Eco-epidemiology of american cutaneous leishmaniasis in Argentina

SALOMÓN OD, QUINTANA MG, ROSA JR, ACARDI, SA

Lucknow, India

Congreso; WordLeish 4; 2009

 The eco-epidemiology of (ACL) has being studied in the nine endemic provinces of Argentina since 1990 (7,000 human cases, 250,000 sand flies). The epidemic scenarios of ACL transmission inferred from the focus studies are: 1) Forest cycle/forest transmission: Human-vector interaction related with forest activities, for subsistence, paid work, or leisure. 2) Forest cycle/peridomestic transmission: Human-vector contact in the peridomestic setting when: 2a) houses about a forested area (vector source populations-border effect); 2b) houses linked with residual vegetation patches by landscapes that allow vector dispersion-cascade effect after environmental modification (flood, deforestation). 3) Peridomestic cycle/peridomestic (rural, rural.urban interphase, ruralized periurban) transmission: Human-vector contact due to adaption of phlebotmine species to peridomestic modified environments, usually associated with animal breeding. The human risk in each scenario was associated with phlebotomine diversity/bio-ecological region, and vector abundance (Lutzomyia neivai, Lu. withmani, and Lu. migonei). Therefore, a risk map of ACL is developing to be used by the National Program of Leishmaniasis in order to design recommendations and activities adiscriminated by area: 1) Hyperendemic-epidemic transmission: 1a) High risk; 1b) Moderate risk. 2) Sporadic Transmission (eventually “commom source” outbreaks). 3) Receptive (with vectors without cases). 4) Vulnerable (adjacent or with intense transit with area 1.a). Some stratified measures proposed include active search of cases, risk assessment of environmental changes, focus monitoring of eco.epidemiological moment (social, biological, environmental), and trends, and entomological screening to define high risk sites and surveillance in sentinel sites. Operational research should also be stratified to evaluate static/movile barriers limited in space and time, control trials, predictive models (focus scale), and the social construction of risk about human-forest interaction (risky vs needs behaviors, the nature as risk); domestic.peridomestic management and human-animal relationshio (spatial domains, shadow distribution, trash, wild-synanthropic-domestic-pet animal breeding-control).