Guilherme Loureiro Werneck|Carlos Henrique Nery Costa|Fernando Aécio de Amorim Carvalho|Maria do Socorro Pires e Cruz|James H. Maguire|Márcia C. Castro
Effectiveness of Insecticide Spraying and Culling of Dogs on the Incidence of Leishmania infantum Infection in Humans: A Cluster Randomized Trial in Teresina, Brazil
Harvard Global Health Institute|Universidade do Estado do Rio de Janeiro|Departamento de Epidemiología|Universidade Federal do Piauí|Universidade Federal do Piauí|Universidade Federal do Piauí|Brigham and Women's Hospital|Harvard University|Harvard Global Health Institute
evaluate effect insecticide spraying vector control elimination infected dogs incidence human infection l infantum randomized community intervention trial carried city teresina brazilwithin ten localities city four blocks selected randomized 4 interventions 1 spraying houses animal pens insecticide 2 eliminating infected dogs 3 combination spraying eliminating dogs 4 nothing main outcome incidence infection assessed conversion montenegro skin test mst 18 months followup residents aged 1 year previous history visceral leishmaniasis vl reactions measured 4872 h induration 5 mm considered positive interventions executed baseline interview repeated 6 12 months later effects type intervention scheme incidence infection assessed calculating relative risks 95 confidence intervals using poisson populationaveraged regression models robust variance among 1105 participants 408 37 mst positive baseline 697 negatives 423 61 reexamined end followup 151 36 converted positive mst dog culling statistically significant effect reducing incidence infection estimates effectiveness varying 27 52 depending type analysis performedin light continuous spread vl brazil despite large scale deployment insecticide spraying dog culling relatively low moderate effectiveness dog culling nonsignificant effect insecticide spraying incidence human infection conclude urgent need revision brazilian vl control program