title: Chagas disease transmission in periurban communities of Arequipa, Peru.
abstract: BACKGROUND
  Chagas disease, caused by Trypanosoma cruzi infection, is an urban problem in Arequipa, Peru, and the epidemiology of Chagas disease is likely to be quite different in this area, compared with in rural zones.
  
  
  METHODS
  We conducted a serosurvey of 1615 children <18 years old in periurban districts that included hillside shantytowns and slightly more affluent low-lying communities. In addition, 639 adult residents of 1 shantytown were surveyed to provide data across the age spectrum for this community.
  
  
  RESULTS
  Of 1615 children, 75 (4.7%) were infected with Trypanosoma cruzi. Infection risk increased by 12% per year of age, and children living in hillside shantytowns were 2.5 times as likely to be infected as were those living in lower-lying communities. However, age-prevalence data from 1 shantytown demonstrated that adults were no more likely to be seropositive than were teenagers; the results of maximum likelihood modeling suggest that T. cruzi transmission began in this community <20 years ago.
  
  
  CONCLUSIONS
  The problem of Chagas disease in periurban settings, such as those around Arequipa, must be addressed to achieve elimination of vector-borne T. cruzi transmission. Identification of infected children, vector-control efforts, and education to avoid modifiable risk factors are necessary to decrease the burden of Chagas disease.
authors.affiliation: Asociación Benéfica Proyectos en Informática, Salud, Medicina y Agricultura, Lima, Peru.
authors.forename: Natalie M
authors.initials: NM
authors.lastname: Bowman
authors.forename: Vivian
authors.initials: V
authors.lastname: Kawai
authors.forename: Michael Z
authors.initials: MZ
authors.lastname: Levy
authors.forename: Juan Geny
authors.initials: JG
authors.lastname: Cornejo del Carpio
authors.forename: Lilia
authors.initials: L
authors.lastname: Cabrera
authors.forename: F
authors.initials: F
authors.lastname: Delgado
authors.forename: Francisco
authors.initials: F
authors.lastname: Malaga
authors.forename: Eleazar
authors.initials: E
authors.lastname: Cordova Benzaquen
authors.forename: Viviana V
authors.initials: VV
authors.lastname: Pinedo
authors.forename: Francis
authors.initials: F
authors.lastname: Steurer
authors.forename: Amy E
authors.initials: AE
authors.lastname: Seitz
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
authors.forename: Caryn
authors.initials: C
authors.lastname: Bern
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000818:Animals; D014355:Chagas Disease / Q000453:epidemiology* / Q000635:transmission*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016013:Likelihood Functions; D008297:Male; D010568:Peru / Q000453:epidemiology; D016036:Seroepidemiologic Studies; D013997:Time Factors; D014349:Trypanosoma cruzi / Q000276:immunology / Q000302:isolation & purification*; D014505:Urban Population