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. 2013 Aug 1;7(8):e2358.
doi: 10.1371/journal.pntd.0002358. Print 2013.

Epidemiology of and Impact of Insecticide Spraying on Chagas Disease in Communities in the Bolivian Chaco

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Free PMC article

Epidemiology of and Impact of Insecticide Spraying on Chagas Disease in Communities in the Bolivian Chaco

Aaron M Samuels et al. PLoS Negl Trop Dis. .
Free PMC article

Abstract

Background: Chagas disease control campaigns relying upon residual insecticide spraying have been successful in many Southern American countries. However, in some areas, rapid reinfestation and recrudescence of transmission have occurred.

Methodology/principal findings: We conducted a cross-sectional survey in the Bolivian Chaco to evaluate prevalence of and risk factors for T. cruzi infection 11 years after two rounds of blanket insecticide application. We used a cubic B-spline model to estimate change in force of infection over time based on age-specific seroprevalence data. Overall T. cruzi seroprevalence was 51.7%. The prevalence was 19.8% among children 2-15, 72.7% among those 15-30 and 97.1% among participants older than 30 years. Based on the model, the estimated annual force of infection was 4.3% over the two years before the first blanket spray in 2000 and fell to 0.4% for 2001-2002. The estimated annual force of infection for 2004-2005, the 2 year period following the second blanket spray, was 4.6%. However, the 95% bootstrap confidence intervals overlap for all of these estimates. In a multivariable model, only sleeping in a structure with cracks in the walls (aOR = 2.35; 95% CI = 1.15-4.78), age and village of residence were associated with infection.

Conclusions/significance: As in other areas in the Chaco, we found an extremely high prevalence of Chagas disease. Despite evidence that blanket insecticide application in 2000 may have decreased the force of infection, active transmission is ongoing. Continued spraying vigilance, infestation surveillance, and systematic household improvements are necessary to disrupt and sustain interruption of infection transmission.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Actual seroprevalence and estimated seroprevalence by the three catalytic models.
The scatter plot represents age-specific seroprevalence determined by serologic testing (see methods section). The solid, dashed, and dotted line are estimated seroprevalence curves using the constant, Weibull, and cubic B-spline models, respectively.
Figure 2
Figure 2. Estimated seroprevalence based on the spline model.
Gray shading around the seroprevalence curve represents 95% confidence intervals of model to data points. Vertical dashed lines indicate where knots corresponding to the years of blanket spray campaigns are included in the model.
Figure 3
Figure 3. Estimated incidence calculated from the catalytic model.
Shaded regions around the line are the 95% confidence intervals of model to data points. Vertical dash lines indicate the knots corresponding to the years of blanket spray campaigns.

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