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The perception of vectors and a need for education

Unfortunately, even now, humans in the affected regions do not associate the presence of triatomines in their home with the transmission of any illnesses. The ignorance surrounding Chagas disease works against efforts to control it. Indeed to fight against Chagas disease, people should become aware that living with triatomines could be dangerous to their health. It is urgent that people exposed to vector transmission be made aware of this danger so that they can become involved in combating Chagas disease. In recent years, several initiatives have been developed to involve residents in the fight against vectors. This has been done in Mexico (Yucatan), Guatemala, and Bolivia in two regions (Andean valleys and lowlands), as well as in other countries. Consultations and discussions were carried out during meetings implemented between the group of researchers and the inhabitants to evaluate different strategies and then have a better exchange within the population for the actions that they decided to implement.89,111,112 Also, the experience in the

United States on information dissemination and collection of triatomines through different media is very interesting: printed pamphlets, radio, phone, website, and a dedicated email address were all used.113

Knowledge about Chagas disease should be disseminated throughout the at-risk population so that testimonies such as Jose’s are not repeated. “Montero is a town 100 km from Santa Cruz de la Sierra in Bolivia. A large family of ten children live in a house near the sawmill on the outskirts of the city. The nuisance is so great that the mother regularly struggles against the triatomines and cockroaches invading the house. She periodically removes the mattresses and places them in the sun. Jose remembers: ‘Frequently at night, we’d catch Triatoma infestans, and then Mom would send us to sleep with our uncle as she treated the house with insecticide overnight. But it is impossible to get rid of these disgusting insects. When did I know that the Triatoma infestans transmitted disease? When my sister, Juana, began her nursing studies, she discovered that she was chagasic and began treatment but soon discontinued her treatment because she had adverse reactions. No one in the family realized that Chagas disease could be a problem for the other members of the family, and everyone needed a checkup. A few years later in 2000, my brother suffered a heart attack during a football game and died. He was 46 years old. The autopsy showed infection by T. cruzi. Then we were all concerned about our health, and my brothers and sisters are all chagasic. Juana is in Italy and I am in France, the countries to which we immigrated a few years ago. During recent years, two other siblings died, both suddenly. We did not know about the bugs, the insects that transmit Chagas disease. And then later, we heard only that Chagas disease could not be treated, and that we should live with it without worrying about it.’ I talked with Jose, and I explained several things. I told him that parasites are in the feces and that the parasite is not in the salivary glands; he did not know. He remembered that when he was a young boy, he and his siblings frequently found Triatoma infestans in the bedroom, usually engorged with blood, and they would remove the head, but they had not taken any precautions, and they would get blood and feces on their hands.”

The lack of satisfactory treatments and a vaccine for Chagas disease is a huge problem at the clinical, educational social, and psychological levels. For this reason, prevention is the best alternative to fight against this disease, and education is key of sustained prevention.

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