Background:Chagas disease is one of the neglected tropical diseases(NTDs).International goals for its control involve elimination of vector-borne transmission.Central American countries face challenges in establishing...Background:Chagas disease is one of the neglected tropical diseases(NTDs).International goals for its control involve elimination of vector-borne transmission.Central American countries face challenges in establishing sustainable vector control programmes,since the main vector,Triatoma dimidiata,cannot be eliminated.In 2012,the Ministry of Health in Nicaragua started a field test of a vector surveillance-response system to control domestic vector infestation.This paper reports the main findings from this pilot study.Methods:This study was carried out from 2012 to 2015 in the Municipality of Totogalpa.The Japan International Cooperation Agency provided technical cooperation in designing and monitoring the surveillance-response system until 2014.This system involved 1)vector reports by householders to health facilities,2)data analysis and planning of responses at the municipal health centre and 3)house visits or insecticide spraying by health personnel as a response.We registered all vector reports and responses in a digital database.The collected data were used to describe and analyse the system performance in terms of amount of vector reports as well as rates and timeliness of responses.Results:During the study period,T.dimidiata was reported 396 times.Spatiotemporal analysis identified some high-risk clusters.All houses reported to be infested were visited by health personnel in 2013 and this response rate dropped to 39%in 2015.Rates of insecticide spraying rose above 80%in 2013 but no spraying was carried out in the following 2 years.The timeliness of house visits improved significantly after the responsibility was transferred from a vector control technician to primary health care staff.Conclusions:We argue that the proposed vector surveillance-response system is workable within the resourceconstrained health system in Nicaragua.Integration to the primary health care services was a key to improve the system performance.Continual efforts are necessary to keep adapting the surveillance-response system to the dynamic health systems.We also discuss that the goal of eliminating vector-borne transmission remains unachievable.This paper provides lessons not only for Chagas disease control in Central America,but also for control efforts for other NTDs that need a sustainable surveillance-response system to support elimination.展开更多
Background:Since the late twentieth century,Chagas disease gained global attention to suppress the vector burden as a main control strategy in endemic countries.In Central America,multi-national initiative successfull...Background:Since the late twentieth century,Chagas disease gained global attention to suppress the vector burden as a main control strategy in endemic countries.In Central America,multi-national initiative successfully achieved significant reduction in the estimated disease prevalence as well as elimination of the region's principal vector species at the time in 2012.While the last decade has witnessed significant changes in ecosystem-such as urbanization and replacement of the main vector species-that can possibly affect the vector's habitation and residual transmission,the up-to-date vector burden in the region has not been evaluated thoroughly due to the cessation of active vector surveillance.The aim of this study was to update the risk of vector-borne Trypanosoma cruzi infection in El Salvador,the top Chagas disease-endemic country in Central America.Methods:A nationwide vector survey was conducted in the domestic environment of El Salvador from September 2018 to November 2020.The selection of the houses for inspection was based on expert purposeful sampling.Infection for T.cruzi was examined by microscopic observation of the insects'feces,followed by a species confrmation using PCR.The data were analyzed using R software version 4.1.3.Proportion estimates with 95%confidence intervals were inferred using the Jeffrey's method provided under the epiR package.Results:A total of 1529 Triatoma dimidiata was captured from 107 houses(infestation rate,34.4%;107/311)in all the fourteen departments of the country visited within the period;prevalence of T.cruzi infection was as high as 10%(153/1529).In the country,domestic T.dimidiata infestation was distributed ubiquitously,while T.cruzi infection rates varied across the departments.Five out of fourteen departments showed higher infection rates than the average,suggesting sporadic high-risk areas in the country.Conclusions:Our comprehensive study revealed substantial T.cruzi infection of T.dimidiata across the country,indicating potential active transmission of the disease.Therefore,strengthened surveillance for both vector and human infection is required to truly eliminate the risk of T.cruzi transmission in Central America.展开更多
基金This study used funding from the Ministry of Health in Nicaragua(MoH)and Japan International Cooperation Agency(JICA)The MoH played an important role in the design of the study and data collection as described in the paper.Neither organization were not involved in analysing and interpreting data or in writing the manuscript.
文摘Background:Chagas disease is one of the neglected tropical diseases(NTDs).International goals for its control involve elimination of vector-borne transmission.Central American countries face challenges in establishing sustainable vector control programmes,since the main vector,Triatoma dimidiata,cannot be eliminated.In 2012,the Ministry of Health in Nicaragua started a field test of a vector surveillance-response system to control domestic vector infestation.This paper reports the main findings from this pilot study.Methods:This study was carried out from 2012 to 2015 in the Municipality of Totogalpa.The Japan International Cooperation Agency provided technical cooperation in designing and monitoring the surveillance-response system until 2014.This system involved 1)vector reports by householders to health facilities,2)data analysis and planning of responses at the municipal health centre and 3)house visits or insecticide spraying by health personnel as a response.We registered all vector reports and responses in a digital database.The collected data were used to describe and analyse the system performance in terms of amount of vector reports as well as rates and timeliness of responses.Results:During the study period,T.dimidiata was reported 396 times.Spatiotemporal analysis identified some high-risk clusters.All houses reported to be infested were visited by health personnel in 2013 and this response rate dropped to 39%in 2015.Rates of insecticide spraying rose above 80%in 2013 but no spraying was carried out in the following 2 years.The timeliness of house visits improved significantly after the responsibility was transferred from a vector control technician to primary health care staff.Conclusions:We argue that the proposed vector surveillance-response system is workable within the resourceconstrained health system in Nicaragua.Integration to the primary health care services was a key to improve the system performance.Continual efforts are necessary to keep adapting the surveillance-response system to the dynamic health systems.We also discuss that the goal of eliminating vector-borne transmission remains unachievable.This paper provides lessons not only for Chagas disease control in Central America,but also for control efforts for other NTDs that need a sustainable surveillance-response system to support elimination.
文摘Background:Since the late twentieth century,Chagas disease gained global attention to suppress the vector burden as a main control strategy in endemic countries.In Central America,multi-national initiative successfully achieved significant reduction in the estimated disease prevalence as well as elimination of the region's principal vector species at the time in 2012.While the last decade has witnessed significant changes in ecosystem-such as urbanization and replacement of the main vector species-that can possibly affect the vector's habitation and residual transmission,the up-to-date vector burden in the region has not been evaluated thoroughly due to the cessation of active vector surveillance.The aim of this study was to update the risk of vector-borne Trypanosoma cruzi infection in El Salvador,the top Chagas disease-endemic country in Central America.Methods:A nationwide vector survey was conducted in the domestic environment of El Salvador from September 2018 to November 2020.The selection of the houses for inspection was based on expert purposeful sampling.Infection for T.cruzi was examined by microscopic observation of the insects'feces,followed by a species confrmation using PCR.The data were analyzed using R software version 4.1.3.Proportion estimates with 95%confidence intervals were inferred using the Jeffrey's method provided under the epiR package.Results:A total of 1529 Triatoma dimidiata was captured from 107 houses(infestation rate,34.4%;107/311)in all the fourteen departments of the country visited within the period;prevalence of T.cruzi infection was as high as 10%(153/1529).In the country,domestic T.dimidiata infestation was distributed ubiquitously,while T.cruzi infection rates varied across the departments.Five out of fourteen departments showed higher infection rates than the average,suggesting sporadic high-risk areas in the country.Conclusions:Our comprehensive study revealed substantial T.cruzi infection of T.dimidiata across the country,indicating potential active transmission of the disease.Therefore,strengthened surveillance for both vector and human infection is required to truly eliminate the risk of T.cruzi transmission in Central America.
