The risk of oral transmission in an area of a Chagas disease outbreak in the Brazilian northeast evaluated through entomological, socioeconomic and schooling indicators

•Eighteen cases of Chagas disease were confirmed serologically in the semiarid region of Rio Grande do Norte state, Brazil, with two deaths reported.•Only 7.5% of residents in the outbreak area admitted knowledge that Chagas disease can also be acquired orally;.•Twelve percent of dwellings were found to be suitable for triatomine colonization;.•Thirteen percent of people reported they may have been bitten by triatomines in the last three years;.•The physical proximity between humans and triatomine populations with high trypanosoma cruzi prevalence represents a risk factor to further oral/vector contaminations. 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 prevalen