1. A History of Chagas Disease Transmission, Control, and Re-Emergence in Peri-Rural La Joya, Peru
- Author
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Robert H. Gilman, Stephen Delgado, Charles R. Sterling, Ricardo Castillo Neyra, Víctor R. Quispe Machaca, Manuela Verastegui, Andrew C. Comrie, Aaron W. Tustin, Caryn Bern, César D. Bocángel, César Náquira, Lily Chou Chu, Juan G. Cornejo del Carpio, Michael J. Levy, Jenny Ancca Juárez, and Giovanna M. Moscoso Apaza
- Subjects
Male ,Rural Population ,Time Factors ,recurrent disease ,Cross-sectional study ,RC955-962 ,serology ,Antibodies, Protozoan ,disease carrier ,law.invention ,immunology ,0302 clinical medicine ,law ,Recurrence ,Seroepidemiologic Studies ,Arctic medicine. Tropical medicine ,11. Sustainability ,Peru ,Credible interval ,protozoon antibody ,Child ,disease transmission ,2. Zero hunger ,0303 health sciences ,biology ,Incidence (epidemiology) ,methodology ,Middle Aged ,infection control ,3. Good health ,Infectious Diseases ,Transmission (mechanics) ,Triatoma ,parasitosis ,epidemiology ,Female ,Topography, Medical ,history ,Public aspects of medicine ,RA1-1270 ,purl.org/pe-repo/ocde/ford#3.03.06 [https] ,Research Article ,Chagas disease ,Adult ,Adolescent ,Trypanosoma cruzi ,030231 tropical medicine ,vector control ,rural area ,History, 21st Century ,Insect Control ,03 medical and health sciences ,Young Adult ,blood ,medicine ,Humans ,controlled study ,Chagas Disease ,030304 developmental biology ,zoology ,Public Health, Environmental and Occupational Health ,History, 20th Century ,school child ,biology.organism_classification ,medicine.disease ,major clinical study ,Cross-Sectional Studies ,Infectious Diseases/Neglected Tropical Diseases ,Vector (epidemiology) ,Immunology ,Communicable Disease Control ,incidence ,cluster analysis ,Demography - Abstract
Background The history of Chagas disease control in Peru and many other nations is marked by scattered and poorly documented vector control campaigns. The complexities of human migration and sporadic control campaigns complicate evaluation of the burden of Chagas disease and dynamics of Trypanosoma cruzi transmission. Methodology/Principal Findings We conducted a cross-sectional serological and entomological study to evaluate temporal and spatial patterns of T. cruzi transmission in a peri-rural region of La Joya, Peru. We use a multivariate catalytic model and Bayesian methods to estimate incidence of infection over time and thereby elucidate the complex history of transmission in the area. Of 1,333 study participants, 101 (7.6%; 95% CI: 6.2–9.0%) were confirmed T. cruzi seropositive. Spatial clustering of parasitic infection was found in vector insects, but not in human cases. Expanded catalytic models suggest that transmission was interrupted in the study area in 1996 (95% credible interval: 1991–2000), with a resultant decline in the average annual incidence of infection from 0.9% (95% credible interval: 0.6–1.3%) to 0.1% (95% credible interval: 0.005–0.3%). Through a search of archival newspaper reports, we uncovered documentation of a 1995 vector control campaign, and thereby independently validated the model estimates. Conclusions/Significance High levels of T. cruzi transmission had been ongoing in peri-rural La Joya prior to interruption of parasite transmission through a little-documented vector control campaign in 1995. Despite the efficacy of the 1995 control campaign, T. cruzi was rapidly reemerging in vector populations in La Joya, emphasizing the need for continuing surveillance and control at the rural-urban interface., Author Summary The historically rural problem of Chagas disease is increasing in urban areas in Latin America. Peri-rural development may play a critical role in the urbanization of Chagas disease and other parasitic infections. We conducted a cross-sectional study in an urbanizing rural area in southern Peru, and we encountered a complex history of Chagas disease in this peri-rural environment. Specifically, we discovered: (1) long-standing parasite transmission leading to substantial burden of infection; (2) interruption in parasite transmission resulting from an undocumented insecticide application campaign; (3) relatively rapid re-emergence of parasite-infected vector insects resulting from an unsustained control campaign; (4) extensive migration among peri-rural inhabitants. Long-standing parasite infection in peri-rural areas with highly mobile populations provides a plausible mechanism for the expansion of parasite transmission to nearby urban centers. Lack of commitment to control campaigns in peri-rural areas may have unforeseen and undesired consequences for nearby urban centers. Novel methods and perspectives are needed to address the complexities of human migration and erratic interventions.
- Published
- 2011