{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T18:17:11Z","timestamp":1783448231224,"version":"3.55.0"},"update-to":[{"DOI":"10.1371\/journal.pntd.0014464","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000}}],"reference-count":47,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100015691","name":"Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["NIH-NIAID 1R01AI146129"],"award-info":[{"award-number":["NIH-NIAID 1R01AI146129"]}],"id":[{"id":"10.13039\/100015691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:p>Vector-borne pathogens continue to emerge, kill and harm humans with unrelenting regularity. Conventional strategies for controlling insect vectors grew out of the military; communication is hierarchical, responses unilateral, and regulation predetermined. We developed an alternative approach, modeled after the adaptive immune system, and compared the approaches through a cluster-randomized trial in the context of an ongoing urban Chagas disease vector control campaign in Arequipa, Peru. Clusters consisted of pre-defined geographic jurisdictions of health facilities, and averaged 2,271 households. Thirty clusters were assigned to the immune arm, and thirty to the conventional arm, balancing on antecedents related to the probability of vector infestation. Following delays, the trial initiated in October 2021. We report here early results from a pre-planned interim analysis scheduled for March 2023. In the immune arm 23 infested households were discovered and confirmed in 10 separate foci; in the conventional arm only 5 infested households were discovered and confirmed, and all were from the same focus. The immune approach was adaptive, and more effort was expended upon confirmation of an infestation (1085.2 person days in the immune arm vs 864.2 in the conventional; Rate ratio 23\/1085.2:5\/864.2\u2009=\u20093.66 [1.49 - 10.60], p-value\u2009=\u20090.0038). Vector surveillance approaches modeled after the immune system are a potentially more effective alternative to conventional approaches, especially to control vector borne diseases in cities and other complex environments.<\/jats:p>","DOI":"10.1371\/journal.pntd.0014464","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T17:47:17Z","timestamp":1782150437000},"page":"e0014464","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["An immune system for the city: A cluster-randomized trial of a new paradigm for surveillance and control of disease vectors"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4661-3764","authenticated-orcid":true,"given":"Michael Z.","family":"Levy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4164-6161","authenticated-orcid":true,"given":"Laura D.","family":"Tamayo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos E.","family":"Condori-Pino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Arevalo-Nieto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Castillo-Neyra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie A.","family":"Paz-Sold\u00e1n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"key":"pntd.0014464.ref001","volume-title":"Molecular biology of the cell","author":"B Alberts","year":"2002","edition":"4"},{"issue":"2","key":"pntd.0014464.ref002","doi-asserted-by":"crossref","first-page":"194","DOI":"10.5114\/ceji.2018.77390","article-title":"Immunological memory cells","volume":"43","author":"W Ratajczak","year":"2018","journal-title":"Cent Eur J Immunol"},{"key":"pntd.0014464.ref003","first-page":"142","volume-title":"Chapter 6 \u201cMosquito or Man?\u201d: Imperialism and the Rise of Tropical Medicine, 1878-1912. Yellow fever, race, and ecology in nineteenth-century New Orleans","author":"UE Willoughby","year":"2017"},{"key":"pntd.0014464.ref004","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/s13071-016-1315-x","article-title":"Increased mortality attributed to Chagas disease: a systematic review and meta-analysis","volume":"9","author":"ZM Cucunub\u00e1","year":"2016","journal-title":"Parasit Vectors"},{"key":"pntd.0014464.ref005","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1051\/parasite\/2014012","article-title":"Chagas disease in the 21st century: a public health success or an emerging threat?","volume":"21","author":"KM Bonney","year":"2014","journal-title":"Parasite"},{"key":"pntd.0014464.ref006","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1590\/S0074-02762007005000092","article-title":"Southern Cone Initiative for the elimination of domestic populations of Triatoma infestans and the interruption of transfusional Chagas disease. Historical aspects, present situation, and perspectives","author":"JCP Dias","year":"2007","journal-title":"Mem Inst Oswaldo Cruz"},{"key":"pntd.0014464.ref007","first-page":"1","article-title":"The Southern Cone Initiative against Chagas Disease","author":"CJ Schofield","year":"1999","journal-title":"Advances in Parasitology"},{"key":"pntd.0014464.ref008","first-page":"80","article-title":"Evaluaci\u00f3n de los programas de erradicaci\u00f3n de vectores de la enfermedad de Chagas en Chile mediante estudio serol\u00f3gico de ni\u00f1os menores de 10 a\u00f1os","volume":"51","author":"M Lorca","year":"1996","journal-title":"Bol chil parasitol"},{"key":"pntd.0014464.ref009","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1590\/S0074-02761999000700080","article-title":"Elimination of vector-borne transmission of Chagas disease","author":"A Silveira","year":"1999","journal-title":"Mem Inst Oswaldo Cruz"},{"issue":"56","key":"pntd.0014464.ref010","first-page":"6","article-title":"Uruguay declared free of Chagas disease transmission","year":"1998","journal-title":"TDR News"},{"key":"pntd.0014464.ref011","author":"Pan American Health Organization","year":"2018"},{"key":"pntd.0014464.ref012","volume-title":"Case 12 Controlling Chagas Disease in the Southern Cone of South America","author":"What Works Working Group","year":"2004"},{"issue":"9","key":"pntd.0014464.ref013","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.3201\/eid1209.051662","article-title":"Periurban Trypanosoma cruzi-infected Triatoma infestans, Arequipa, Peru","volume":"12","author":"MZ Levy","year":"2006","journal-title":"Emerg Infect Dis"},{"issue":"11","key":"pntd.0014464.ref014","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0006883","article-title":"Integrating evidence, models and maps to enhance Chagas disease vector surveillance","volume":"12","author":"A Gutfraind","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"issue":"9","key":"pntd.0014464.ref015","article-title":"Retracing micro-epidemics of Chagas disease using epicenter regression","volume":"7","author":"MZ Levy","year":"2011","journal-title":"PLoS Comput Biol"},{"key":"pntd.0014464.ref016","first-page":"1","article-title":"Recommendations of the International Task Force for Disease Eradication","volume":"42","year":"1993","journal-title":"MMWR Recomm Rep"},{"key":"pntd.0014464.ref017","unstructured":"World Health Organization. Handbook for integrated vector management. 2012; 67."},{"issue":"3","key":"pntd.0014464.ref018","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1111\/rssa.12077","article-title":"Mapping the Spatial Distribution of a Disease-Transmitting Insect in the Presence of Surveillance Error and Missing Data","volume":"178","author":"AE Hong","year":"2014","journal-title":"Journal of the Royal Statistical Society Series A: Statistics in Society"},{"key":"pntd.0014464.ref019","article-title":"Evaluacion programa de Chagas, Chile","year":"2003"},{"issue":"2","key":"pntd.0014464.ref020","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0000970","article-title":"A history of chagas disease transmission, control, and re-emergence in peri-rural La Joya, Peru","volume":"5","author":"S Delgado","year":"2011","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"pntd.0014464.ref021","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0001468","article-title":"A field trial of alternative targeted screening strategies for Chagas disease in Arequipa, Peru","volume":"6","author":"GC Hunter","year":"2012","journal-title":"PLoS Negl Trop Dis"},{"issue":"8","key":"pntd.0014464.ref022","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1086\/597464","article-title":"Spatial patterns in discordant diagnostic test results for Chagas disease: links to transmission hotspots","volume":"48","author":"MZ Levy","year":"2009","journal-title":"Clin Infect Dis"},{"key":"pntd.0014464.ref023","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1186\/1476-072X-12-48","article-title":"A country bug in the city: urban infestation by the Chagas disease vector Triatoma infestans in Arequipa, Peru","volume":"12","author":"S Delgado","year":"2013","journal-title":"Int J Health Geogr"},{"issue":"12","key":"pntd.0014464.ref024","doi-asserted-by":"crossref","first-page":"2055","DOI":"10.3201\/eid2012.131820","article-title":"Residual infestation and recolonization during urban Triatoma infestans Bug Control Campaign, Peru","volume":"20","author":"CM Barbu","year":"2014","journal-title":"Emerg Infect Dis"},{"issue":"1","key":"pntd.0014464.ref025","article-title":"A real-time search strategy for finding urban disease vector infestations","volume":"9","author":"EB Rose","year":"2020","journal-title":"Epidemiologic Methods"},{"issue":"8","key":"pntd.0014464.ref026","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0000145","article-title":"Incentivizing optimal risk map use for Triatoma infestans surveillance in urban environments","volume":"2","author":"C Arevalo-Nieto","year":"2022","journal-title":"PLOS Glob Public Health"},{"key":"pntd.0014464.ref027","year":"2022"},{"issue":"8","key":"pntd.0014464.ref028","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0013373","article-title":"Barriers to surveillance and control of re-emergence of the Chagas disease vector Triatoma infestans in Arequipa, Peru","volume":"19","author":"LD Tamayo","year":"2025","journal-title":"PLoS Negl Trop Dis"},{"issue":"10","key":"pntd.0014464.ref029","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0011694","article-title":"An effective internet-based system for surveillance and elimination of triatomine insects: AlertaChirimacha","volume":"17","author":"LD Tamayo","year":"2023","journal-title":"PLoS Negl Trop Dis"},{"issue":"7404","key":"pntd.0014464.ref030","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1038\/nature11098","article-title":"Generalized L\u00e9vy walks and the role of chemokines in migration of effector CD8+ T cells","volume":"486","author":"TH Harris","year":"2012","journal-title":"Nature"},{"issue":"1","key":"pntd.0014464.ref031","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1198\/tast.2011.08294","article-title":"Optimal Nonbipartite Matching and Its Statistical Applications","volume":"65","author":"B Lu","year":"2011","journal-title":"Am Stat"},{"key":"pntd.0014464.ref032","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1215\/0961754X-1630424","article-title":"On nonscalability: The living world is not amenable to precision-nested scales","volume":"18","author":"AL Tsing","year":"2012","journal-title":"Common Knowledge"},{"key":"pntd.0014464.ref033","volume-title":"The fever: how malaria has ruled humankind for 500,000 years","author":"S Shah","year":"2010","edition":"1"},{"key":"pntd.0014464.ref034","volume-title":"El control de la enfermedad de Chagas en los pa\u00edses del Cono Sur de Am\u00e9rica. Historia de una iniciativa internacional","author":"AC Silveira","year":"2002"},{"key":"pntd.0014464.ref035","volume-title":"Global vector control response 2017-2030","author":"World Health Organization, UNICEF\/UNDP\/World Bank\/WHO Special Programme for Research and Training in Tropical Diseases","year":"2017"},{"key":"pntd.0014464.ref036","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/B978-0-12-384876-5.00004-6","article-title":"Current trends and future prospects for control of Chagas disease","author":"\u00c1 Moncayo","year":"2010","journal-title":"American trypanosomiasis"},{"key":"pntd.0014464.ref037","author":"J Turney","year":"2016"},{"key":"pntd.0014464.ref038","doi-asserted-by":"crossref","DOI":"10.1093\/acprof:oso\/9780190651244.001.0001","author":"AI Tauber","year":"2017","journal-title":"Immunity: The Evolution of an Idea"},{"issue":"2","key":"pntd.0014464.ref039","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.clim.2015.05.010","article-title":"Self or non-self? The multifaceted role of the microbiota in immune-mediated diseases","volume":"159","author":"MA Kriegel","year":"2015","journal-title":"Clin Immunol"},{"key":"pntd.0014464.ref040","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1590\/S0037-86821999000600007","article-title":"Doen\u00e7a de Chagas no Estado de S\u00e3o Paulo: compara\u00e7\u00e3o entre pesquisa ativa de triatom\u00edneos em domic\u00edlios e notifica\u00e7\u00e3o de sua presen\u00e7a pela popula\u00e7\u00e3o em \u00e1rea sob vigil\u00e2ncia entomol\u00f3gica","volume":"32","author":"RA Silva","year":"1999","journal-title":"Rev Soc Bras Med Trop"},{"issue":"2","key":"pntd.0014464.ref041","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/S0001-706X(98)00096-5","article-title":"Monitoring house reinfestation by vectors of Chagas disease: a comparative trial of detection methods during a four-year follow-up","volume":"72","author":"RE G\u00fcrtler","year":"1999","journal-title":"Acta Trop"},{"key":"pntd.0014464.ref042","article-title":"Programa Presupuestal 0017: Enfermedades Metax\u00e9nicas y Zoonosis Reporte de Seguimiento Anual 2022","author":"Oficina General de planeamiento presupuesto y modernizaci\u00f3n MN de salud del P","year":"2022"},{"key":"pntd.0014464.ref043","doi-asserted-by":"crossref","DOI":"10.5325\/b.20107194","volume-title":"Second-wave neoliberalism: gender, race, and health sector reform in Peru","author":"C Ewig","year":"2010"},{"key":"pntd.0014464.ref044","article-title":"Anexo 2 Programa Presupuestal 0017: Enfermedades Metax\u00e9nicas y Zoonosis","author":"Ministerio de Salud del Peru","year":"2016"},{"key":"pntd.0014464.ref045","article-title":"Nada personal: reporte de derechos humanos sobre la aplicaci\u00f3n de la anticoncepci\u00f3n quir\u00fargica en el Per\u00fa, 1996 - 1998","author":"G Cevasco","year":"1999"},{"key":"pntd.0014464.ref046","author":"JM Urrunaga","year":"1998","journal-title":"El comercio"},{"key":"pntd.0014464.ref047","author":"personal Nada","year":"1999"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0014464","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0014464","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T17:44:06Z","timestamp":1783446246000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0014464"}},"subtitle":[],"editor":[{"given":"Jennifer K.","family":"Peterson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,6,22]]},"references-count":47,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,22]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0014464","relation":{},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,22]]}}}