Persistence of Trypanosoma cruzi vector-borne transmission among school-age children in the Bolivian Chaco documented by 24-month longitudinal serosurveillance.

BACKGROUND: Chagas disease represents a major public health concern in several Latin American countries, including Bolivia. METHODS: We present a longitudinal serosurvey for Trypanosoma cruzi antibodies among a cohort of 120 school-age children from rural communities in the Bolivian Chaco at three time points between 2017 and 2019. Serum samples extracted from dry blood spots collected on filter paper were tested for T. cruzi antibodies by enzyme-linked immunosorbent assay and rapid diagnostic test. RESULTS: T. cruzi antibodies were detected in 7/120 (5.8%), 8/120 (6.7%) and 11/120 (9.2%) samples in 2017, 2018 and 2019, respectively. An average incidence of 1.76 per 100 person-years was observed. CONCLUSIONS: Our findings support the persistence of vector-borne T. cruzi transmission in this area, highlighting the need for strengthening multidisciplinary efforts against Chagas disease.

Long-Standing International Cooperation in Parasitology Research: A Summary of 35 Years of Activities in the Bolivian Chaco.

The Bolivian Chaco is a semiarid region with a low population density, situated in the southeast part of the Plurinational State of Bolivia. Here, despite the improvements of the last 15 years, poverty remains high in rural areas, where social vulnerability is widespread. The Guaraní ethnic group often lives in isolated communities with a low standard of hygiene and sanitation. This epidemiological scenario favors the spread of transmissible diseases, including several parasitic infections belonging to the neglected tropical diseases (NTDs) group. In this area, a long-standing research activity, built upon the synergism between local and foreign institutions, has been established since the late 1980s and helps to fill in the knowledge gap about the epidemiology dynamics of soil-transmitted helminths, vector-borne parasites, and other parasitic diseases. A 35-year history of cooperation programs in parasitology research has contributed to informing local health authorities of the NTD burden in the Bolivian Chaco and, ultimately, supports local healthcare providers in the management of parasitic diseases.

Cross-sectional study on intestinal parasite infections in different ecological zones of the Department of La Paz, Bolivia.

We performed a cross-sectional parasitological survey to assess the prevalence of protozoa and helminth infection among 275 school-age children (SAC) living in rural and peri-urban areas located in different ecological zones of the Department of La Paz, Bolivia. Public health activities for the control of STH, based on the biannual administration of mebendazole to preschool and school children are implemented at national level since 1986. We found an overall prevalence of 82.2% for intestinal parasites, including protozoa (80%) and helminths (23.3%). Blastocystis and Entamoeba coli were the most prevalent protozoa (found in 44% and 20.7% of the SAC enrolled); as for helminths, Ascaris lumbricoides and Hymenolepis nana were diagnosed in 14.5% and 3.3% of the children, respectively, followed by Trichuris trichiura 1.4%, Enterobius vermicularis 1.4%, Strongyloides stercoralis 0.7% and hookworms 0.7%. Molecular characterization of Blastocystis positive samples evidenced three different subtypes (ST1, ST2, ST3) highlighting the risk of transmission also from animal reservoir. We found a significant difference in the distribution of intestinal parasitic infection (IPIs) by ecological zone (44/74. 59% in Andean highlands, 94/170, 88% in tropical lowlands and 88/94, 94% in the Yungas, p < 0.001). Access to potable water (OR 0.1 95%CI 0.02-0.5, p = 0.004) and the habit of boiling drinking water (OR 0.3, 95% CI 0.2-0.7, p = 0.004) showed an independent association with a lower risk of all IPIs and STHs, respectively. The very low prevalence of STH infections of moderate heavy intensity demonstrate that periodical deworming has been successful in reducing the morbidity due to these parasites, however the high prevalence of protozoa demonstrate that sanitation is still problematic and there is a relevant contamination of the environment with human faeces. Significant efforts are still needed to reduce IPIs transmission and to improve health and sanitation in this area.

Trypanosoma cruzi infection in the human population of the Bolivian Chaco: four serosurveys over a 26-year period (1987-2013).

INTRODUCTION: Chagas disease (CD) remains a public health concern in several Latin American countries. At global level, Bolivia has the highest CD burden and the Chaco region, in the southeast of the country, is the most affected area. We report the results of four serosurveys for Trypanosoma cruzi antibodies, carried out approximately ten years apart from each other, during the lapse 1987-2013, in different localities of the Bolivian Chaco. METHODOLOGY: Four cross-sectional surveys were conducted in various localities, mostly rural, of the Bolivian Chaco, during the period 1987-2013. RESULTS: Although a reliable analysis of CD epidemiological trend is challenging, a partial reduction of anti-T. cruzi seroprevalence over the past four decades in the Bolivian Chaco may be assumed. In particular, in 1987 the exposure to T. cruzi in rural setting was universal since the first years of life, while it resulted gradually lower and age-dependent thereafter. Moreover, T. cruzi seroprevalence among women of reproductive age (15-45 years) has been persistently high in rural areas. CONCLUSIONS: T. cruzi transmission is still active and CD remains a concern throughout the Bolivian Chaco. More efforts are needed in order to achieve a sustainable interruption of vector-borne CD transmission in this area.

Decline in Total Serum IgE and Soluble CD30 in the Context of Soil-Transmitted Helminth Decline in Bolivia.

In the Bolivian Chaco, recent surveys documented a dramatic decrease in the prevalence of soil-transmitted helminth (STH) infections as compared with the 1980s after thirty years of preventive chemotherapy (PC). Concomitant immunological rearrangements are expected. Because nematode infections are associated with increased levels of circulating IgE and glycoprotein CD30 soluble form (sCD30), this study aims to evaluate changes in serological markers of T helper (Th)2-cells activity between 1987 (high STH prevalence) and 2013 (low STH prevalence) in rural communities in the Bolivian Chaco area. We collected 151 sera during two different surveys in 1987 (n = 65) and 2013 (n = 86) and measured the concentration of total IgE and sCD30 by immunoassays. We found a statistically significant age-independent decrease in the total IgE (P < 0.0001) and sCD30 (P < 0.0001) from 1987 to 2013. The significant decrease in serological Th2 markers (IgE and sCD30) between 1987 and 2013 is consistent with the drop in STH prevalence in this geographical area during the same period of time. Further studies might elucidate the clinical and epidemiological impact of these serological rearrangements.

Seroprevalence of West Nile and dengue virus in the human population of the Bolivian Chaco.

To determine the seroprevalence of antibodies against dengue virus (DENV) and West Nile virus (WNV) in the human population of the Bolivian Chaco, we tested 256 inhabitants of two rural communities. The seroprevalence, confirmed by plaque reduction neutralization test, was 7.8% and 2.7% for DENV and WNV, respectively.

Canine Trypanosoma cruzi infection in the Bolivian Chaco.

A cross-sectional study on Trypanosoma cruzi was carried out in 2013 to evaluate the role of dogs as possible source of infection for humans in two rural communities of the highly endemic Bolivian Chaco (Bartolo, Chuquisaca Department, n = 57 dogs; and Ivamirapinta, Santa Cruz Department, n = 48 dogs). Giemsa-stained thick and thin smears, rapid immunochromatographic test (ICT) (Chagas Quick test, Cypress Diagnostic, Belgium) and polymerase chain reaction for T. cruzi on dried blood spots were performed. All smears proved negative by microscopic examination, whereas 23/103 (22%) were positive by ICT and 5/105 (5%) blood samples contained T. cruzi DNA, evidencing the potential role of dogs in the domestic transmission of the parasite.

Hymenolepis nana-An Emerging Intestinal Parasite Associated with Anemia in School Children from the Bolivian Chaco.

Tropical anemia can have multiple causes, whether socioeconomic, dietary, or infectious. In the Bolivian Chaco, soil-transmitted helminthiases (STH), malaria, and Chagas disease are potential infectious causes of anemia among school-aged children (SAC). Following years of preventive chemotherapy with mebendazole, the prevalence of STH among SAC living in that area is now negligible, whereas protozoan infections are still highly prevalent (81%); Hymenolepis nana is the most frequent intestinal helminth (∼13%). We present results of hemoglobin (Hb) assessment and the association between parasitic infections and Hb levels of that SAC population. Overall, 511 SAC (girls:boys ratio 1:1, mean age 9.4 years [95% confidence interval {CI}: 9.3-9.5]) had Hb levels measured by using a point of care testing (HemoCue® Hb 301 System; HemoCue, Angelhome, Sweden). The prevalence of anemia was 23% (117/511), with mean and median Hb level = 12.2 g/dL (95% CI: 12.1-12.3; range 9.2-15.4 g/dL). By multivariate analysis, H. nana infection was associated with an increased risk of anemia (odds ratio 2.9, 95% CI: 1.5-5.7, P = 0.002). Two samples (0.5%) were positive for Trypanosoma cruzi and none for Plasmodium spp. by polymerase chain reaction of the 439 children tested. Anemia is still a concern among SAC living in the Bolivian Chaco. Our findings call for a greater attention to fecal-oral emerging pathogens, such as H. nana, and highlight the importance of water, sanitation, and hygiene improvements for disadvantaged population such as those living in the Bolivian Chaco.

Scaling down of a deworming programme among school-age children after a thirty-year successful intervention in the Bolivian Chaco.

OBJECTIVE: Preventive chemotherapy is the WHO-recommended control method for soil-transmitted helminthiases. In the Bolivian Chaco, 6-monthly single-dose mebendazole delivery to school-age children achieved a dramatic decrease in soil-transmitted helminthiases prevalence between 1987 and 2013. Consequently, in September 2016, preventive chemotherapy delivery was interrupted in nine rural communities. In compliance with WHO recommendations, we intensified surveillance to monitor soil-transmitted helminthiases prevalence and detect potential changes that would require interventions. METHODS: We conducted two cross-sectional parasitology surveys 12 months apart (September 2016-2017) among school-age children living in the communities where preventive chemotherapy delivery had been halted. Study design, methods of sampling and sample analysis technique (direct microscopy, Kato-Katz technique) followed WHO recommendations, aiming to obtain data representative of the Bolivian Chaco ecological zone. RESULTS: We collected 426 samples in 2016 and 520 in 2017. Soil-transmitted helminthiasis prevalence was unremarkable: 0.7% (95% CI 0-1.5%) in 2016 and 0.8% (0-1.5%) in 2017. Conversely, the prevalence of tapeworms (13% in 2016, 12% in 2017) and intestinal protozoan infections (81% in 2016 and 75% in 2017) continued to be high. CONCLUSIONS: Our findings support the role of preventive chemotherapy in reducing soil-transmitted helminthiases transmission, as otherwise poor hygienic and health conditions persist in the Bolivian Chaco. A national survey, involving areas from all the ecological zones of Bolivia, is now warranted.

Seroepidemiological trend of strongyloidiasis in the Bolivian Chaco (1987-2013) in the absence of disease-specific control measures.

OBJECTIVES: The prevalence of Strongyloides stercoralis infections is grossly underestimated because infections go mostly undetected, although they can persist for a lifetime due to the auto-infective cycle. In the Bolivian Chaco, the prevalence of soil-transmitted nematodes dropped dramatically in the past 25 years, but the mebendazole used for preventive chemotherapy has no effect on S. stercoralis. Meanwhile, the prevalence of intestinal protozoan infections remains unchanged. We compared S. stercoralis seroprevalence in rural communities of the Bolivian Chaco from 1987 to 2013. METHODS: Sera collected during two previous serosurveys, conducted in the Chaco region in 1987 and 2013, were tested for S. stercoralis using a commercial assay (Bordier-ELISA, Bordier Affinity Products, Switzerland). RESULTS: Overall, 355 sera were analysed, 122 from the 1987 survey and 233 from the 2013 survey. Seropositivity for S. stercoralis was significantly more prevalent in 1987 (19/122, 16% in 1987 vs. 15/233, 6% in 2013, P = 0.006), accounted for by a drop from 17% to 3% in people under 26 years of age. Multivariate analysis showed a significant association between seropositivity for S. stercoralis and age in the 2013 population (OR 1.03 for each one-year increase, 95%CI 1.00-1.05, P = 0.04), but none in 1987. CONCLUSIONS: The significant reduction in S. stercoralis seroprevalence in Bolivian Chaco cannot be explained by preventive chemotherapy or improved social-sanitary conditions. As the drop is seen in younger generations, it is consistent with little transmission occurring. However, the risk of transmission still exists, as prevalence is persistently high in older individuals, who present a potential reservoir due to the lifelong nature of S. stercoralis infections.

Intestinal parasitic infections and associated epidemiological drivers in two rural communities of the Bolivian Chaco.

INTRODUCTION: In 2013 a coproparasitological survey was carried out in two rural communities of the Bolivian Chaco to determine the prevalence of intestinal parasitic infections (IPIs) and to investigate on possible infection drivers through a questionnaire interview. METHODOLOGY: Faecal samples were examined by microscopy. Samples positive for Entamoeba histolytica complex and Blastocystis were molecularly examined to identify the species/subtypes involved. RESULTS: The overall infection rate was 86%, identical in both communities and mostly due to protozoa. Soil-transmitted helminths were detected in <3% of children and adults. DISCUSSION: The protozoa detected, including Blastocystis subtypes, indicate faecal contamination of the environment by both humans (as confirmed by the presence of Hymenolepis nana) and animals. Nested-PCR identified E. histolytica, thus signalling the possible occurrence of invasive amoebosis. Lack of safe water, environmental contamination, poor sanitation and hygiene, shared by both communities, are the main drivers of IPIs. In addition, unlike gender and socioeconomic factors, childhood (only for some species), crowding and cohabitation with animals proved to be further significant protozoon infection risk factors. CONCLUSIONS: These results highlight the need for the promotion of access to clean water, improved sanitation and better hygiene, thus reducing the frequency of preventive chemotherapy for STHs while continuing to monitor the population for possible recrudescence.

Human Babesiosis, Bolivia, 2013.

To investigate human babesiosis in the Bolivian Chaco, in 2013 we tested blood samples from 271 healthy persons living in 2 rural communities in this region. Microscopy and PCR indicated that 3.3% of persons were positive for Babesia microti parasites (US lineage); seroprevalence was 45.7%. Appropriate screening should mitigate the risk for transfusion-associated babesiosis.

Dramatic decrease in prevalence of soil-transmitted helminths and new insights into intestinal protozoa in children living in the Chaco region, Bolivia.

We assessed the prevalence of intestinal parasites among 268 2-12-year-old children living in rural areas, small villages, and semi-urban areas of the Chaco region, south-eastern Bolivia. The overall parasitism was 69%. Only protozoa, helminths, or co-infections were observed in 89.2%, 5.9%, or 4.9% of the positive children, respectively. A significant progressive increase in overall parasite prevalence was found when passing from rural areas to small villages and semi-urban areas. The most commonly found species were Entamoeba coli (38.4%), Giardia intestinalis (37.7%), and Blastocystis spp. (16%). Hymenolepis nana was the most prevalent helminth (5.6%), followed by Ascaris lumbricoides and hookworms (1.5% and 0.4%) evidenced only in rural areas and in villages. Molecular diagnostics identified Blastocystis subtypes 9 and 2, and 5 infections by Entamoeba histolytica and 4 by Entamoeba dispar. The dramatic decrease in prevalence of soil-transmitted helminths with respect to that observed about 20 years ago (> 40%) evidences the success of the preventive chemotherapy intervention implemented in 1986. Health education and improved sanitation should be intensified to control protozoan infections.

West Nile seroprevalence study in Bolivian horses, 2011.

West Nile virus (WNV) is a mosquito-borne virus belonging to the family Flaviviridae included in the Japanese encephalitis antigenic complex (JEAC). A seroepidemiological study was carried out in 2011 using 160 horse sera collected from different areas of Bolivia to investigate the presence of WNV antibody. A high proportion (59.4%) of the tested sera were positive to a commercially available WNV competitive enzyme-linked immunosorbent assay (C-ELISA). Sixty-six randomly selected C-ELISA-positive sera were further tested by WNV plaque reduction neutralization test (PRNT), virus neutralization (VN), and immunoglobulin M (IgM)-WNV ELISA to exclude false-positive results due to possible cross-reactions to other members of the JEAC and to investigate if the horses were recently infected. No WNV IgM was detected in these samples, whereas neutralizing antibodies were found in 21 and 18 samples by PRNT and VN, respectively. In conclusion, a high proportion of the Bolivian horses included in this study reacted serologically against viruses of the JEAC. WNV was partially responsible (31.8%) for these reactions, supporting the conclusion that WNV circulated in Bolivia.