Epidemiology of and Impact of Insecticide Spraying on Chagas Disease in Communities in the Bolivian Chaco

• Authors: Aaron M. Samuels, Centers for Disease Control and Prevention; Eva H. Clark, University of Alabama Birmingham; Gerson Galdos-Cardenas, Johns Hopkins Bloomberg Sch Publ Hlth; Ryan E. Wiegand, Centers for Disease Control and Prevention; Lisbeth Ferrufino, Hospital Universitario Japone; Silvio Menacho, Centro de Salud; Jose Gil, Universidad Nacional de Salta; Jennifer Oliver Spicer, Emory University; Julia Budde, Emory University; Michael Z. Levy, University of Pennsylvania; Ricardo W. Bozo, Hosp Municipal Camiri; Robert H. Gilman, Johns Hopkins Bloomberg School of Public Health; Caryn Bern, University of California San Francisco
• Journal Title: PLoS Neglected Tropical Diseases
• Volume: Volume 7, Number 8
• Publisher: Public Library of Science | 2013-08-01, Pages e2358-e2358
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1371/journal.pntd.0002358
• Subjects: Health Sciences, Epidemiology; Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Infectious Diseases; Parasitology; Tropical Medicine; TRYPANOSOMA-CRUZI INFECTION; TRIATOMA-INFESTANS HEMIPTERA; RURAL NORTHWESTERN ARGENTINA; DOMESTIC REINFESTATION; ENDEMIC AREA; RISK-FACTORS; GRAN CHACO; TRANSMISSION; REDUVIIDAE; VECTOR

Abstract

Background:Chagas disease control campaigns relying upon residual insecticide spraying have been successful in many Southern American countries. However, in some areas, rapid reinfestation and recrudescence of transmission have occurred.Methodology/Principal Findings:We conducted a cross-sectional survey in the Bolivian Chaco to evaluate prevalence of and risk factors for T. cruzi infection 11 years after two rounds of blanket insecticide application. We used a cubic B-spline model to estimate change in force of infection over time based on age-specific seroprevalence data. Overall T. cruzi seroprevalence was 51.7%. The prevalence was 19.8% among children 2-15, 72.7% among those 15-30 and 97.1% among participants older than 30 years. Based on the model, the estimated annual force of infection was 4.3% over the two years before the first blanket spray in 2000 and fell to 0.4% for 2001-2002. The estimated annual force of infection for 2004-2005, the 2 year period following the second blanket spray, was 4.6%. However, the 95% bootstrap confidence intervals overlap for all of these estimates. In a multivariable model, only sleeping in a structure with cracks in the walls (aOR = 2.35; 95% CI = 1.15-4.78), age and village of residence were associated with infection.Conclusions/Significance:As in other areas in the Chaco, we found an extremely high prevalence of Chagas disease. Despite evidence that blanket insecticide application in 2000 may have decreased the force of infection, active transmission is ongoing. Continued spraying vigilance, infestation surveillance, and systematic household improvements are necessary to disrupt and sustain interruption of infection transmission.