An innovative ecohealth intervention for Chagas disease vector control in Yucatan, Mexico.

Non-domiciliated (intrusive) triatomine vectors remain a challenge for the sustainability of Chagas disease vector control as these triatomines are able to transiently (re-)infest houses. One of the best-characterized examples is Triatoma dimidiata from the Yucatan peninsula, Mexico, where adult insects seasonally infest houses between March and July. We focused our study on three rural villages in the state of Yucatan, Mexico, in which we performed a situation analysis as a first step before the implementation of an ecohealth (ecosystem approach to health) vector control intervention. The identification of the key determinants affecting the transient invasion of human dwellings by T. dimidiata was performed by exploring associations between bug presence and qualitative and quantitative variables describing the ecological, biological and social context of the communities. We then used a participatory action research approach for implementation and evaluation of a control strategy based on window insect screens to reduce house infestation by T. dimidiata. This ecohealth approach may represent a valuable alternative to vertically-organized insecticide spraying. Further evaluation may confirm that it is sustainable and provides effective control (in the sense of limiting infestation of human dwellings and vector/human contacts) of intrusive triatomines in the region.

Waleckx E ，Camara-Mejia J ，Ramirez-Sierra MJ ，Cruz-Chan V ，Rosado-Vallado M ，Vazquez-Narvaez S ，Najera-Vazquez R ，Gourbière S ，Dumonteil E ... -  《-》

Non-randomized controlled trial of the long-term efficacy of an Ecohealth intervention against Chagas disease in Yucatan, Mexico.

Non-domiciliated intrusive triatomine vectors are responsible for a low but significant transmission of Trypanosoma cruzi to humans. Their control is a challenge as insecticide spraying is of limited usefulness, and alternative strategies need to be developed for a sustainable control. We performed a non-randomized controlled trial of an Ecohealth intervention based on window insect screens and community participation to reduce house infestation by Triatoma dimidiata in two rural villages in Yucatan, Mexico. Efficacy of the intervention was measured over a three years follow-up period and entomological indicators showed that the proportion of triatomines found inside houses was significantly reduced in houses with insect screens, which effectively kept more bugs on the outside of houses. Using a previously developed model linking entomological data to the prevalence of infection in human, we predicted that the intervention would lead to a 32% reduction in yearly incidence and in the prevalence of T. cruzi infection. The cost for the coverage of all the windows of a house was of comparable magnitude to what families currently spend on various domestic insecticide, and most screens were still in good conditions after three years. In conclusion, the Ecohealth approach proposed here is effective for the long-term and sustainable control of intrusive T. dimidiata vectors in the Yucatan peninsula, Mexico. This strategy may also be easily adapted to other intrusive triatomine species as well as other regions/countries with comparable eco-epidemiological settings, and would be an excellent component of a larger integrated program for the control of a variety of other vector-borne diseases, bringing additional benefits to the communities. Our results should encourage a further scaling-up of our implementation strategy in additional villages in the region.

Waleckx E ，Pérez-Carrillo S ，Chávez-Lazo S ，Pasos-Alquicira R ，Cámara-Heredia M ，Acuña-Lizama J ，Collí-Balám F ，Cámara-Mejía J ，Ramírez-Sierra MJ ，Cruz-Chan V ，Rosado-Vallado M ，Vázquez-Narvaez S ，Najera-Vázquez R ，Gourbière S ，Dumonteil E ... -  《PLoS Neglected Tropical Diseases》

Patterns of house infestation dynamics by non-domiciliated Triatoma dimidiata reveal a spatial gradient of infestation in rural villages and potential insect manipulation by Trypanosoma cruzi.

Chagas disease is a major vector-borne parasitic disease in Latin America, primarily transmitted to humans by triatomine vectors. Non-domiciliated triatomine species such as Triatoma dimidiata in the Yucatan peninsula, Mexico, can transiently invade houses and are emerging as a major challenge to control Trypanosoma cruzi transmission to humans. We analyzed the spatio-temporal spreading of house infestation by T. dimidiata in four rural villages. Triatomines were collected in four rural villages over a 2 years period, and the spatio-temporal patterns of infestation were analyzed. Triatomines were consistently more abundant at the periphery of villages than in centers, indicating a much higher risk of T. cruzi transmission at the periphery. Male T. dimidiata were found further in the center of the village, while females remained closer to the periphery, suggesting differential dispersal capabilities between sexes, although the timing of dispersal appeared identical. Surprisingly, infected females were consistently collected in houses much further from the surrounding bushes than non-infected females, while the distribution of males was unaffected by their T. cruzi infection status, suggesting an increased dispersal capability in infected females. The spatial structure of infestation should be taken into account for the prioritization of vector control activities within villages, and spatially targeted interventions may be explored. A potential vector manipulation by T. cruzi, observed for the first time in triatomines, may favor parasite transmission to new hosts.

Ramirez-Sierra MJ ，Herrera-Aguilar M ，Gourbière S ，Dumonteil E ... -  《-》

Eco-bio-social research on community-based approaches for Chagas disease vector control in Latin America.

This article provides an overview of three research projects which designed and implemented innovative interventions for Chagas disease vector control in Bolivia, Guatemala and Mexico. The research initiative was based on sound principles of community-based ecosystem management (ecohealth), integrated vector management, and interdisciplinary analysis. The initial situational analysis achieved a better understanding of ecological, biological and social determinants of domestic infestation. The key factors identified included: housing quality; type of peridomestic habitats; presence and abundance of domestic dogs, chickens and synanthropic rodents; proximity to public lights; location in the periphery of the village. In Bolivia, plastering of mud walls with appropriate local materials and regular cleaning of beds and of clothes next to the walls, substantially decreased domestic infestation and abundance of the insect vector Triatoma infestans. The Guatemalan project revealed close links between house infestation by rodents and Triatoma dimidiata, and vector infection with Trypanosoma cruzi. A novel community-operated rodent control program significantly reduced rodent infestation and bug infection. In Mexico, large-scale implementation of window screens translated into promising reductions in domestic infestation. A multi-pronged approach including community mobilisation and empowerment, intersectoral cooperation and adhesion to integrated vector management principles may be the key to sustainable vector and disease control in the affected regions.

Gürtler RE ，Yadon ZE 《-》

CHICKEN COOPS, Triatoma dimidiata INFESTATION AND ITS INFECTION WITH Trypanosoma cruzi IN A RURAL VILLAGE OF YUCATAN, MEXICO.

This study longitudinally investigated the association between Triatoma dimidiata infestation, triatomine infection with Trypanosoma cruzi and household/backyard environmental characteristics in 101 homesteads in Molas and Yucatan, Mexico, between November 2009 (rainy season) and May 2010 (dry season). Logistic regression models tested the associations between insect infestation/infection and potential household-level risk factors. A total of 200 T. dimidiata were collected from 35.6% of the homesteads, mostly (73%) from the peridomicile. Of all the insects collected, 48% were infected with T. cruzi. Infected insects were collected in 31.6% of the homesteads (54.1% and 45.9% intra- and peridomiciliary, respectively). Approximately 30% of all triatomines collected were found in chicken coops. The presence of a chicken coop in the backyard of a homestead was significantly associated with both the odds of finding T. dimidiata (OR = 4.10, CI 95% = 1.61-10.43, p = 0.003) and the presence of triatomines infected with T. cruzi (OR = 3.37, CI 95% = 1.36-8.33, p = 0.006). The results of this study emphasize the relevance of chicken coops as a putative source of T. dimidiata populations and a potential risk for T. cruzi transmission.

Koyoc-Cardeña E ，Medina-Barreiro A ，Escobedo-Ortegón FJ ，Rodríguez-Buenfil JC ，Barrera-Pérez M ，Reyes-Novelo E ，Chablé-Santos J ，Selem-Salas C ，Vazquez-Prokopec G ，Manrique-Saide P ... -  《-》