Elusive killer parasite being traced in Peru

of distance from their home to an unknown site, or sites, where disease has been introduced, and combines that measure with other known risks to estimate the probability of infection. From this data, the course of infection can be traced backward to infer where and when a disease first struck a community.

Levy’s team has been collecting data in Peru since 2004. “We do all the field work, we gather all our data, which is very much door-to-door, old-fashioned epidemiology,” said Levy. That involves both entering households to search for infected insects and collecting blood samples from residents. The team’s survey work led to the observation of spatial clusters of parasites in insects such that “it looked like there were isolated clusters of transmission, or ‘micro-epidemics.’ It was really observation, then hypothesis, then testing.”

According to their findings, the Chagas parasite was introduced into the region about twenty years ago, and most infections occurred over the last ten years. Spread of the disease is being disrupted in Arequipa through insecticide application, but up to 5 percent of the population was infected before their houses were sprayed with insecticide. Levy and his colleagues conclude that the lack of chronic disease symptoms among these infected individuals could be due to the relatively short time of transmission: Most individuals may have yet to pass from the long asymptomatic period to symptomatic Chagas disease.

Inevitable increase

The finding has crucial implications for the future management of the disease. Because the lack of late-stage Chagas disease in Arequipa is not an indication of a weakened parasite, the researchers believe that preparations should be made for a potential increase in chronic Chagas cases in coming years. As they have throughout their research, Levy’s team is working in close collaboration with the Peruvian government to ensure that the warning provided by their work does not go unheeded. “Everything we do in Arequipa is with the local Ministry of Health,” Levy said. “We’re very much integrated with the government’s Chagas disease control program. We started diagnosing people who are asymptomatic and the Ministry of Health is treating the individuals who are diagnosed to increase the probability they don’t progress to later-stage disease.”

Levy and his collaborators, including Eleazar Cordova-Benzaquen and Cesar Naquira in Peru, plan to expand their epicenter regression modeling techniques to study other infectious diseases, including the West Nile virus in New York City. The method can even be applied to fighting the spread of pesky insects such as bedbugs. “We’re trying to work in parallel to improve control of Chagas vectors and bedbugs,” he noted. “The idea is if you find a house with bedbugs, where do you go next? Same thing with the Chagas bugs. When they come back after the insecticide campaigns, you get a report and you have to figure out how to react to those reports, which are pretty scattered.”

Levy and his team have found a way to find patterns, and thus more predictability, in the chaos of infectious disease transmission.

This work was funded by the National Institutes of Allergy and Infectious Diseases.

— Read more in Michael Z. Levy et al., “Retracing Micro-Epidemics of Chagas Disease Using Epicenter Regression,” PLoS Comput Biol 7, no. 9, e1002146 (15 Septeber 2011) (doi:10.1371/journal.pcbi.1002146)