Segura E L, Sosa Estani S, Esquivel M L, Gómez A, Salomon O D
Administración Nacional de Laboratorios, Ministerio de Salud y Acción Social de la Nación, Buenos Aires, Argentina.
Medicina (B Aires). 1999;59 Suppl 2:91-6.
Approximately 2 million people in Argentina are infected with Trypanosoma cruzi, the etiologic agent of Chagas disease, thereby constituting the major tropical disease in the country. As in other six Southern Cone countries, Triatoma infestans is the only or major vector of T. cruzi among human and domestic animals. In Argentina, a vertically structured National Chagas Control Program was established in 1962. Such a program pursued the elimination of domestic and peri-domestic populations of T. infestans through insecticidal spraying, and the serological control of blood donors to prevent transfusion-related infections. This program strongly reduced the nation-wide serological prevalence of T. cruzi in the population. For example, in 18 or 20 year-old men drafted into military service, the seroprevalence decreased from 10.1% in 1964 for those who had been born in 1944 to 1.9% in 1993 for those born in 1975. However, the vertical strategy failed to reach and sustain the surveillance phase in widespread rural areas with disperse populations due to its intrinsic limitations and the reduced priority level assigned to rural health programs. An alternative, horizontally-structured control strategy of T. infestans was developed and assayed in the Province of Santiago del Estero between 1985-1989, and 1991-1992. The projects demonstrated that insecticidal spraying carried out with community participation combined effectiveness and commitment in such a way as to produce a strong impact on house reinfestation and the extension of the area under entomological surveillance. This experience has been transferred in a chain of responsibilities to the personnel of the National Chagas Control Program, using participating workshops, procedural guidelines, and practical training. This personnel transferred the strategy using similar methods to the field health care agents and volunteers chosen by their own communities (community leaders). After the workshops, the leaders received all the materials needed to install and develop the ongoing surveillance activities: third generation pyrethroid insecticides, manuals, hand-operated sprayers, and sensor boxes to detect domiciliary infestations. From 1993 to 1998, a total of 15,000 health care agents or community leaders were trained. A total of 675,000 houses were sprayed with residual insecticides in the attack phase, and 850,000 houses entered the surveillance phase. This is the first time that such large coverage has been accomplished in Argentina. The network of laboratories installed a quality assurance program to current serological procedures applied to blood donors, organ transplant, and the detection and treatment of newborns to women sero-reactive for T. cruzi in Argentina. We expect to interrupt the vector-mediated transmission of T. cruzi in the next 18 months, but the sustainability of such a program depends on, at least, additional work with the community to achieve a change of attitudes and practices related to house infestation for the next 10 years. A social effort will be needed to cover those expenses, but the expected economic returns exceed largely the cost of any such program, as suggested by cost-benefit studies. To illustrate, the annual treatment costs of one Chagas patient can help maintain 25 households free from triatomine bugs in Argentina.
