Abstract
BackgroundMillions of people are infected with Trypanosoma cruzi, the causative agent of Chagas disease in Latin America. Anti-trypanosomal drug therapy can cure infected individuals, but treatment efficacy is highest early in infection. Vector control campaigns disrupt transmission of T. cruzi, but without timely diagnosis, children infected prior to vector control often miss the window of opportunity for effective chemotherapy.Methods and FindingsWe performed a serological survey in children 2–18 years old living in a peri-urban community of Arequipa, Peru, and linked the results to entomologic, spatial and census data gathered during a vector control campaign. 23 of 433 (5.3% [95% CI 3.4–7.9]) children were confirmed seropositive for T. cruzi infection by two methods. Spatial analysis revealed that households with infected children were very tightly clustered within looser clusters of households with parasite-infected vectors. Bayesian hierarchical mixed models, which controlled for clustering of infection, showed that a child's risk of being seropositive increased by 20% per year of age and 4% per vector captured within the child's house. Receiver operator characteristic (ROC) plots of best-fit models suggest that more than 83% of infected children could be identified while testing only 22% of eligible children.ConclusionsWe found evidence of spatially-focal vector-borne T. cruzi transmission in peri-urban Arequipa. Ongoing vector control campaigns, in addition to preventing further parasite transmission, facilitate the collection of data essential to identifying children at high risk of T. cruzi infection. Targeted screening strategies could make integration of diagnosis and treatment of children into Chagas disease control programs feasible in lower-resource settings.
Highlights
An estimated 11 million people are currently infected with the causative agent of Chagas disease, Trypanosoma cruzi, in Latin America [1,2]
Many countries have implemented Chagas disease control activities, though most focus on interruption of T. cruzi transmission rather than surveillance for infection among human populations at risk
At the time of insecticide application, 194 (52.0%) households were found to be infested with Triatoma infestans, and 72 (19.3%) were infested with triatomines carrying T. cruzi [10]
Summary
An estimated 11 million people are currently infected with the causative agent of Chagas disease, Trypanosoma cruzi, in Latin America [1,2]. Many countries have implemented Chagas disease control activities, though most focus on interruption of T. cruzi transmission rather than surveillance for infection among human populations at risk. The World Health Organization recommends serologic diagnosis and drug treatment of all T. cruzi-infected children in affected areas, national control programs in Peru and other countries have not had sufficient resources for comprehensive serological screening [3]. Millions of people are infected with Trypanosoma cruzi, the causative agent of Chagas disease in Latin America. Vector control campaigns disrupt transmission of T. cruzi, but without timely diagnosis, children infected prior to vector control often miss the window of opportunity for effective chemotherapy
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