RESUMEN
Long-term control of Chagas disease requires not only interruption of the human transmission cycle of Trypanosoma cruzi Schyzotrypanum, Chagas, 1909 by controlling its domestic triatomine vectors but also surveillance to prevent reinfestation of residences from sylvatic or persistent peridomestic populations. Although a number of potential risk factors for infestation have been implicated in previous studies, the explanatory power of resulting models has been low. Two years after cessation of triatomine vector control efforts in the town of Chalcatzingo, Morelos, 78 environmental, socioecological, and spatial variables were analyzed for association with infestation by Triatoma pallidipennis Stal 1872 (Hemiptera: Reduviidae: Triatominae), the principal vector of T. cruzi. We studied 712 residences in this rural community to identify specific intradomestic and peridomestic risk factors that predicted infestation with T. pallidipennis. From numerous characteristics that were identified as correlated with infestation, we derived multivariate logistic regression models to predict residences that were more or less likely to be infested with T. pallidipennis. The most important risk factors for infestation included measurements of house age, upkeep, and spatial location in the town. The effects of certain risk factors on infestation were found to be modified by spatial characteristics of residences. The results of this study provide new information regarding risk factors for infestation by T. pallidipennis that may aid in designing sustainable disease control programs in rural Mexico.
Asunto(s)
Vivienda , Control de Insectos/estadística & datos numéricos , Insectos Vectores/fisiología , Modelos Teóricos , Población Rural , Triatominae/fisiología , Trypanosoma cruzi , Animales , Geografía , Humanos , Insectos Vectores/parasitología , Modelos Logísticos , México , Factores de Riesgo , Encuestas y Cuestionarios , Triatominae/parasitologíaRESUMEN
A single village control trial for Triatoma pallidipennis and T. barberi was conducted using three synthetic pyrethroids (bifenthrin, cyfluthrin, and deltamethrin), evaluated as residual treatments in separate sectors, with complete coverage indoors and in peridomiciliary areas. Spray intervention was preceded by a preintervention entomological evaluation and household survey, followed by four postintervention evaluations at 1, 3, 6, and 12 mo of > 96% of houses. Overall preintervention adjusted infestation index was 38%, 17% of which represented intradomicile infestation. Dose verification using high-performance liquid chromatography (HPLC) demonstrated correct spray doses for all but deltamethrin treatments. There was between a 6- and 13-fold decrease in intradomicile live bug infestation for cyfluthrin- and bifenthrin-treated areas, resulting at 1 mo in 0 and 0.6% infestation, respectively. Intradomicile infestation recovered somewhat, terminating at 20 and 50% of preintervention levels at 12 mo, respectively, while peridomicile infestation recovered preintervention levels within 3-6 mo. Households with persistent live peridomiciliary infestation had 1.9 times the risk of having a persistent intradomiciliary infestation, while 80% of peridomicile infestations for both triatomine species were in houses not having a previous infestation. New or reinfestation of households did not occur consistent with a sylvan source, and unconstructed lots were not a significant source of bugs. Houses with persistent peridomicile infestation did represent a significant risk for surrounding uninfested houses by cluster analysis (P < 0.05). Along with the increased prevalence of T. cruzi infection after intervention, the data indicate that a sylvan reservoir source, probably peridomicile small rodent nests, represent the major risk factor for persistent and new infestations.