Abstract
BackgroundIn Brazil, tungiasis is endemic in some resource-poor communities where various domestic and sylvatic animals act as reservoirs for this zoonosis. To determine the effect of control measures on the prevalence and intensity of infestation of human and animal tungiasis, a repeated cross-sectional survey with intervention was carried out.Methodology/Principal FindingsIn a traditional fishing community in Northeast Brazil, humans and reservoir animals were treated, and premise-spraying using an insecticide was done, while a second fishing community served as a control. Both communities were followed up 10 times during a 12-month period. At baseline, prevalence of tungiasis was 43% (95% confidence interval [CI]: 35%–51%) and 37% (95% CI: 31%–43%) in control and intervention villages, respectively. During the study, prevalence of tungiasis dropped to 10% (95% CI: 8%–13%; p<0.001) in the intervention village, while the prevalence remained at a high level in the control village. However, after one year, at the end of the study, in both communities the prevalence of the infestation had reached pre-intervention levels. Whereas the intensity of infestation was significantly reduced in the intervention community (p<0.001), and remained low at the end of the study (p<0.001), it did not change in the control village.Conclusion/SignificanceOur study shows that a reduction of prevalence and intensity of infestation is possible, but in impoverished communities a long-lasting reduction of disease occurrence can only be achieved by the regular treatment of infested humans, the elimination of animal reservoirs, and, likely, through environmental changes.Trial RegistrationControlled-Trials.com ISRCTN27670575
Highlights
Tungiasis is a parasitic disease caused by the sand flea Tunga penetrans
Tungiasis is a disease caused by the sand flea Tunga penetrans, a parasite prevalent in many impoverished communities in developing countries
We investigated the impact of a package of intervention measures targeted against on-host and off-host stages of T. penetrans in a fishing community in Northeast Brazil
Summary
Tungiasis is a parasitic disease caused by the sand flea Tunga penetrans. The occurrence of tungiasis is confined to resource-poor communities located at the coast or in the rural hinterland, and to slums of rapidly growing urban agglomerations in Latin America, the Caribbean and Sub-Saharan Africa [2,3]. In these settings prevalences range between 15% and 51% [2,4,5,6]. Intensity of infestation, and morbidity are positively related [7], debilitating and disfiguring sequels are common in resource-poor rural and urban communities. To determine the effect of control measures on the prevalence and intensity of infestation of human and animal tungiasis, a repeated cross-sectional survey with intervention was carried out
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