Chagas disease is a neglected tropical disease strongly associated with low socioeconomic status, affecting nearly 8 million people – mainly Latin Americans. The current infection risk is based on acute case reports, most of which are typically associated with oral transmissions. In the semi-arid region of Northeastern Brazil, serious outbreaks of this transmission type have surged in the last years. One of those occurred in 2016 in the state of Rio Grande do Norte. Rural residents of four municipalities surrounding Marcelino Vieira ingested sugar cane juice – which was probably ground with Trypanosoma cruzi-infected insects. Eighteen cases of Chagas disease were confirmed serologically, with two deaths reported. Socioeconomic information, schooling of residents and the structure of peridomestic and domestic environments in the rural area of Marcelino Vieira, along with entomological indicators, were investigated to understand better the factors related to the outbreaks in this region. We found triatomines (mainly Triatoma brasiliensis) in 35% (24/67) of domiciliary units and all rocky outcrops inspected (n = 7). Overall, 25% (91/357) of examined T. brasiliensis were infected by T. cruzi in artificial ecotopes, with almost the same prevalence in the sylvatic environment (22%; 35/154). Among all ecotopes investigated, wood/tile/brick piles were the ones linked to high insect infestations and triatomine T. cruzi infection prevalence. Ninety-five percent of people interviewed recognized the triatomines and knew the classic route of transmission of disease – triatomine bite-dependent. However, only 7.5% admitted knowledge that Chagas disease can also be acquired orally – which poses a risk this transmission route currently recognized. Here, we highlight the physical proximity between humans and triatomine populations with high T. cruzi infection prevalence as an additional risk factor to oral/vector contaminations. In sum, residents have low income, low level of education, and/or a willful disregard for the routes of Chagas disease transmission (specifically oral transmission), a combination of factors that may have favored the Chagas disease outbreak. We here provide recommendations to avoid further outbreaks.

恰加斯病是一种被忽视的热带病，与低社会经济地位密切相关，影响了近800万人，主要是拉丁美洲人。当前的感染风险基于急性病例报告，其中大多数通常与口腔传播有关。在巴西东北部的半干旱地区，这种传播类型的严重暴发在最近几年激增。其中之一发生在2016年，发生在北里奥格兰德州。Marcelino Vieira周围四个城市的农村居民摄取了甘蔗汁-可能是用克鲁斯锥虫磨碎的感染的昆虫。经血清学证实有18例恰加斯病，据报道有2例死亡。调查了Marcelino Vieira农村地区的社会经济信息，居民的受教育程度以及家庭和家庭环境的结构，以及昆虫学指标，以更好地了解与该地区暴发相关的因素。我们在35％（24/67）的住所单位中发现了三atomines（主要是巴西的Triatoma），并且检查了所有岩石露头（n  = 7）。总体而言，有25％（91/357）的受检巴西巴西锥虫被克鲁氏锥虫感染在人造生态区中，在sylvatic环境中的患病率几乎相同（22％； 35/154）。在所有被调查的生态环境中，木/砖/砖堆是与高虫害和克鲁维氏锥虫感染率相关的。百分之九十五的受访者认识到三松散，并知道疾病的经典传播途径-三松散咬伤。但是，只有7.5％的人承认也可以口服获得恰加斯病，这构成了目前公认的传播途径的风险。在这里，我们突出显示人类与高T. cruzi的三atomine种群之间的物理接近性感染的流行是口腔/媒介物污染的另一个危险因素。总之，居民收入低，教育水平低和/或故意忽视南美锥虫病传播途径（特别是口头传播途径），这可能是导致南美锥虫病爆发的多种因素的综合。我们在此提供建议，以避免进一步爆发。