Ecological aspects of the vectorial control of Chagas' disease in Brazil

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Abstract

The feasibility and most important ecological aspects of vectorial Chagas' disease control are discussed. The spread and maintenance of this disease involve multiple ecological and sociopolitical factors that must be taken into account when control programs are planned, executed and evaluated. In spite of its complexity, Chagas disease can be controlled using methods that target specific mechanisms of transmission, the most important being vectorial and transfusional. Major ecological problems in Chagas' disease control do not exist, even in the case of the chemical control of triatomine vectors. The main challenges for the Brazilian Control Program at this moment are: its maintenance as a political priority; the threat of peridomestic vectors; and the consolidation of permanent horizontal and participative epidemiological surveillance systems against the vector.

Translated abstract

A importância da doença de Chagas e de seu controle é assinalada para o Brasil e demais países endêmicos da América Latina, enfatizando-se os aspectos ecológicos envolvidos. Os principais insumos e estratégias de combate à doença humana já existem e estão disponíveis, devendo-se priorizar o controle dos vetores domiciliados e das transfusões de sangue. Os programas de controle devem levar em conta os elementos ecológicos e sociais pertinentes, inclusive para se prevenir novas situações epidemiológicas no futuro. Não se assinalam problemas ecológicos de importância quando os programas de controle são planejados e executados com racionalidade. Os maiores desafios ao programa brasileiro, são hoje, a manutenção de sua continuidade a nível nacional, o controle de vetores secundários no peridomicílio e a consolidação de uma vigilância epidemiológica horizontalizada e participativa.

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Control of Chagas disease.

Yoichi Yamagata, Jun Nakagawa (2005)

The Southern Cone Initiative (Iniciativa de Salud del Cono Sur, INCOSUR) to control domestic transmission of Trypanosoma cruzi is a substantial achievement based on the enthusiasm of the scientific community, effective strategies, leadership, and cost-effectiveness. INCOSUR triggered the launch of other regional initiatives in Central America and in the Andean and Amazon regions, which have all made progress. The Central American Initiative targeted the elimination of an imported triatomine bug (Rhodnius prolixus) and the control of a widespread native species (Triatoma dimidiata), and faced constraints such as a small scientific community, the difficulty in controlling a native species, and a vector control programme that had fragmented under a decentralized health system. International organizations such as the Japan International Cooperation Agency (JICA) have played an important role in bridging the gaps between fragmented organizational resources. Guatemala achieved virtual elimination of R. prolixus and ;reduction of Tri. Dimidiata and El Salvador and Honduras revitalized their national programmes. The programme also revealed new challenges. Tri. dimidiata control needs to cover a large geographic area efficiently with stratification, quality control, community mobilization, and information management. Stakeholders such as the National Chagas Program, the local health system and their communities, as well as local government must share responsibilities to continue comprehensive vector control.

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Control of Chagas disease in Brazil.

Paulo J. Dias (1987)

Chagas disease (South American trypanosomiasis) is a chronic but often fatal disease endemic throughout much of Latin America. Serological surveys suggest around 24 million people seropositive for the causative agent, Trypanosoma cruzi (Fig. 1), with over 65 million living in the endemic areas and at risk to infection. In Brazil, over 25 million people are considered at risk, and control of the disease constitutes one of Brazil's public health priorities. Treatment or vaccination against T. cruzi is impossible at the public health level because suitable drugs or vaccines are not available. But it is well recognized that transmission can be interrupted by eliminating the domestic vectors - blood-sucking reduviid bugs of the subfamily Triatominae. In Brazil, eradication of Triatoma infestans - the major domestic vector of T. cruzi - is now seen as a feasible target by the Ministry of Health. However, although other domestic vectors can also be controlled, they will retain their sylvatic ecotopes from which they can reinvade houses. In this article, Joao Carlos Pinto Dias explains the current Brazilian policy, high-lighting the successful elimination of T. infestans from much of the southern part of the country.