Implementação de um sistema de vigilância-resposta de vetores para o controle da doença de Chagas: um ensaio de campo de 4 anos na Nicarágua / Implementing a vector surveillance-response system for chagas disease control: a 4-year field trial in Nicaragua

Abstract Background: Chagas disease is one of the neglected tropical diseases (NTDs). International goals for its control involve elimination of vector-borne transmission. Central American countries face challenges in establishing sustainable vector control programmes, since the main vector, Triatoma dimidiata, cannot be eliminated. In 2012, the Ministry of Health in Nicaragua started a field test of a vector surveillance-response system to control domestic vector infestation. This paper reports the main findings from this pilot study. Methods: This study was carried out from 2012 to 2015 in the Municipality of Totogalpa. The Japan International Cooperation Agency provided technical cooperation in designing and monitoring the surveillance-response system until 2014. This system involved 1) vector reports by householders to health facilities, 2) data analysis and planning of responses at the municipal health centre and 3) house visits or insecticide spraying by health personnel as a response. We registered all vector reports and responses in a digital database. The collected data were used to describe and analyse the system performance in terms of amount of vector reports as well as rates and timeliness of responses. Results: During the study period, T. dimidiata was reported 396 times. Spatiotemporal analysis identified some high-risk clusters. All houses reported to be infested were visited by health personnel in 2013 and this response rate dropped to 39% in 2015. Rates of insecticide spraying rose above 80% in 2013 but no spraying was carried out in the following 2 years. The timeliness of house visits improved significantly after the responsibility was transferred from a vector control technician to primary health care staff. Conclusions: We argue that the proposed vector surveillance-response system is workable within the resourceconstrained health system in Nicaragua. Integration to the primary health care services was a key to improve the system performance. Continual efforts are necessary to keep adapting the surveillance-response system to the dynamic health systems. We also discuss that the goal of eliminating vector-borne transmission remains unachievable. This paper provides lessons not only for Chagas disease control in Central America, but also for control efforts for other NTDs that need a sustainable surveillance-response system to support elimination.

Certifying achievement in the control of Chagas disease native vectors: what is a viable scenario?

As an evaluation scheme, we propose certifying for “control”, as alternative to “interruption”, of Chagas disease transmission by native vectors, to project a more achievable and measurable goal and sharing good practices through an “open online platform” rather than “formal certification” to make the key knowledge more accumulable and accessible.

Impact of a community-based bug-hunting campaign on Chagas disease control: a case study in the department of Jalapa, Guatemala

Chagas disease control requires an innovative approach to strengthen community participation in vector surveillance. This paper presents a case study of a community-based bug-hunting campaign in Guatemala. The campaign was implemented in 2007 in the following three stages: (i) a four week preparation stage to promote bug-hunting, (ii) a one week bug-hunting stage to capture and collect bugs and (iii) a 10 week follow-up stage to analyse the bugs and spray insecticide. A total of 2,845 bugs were reported, of which 7% were Triatominae vectors, such as Rhodnius prolixus and Triatoma dimidiata. The bug-hunting campaign detected a five-six-fold higher amount of vectors in one week than traditional community-based surveillance detects in one year. The bug-hunting campaign effectively detected vectors during a short period, provided information to update the vector infestation map and increased community and political awareness regarding Chagas disease. This approach could be recommended as an effective and feasible strategy to strengthen vector surveillance on a larger scale.

Rhodnius prolixus en Nicaragua: distribución geogrßfica, control y vigilancia entre 1998 y 2009 / Rhodnius prolixus in Nicaragua: geographical distribution, control, and surveillance, 1998-2009

OBJETIVO: Presentar la perspectiva general del control de Rhodnius prolixus, el principal vector en la transmisión de la enfermedad de Chagas en Centroamérica, durante el período 1998-2009 en Nicaragua. Describir el control vectorial realizado y presentar la distribución geogrßfica de las localidades infestadas. MÉTODOS: Se estudió y analizó la información disponible en el Ministerio de Salud de Nica ragua. Se visualizó la distribución geogrßfica de R. prolixus mediante el programa visualiza dor de mapas Quantum GIS 1.5.0. RESULTADOS: Se determinó que 59 localidades en 14 municipios de 8 departamentos presen taron antecedentes de infestación con R. prolixus entre 1998 y 2009. La altitud de las locali dades infestadas oscila entre 160 y 1 414 metros sobre el nivel del mar. Se han tratado con mßs de dos ciclos de control químico 56 localidades. En el segundo ciclo de rociamiento se detectó la presencia del vector, pero durante el tercer ciclo no se lo encontró en ninguna localidad. CONCLUSIONES: La mayor concentración geogrßfica de R. prolixus se observó en dos depar tamentos de la región norte: Madriz y Nueva Segovia. La cantidad de localidades infestadas es menor en Nicaragua que en otros países centroamericanos. El control químico ha sido exitoso en las localidades intervenidas, pero es necesario fortalecer el sistema de vigilancia institucio nal y comunitaria tanto para vigilar la reinfestación con R. prolixus como para ampliar la cobertura del control vectorial.

OBJECTIVE: Present an overview of the control of Rhodnius prolixus, the principal vector in the transmission of Chagas' disease in Central America, during the period 1998-2009 in Nicaragua. Describe the vector control carried out and the geographical distribution of the infested localities. METHODS: The available information in Nicaragua's Ministry of Health was studied and analyzed. The geographical distribution of R. prolixus was visualized using the Quantum GIS 1.5.0 map visualization program. RESULTS: It was determined that 59 localities in 14 municipalities of 8 departments had a history of R. prolixus infestation between 1998 and 2009. The altitude of the infested localities ranges between 160 and 1 414 meters above sea level. A total of 56 localities have been treated with more than two cycles of chemical control. The presence of the vector was detected in the second spraying cycle, but it was not found in any locality during the third cycle. CONCLUSIONS: The greatest geographical concentration of R. prolixus was found in two departments in the northern region: Madriz and Nueva Segovia. There were fewer infested localities in Nicaragua than in other Central American countries. Chemical control has been successful in the localities treated, but the institutional and community surveillance system needs to be strengthened to monitor R. prolixusreinfestation and expand vector control coverage.