03022nas a2200289   4500000000100000008004100001653003900042653001900081653004100100653001100141653001800152100001100170700001400181700001200195700001800207700001300225700001800238700001400256700001600270700001500286245012900301856009800430300001300528490000700541520217000548022001402718       2018                            d10aNeglected tropical diseases (NTDs)10aChagas disease10aSustainable Development Goals (SDGs)10aMexico10aLatin America1 aLee BY1 aBartsch S1 aSkrip L1 aHertenstein D1 aAvelis C1 aNdeffo-Mbah M1 aTilchin C1 aDumonteil E1 aGalvani AP00aAre the London Declaration's 2020 goals sufficient to control Chagas disease?: Modeling scenarios for the Yucatan Peninsula.  uhttp://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0006337&type=printable  ae00063370 v123 a<p><strong>BACKGROUND: </strong>The 2020 Sustainable Development goals call for 100% certified interruption or control of the three main forms of Chagas disease transmission in Latin America. However, how much will achieving these goals to varying degrees control Chagas disease; what is the potential impact of missing these goals and if they are achieved, what may be left?</p>

<p><strong>METHODS: </strong>We developed a compartmental simulation model that represents the triatomine, human host, and non-human host populations and vector-borne, congenital, and transfusional T. cruzi transmission between them in the domestic and peridomestic settings to evaluate the impact of limiting transmission in a 2,000 person virtual village in Yucatan, Mexico.</p>

<p><strong>RESULTS: </strong>Interruption of domestic vectorial transmission had the largest impact on T. cruzi transmission and prevalence in all populations. Most of the gains were achieved within the first few years. Controlling vectorial transmission resulted in a 46.1-83.0% relative reduction in the number of new acute Chagas cases for a 50-100% interruption in domestic vector-host contact. Only controlling congenital transmission led to a 2.4-8.1% (30-100% interruption) relative reduction in the total number of new acute cases and reducing only transfusional transmission led to a 0.1-0.3% (30-100% reduction). Stopping all three forms of transmission resulted in 0.5 total transmission events over five years (compared to 5.0 with no interruption); interrupting all forms by 30% resulted in 3.4 events over five years per 2,000 persons.</p>

<p><strong>CONCLUSIONS: </strong>While reducing domestic vectorial, congenital, and transfusional transmission can successfully reduce transmission to humans (up to 82% in one year), achieving the 2020 goals would still result in 0.5 new acute cases per 2,000 over five years. Even if the goals are missed, major gains can be achieved within the first few years. Interrupting transmission should be combined with other efforts such as a vaccine or improved access to care, especially for the population of already infected individuals.</p>
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