Chagas disease in the Amazon Region
Chagas disease in the Amazon Region
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DOI：
10.1590/s0074-02762007005000098
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发表时间：
2007-10-01
期刊：
影响因子：
--
通讯作者：
Coura, José Rodrigues
中科院分区：
文献类型：
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作者：
Aguilar, Hugo Marcelo;Abad-Franch, Fernando;Coura, José Rodrigues
查加斯病成为亚马孙地区（世界上最大的热带生物群落，目前居住着3 000多万人）一个主要地方病威胁的风险涉及一系列复杂的相互作用的生物和社会决定因素。这些因素包括来自地方病流行区的大量移民（可能引入寄生虫和病媒），不受控制的森林砍伐造成的广泛景观改造，以及野生克氏锥虫宿主和病媒（9属25种）的巨大多样性，这些宿主和病媒保持着强烈的森林传播周期。外来媒介入侵房屋（感染率> 60%）是常见的，已有报道称本地锥蝽对人工结构的局部适应。毫无疑问，该地区有记录显示，当地人患有急性（约500例）和慢性恰加斯病。持续、低强度的传播似乎发生在整个亚马逊地区，并产生了血清阳性率接近1- 3%的低流行模式。也存在传播更强烈的离散病灶（例如，在局部爆发中可能与口腔传播有关）且患病率更高。急性病例的早期发现和治疗对于避免南美锥虫病在亚马孙地区的地方性传播进一步扩散至关重要，这将需要疟疾控制和初级保健系统的参与。仍然需要进行全面的生态流行病学研究，包括流行率调查或不同生态环境中传播动态的特征描述。亚马孙查加斯病监测和预防国际倡议为建立必要的政治和科学合作网络提供了框架，以应对在亚马孙地区预防查加斯病的挑战。
The risk that Chagas disease becomes established as a major endemic threat in Amazonia (the world's largest tropical biome, today inhabited by over 30 million people) relates to a complex set of interacting biological and social determinants. These include intense immigration from endemic areas (possibly introducing parasites and vectors), extensive landscape transformation with uncontrolled deforestation, and the great diversity of wild Trypanosoma cruzi reservoir hosts and vectors (25 species in nine genera), which maintain intense sylvatic transmission cycles. Invasion of houses by adventitious vectors (with infection rates > 60%) is common, and focal adaptation of native triatomines to artificial structures has been reported. Both acute (similar to 500) and chronic cases of autochthonous human Chagas disease have been documented beyond doubt in the region. Continuous, low-intensity transmission seems to occur throughout the Amazon, and generates a hypoendemic pattern with seropositivity rates of similar to 1-3%. Discrete foci also exist in which transmission is more intense (e.g., in localized outbreaks probably linked to oral transmission) and prevalence rates higher. Early detection-treatment of acute cases is crucial for avoiding further dispersion of endemic transmission of Chagas disease in Amazonia, and will require the involvement of malaria control and primary health care systems. Comprehensive eco-epidemiological research, including prevalence surveys or the characterization of transmission dynamics in different ecological settings, is still needed. The International Initiative for Chagas Disesae Surveillance and Prevention in the Amazon provides the framework for building up the political and scientific cooperation networks required to confront the challenge of preventing Chagas disease in Amazonia.