title: Prevalence and Transmission of Trypanosoma cruzi in People of Rural Communities of the High Jungle of Northern Peru.
abstract: BACKGROUND
  Vector-borne transmission of Trypanosoma cruzi is seen exclusively in the Americas where an estimated 8 million people are infected with the parasite. Significant research in southern Peru has been conducted to understand T. cruzi infection and vector control, however, much less is known about the burden of infection and epidemiology in northern Peru.
  
  
  METHODS
  A cross-sectional study was conducted to estimate the seroprevalence of T. cruzi infection in humans (n=611) and domestic animals [dogs (n=106) and guinea pigs (n=206)] in communities of Cutervo Province, Peru. Sampling and diagnostic strategies differed according to species. An entomological household study (n=208) was conducted to identify the triatomine burden and species composition, as well as the prevalence of T. cruzi in vectors. Electrocardiograms (EKG) were performed on a subset of participants (n=90 T. cruzi infected participants and 170 age and sex-matched controls). The seroprevalence of T. cruzi among humans, dogs, and guinea pigs was 14.9% (95% CI: 12.2-18.0%), 19.8% (95% CI: 12.7-28.7%) and 3.3% (95% CI: 1.4-6.9%) respectively. In one community, the prevalence of T. cruzi infection was 17.2% (95% CI: 9.6-24.7%) among participants < 15 years, suggesting recent transmission. Increasing age, positive triatomines in a participant's house, and ownership of a T. cruzi positive guinea pig were independent correlates of T. cruzi infection. Only one species of triatomine was found, Panstrongylus lignarius, formerly P. herreri. Approximately forty percent (39.9%, 95% CI: 33.2-46.9%) of surveyed households were infested with this vector and 14.9% (95% CI: 10.4-20.5%) had at least one triatomine positive for T. cruzi. The cardiac abnormality of right bundle branch block was rare, but only identified in seropositive individuals.
  
  
  CONCLUSIONS
  Our research documents a substantial prevalence of T. cruzi infection in Cutervo and highlights a need for greater attention and vector control efforts in northern Peru.
authors.affiliation: American Association for the Advancement of Science (AAAS) Science & Technology Policy Fellow at the Division of Environmental Biology, National Science Foundation, Arlington, Virginia, United States of America; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Alroy
authors.affiliation: Department of Pediatrics and Department of Emergency Medicine, University of Arizona, Tucson, Arizona, United States of America.
authors.forename: Christine
authors.initials: C
authors.lastname: Huang
authors.affiliation: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America; Faculty of Science and Philosophy Alberto Cazorla Talleri, Urbanización Ingeniería, University Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
authors.affiliation: Faculty of Science and Philosophy Alberto Cazorla Talleri, Urbanización Ingeniería, University Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Victor R
authors.initials: VR
authors.lastname: Quispe-Machaca
authors.affiliation: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Morgan A
authors.initials: MA
authors.lastname: Marks
authors.affiliation: Faculty of Science and Philosophy Alberto Cazorla Talleri, Urbanización Ingeniería, University Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Jenny
authors.initials: J
authors.lastname: Ancca-Juarez
authors.affiliation: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Miranda
authors.initials: M
authors.lastname: Hillyard
authors.affiliation: Faculty of Science and Philosophy Alberto Cazorla Talleri, Urbanización Ingeniería, University Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Manuela
authors.initials: M
authors.lastname: Verastegui
authors.affiliation: Faculty of Science and Philosophy Alberto Cazorla Talleri, Urbanización Ingeniería, University Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Sanchez
authors.affiliation: Faculty of Science and Philosophy Alberto Cazorla Talleri, Urbanización Ingeniería, University Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Lilia
authors.initials: L
authors.lastname: Cabrera
authors.affiliation: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: Elisa
authors.initials: E
authors.lastname: Vidal
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
authors.forename: Erica M W
authors.initials: EM
authors.lastname: Billig
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Vitaliano A
authors.initials: VA
authors.lastname: Cama
authors.affiliation: Faculty of Science and Philosophy Alberto Cazorla Talleri, Urbanización Ingeniería, University Peruana Cayetano Heredia, Lima, Peru.
authors.forename: César
authors.initials: C
authors.lastname: Náquira
authors.affiliation: Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, United States of America.
authors.forename: Caryn
authors.initials: C
authors.lastname: Bern
authors.affiliation: Faculty of Science and Philosophy Alberto Cazorla Talleri, Urbanización Ingeniería, University Peruana Cayetano Heredia, Lima, Peru; Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
authors.forename: Michael Z
authors.initials: MZ
authors.lastname: Levy
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D000829:Animals, Domestic; D000913:Antibodies, Protozoan / Q000097:blood*; D014355:Chagas Disease / Q000453:epidemiology* / Q000469:parasitology / Q000635:transmission*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004285:Dogs; D004562:Electrocardiography; D005260:Female; D006168:Guinea Pigs; D006801:Humans; D007303:Insect Vectors / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D010203:Panstrongylus / Q000469:parasitology; D010568:Peru / Q000453:epidemiology; D012424:Rural Population; D016036:Seroepidemiologic Studies; D014349:Trypanosoma cruzi / Q000276:immunology* / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D000913:Antibodies, Protozoan