Eco-epidemiology of American Cutaneous Leishmaniasis in Argentina

SALOMÓN, OD; QUINTANA, MG; ROSA, JR; ACARDI, S; MASTRANGELO, AV

Lucknow, India

Congreso; World Leish 4; 2009

OMS - CDRI, India

The eco--epidemiology of ACL has being studied in the nine endemic provinces of Argentina since 1990 (7,000) human cases, 250,000 sandflies). The epidemic scenarios of AC transmision inferred from the focus studies are: 1) Forest cycle/forest transmission: human vector interaction realted with forest activities , for subsistence, paid work, or leisure. 2) Forest cycle/peridomestic transmission: human-vector contact in the peridomestic setting when: 2a) houses abut a forested area (vector source populations-border effect); 2b) houses linked with residual vegatation 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 contactdue the adaptation of flebotomine species to peridomestic modifed environments, ussually associated with animal breeding. The human risk in each scenario was associated with flebotomine diversity/bio-ecological region and vector abundance (Lutzomyia neivai, Lu whitmani; and Lu. migonei). Therefore a risk map of ACL is developingo to be used by the National Program of Leishmaniasis in order to design recommendations and activities adiscriminated by area: 1)Hyperendemic-epedemic transmission:1a) High risk; 1b)Moderate risk. 2) Sporadic transmission (eventually common source autbreaks).3) Receptive (with vectors without cases).4) Vulnerable (adjacent or with intense transit area 1a) Some stratified measures proposed include active search of cases, risk assessment of environmental changes, focus monitoring of eco-epidemiological momento (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 humna-forest interaction (risky vs. needs behaviors, the nature as risk); domestic-peridomestic managemant and humna-animal relation ship (spatial domains, shadow distribution, trash, wild synanthropic-domestic-pet animal breeding-control).