A simple, biologically sound, and potentially useful working classification of Chagas disease vectors

Urban vectors of Chagas disease in the American continent: A systematic review of epidemiological surveys

BACKGROUND

Chagas is a complex and multidimensional socio-environmental health phenomenon, in which different components converge and interact. Historically, this disease was associated with insect vectors found in the rural environment. However, in the Americas, we are currently facing a new paradigm, in which different scenarios allow maintaining the vectorial transmission of the parasite through triatomine populations that either occasionally enter the dwellings or colonize urban environments.

METHODOLOGY/PRINCIPAL FINDINGS

Records of scientific reports available in the PubMed and LILACS search engines were retrieved, using three criteria according to the main triatomine genera of epidemiological importance and to the general scientific production on Chagas disease in urban contexts. Results showed that records on the occurrence of vectors in urban dwellings began to increase in the last three decades. Results also showed that the main species of triatomines collected inside dwellings (18 in total) belong mainly to the genera Triatoma and Panstrongylus, with most species (16/18, 88.8%) infected with the parasite, and that infestation of triatomine species occurs in all types of cities (small, medium and large, including megalopolises), from Argentina to the USA.

CONCLUSIONS/SIGNIFICANCE

Urban Chagas represents a new challenge that adds a different dimension to the problem of Chagas disease due to the particular characteristics of the lifestyle in urban agglomerates. The new scenario will require adaptations of the programs of control of vector to this shift from rural to urban settlements.

Triatoma costalimai, a neglected vector of Trypanosoma cruzi in the Cerrado savannas of South America: A comprehensive review

Triatoma costalimai is a little-known triatomine-bug species whose role as a vector of Chagas disease remains poorly understood. To address this gap, we conducted a comprehensive review of the literature and assessed the evidence base from a public-health perspective. We found 89 individual documents/resources with information about T. costalimai. DNA-sequence and cytogenetic data indicate that T. costalimai belongs, together with Triatoma jatai, in a distinct clade within the 'pseudomaculata group' of South American Triatoma. Triatoma costalimai is probably a narrow endemic of the Cerrado on the upper Tocantins River Basin and associated ranges/plateaus; there, the species thrives in the sandstone/limestone outcrops typical of the "Cerrado rupestre" (rocky-soil savanna) and "mata seca decídua calcária" (limestone-soil dry forest) phytophysiognomies. Wild T. costalimai appear to feed on whatever vertebrates are available in rocky outcrops, with lizards and rodents being most common. There is persuasive evidence that house invasion/infestation by T. costalimai has increased in frequency since the 1990s. The bugs often carry Trypanosoma cruzi, often defecate while feeding, have high fecundity/fertility, and, under overtly favorable conditions, can produce two generations per year. Current knowledge suggests that T. costalimai can transmit human Chagas disease in the upper Tocantins Basin; control-surveillance systems should 'tag' the species as a potentially important local vector in the Brazilian states of Goiás and Tocantins. Further research is needed to clarify (i) the drivers and dynamics of house invasion, infestation, and reinfestation by T. costalimai and (ii) the genetic structuring and vector capacity of the species, including its wild and non-wild populations.

Synanthropic triatomines in Hidalgo state, Mexico: Spatial-temporal distribution, domestic transmission cycle, and natural infection with Trypanosoma cruzi

Triatomine vectors are responsible for the main route of transmission of the protozoan Trypanosoma cruzi, the etiological agent of Chagas disease. This illness is potentially life-threatening and highly disabling and represents a major public health concern in the endemic countries in Latin America. The analysis of the spatial and temporal occurrence of triatomine insects is critical, since control strategies strongly depend on the vector species found within each area. Such knowledge is non-existent in Hidalgo state, an endemic region of Chagas disease in Mexico. A Geographic Information System (GIS) was used to analyze broad-scale spatial and temporal patterns of synanthropic triatomines collected in Hidalgo. Data was taken from the Institute of Epidemiological Diagnosis and Reference (InDRE) of Mexico and the state program of Vector Control of the Secretary of Health, covering the period of 1997-2019. Our analyses demonstrate a differential distribution of Triatoma dimidiata, T. mexicana, T. gerstaeckeri and T. barberi, which are the four predominant species, and that climate, temperature, and precipitation are some of the drivers of their distribution pattern. Notably, we report the presence of T. nitida, T. pallidipennis and T. phyllosoma for the first time in the state. In addition, we found seasonal variations of the populations of T. mexicana and T. gerstaeckeri, but not for T. dimidiata, whose population remains constant throughout the year. The insects were found mainly intradomicile (81.79 %), followed by peridomicile (17.56 %) and non-domestic areas (0.65%), with an average T. cruzi infection of 16.4%. Based on this evidence, priority sites for vector control intervention were identified. Our findings are very valuable for understanding the epidemiology of Chagas disease, the generation of future potential risk maps and for the development and implementation of effective and targeted vector control programs in Hidalgo state.

Chagas disease control-surveillance in the Americas: the multinational initiatives and the practical impossibility of interrupting vector-borne Trypanosoma cruzi transmission

Chagas disease (CD) still imposes a heavy burden on most Latin American countries. Vector-borne and mother-to-child transmission cause several thousand new infections per year, and at least 5 million people carry Trypanosoma cruzi. Access to diagnosis and medical care, however, is far from universal. Starting in the 1990s, CD-endemic countries and the Pan American Health Organization-World Health Organization (PAHO-WHO) launched a series of multinational initiatives for CD control-surveillance. An overview of the initiatives’ aims, achievements, and challenges reveals some key common themes that we discuss here in the context of the WHO 2030 goals for CD. Transmission of T. cruzi via blood transfusion and organ transplantation is effectively under control. T. cruzi, however, is a zoonotic pathogen with 100+ vector species widely spread across the Americas; interrupting vector-borne transmission seems therefore unfeasible. Stronger surveillance systems are, and will continue to be, needed to monitor and control CD. Prevention of vertical transmission demands boosting current efforts to screen pregnant and childbearing-aged women. Finally, integral patient care is a critical unmet need in most countries. The decades-long experience of the initiatives, in sum, hints at the practical impossibility of interrupting vector-borne T. cruzi transmission in the Americas. The concept of disease control seems to provide a more realistic description of what can in effect be achieved by 2030.

TriatoScore: an entomological-risk score for Chagas disease vector control-surveillance

BACKGROUND

Triatomine bugs transmit Chagas disease across Latin America, where vector control-surveillance is increasingly decentralized. Locally run systems often deal with highly diverse native-vector faunas-plus, in some areas, domestic populations of non-native species. Flexible entomological-risk indicators that cover native and non-native vectors and can support local decision-making are therefore needed.

METHODS

We present a local-scale entomological-risk score ("TriatoScore") that leverages and builds upon information on the ecology-behavior and distribution-biogeography of individual triatomine bug species. We illustrate our approach by calculating TriatoScores for the 417 municipalities of Bahia state, Brazil. For this, we (i) listed all triatomine bug species recorded statewide; (ii) derived a "species relevance score" reflecting whether each species is native/non-native and, if native, whether/how often it invades/colonizes dwellings; (iii) mapped each species' presence by municipality; (iv) for native vectors, weighted presence by the proportion of municipal territory within ecoregions occupied by each species; (v) multiplied "species relevance score" × "weighted presence" to get species-specific "weighted scores"; and (vi) summed "weighted scores" across species to get municipal TriatoScores. Using standardized TriatoScores, we then grouped municipalities into high/moderate/low entomological-risk strata.

RESULTS

TriatoScores were higher in municipalities dominated by dry-to-semiarid ecoregions than in those dominated by savanna-grassland or, especially, moist-forest ecoregions. Bahia's native triatomines can maintain high to moderate risk of vector-borne Chagas disease in 318 (76.3%) municipalities. Historical elimination of Triatoma infestans from 125 municipalities reduced TriatoScores by ~ 27% (range, 20-44%); eight municipalities reported T. infestans since Bahia was certified free of Trypanosoma cruzi transmission by this non-native species. Entomological-risk strata based on TriatoScores agreed well with Bahia's official disease-risk strata, but TriatoScores suggest that the official classification likely underestimates risk in 42 municipalities. Of 152 municipalities failing to report triatomines in 2006-2019, two and 71 had TriatoScores corresponding to, respectively, high and moderate entomological risk.

CONCLUSIONS

TriatoScore can help control-surveillance managers to flexibly assess and stratify the entomological risk of Chagas disease at operationally relevant scales. Integrating eco-epidemiological, demographic, socioeconomic, or operational data (on, e.g., local-scale dwelling-infestation or vector-infection frequencies, land-use change and urbanization, housing conditions, poverty, or the functioning of control-surveillance systems) is also straightforward. TriatoScore may thus become a useful addition to the triatomine bug control-surveillance toolbox.

Deforestation effects on Attalea palms and their resident Rhodnius, vectors of Chagas disease, in eastern Amazonia

Attalea palms provide primary habitat to Rhodnius spp., vectors of Trypanosoma cruzi. Flying from palms, these blood-sucking bugs often invade houses and can infect people directly or via food contamination. Chagas disease (CD) risk may therefore increase when Attalea palms thrive near houses. For example, Attalea dominate many deforested landscapes of eastern Amazonia, where acute-CD outbreaks are disturbingly frequent. Despite this possible link between deforestation and CD risk, the population-level responses of Amazonian Attalea and their resident Rhodnius to anthropogenic landscape disturbance remain largely uncharted. We studied adult Attalea palms in old-growth forest (OGF), young secondary forest (YSF), and cattle pasture (CP) in two localities of eastern Amazonia. We recorded 1856 Attalea along 10 transects (153.6 ha), and detected infestation by Rhodnius spp. in 18 of 280 systematically-sampled palms (33 bugs caught). Distance-sampling models suggest that, relative to OGF, adult Attalea density declined by 70-80% in CP and then recovered in YSF. Site-occupancy models estimate a strong positive effect of deforestation on palm-infestation odds (βCP-infestation = 4.82±1.14 SE), with a moderate decline in recovering YSF (βYSF-infestation = 2.66±1.10 SE). Similarly, N-mixture models suggest that, relative to OGF, mean vector density sharply increased in CP palms (βCP-density = 3.20±0.62 SE) and then tapered in YSF (βYSF-density = 1.61±0.76 SE). Together, these results indicate that disturbed landscapes may support between ~2.5 (YSF) and ~5.1 (CP) times more Attalea-dwelling Rhodnius spp. per unit area than OGF. We provide evidence that deforestation may favor palm-dwelling CD vectors in eastern Amazonia. Importantly, our landscape-disturbance effect estimates explicitly take account of (i) imperfect palm and bug detection and (ii) the uncertainties about infestation and vector density arising from sparse bug data. These results suggest that incorporating landscape-disturbance metrics into the spatial stratification of transmission risk could help enhance CD surveillance and prevention in Amazonia.

TriatoDex, an electronic identification key to the Triatominae (Hemiptera: Reduviidae), vectors of Chagas disease: Development, description, and performance

Correct identification of triatomine bugs is crucial for Chagas disease surveillance, yet available taxonomic keys are outdated, incomplete, or both. Here we present TriatoDex, an Android app-based pictorial, annotated, polytomous key to the Triatominae. TriatoDex was developed using Android Studio and tested by 27 Brazilian users. Each user received a box with pinned, number-labeled, adult triatomines (33 species in total) and was asked to identify each bug to the species level. We used generalized linear mixed models (with user- and species-ID random effects) and information-theoretic model evaluation/averaging to investigate TriatoDex performance. TriatoDex encompasses 79 questions and 554 images of the 150 triatomine-bug species described worldwide up to 2017. TriatoDex-based identification was correct in 78.9% of 824 tasks. TriatoDex performed better in the hands of trained taxonomists (93.3% vs. 72.7% correct identifications; model-averaged, adjusted odds ratio 5.96, 95% confidence interval [CI] 3.09–11.48). In contrast, user age, gender, primary job (including academic research/teaching or disease surveillance), workplace (including universities, a reference laboratory for triatomine-bug taxonomy, or disease-surveillance units), and basic training (from high school to biology) all had negligible effects on TriatoDex performance. Our analyses also suggest that, as TriatoDex results accrue to cover more taxa, they may help pinpoint triatomine-bug species that are consistently harder (than average) to identify. In a pilot comparison with a standard, printed key (370 tasks by seven users), TriatoDex performed similarly (84.5% correct assignments, CI 68.9–94.0%), but identification was 32.8% (CI 24.7–40.1%) faster on average–for a mean absolute saving of ~2.3 minutes per bug-identification task. TriatoDex holds much promise as a handy, flexible, and reliable tool for triatomine-bug identification; an updated iOS/Android version is under development. We expect that, with continuous refinement derived from evolving knowledge and user feedback, TriatoDex will substantially help strengthen both entomological surveillance and research on Chagas disease vectors.

Disentangling Trypanosoma cruzi transmission cycle dynamics through the identification of blood meal sources of natural populations of Triatoma dimidiata in Yucatán, Mexico

Background

In the Yucatán Peninsula, Mexico, Triatoma dimidiata is the main vector of Trypanosoma cruzi, the causative agent of Chagas disease. Little effort has been made to identify blood meal sources of T. dimidiata in natural conditions in this region, although this provides key information to disentangle T. cruzi transmission cycles and dynamics and guide the development of more effective control strategies. We identified the blood meals of a large sample of T. dimidiata bugs collected in different ecotopes simultaneously with the assessment of bug infection with T. cruzi, to disentangle the dynamics of T. cruzi transmission in the region.

Methods

A sample of 248 T. dimidiata bugs collected in three rural villages and in the sylvatic habitat surrounding these villages was used. DNA from each bug midgut was extracted and bug infection with T. cruzi was assessed by PCR. For blood meal identification, we used a molecular assay based on cloning and sequencing following PCR amplification with vertebrate universal primers, and allowing the detection of multiple blood meals in a single bug.

Results

Overall, 28.7% of the bugs were infected with T. cruzi, with no statistical difference between bugs from the villages or from sylvatic ecotopes. Sixteen vertebrate species including domestic, synanthropic and sylvatic animals, were identified as blood meal sources for T. dimidiata. Human, dog and cow were the three main species identified, in bugs collected in the villages as well as in sylvatic ecotopes. Importantly, dog was highlighted as the main blood meal source after human. Dog was also the most frequently identified animal together with human within single bugs, and tended to be associated with the infection of the bugs.

Conclusions

Dog, human and cow were identified as the main mammals involved in the connection of sylvatic and domestic transmission cycles in the Yucatán Peninsula, Mexico. Dog appeared as the most important animal in the transmission pathway of T. cruzi to humans, but other domestic and synanthropic animals, which most were previously reported as important hosts of T. cruzi in the region, were evidenced and should be taken into account as part of integrated control strategies aimed at disrupting parasite transmission.

Insights from quantitative and mathematical modelling on the proposed WHO 2030 goals for Chagas disease

Chagas disease (CD) persists as one of the neglected tropical diseases (NTDs) with a particularly large impact in the Americas. The World Health Organization (WHO) recently proposed goals for CD elimination as a public health problem to be reached by 2030 by means of achieving intradomiciliary transmission interruption (IDTI), blood transfusion and transplant transmission interruption, diagnostic and treatment scaling-up and prevention and control of congenital transmission. The NTD Modelling Consortium has developed mathematical models to study Trypanosoma cruzi transmission dynamics and the potential impact of control measures. Modelling insights have shown that IDTI is feasible in areas with sustained vector control programmes and no presence of native triatomine vector populations. However, IDTI in areas with native vectors it is not feasible in a sustainable manner. Combining vector control with trypanocidal treatment can reduce the timeframes necessary to reach operational thresholds for IDTI (<2% seroprevalence in children aged <5 years), but the most informative age groups for serological monitoring are yet to be identified. Measuring progress towards the 2030 goals will require availability of vector surveillance and seroprevalence data at a fine scale, and a more active surveillance system, as well as a better understanding of the risks of vector re-colonization and disease resurgence after vector control cessation. Also, achieving scaling-up in terms of access to treatment to the expected levels (75%) will require a substantial increase in screening asymptomatic populations, which is anticipated to become very costly as CD prevalence decreases. Further modelling work includes refining and extending mathematical models (including transmission dynamics and statistical frameworks) to predict transmission at a sub-national scale, and developing quantitative tools to inform IDTI certification, post-certification and re-certification protocols. Potential perverse incentives associated with operational thresholds are discussed. These modelling insights aim to inform discussions on the goals and treatment guidelines for CD.

Evolution, Systematics, and Biogeography of the Triatominae, Vectors of Chagas Disease

In this chapter, we review and update current knowledge about the evolution, systematics, and biogeography of the Triatominae (Hemiptera: Reduviidae)-true bugs that feed primarily on vertebrate blood. In the Americas, triatomines are the vectors of Trypanosoma cruzi, the etiological agent of Chagas disease. Despite declining incidence and prevalence, Chagas disease is still a major public health concern in Latin America. Triatomines occur also in the Old World, where vector-borne T. cruzi transmission has not been recorded. Triatomines evolved from predatory reduviid bugs, most likely in the New World, and diversified extensively across the Americas (including the Caribbean) and in parts of Asia and Oceania. Here, we first discuss our current understanding of how, how many times, and when the blood-feeding habit might have evolved among the Reduviidae. Then we present a summary of recent advances in the systematics of this diverse group of insects, with an emphasis on the contribution of molecular tools to the clarification of taxonomic controversies. Finally, and in the light of both up-to-date phylogenetic hypotheses and a thorough review of distribution records, we propose a global synthesis of the biogeography of the Triatominae. Over 130 triatomine species contribute to maintaining T. cruzi transmission among mammals (sometimes including humans) in almost every terrestrial ecoregion of the Americas. This means that Chagas disease will never be eradicated and underscores the fact that effective disease prevention will perforce require stronger, long-term vector control-surveillance systems.

Evolutionary ecology of Chagas disease; what do we know and what do we need?

The aetiological agent of Chagas disease, Trypanosoma cruzi, is a key human pathogen afflicting most populations of Latin America. This vectorborne parasite is transmitted by haematophageous triatomines, whose control by large‐scale insecticide spraying has been the main strategy to limit the impact of the disease for over 25 years. While those international initiatives have been successful in highly endemic areas, this systematic approach is now challenged by the emergence of insecticide resistance and by its low efficacy in controlling species that are only partially adapted to human habitat. In this contribution, we review evidences that Chagas disease control shall now be entering a second stage that will rely on a better understanding of triatomines adaptive potential, which requires promoting microevolutionary studies and –omic approaches. Concomitantly, we show that our knowledge of the determinants of the evolution of T. cruzi high diversity and low virulence remains too limiting to design evolution‐proof strategies, while such attributes may be part of the future of Chagas disease control after the 2020 WHO's target of regional elimination of intradomiciliary transmission has been reached. We should then aim at developing a theory of T. cruzi virulence evolution that we anticipate to provide an interesting enrichment of the general theory according to the specificities of transmission of this very generalist stercorarian trypanosome. We stress that many ecological data required to better understand selective pressures acting on vector and parasite populations are already available as they have been meticulously accumulated in the last century of field research. Although more specific information will surely be needed, an effective research strategy would be to integrate data into the conceptual and theoretical framework of evolutionary ecology and life‐history evolution that provide the quantitative backgrounds necessary to understand and possibly anticipate adaptive responses to public health interventions.

Drivers of house invasion by sylvatic Chagas disease vectors in the Amazon-Cerrado transition: A multi-year, state-wide assessment of municipality-aggregated surveillance data

Background

Insecticide spraying efficiently controls house infestation by triatomine bugs, the vectors of Trypanosoma cruzi. The strategy, however, is ineffective against sylvatic triatomines, which can transmit Chagas disease by invading (without colonizing) man-made structures. Despite growing awareness of the relevance of these transmission dynamics, the drivers of house invasion by sylvatic triatomines remain poorly understood.

Methods/Findings

About 12,000 sylvatic triatomines were caught during routine surveillance in houses of Tocantins state, Brazil, in 2005–2013. Using negative binomial regression, information-theoretic model evaluation/averaging, and external model validation, we investigated the effects of regional (Amazon/Cerrado), landscape (preservation/disturbance), and climate covariates (temperature, rainfall) on the municipality-aggregated numbers of house-invading Rhodnius pictipes, R. robustus, R. neglectus, and Panstrongylus geniculatus. House invasion by R. pictipes and R. robustus was overall more frequent in the Amazon biome, tended to increase in municipalities with more well-preserved land, and decreased in rainier municipalities. Across species, invasion decreased with higher landscape-disturbance levels and in hotter-day municipalities. Invasion by R. neglectus and P. geniculatus increased somewhat with more land at intermediate disturbance and peaked in average-rainfall municipalities. Temperature effects were more pronounced on P. geniculatus than on Rhodnius spp.

Conclusions

We report widespread, frequent house invasion by sylvatic triatomines in the Amazon–Cerrado transition. Our analyses indicate that readily available environmental metrics may help predict the risk of contact between sylvatic triatomines and humans at coarse geographic scales, and hint at specific hypotheses about climate and deforestation effects on those vectors–with some taxon-specific responses and some seemingly general trends. Thus, our focal species appear to be quite sensitive to higher temperatures, and might be less common in more heavily-disturbed than in better-preserved environments. This study illustrates, in sum, how entomological routine-surveillance data can be efficiently used for Chagas disease risk prediction and stratification when house-colonizing vectors are absent.

Triatomine bugs are the vectors of Chagas disease, still a key public health concern in the Americas. Insecticide spraying efficiently controls house infestation by triatomines, but is useless against sylvatic bugs–which can transmit the disease by simply invading human residences. Although this behavior is common, the drivers of house invasion by wild triatomines remain poorly understood. Using municipality-aggregated data from routine surveillance, we investigated whether and how some major environmental factors affect house invasion by four triatomine species across the transition between Amazon rainforests and Cerrado savannahs in Brazil. We found that house invasion (i) is widespread, (ii) varies by region for some species, (iii) is overall less frequent in areas with higher levels of landscape disturbance, and (iv) is less common in hotter and in rainier sites. Although the effects of landscape disturbance and climate differed somewhat among bug species, the general approach we describe here may help advance Chagas disease risk assessment when house-colonizing vectors are absent.

Triatoma costalimai (Hemiptera: Reduviidae) in and Around Houses of Tocantins State, Brazil, 2005-2014

Triatoma costalimai Verano & Galvão, a little-known vector of Trypanosoma cruzi Chagas, occupies rocky environments in the Brazilian Cerrado and occasionally infests man-made habitats. Entomological surveillance records show that T. costalimai occurs fairly often inside and around houses in south-eastern Tocantins, Brazil, with 859 specimens reported in 2005-2014. Most adults were caught indoors, and breeding colonies were found inside and around houses. Trypanosoma cruzi was detected in 13.7% of 839 bugs. These data suggest that T. costalimai can contribute to T. cruzi transmission in human environments, underscoring the need for long-term entomological-epidemiological surveillance wherever native Chagas disease vectors occur.

Multi-criteria decision analysis and spatial statistic: an approach to determining human vulnerability to vector transmission of Trypanosoma cruzi

BACKGROUND

Chagas disease (CD), caused by the protozoan Trypanosoma cruzi, is a neglected human disease. It is endemic to the Americas and is estimated to have an economic impact, including lost productivity and disability, of 7 billion dollars per year on average.

OBJECTIVES

To assess vulnerability to vector-borne transmission of T. cruzi in domiciliary environments within an area undergoing domiciliary vector interruption of T. cruzi in Colombia.

METHODS

Multi-criteria decision analysis [preference ranking method for enrichment evaluation (PROMETHEE) and geometrical analysis for interactive assistance (GAIA) methods] and spatial statistics were performed on data from a socio-environmental questionnaire and an entomological survey. In the construction of multi-criteria descriptors, decision-making processes and indicators of five determinants of the CD vector pathway were summarily defined, including: (1) house indicator (HI); (2) triatominae indicator (TI); (3) host/reservoir indicator (Ho/RoI); (4) ecotope indicator (EI); and (5) socio-cultural indicator (S-CI).

FINDINGS

Determination of vulnerability to CD is mostly influenced by TI, with 44.96% of the total weight in the model, while the lowest contribution was from S-CI, with 7.15%. The five indicators comprise 17 indices, and include 78 of the original 104 priority criteria and variables. The PROMETHEE and GAIA methods proved very efficient for prioritisation and quantitative categorisation of socio-environmental determinants and for better determining which criteria should be considered for interrupting the man-T. cruzi-vector relationship in endemic areas of the Americas. Through the analysis of spatial autocorrelation it is clear that there is a spatial dependence in establishing categories of vulnerability, therefore, the effect of neighbors’ setting (border areas) on local values should be incorporated into disease management for establishing programs of surveillance and control of CD via vector.

CONCLUSIONS

The study model proposed here is flexible and can be adapted to various eco-epidemiological profiles and is suitable for focusing anti-T. cruzi serological surveillance programs in vulnerable human populations.