disease control. Chagas disease vector control based on insecticide spraying could benefit from improved concepts and methods to deal with spatial variations in vector population density. METHODOLOGY/PRINCIPAL FINDINGS: We show that Taylor's law (TL) of fluctuation scaling describes accurately the mean and variance over space of relative abundance, by habitat, of four insect vectors of Chagas disease (Triatoma infestans, Triatoma guasayana, Triatoma garciabesi and Triatoma sordida) in 33,908 searches of people's dwellings and associated habitats in 79 field surveys in four districts in the Argentine Chaco region, before and after insecticide spraying. As TL predicts, the logarithm of the sample variance of bug relative abundance closely approximates a linear function of the logarithm of the sample mean of abundance in different habitats. Slopes of TL indicate spatial aggregation or variation in habitat suitability. Predictions of new mathematical models of the effect of vector control measures on TL agree overall with field data before and after community-wide spraying of insecticide. CONCLUSIONS/SIGNIFICANCE: A spatial Taylor's law identifies key habitats with high average infestation and spatially highly variable infestation, providing a new instrument for the control and elimination of the vectors of a major human disease.
Asunto(s)
Enfermedad de Chagas/transmisión , Control de Insectos , Modelos Teóricos , Triatoma/fisiología , Animales , Ecosistema , Humanos , Insectos Vectores , Análisis Espacio-TemporalRESUMEN
Human sleeping quarters (domiciles) and chicken coops are key source habitats of Triatoma infestans-the principal vector of the infection that causes Chagas disease-in rural communities in northern Argentina. Here we investigated the links among individual bug bloodmeal contents (BMC, mg), female fecundity, body length (L, mm), host blood sources and habitats. We tested whether L, habitat and host blood conferred relative fitness advantages using generalized linear mixed-effects models and a multimodel inference approach with model averaging. The data analyzed include 769 late-stage triatomines collected in 120 sites from six habitats in 87 houses in Figueroa, Santiago del Estero, during austral spring. L correlated positively with other body-size surrogates and was modified by habitat type, bug stage and recent feeding. Bugs from chicken coops were significantly larger than pig-corral and kitchen bugs. The best-fitting model of log BMC included habitat, a recent feeding, bug stage, log Lc (mean-centered log L) and all two-way interactions including log Lc. Human- and chicken-fed bugs had significantly larger BMC than bugs fed on other hosts whereas goat-fed bugs ranked last, in consistency with average blood-feeding rates. Fecundity was maximal in chicken-fed bugs from chicken coops, submaximal in human- and pig-fed bugs, and minimal in goat-fed bugs. This study is the first to reveal the allometric effects of body-size surrogates on BMC and female fecundity in a large set of triatomine populations occupying multiple habitats, and discloses the links between body size, microsite temperatures and various fitness components that affect the risks of transmission of Trypanosoma cruzi.