Review: surveillance of Chagas disease

After remarkable reduction in prevalence through regional elimination of domestic vectors, the central challenge of Chagas disease control is shifting towards interruption of the disease transmission by non-eliminable vectors in Latin America. Vector surveillance with community participation was cost-effective against the eliminable vectors. But the efforts often failed against the non-eliminable vectors due to lack of surveillance coverage or sustainability. For instance, in El Salvador and Honduras, the operational vector control personnel lost access to many communities under decentralized health systems. To cover wider areas lastingly, the countries implemented the surveillance systems involving non-specialists from locally embedded resources, such as local health services, schools and community leaders. From these experiences, this paper outlines a common structure of the current community-based surveillance systems, consisting of five fundamental sequential functions. To increase scalability and sustainability, four of the five functions could be delegated to the locally available human resources, and the surveillance systems can be integrated into the general health systems. Challenges at national and regional levels are discussed for further evolution of the surveillance systems.