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Ahead of Print -Residual Infestation and Recolonization during Urban Triatoma infestans Bug Control Campaign, Peru1 - Volume 20, Number 12—December 2014 - Emerging Infectious Disease journal - CDC

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Ahead of Print -Residual Infestation and Recolonization during Urban Triatoma infestans Bug Control Campaign, Peru1 - Volume 20, Number 12—December 2014 - Emerging Infectious Disease journal - CDC

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Volume 20, Number 12—December 2014


Residual Infestation and Recolonization during Urban Triatoma infestans Bug Control Campaign, Peru1

Corentin M. BarbuComments to Author , Alison M. Buttenheim, Maria-Luz Hancco Pumahuanca, Javier E. Quintanilla Calderón, Renzo Salazar, Malwina Carrión, Andy Catacora Rospigliossi, Fernando S. Malaga Chavez, Karina Oppe Alvarez, Juan Cornejo del Carpio, César Náquira, and Michael Z. Levy
Author affiliations: University of Pennsylvania, Philadelphia, Pennsylvania, USA (C.M. Barbu, A.M. Buttenheim, M.Z. Levy)Universidad Peruana Cayetano Heredia, Arequipa, Peru (M.-L. Hancco Pumahuanca, J.E. Quintanilla Calderón, R. Salazar, M. Carrión, C. Náquira)Red de Salud Aequipa Caylloma, Arequipa (A. Catacora Rospigliossi)Dirección Regional del Ministerio de Salud, Arequipa (F.S. Malaga Chavez, K.Oppe Alvarez, J. Cornejo del Carpio)


Chagas disease vector control campaigns are being conducted in Latin America, but little is known about medium-term or long-term effectiveness of these efforts, especially in urban areas. After analyzing entomologic data for 56,491 households during the treatment phase of a Triatoma infestans bug control campaign in Arequipa, Peru, during 2003–2011, we estimated that 97.1% of residual infestations are attributable to untreated households. Multivariate models for the surveillance phase of the campaign obtained during 2009–2012 confirm that nonparticipation in the initial treatment phase is a major risk factor (odds ratio [OR] 21.5, 95% CI 3.35–138). Infestation during surveillance also increased over time (OR 1.55, 95% CI 1.15–2.09 per year). However, we observed a negative interaction between nonparticipation and time (OR 0.73, 95% CI 0.53–0.99), suggesting that recolonization by vectors progressively dilutes risk associated with nonparticipation. Although the treatment phase was effective, recolonization in untreated households threatens the long-term success of vector control.
Chagas disease, an often deadly disease widespread in the Americas, is caused by the protozoan parasiteTrypanosoma cruzi (1,2) and transmitted by hematophageous triatomine insects (3). In southern South AmericaTriatoma infestans bugs are the primary vector (2). In 1991, the nations of this region created the Southern Cone Initiative to coordinate control efforts against T. infestans bugs. During the first decade of this initiative, 2.5 million households were treated with insecticide (4), which led to disruption of transmission of T. cruzi by T. infestans bugs in several countries and states (2). However, vector control efforts have at times failed unexpectedly and repeatedly in some areas (5,6).
Across most of its range, T. infestans bugs are found predominantly in rural areas (2). However, the vector has become an urban problem in Arequipa, Peru, a city of 850,000 inhabitants (79) where infected vectors have been observed since 1952 (10). Since 2003, municipal authorities and the regional ministry of health, in collaboration with the Pan American Health Organization, have worked to eliminate the vector from this city. The challenges to elimination in an urban area potentially differ from those in rural settings. Urban households have smaller peridomestic areas, fewer sources of blood, and fewer hiding places for the vector, thus mitigating some of the difficulties encountered in rural environments (7,1113). However, although participation in control campaigns in rural areas is typically high (5,7), more affluent urban populations (14) might be more reluctant to participate (15). Thus, household level control might be easier in an urban household than in a rural household. However, at the community level, sustained control in an urban community might be more difficult.
We explored this hypothesis by using data obtained in Arequipa during the initial treatment phase or attack phase of the vector campaign and during the subsequent surveillance phase after insecticide application. We evaluated the effectiveness of the treatment phase in 3 ways. First, we estimated the reduction in the infestation prevalence resulting from the 2 insecticide applications of the treatment phase. Second, we modeled recolonization (the colonization of new households after the initial treatment) as a function of treatment phase factors. Third, during the surveillance phase, we tested insects captured from households treated during the treatment phase for resistance to insecticide. We discuss converging results of these approaches in terms of their implications for continued efforts of the control campaign in Arequipa and, more generally, for design of strategies to control Chagas disease vectors in urban environments.

Dr Barbu is a postdoctoral fellow in epidemiology at the University of Pennsylvania, Philadelphia, Pennsylvania. His primary research interest is applying computational and statistical methods to understand and control populations of Chagas disease vectors.


We thank the Ministerio de Salud del Peru, the Dirección General de Salud de las Personas through the Estrategia Sanitaria Nacional de Prevención y Control de Enfermedades Metaxénicas y Otras Transmitidas por Vectores, the Dirección General de Salud Ambiental, the Gobierno Regional de Arequipa, the Gerencia Regional de Salud de Arequipa, the Red de Salud Arequipa Caylloma, the Pan American Health Organization, the Canadian International Development Agency, and the Gobierno Regional de Arequipa for organizing and conducting the Chagas disease control campaign in Arequipa; and Sébastien Gourbière, Yage Wu, Daniel Rivera Lana, Karthik Sethuraman, and Dylan Tracy for providing editing suggestions for the manuscript.
This study was supported by National Institutes of Health grants NIH-NIAID R01AI101229, P50 AI074285, and K01 AI079162, and a University of Pennsylvania Global Engagement grant.


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Suggested citation for this article: Barbu CM, Buttenheim AM, Hancco Pumahuanca ML, Quintanilla Calderón JE, Salazar R, Carrión M, et al. Residual infestation and recolonization during urban Triatoma infestans bug control campaign, Peru. Emerg Infect Dis [Internet]. 2012 Dec [date cited].http://dx.doi.org/10.3201/eid2012.131820
DOI: 10.3201/eid2012.131820
1A Spanish version of this article is available online (http://www.spatcontrol.net/articles/Barbu2014/traduccionEspanol.pdf).

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