Emergence, Control, and Reemergence of Triatoma infestans and Trypanosoma cruzi Across the Urban-Rural Interface in Arequipa, Peru

Abstract

In recent decades, transmission of Trypanosoma cruzi, the causative agent of Chagas disease, by Triatoma infestans and other vector insects has expanded from historically rural areas to urban centers across Latin America. The urbanization of the T. cruzi transmission cycle necessitates new understanding of Chagas disease ecology and epidemiology, as well as new approaches to the surveillance, control, and prevention of vector infestation and parasite transmission. In rural La Joya, Peru, analyses highlight how the complexities of human migration and intermittent intervention influence the prevalence and incidence of Chagas disease. Substantial prevalence of T. cruzi infection was found in the adult population as a result of relatively higher incidence of infection among long-term inhabitants and relatively lower incidence of infection among short-term in-migrants. While an insecticide intervention in 1995 effectively eliminated incidence of infection among children, T. infestans and T. cruzi were rapidly reemerging in the absence of continuing vector control. In Arequipa, Peru, T. infestans had extensively and intensively infested an urban and peri-urban landscape prior to vector control. Environmental and social factors, which may directly or indirectly influence insect biology and behavior, were associated with infestation. Large clusters of infestation and spatial dependence among infested households at short and long distances suggest that T. infestans can disperse by crawling or flying in an urban environment, which may challenge ongoing vector surveillance and control. Reemergence of vector insects, including T. infestans, complicates continuing control of Chagas disease. While relatively rare, reemergence of T. infestans is a present and possibly persistent problem in urban and peri-urban Arequipa. The probability of a reemergence event varied spatially. Events were both clustered and non-clustered, and were spatially dependent at distances up to 1,600 meters. Event-to-event spatial proximity occurred at shorter distances in higher risk areas and longer distances in lower risk areas. Identifiable predictors and patterns of risk offer opportunities for more effective and efficient strategies for vector surveillance and control.