A history of chagas disease transmission, control, and re-emergence in peri-rural La Joya, Peru.
A history of chagas disease transmission, control, and re-emergence in peri-rural La Joya, Peru.
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DOI：
10.1371/journal.pntd.0000970
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发表时间：
2011-02-22
影响因子：
3.8
通讯作者：
Levy MZ
中科院分区：
文献类型：
--
作者：
Delgado S;Castillo Neyra R;Quispe Machaca VR;Ancca Juárez J;Chou Chu L;Verastegui MR;Moscoso Apaza GM;Bocángel CD;Tustin AW;Sterling CR;Comrie AC;Náquira C;Cornejo del Carpio JG;Gilman RH;Bern C;Levy MZ
秘鲁和许多其他国家的恰加斯病控制历史的特点是分散的病媒控制运动和缺乏记录。人类迁徙和零星控制运动的复杂性使对恰加斯病负担和克氏锥虫传播动态的评估复杂化。我们进行了一项横断面血清学和昆虫学研究，以评估秘鲁拉霍亚农村地区克氏锥虫传播的时空格局。我们使用多元催化模型和贝叶斯方法来估计感染随时间的发生率，从而阐明该地区复杂的传播历史。在1333名研究参与者中，101名（7.6%;95% CI: 6.2-9.0%）被证实克氏弓形虫血清阳性。在媒介昆虫中发现了寄生虫感染的空间聚集性，但在人类病例中没有发现。扩大的催化模型表明，1996年研究地区的传播被阻断（95%可信区间：1991-2000年），导致年平均感染率从0.9%（95%可信区间：0.6-1.3%）下降到0.1%（95%可信区间：0.005-0.3%）。通过对档案报纸报道的搜索，我们发现了1995年病媒控制运动的文件，从而独立验证了模型估计。在1995年通过一项文献很少的病媒控制运动阻断寄生虫传播之前，拉霍亚农村地区一直存在高水平的克氏体传播。尽管1995年的控制运动取得了成效，但克氏锥虫病正在拉霍亚的病媒种群中迅速重新出现，这强调需要在城乡结合部继续进行监测和控制。拉丁美洲城市地区历来存在的恰加斯病农村问题日益严重。农村周边地区的发展可能在南美锥虫病和其他寄生虫感染的城市化进程中发挥关键作用。我们在秘鲁南部一个正在城市化的农村地区进行了一项横断面研究，我们在这个农村周边环境中遇到了复杂的恰加斯病病史。具体来说，我们发现：(1)长期存在的寄生虫传播导致了严重的感染负担；(2)未登记的杀虫剂使用活动导致寄生虫传播中断；(3)由于控制运动不持久，感染寄生虫的病媒昆虫相对迅速地重新出现；(4)近郊人口大量迁移。人口高度流动的农村周边地区长期存在的寄生虫感染为寄生虫向附近城市中心传播提供了一种合理的机制。缺乏对农村周边地区控制运动的承诺可能会对附近的城市中心产生不可预见和不希望的后果。需要新的方法和观点来解决人类迁移和不稳定干预的复杂性。
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. 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. 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. 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.
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影响因子：
3.2
作者：
Marcet, P. L.;Mora, M. S.;Cutrera, A. P.;Jones, L.;Guertler, R. E.;Kitron, U.;Dotson, E. M.
通讯作者：
Dotson, E. M.
影响因子：
11.8
作者：
Levy MZ;Bowman NM;Kawai V;Waller LA;Cornejo del Carpio JG;Cordova Benzaquen E;Gilman RH;Bern C
通讯作者：
Bern C
影响因子：
5
作者：
Armstrong, GL;Schillinger, J;St Louis, ME
通讯作者：
St Louis, ME
影响因子：
2.7
作者：
HASTINGS, WK
通讯作者：
HASTINGS, WK
DOI：
10.1590/s0074-02762002000500002
发表时间：
2002-07-01
期刊：
Memórias do Instituto Oswaldo Cruz
影响因子：
--
作者：
Dias, JCP;Silveira, AC;Schofield, CJ
通讯作者：
Schofield, CJ