Chagas disease control in Brazil: which strategy after the attack phase?

Area of Science:

• Vector-borne disease control
• Public health entomology
• Tropical medicine

Background:

• Chagas disease transmission in Brazil is primarily linked to domestic triatomine bugs.
• The Brazilian Chagas Disease Programme (CDP) initiated a large-scale insecticide spraying campaign in 1983.
• Over 80% of human Chagas disease cases are attributed to vector transmission.

Purpose of the Study:

• To evaluate the effectiveness of the Brazilian Chagas Disease Programme's (CDP) attack phase.
• To outline the transition to a vigilance phase for sustained vector control.
• To identify challenges and future strategies for Chagas disease prevention.

Main Methods:

• Implementation of a vertical, nationwide insecticide spraying strategy across 2,400 municipalities.
• Transition to a regional vigilance phase involving community participation and surveillance.
• Monitoring of triatomine bug populations, focusing on peridomestic environments.

Main Results:

• The attack phase achieved good entomological results in approximately 70% of the endemic area.
• Significant reduction in Chagas disease transmission has been observed.
• The vigilance phase is active in over 700 municipalities, with regional posts responding to infestations.

Conclusions:

• The CDP has been effective in reducing Chagas disease vectors through widespread spraying.
• Sustained control requires a shift to a vigilance phase emphasizing community participation and surveillance.
• Future strategies must address environmental changes, peridomestic vector control, and integrated public health measures.