Chagas disease in the context of the 2030 agenda: global warming and vectors.

The 2030 Agenda for Sustainable Development is a plan of action for people, planet and prosperity. Thousands of years and centuries of colonisation have passed the precarious housing conditions, food insecurity, lack of sanitation, the limitation of surveillance, health care programs and climate change. Chagas disease continues to be a public health problem. The control programs have been successful in many countries in reducing transmission by T. cruzi; but the results have been variable. WHO makes recommendations for prevention and control with the aim of eliminating Chagas disease as a public health problem. Climate change, deforestation, migration, urbanisation, sylvatic vectors and oral transmission require integrating the economic, social, and environmental dimensions of sustainable development, as well as the links within and between objectives and sectors. While the environment scenarios change around the world, native vector species pose a significant public health threat. The man-made atmosphere change is related to the increase of triatomines' dispersal range, or an increase of the mobility of the vectors from their sylvatic environment to man-made constructions, or humans getting into sylvatic scenarios, leading to an increase of Chagas disease infection. Innovations with the communities and collaborations among municipalities, International cooperation agencies, local governmental agencies, academic partners, developmental agencies, or environmental institutions may present promising solutions, but sustained partnerships, long-term commitment, and strong regional leadership are required. A new world has just opened up for the renewal of surveillance practices, but the lessons learned in the past should be the basis for solutions in the future.

Different profiles and epidemiological scenarios: past, present and future.

The multiplicity of epidemiological scenarios shown by Chagas Disease, derived from multiple transmission routes of the aetiological agent, occurring on multiple geo-ecobiosocial settings determines the complexity of the disease and reveal the difficulties for its control. From the first description of the link between the parasite, the vector and its domestic habitat and the disease that Carlos Chagas made in 1909, the epidemiological scenarios of the American Trypanosomiasis has shown a dynamic increasing complexity. These scenarios changed with time and geography because of new understandings of the disease from multiple studies, because of policies change at the national and international levels and because human movements brought the parasite and vectors to new geographies. Paradigms that seemed solid at a time were broken down, and we learnt about the global dispersion of Trypanosoma cruzi infection, the multiplicity of transmission routes, that the infection can be cured, and that triatomines are not only a health threat in Latin America. We consider the multiple epidemiological scenarios through the different T. cruzi transmission routes, with or without the participation of a Triatominae vector. We then consider the scenario of regions with vectors without the parasite, to finish with the consideration of future prospects.

Association between environmental gradient of anthropization and phenotypic plasticity in two species of triatomines.

BACKGROUND: Triatoma garciabesi and T. guasayana are considered secondary vectors of Trypanosoma cruzi and frequently invade rural houses in central Argentina. Wing and head structures determine the ability of triatomines to disperse. Environmental changes exert selective pressures on populations of both species, promoting changes in these structures that could have consequences for flight dispersal. The aim of this study was to investigate the relationship between a gradient of anthropization and phenotypic plasticity in flight-related traits. METHODS: The research was carried out in Cruz del Eje and Ischilín departments (Córdoba, Argentina) and included 423 individuals of the two species of triatomines. To measure the degree of anthropization, a thematic map was constructed using supervised classification, from which seven landscapes were selected, and nine landscape metrics were extracted and used in a hierarchical analysis. To determine the flight capacity and the invasion of dwellings at different levels of anthropization for both species, entomological indices were calculated. Digital images of the body, head and wings were used to measure linear and geometric morphometric variables related to flight dispersion. One-way ANOVA and canonical variate analysis (CVA) were used to analyze differences in size and shape between levels of anthropization. Procrustes variance of shape was calculated to analyze differences in phenotypic variation in heads and wings. RESULTS: Hierarchical analysis was used to classify the landscapes into three levels of anthropization: high, intermediate and low. The dispersal index for both species yielded similar results across the anthropization gradient. However, in less anthropized landscapes, the density index was higher for T. garciabesi. Additionally, in highly anthropized landscapes, females and males of both species exhibited reduced numbers. Regarding phenotypic changes, the size of body, head and wings of T. garciabesi captured in the most anthropized landscapes was greater than for those captured in less anthropized landscapes. No differences in body size were observed in T. guasayana collected in the different landscapes. However, males from highly anthropized landscapes had smaller heads and wings than those captured in less anthropized landscapes. Both wing and head shapes varied between less and more anthropogenic environments in both species. CONCLUSIONS: Results of the study indicate that the flight-dispersal characteristics of T. garciabesi and T. guasayana changed in response to varying degrees of anthropization.

Effects of fipronil on dogs over Triatoma infestans, the main vector of Trypanosoma cruzi, causative agent of Chagas disease.

Chagas disease is the most important endemic disease in Latin America, mainly transmitted by Triatoma infestans in the Southern Cone countries of South America. Dogs are one of the main domestic reservoirs of Trypanosoma cruzi, the etiological agent of Chagas disease. The presence of dogs in rural households of endemic areas significantly increases the likelihood of the vectorial transmission of the parasite. We studied the mortality and blood intake of T. infestans exposed to dogs treated with different doses and formulations of fipronil. Two doses, two formulations, and different distances to the application point of fipronil were compared. Third instar nymphs of T. infestans were fed at different time intervals after the insecticide application up to 45 days post-application. No significant difference was found between the blood intake of nymphs fed on control and treated dogs with different doses and formulations (p > 0.05). The spray formulation showed lower effect and persistence than the spot-on formulation. The mortality rate caused by the spot-on formulation in the 26.8-mg active ingredient (a.i.)/kg dose was higher (48%) than with the 13.4-mg a.i./kg dose (25%), 24 h after the insecticide application. The effect was highly heterogeneous among replicates of the same treatment. The mortality rate of nymphs fed over the point of the insecticide application was higher than the mortality of nymphs fed over places 12 cm apart from the fipronil application point, suggesting that the distribution of fipronil over the dog body is lower than the needed one to obtain a persistent triatomicide effect.

Variability of the susceptibility to deltamethrin in Triatoma infestans: the female factor.

We analyzed the variability of susceptibility to deltamethrin in putatively susceptible Triatoma infestans Klug (Hemiptera: Reduviidae), and evaluated the sample size implications on the hypotheses used in the current World Health Organization protocol for the measure of insecticide resistance in Triatominae. Following the protocol, using topical application of deltamethrin to unfed first instar nymphs of T. infestans, we found that susceptibility showed significant differences between offspring from different females, a significant association with female age, and significant interaction female x female age. Considering individual female data, three patterns of nymphal mortality were identified: one showed a strong positive relation between nymphal mortality and their mother's age, another showed high mortality with low variability and the third showed intermediate mortality with high variability along female age. The analysis suggests revision of the World Health Organization protocol for resistance detection in Triatominae, not only to take into consideration the sources of variation in susceptibility, but also the effects of sample size in relation to the significance and power probabilities of the test.

[Climate change and vector-borne diseases in Argentina]. / Cambio climático y enfermedades transmitidas por vectores en Argentina.

Vector-borne diseases (VBDs) continue to pose a challenge to the efforts of public health agencies by increasing their impact on the health of the affected communities. The common feature of VBDs is that the only way of preventing them is by avoiding the contact between vectors and humans. There are no vaccines, and they will not be available shortly as tools for prevention and control in Argentina. Although dengue outbreaks attracted the attention of mass media from 2009, other VBDs have been affecting public health in Argentina for many decades, as Chagas disease and leishmaniasis. Over these, and others that could potentially settle in the national territory (West Nile, Lyme, etc.), there are repeated mass media claims and political declarations justifying their increase because of climate changes. The argument asserts that the "tropicalization" of the climate in temperate regions promotes the installation of VBDs in areas previously unfavorable for them. Although much evidence exists showing that the climate is changing, there is very little evidence that the climate is the main factor promoting the increase of VBDs. In this article, the influence of the so-called climate change on the situation of disease vectors in Argentina (with emphasis on triatomines) and vector control activities implemented by governmental public health agencies are discussed.

Las enfermedades transmitidas por vectores (ETVs) continúan siendo un desafío para los esfuerzos de agencias de salud pública, ya que mantienen o están aumentando su impacto sobre la salud de las comunidades afectadas. La característica común de las ETVs es que la única manera de prevenir exitosamente nuevas infecciones es evitar el contacto entre vectores y humanos. No existen vacunas y no existirán en un futuro previsible para las principales ETVs que afectan la salud pública en Argentina. Aunque las epidemias de dengue desde 2009 atrajeron la atención mediática, otras ETVs, tales como Chagas o leishmaniasis, afectan la salud pública en Argentina desde hace décadas. Sobre ellas, y otras que potencialmente podrían instalarse en el territorio nacional (West Nile, Lyme, etc) hay repetidas referencias mediáticas que explican su recrudecimiento por el cambio climático. El argumento se basa en que la "tropicalización" del clima en regiones templadas promueve la instalación de ETVs en áreas previamente no favorables para ellas. Aunque existen muchas evidencias de que el clima está cambiando, son pocas las evidencias de que sea el clima el principal factor que promueve el recrudecimiento de las ETVs en Argentina. En este artículo, se discute la situación de los vectores de enfermedades en Argentina (con énfasis en triatominos), su vinculación con el llamado cambio climático y las actividades de control de vectores implementados por agencias gubernamentales de salud pública.

Triatominae of the semi-arid Chaco in central Argentina.

The epidemiological scenario in central Argentinian Chaco region shows persistence of Triatoma infestans domestic populations in endemic areas, with control interventions historically affected by the economic instability of the region. Considering this situation, we aimed to (i) update the information regarding to the diversity of triatomines present in domestic, peridomestic and sylvatic environments in departments historically endemic of the Chaco region, (ii) to report the occurrence of secondary vectors of Chagas disease invading domestic environments and (iii) to discuss the possible sources of dispersal of these sylvatic species towards anthropic habitats. Between November 2017 and March 2020, we visited fourteen rural communities of northwest Córdoba province (central Argentina). Entomological data were collected through community vector surveillance in domiciles, active search in peridomiciles and the use of light and yeast traps in sylvatic environments. Seven Triatominae species were captured invading domiciles (T. guasayana, T. garciabesi, T. platensis, T. delpontei, T. breyeri, Panstrongylus guentheri and T. infestans). T. guasayana and T. garciabesi were the species with the highest number of captures. The 32% of the peridomiciles registered infestation with T. infestans (n â€‹= 355), mostly in chicken coops and goat pens. In sylvatic environments, T. garciabesi, T. guasayana, T. infestans and P. guentheri were collected. Only one adult specimen of T. infestans was positive for the presence of Trypanosoma cruzi. Our results suggest that the persistence of T. infestans populations in peridomiciles continues to be a serious challenge for control programs, whereas the finding of secondary vectors of Chagas disease actively invading domiciles emphasizes the need to implement new strategies for entomological surveillance.

The effects of cypermethrin pour-on and piperonyl butoxide on Triatoma infestans under laboratory conditions.

The effect of exposing Triatoma infestans to chickens treated with cypermethrin pour-on combined with piperonyl butoxide (PBO) was studied. Four groups of treated chickens and one control group were used. Each treatment received 1 or 2 ml of the cypermethrin formulation with and without PBO. Independent groups of nymphs were fed 1, 7, 15, 30, and 45 d after the treatment application. Blood intake was estimated after each feeding occasion. Up to 15 d after the pour-on application, high mortality was observed in all nymphs fed on treated chickens (> 93% +/- 12), and lower than the nymphs of the control group (< 33% +/- 15). After 30 d of the pour-on application, there was significantly different mortality between the treatment with 1 ml (80% +/- 9) and 2 ml (> 96% +/- 5); no difference was observed between groups with or without PBO addition. After 45 d of the pour-on application, the treatments did not show significant differences (77% +/- 7), although all treatments showed higher mortality than the control group (10% +/- 9). Up to 45 d after the pour-on application, blood intake by nymphs exposed to treated chickens (0.85 +/- 0.96 mg/nymph) was lower than blood intake by nymphs exposed to control chickens (6.7 +/- 5 mg/nymph). This study shows that cypermethrin pour-on produces high mortality and reduces the blood intake of third-instar nymphs of T. infestans up to 45 d after the insecticide application to chickens. PBO did not produce a detectable effect.

Geospatial tools and Chagas control: a critical comment on the paper of Weinberg et al., Evaluation and planning of Chagas control activities using geospatial tools. Geospat Health 2019;14:229-238.

The contribution of the geospatial tools to the vector control activities of Chagas disease is very clear for the academic and technology-prone communities, but not so much for the state-dependent health agents (national or provincial) that are ultimately responsible for disease control in Latin America. (...).

Response of Triatoma infestans to pour-on cypermethrin applied to chickens under laboratory conditions.

This article reports the effects of a pour-on formulation of cypermethrin (6% active ingredient) applied to chickens exposed to Triatoma infestans, the main vector of Chagas disease in rural houses of the Gran Chaco Region of South America. This study was designed as a completely random experiment with three experimental groups and five replicates. Third instar nymphs were fed on chickens treated with 0, 1 and 2 cc of the formulation. Nymphs were allowed to feed on the chickens at different time intervals after the insecticide application. Third-instar nymphs fed on treated chickens showed a higher mortality, took less blood during feeding and had a lower moulting rate. The mortality rate was highest seven days after the insecticide solution application and blood intake was affected until 30 days after the application of the solution.

Potential impact of climate change on the geographical distribution of two wild vectors of Chagas disease in Chile: Mepraia spinolai and Mepraia gajardoi.

BACKGROUND: Mepraia gajardoi and Mepraia spinolai are endemic triatomine vector species of Trypanosoma cruzi, a parasite that causes Chagas disease. These vectors inhabit arid, semiarid and Mediterranean areas of Chile. Mepraia gajardoi occurs from 18° to 25°S, and M. spinolai from 26° to 34°S. Even though both species are involved in T. cruzi transmission in the Pacific side of the Southern Cone of South America, no study has modelled their distributions at a regional scale. Therefore, the aim of this study is to estimate the potential geographical distribution of M. spinolai and M. gajardoi under current and future climate scenarios. METHODS: We used the Maxent algorithm to model the ecological niche of M. spinolai and M. gajardoi, estimating their potential distributions from current climate information and projecting their distributions to future climatic conditions under representative concentration pathways (RCP) 2.6, 4.5, 6.0 and 8.5 scenarios. Future predictions of suitability were constructed considering both higher and lower public health risk situations. RESULTS: The current potential distributions of both species were broader than their known ranges. For both species, climate change projections for 2070 in RCP 2.6, 4.5, 6.0 and 8.5 scenarios showed different results depending on the methodology used. The higher risk situation showed new suitable areas, but the lower risk situation modelled a net reduction in the future potential distribution areas of M. spinolai and M. gajardoi. CONCLUSIONS: The suitable areas for both species may be greater than currently known, generating new challenges in terms of vector control and prevention. Under future climate conditions, these species could modify their potential geographical range. Preventive measures to avoid accidental human vectorial transmission by wild vectors of T. cruzi become critical considering the uncertainty of future suitable areas projected in this study.

Spatio-temporal characterization of Trypanosoma cruzi infection and discrete typing units infecting hosts and vectors from non-domestic foci of Chile.

BACKGROUND: Trypanosoma cruzi is a protozoan parasite that is transmitted by triatomine vectors to mammals. It is classified in six discrete typing units (DTUs). In Chile, domestic vectorial transmission has been interrupted; however, the parasite is maintained in non-domestic foci. The aim of this study was to describe T. cruzi infection and DTU composition in mammals and triatomines from several non-domestic populations of North-Central Chile and to evaluate their spatio-temporal variations. METHODOLOGY/PRINCIPAL FINDINGS: A total of 710 small mammals and 1140 triatomines captured in six localities during two study periods (summer/winter) of the same year were analyzed by conventional PCR to detect kDNA of T. cruzi. Positive samples were DNA blotted and hybridized with specific probes for detection of DTUs TcI, TcII, TcV, and TcVI. Infection status was modeled, and cluster analysis was performed in each locality. We detected 30.1% of overall infection in small mammals and 34.1% in triatomines, with higher rates in synanthropic mammals and in M. spinolai. We identified infecting DTUs in 45 mammals and 110 triatomines, present more commonly as single infections; the most frequent DTU detected was TcI. Differences in infection rates among species, localities and study periods were detected in small mammals, and between triatomine species; temporally, infection presented opposite patterns between mammals and triatomines. Infection clustering was frequent in vectors, and one locality exhibited half of the 21 clusters found. CONCLUSIONS/SIGNIFICANCE: We determined T. cruzi infection in natural host and vector populations simultaneously in a spatially widespread manner during two study periods. All captured species presented T. cruzi infection, showing spatial and temporal variations. Trypanosoma cruzi distribution can be clustered in space and time. These clusters may represent different spatial and temporal risks of transmission.

Rural houses infestation by Triatoma infestans in northwestern Argentina: Vector control in a high spatial heterogeneous infestation area.

Triatoma infestans (Hemiptera: Reduviidae) is a vector of the Trypanosoma cruzi parasite, causative agent of Chagas disease. During the last decade, vector control activities have been systematically carried out in northwestern Argentina, an endemic region for this disease. The general aim of this study to evaluate was spatio-temporal variation of infestation by T. infestans in rural communities of Los Llanos in La Rioja province. We estimated house infestation using two sampling methods: passive and active. Passive collection was conducted with community participation collecting triatomines. Six passive collections were carried out in 397 houses during the warm season between 2014 and 2017. Active collection of T. infestans was thoroughly performed by trained staff for 60 minutes and was carried out once in March 2016. The estimate of intradomestic infestation did not show significant differences between both collection methods (p = 0.39). However, passive collection method had lower sensitivity than active collection method for the estimation of peridomestic infestation and intradomestic colonization (PDI: p< 0.01; ID colonization: p< 0.01). The results obtained with passive collection methods showed that the infestation in the study area was spatially heterogeneous and temporally variable. Intradomiciliary infestation decreased over time (14.4% to 7.9%, p<0.05) although the effect of the chemical treatment application was not associated with the infestation level of T. infestans (p = 0.15) and the Departments had a different response each year (p<0.01). A high infestation cluster was located in the south of our study area during 2016-2017. The vector presence in the houses confirms the importance of to improve entomological surveillance programs. The search for triatomines carried out by the inhabitants might be a useful method to complement the activities of vector control programs in isolated and rural areas.

DataTri, a database of American triatomine species occurrence.

Trypanosoma cruzi, the causative agent of Chagas disease, is transmitted to mammals - including humans - by insect vectors of the subfamily Triatominae. We present the results of a compilation of triatomine occurrence and complementary ecological data that represents the most complete, integrated and updated database (DataTri) available on triatomine species at a continental scale. This database was assembled by collecting the records of triatomine species published from 1904 to 2017, spanning all American countries with triatomine presence. A total of 21815 georeferenced records were obtained from published literature, personal fieldwork and data provided by colleagues. The data compiled includes 24 American countries, 14 genera and 135 species. From a taxonomic perspective, 67.33% of the records correspond to the genus Triatoma, 20.81% to Panstrongylus, 9.01% to Rhodnius and the remaining 2.85% are distributed among the other 11 triatomine genera. We encourage using DataTri information in various areas, especially to improve knowledge of the geographical distribution of triatomine species and its variations in time.

Spatial and temporal distribution of house infestation by Triatoma infestans in the Toro Toro municipality, Potosi, Bolivia.

BACKGROUND: Triatoma infestans is the main vector of Trypanosoma cruzi in Bolivia. The species is present both in domestic and peridomestic structures of rural areas, and in wild ecotopes of the Andean valleys and the Great Chaco. The identification of areas persistently showing low and high house infestation by the vector is important for the management of vector control programs. This study aimed at analyzing the temporal and spatial distribution of house infestation by T. infestans in the Toro Toro municipality (Potosi, Bolivia) between 2009 and 2014, and its association with environmental variables. METHODS: House infestation and T. infestans density were calculated from entomological surveys of houses in the study area, using a fixed-time effort sampling technique. The spatial heterogeneity of house infestation was evaluated using the SatScan statistic. Association between house infestation with Bioclim variables (Worldclim database) and altitude was analyzed using a generalized linear model (GLM) with a logit link. Model selection was based on the Akaike information criteria after eliminating collinearity between variables using the variable inflation factor. The final model was used to create a probability map of house infestation for the Toro Toro municipality. RESULTS: A total of 73 communities and 16,489 house evaluation events were analyzed. Presence of T. infestans was recorded on 480 house evaluation events, giving an overall annual infestation of 2.9% during the studied period (range 1.5-5.4% in 2009 and 2012). Vector density remained at about 1.25 insects/ house. Infestation was highly aggregated in five clusters, including 11 communities. Relative risk of infestation within these clusters was 1.7-3.9 times the value for the regional average. Four environmental variables were identified as good descriptors of house infestation, explaining 57% of house infestation variability. The model allowed the estimation of a house infestation surface for the Toro Toro municipality. CONCLUSION: This study shows that residual and persistent populations of T. infestans maintain low house infestation, representing a potential risk for the transmission of T. cruzi in these communities, and it is possible to stratify house infestation using EV, and produce a risk map to guide the activities of vector control interventions in the municipality of Toro Toro (Potosi, Bolivia).

Chagas disease in the context of the 2030 agenda: global warming and vectors

The 2030 Agenda for Sustainable Development is a plan of action for people, planet and prosperity. Thousands of years and centuries of colonisation have passed the precarious housing conditions, food insecurity, lack of sanitation, the limitation of surveillance, health care programs and climate change. Chagas disease continues to be a public health problem. The control programs have been successful in many countries in reducing transmission by T. cruzi; but the results have been variable. WHO makes recommendations for prevention and control with the aim of eliminating Chagas disease as a public health problem. Climate change, deforestation, migration, urbanisation, sylvatic vectors and oral transmission require integrating the economic, social, and environmental dimensions of sustainable development, as well as the links within and between objectives and sectors. While the environment scenarios change around the world, native vector species pose a significant public health threat. The man-made atmosphere change is related to the increase of triatomines' dispersal range, or an increase of the mobility of the vectors from their sylvatic environment to man-made constructions, or humans getting into sylvatic scenarios, leading to an increase of Chagas disease infection. Innovations with the communities and collaborations among municipalities, International cooperation agencies, local governmental agencies, academic partners, developmental agencies, or environmental institutions may present promising solutions, but sustained partnerships, long-term commitment, and strong regional leadership are required. A new world has just opened up for the renewal of surveillance practices, but the lessons learned in the past should be the basis for solutions in the future.

Drivers of house invasion by sylvatic Chagas disease vectors in the Amazon-Cerrado transition: A multi-year, state-wide assessment of municipality-aggregated surveillance data.

BACKGROUND: Insecticide spraying efficiently controls house infestation by triatomine bugs, the vectors of Trypanosoma cruzi. The strategy, however, is ineffective against sylvatic triatomines, which can transmit Chagas disease by invading (without colonizing) man-made structures. Despite growing awareness of the relevance of these transmission dynamics, the drivers of house invasion by sylvatic triatomines remain poorly understood. METHODS/FINDINGS: About 12,000 sylvatic triatomines were caught during routine surveillance in houses of Tocantins state, Brazil, in 2005-2013. Using negative binomial regression, information-theoretic model evaluation/averaging, and external model validation, we investigated the effects of regional (Amazon/Cerrado), landscape (preservation/disturbance), and climate covariates (temperature, rainfall) on the municipality-aggregated numbers of house-invading Rhodnius pictipes, R. robustus, R. neglectus, and Panstrongylus geniculatus. House invasion by R. pictipes and R. robustus was overall more frequent in the Amazon biome, tended to increase in municipalities with more well-preserved land, and decreased in rainier municipalities. Across species, invasion decreased with higher landscape-disturbance levels and in hotter-day municipalities. Invasion by R. neglectus and P. geniculatus increased somewhat with more land at intermediate disturbance and peaked in average-rainfall municipalities. Temperature effects were more pronounced on P. geniculatus than on Rhodnius spp. CONCLUSIONS: We report widespread, frequent house invasion by sylvatic triatomines in the Amazon-Cerrado transition. Our analyses indicate that readily available environmental metrics may help predict the risk of contact between sylvatic triatomines and humans at coarse geographic scales, and hint at specific hypotheses about climate and deforestation effects on those vectors-with some taxon-specific responses and some seemingly general trends. Thus, our focal species appear to be quite sensitive to higher temperatures, and might be less common in more heavily-disturbed than in better-preserved environments. This study illustrates, in sum, how entomological routine-surveillance data can be efficiently used for Chagas disease risk prediction and stratification when house-colonizing vectors are absent.

Analytical report of the 2016 dengue outbreak in Córdoba city, Argentina.

After elimination of the Aedes aegypti vector in South America in the 1960s, dengue outbreaks started to reoccur during the 1990s; strongly in Argentina since 1998. In 2016, Córdoba City had the largest dengue outbreak in its history. In this article we report this outbreak including spatio-temporal analysis of cases and vectors in the city. A total of 653 dengue cases were recorded by the laboratory-based dengue surveillance system and georeferenced by their residential addresses. Case maps were generated from the epidemiological week 1 (beginning of January) to week 19 (mid-May). Dengue outbreak temporal evolution was analysed globally and three specific, high-incidence zones were detected using Knox analysis to characterising its spatio-temporal attributes. Field and remotely sensed data were collected and analysed in real time and a vector presence map based on the MaxEnt approach was generated to define hotspots, towards which the pesticide- based strategy was then targeted. The recorded pattern of cases evolution within the community suggests that dengue control measures should be improved.

Different profiles and epidemiological scenarios: past, present and future

The multiplicity of epidemiological scenarios shown by Chagas Disease, derived from multiple transmission routes of the aetiological agent, occurring on multiple geo-ecobiosocial settings determines the complexity of the disease and reveal the difficulties for its control. From the first description of the link between the parasite, the vector and its domestic habitat and the disease that Carlos Chagas made in 1909, the epidemiological scenarios of the American Trypanosomiasis has shown a dynamic increasing complexity. These scenarios changed with time and geography because of new understandings of the disease from multiple studies, because of policies change at the national and international levels and because human movements brought the parasite and vectors to new geographies. Paradigms that seemed solid at a time were broken down, and we learnt about the global dispersion of Trypanosoma cruzi infection, the multiplicity of transmission routes, that the infection can be cured, and that triatomines are not only a health threat in Latin America. We consider the multiple epidemiological scenarios through the different T. cruzi transmission routes, with or without the participation of a Triatominae vector. We then consider the scenario of regions with vectors without the parasite, to finish with the consideration of future prospects.

Cambio climático y enfermedades transmitidas por vectores en Argentina / Climate change and vector-borne diseases in Argentina

Resumen Las enfermedades transmitidas por vectores (ETVs) continúan siendo un desafío para los esfuerzos de agencias de salud pública, ya que mantienen o están aumentando su impacto sobre la salud de las comunidades afectadas. La característica común de las ETVs es que la única manera de prevenir exito samente nuevas infecciones es evitar el contacto entre vectores y humanos. No existen vacunas y no existirán en un futuro previsible para las principales ETVs que afectan la salud pública en Argentina. Aunque las epide mias de dengue desde 2009 atrajeron la atención mediática, otras ETVs, tales como Chagas o leishmaniasis, afectan la salud pública en Argentina desde hace décadas. Sobre ellas, y otras que potencialmente podrían instalarse en el territorio nacional (West Nile, Lyme, etc) hay repetidas referencias mediáticas que explican su recrudecimiento por el cambio climático. El argumento se basa en que la "tropicalización" del clima en regiones templadas promueve la instalación de ETVs en áreas previamente no favorables para ellas. Aunque existen muchas evidencias de que el clima está cambiando, son pocas las evidencias de que sea el clima el principal factor que promueve el recrudecimiento de las ETVs en Argentina. En este artículo, se discute la situación de los vectores de enfermedades en Argentina (con énfasis en triatominos), su vinculación con el llamado cambio climático y las actividades de control de vectores implementados por agencias gubernamentales de salud pública.

Abstract Vector-borne diseases (VBDs) continue to pose a challenge to the efforts of public health agencies by increasing their impact on the health of the affected communities. The common feature of VBDs is that the only way of preventing them is by avoid ing the contact between vectors and humans. There are no vaccines, and they will not be available shortly as tools for prevention and control in Argentina. Although dengue outbreaks attracted the attention of mass media from 2009, other VBDs have been affecting public health in Argentina for many decades, as Chagas disease and leishmaniasis. Over these, and others that could potentially settle in the national territory (West Nile, Lyme, etc.), there are repeated mass media claims and political declarations justifying their increase because of climate changes. The argument asserts that the "tropicalization" of the climate in temperate regions promotes the instal lation of VBDs in areas previously unfavorable for them. Although much evidence exists showing that the climate is changing, there is very little evidence that the climate is the main factor promoting the increase of VBDs. In this article, the influence of the so-called climate change on the situation of disease vectors in Argentina (with emphasis on triatomines) and vector control activities implemented by governmental public health agencies are discussed.