Chagas disease: control, elimination and eradication. Is it possible?
Chagas disease: control, elimination and eradication. Is it possible?
复制标题
DOI：
10.1590/0074-0276130565
复制
发表时间：
2013-12-01
期刊：
影响因子：
--
通讯作者：
Coura, Jose Rodrigues
中科院分区：
文献类型：
--
作者：
Coura, Jose Rodrigues
从流行病学的角度来看，恰加斯病及其宿主和媒介可以呈现以下特征：（i）由野生动物和媒介维持的地方性动物传播，从美国南部到阿根廷南部和智利（北纬42度，南纬49度）广泛发生；（ii）人畜共患病，当人类侵入野生生态环境并从野生动物或媒介感染克氏锥虫时，或者媒介和野生动物，特别是当人类侵入野生生态环境并被野生动物或媒介感染克氏锥虫时，有袋类动物侵入人类住所并感染人类，(iii) 人畜共患病 - 两栖动物病以及流行地区家养媒介在动物与人类之间的交换感染，以及 (iv) 人畜共患病，即通过家养媒介从人传染给动物的感染，这是南美锥虫病流行地区最罕见的情况。查加斯病作为野生动物地方性动物和人畜共患病的特征，在巴西亚马逊地区和整个泛亚马逊地区最为常见，该地区有袋类、翼手类、啮齿类、齿类（Xenarthra）、食肉类和灵长目等六属33种野生动物以及27种锥蝽，其中大多数感染克氏锥虫。这些情况使该地区的居民或其游客——游客、猎人、渔民，尤其是以植物提取为生的人们——面临感染南美锥虫病的风险。另一方面，该地区通过克氏锥虫经口传播的恰加斯病急性病例呈指数增长，导致该病暴发。 1991年、1993年、1997年和2010年在亚马逊州内格罗河微区地区进行的四次血清流行病学调查中，我们发现大量克氏锥虫感染血清学呈阳性的人。他们中的大多数人和/或其亲属从事皮亚萨瓦提取工作，并接触过该地区的野生锥蝽并被其蜇伤。最后，目前非常明显的一个特征是恰加斯病患者从拉丁美洲流行地区迁移到非流行国家。这给这些国家带来了新的困境：通过输血传播的风险以及控制捐献者和治疗患有该疾病的移民的责任。作为一种野生动物和媒介动物以及一种人畜共患病，恰加斯病无法根除，但必须通过消除向人类的传播来控制它。
From an epidemiological point of view, Chagas disease and its reservoirs and vectors can present the following characteristics: (i) enzooty, maintained by wild animals and vectors, with broad occurrence from southern United States of America (USA) to southern Argentina and Chile (42 degrees N 49 degrees S), (ii) anthropozoonosis, when man invades the wild ecotope and becomes infected with Trypanosoma cruzi from wild animals or vectors or when the vectors and wild animals, especially marsupials, invade the human domicile and infect man, (iii) zoonosis-amphixenosis and exchanged infection between animals and humans by domestic vectors in endemic areas and (iv) zooanthroponosis, infection that is transmitted from man to animals, by means of domestic vectors, which is the rarest situation in areas endemic for Chagas disease. The characteristics of Chagas disease as an enzooty of wild animals and as an anthropozoonosis are seen most frequently in the Brazilian Amazon and in the Pan-Amazon region as a whole, where there are 33 species of six genera of wild animals: Marsupialia, Chiroptera, Rodentia, Edentata (Xenarthra), Carnivora and Primata and 27 species of triatomines, most of which infected with T. cruzi. These conditions place the resident populations of this area or its visitors - tourists, hunters, fishermen and especially the people whose livelihood involves plant extraction - at risk of being affected by Chagas disease. On the other hand, there has been an exponential increase in the acute cases of Chagas disease in that region through oral transmission of T. cruzi, causing outbreaks of the disease. In four seroepidemiological surveys that were carried out in areas of the microregion of the Negro River, state of Amazonas, in 1991, 1993, 1997 and 2010, we found large numbers of people who were serologically positive for T. cruzi infection. The majority of them and/or their relatives worked in piassava extraction and had come into contact with and were stung by wild triatomines in that area. Finally, a characteristic that is greatly in evidence currently is the migration of people with Chagas disease from endemic areas of Latin America to non-endemic countries. This has created a new dilemma for these countries: the risk of transmission through blood transfusion and the onus of controlling donors and treating migrants with the disease. As an enzooty of wild animals and vectors, and as an anthropozoonosis, Chagas disease cannot be eradicated, but it must be controlled by transmission elimination to man.