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》

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 ... -  《-》

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 ... -  《-》

Disentangling Trypanosoma cruzi transmission cycle dynamics through the identification of blood meal sources of natural populations of Triatoma dimidiata in Yucatán, Mexico.

In the Yucatán Peninsula, Mexico, Triatoma dimidiata is the main vector of Trypanosoma cruzi, the causative agent of Chagas disease. Little effort has been made to identify blood meal sources of T. dimidiata in natural conditions in this region, although this provides key information to disentangle T. cruzi transmission cycles and dynamics and guide the development of more effective control strategies. We identified the blood meals of a large sample of T. dimidiata bugs collected in different ecotopes simultaneously with the assessment of bug infection with T. cruzi, to disentangle the dynamics of T. cruzi transmission in the region. A sample of 248 T. dimidiata bugs collected in three rural villages and in the sylvatic habitat surrounding these villages was used. DNA from each bug midgut was extracted and bug infection with T. cruzi was assessed by PCR. For blood meal identification, we used a molecular assay based on cloning and sequencing following PCR amplification with vertebrate universal primers, and allowing the detection of multiple blood meals in a single bug. Overall, 28.7% of the bugs were infected with T. cruzi, with no statistical difference between bugs from the villages or from sylvatic ecotopes. Sixteen vertebrate species including domestic, synanthropic and sylvatic animals, were identified as blood meal sources for T. dimidiata. Human, dog and cow were the three main species identified, in bugs collected in the villages as well as in sylvatic ecotopes. Importantly, dog was highlighted as the main blood meal source after human. Dog was also the most frequently identified animal together with human within single bugs, and tended to be associated with the infection of the bugs. Dog, human and cow were identified as the main mammals involved in the connection of sylvatic and domestic transmission cycles in the Yucatán Peninsula, Mexico. Dog appeared as the most important animal in the transmission pathway of T. cruzi to humans, but other domestic and synanthropic animals, which most were previously reported as important hosts of T. cruzi in the region, were evidenced and should be taken into account as part of integrated control strategies aimed at disrupting parasite transmission.

Moo-Millan JI ，Arnal A ，Pérez-Carrillo S ，Hernandez-Andrade A ，Ramírez-Sierra MJ ，Rosado-Vallado M ，Dumonteil E ，Waleckx E ... -  《Parasites & Vectors》

Urban infestation by Triatoma dimidiata in the city of Mérida, Yucatán, México.

Guzman-Tapia Y ，Ramírez-Sierra MJ ，Dumonteil E 《VECTOR-BORNE AND ZOONOTIC DISEASES》