Wash resistance and residual efficacy of long-lasting polyester netting coated with alpha-cypermethrin (Interceptor) against malaria-transmitting mosquitoes in Assam, northeast India

Interceptor® long-lasting insecticidal net: phase III evaluation over three years of household use and calibration with Phase II experimental hut outcomes

BACKGROUND

Long-lasting insecticidal nets (LN) are an effective tool for malaria prevention. The World Health Organization Pesticide Evaluation Scheme has established evaluation criteria to facilitate registration for public use. A household randomised trial was conducted in Tanzania according to WHOPES Phase III procedures to evaluate the alpha-cypermethrin coated Interceptor® LN (BASF) over three years' use. Outcomes were calibrated against results of Phase II experimental hut trials.

METHODS

Interceptor LN (200 mg/m(2) alpha-cypermethrin) and conventionally treated nets CTN (40 mg/m(2) alpha-cypermethrin) were randomly distributed to 934 households. At 6-monthly intervals, household surveys recorded net use, durability, adverse effects, user acceptance and washing practices. Concurrently, 30 nets of each type were collected and tested for knock-down and kill of Anopheles gambiae mosquitoes in cone and tunnel bioassays. Alpha-cypermethrin content of nets was assessed annually.

RESULTS

At 12 months 97% of Interceptor LN met the efficacy criteria by cone or tunnel test; this pass rate declined to 90% at 24 months and 87% at 36 months. In contrast only 63% of CTN met the efficacy criteria at 12 months, 14 % at 24 months and 0% at 36 months. The alpha-cypermethrin content at 36 months on Interceptor LN was 20% (42 ± 13 mg/m(2)) of the initial content but on CTNs only 4% (1.3 ± 1.6 mg/m(2)) remained. Interceptor LN was reported to be used year-round and washed 4.3 times/year. A few recalled facial tingling during the first days of use but this did not deter usage. The average number of holes at 36 months was 18, hole area per net was 229 cm(2) and hole index was 332. Insecticide content and cone bioefficacy of LN and CTN after 36 months' use were similar to that of LN and CTN used in earlier Phase II hut trials, but while the 20 times washed LN tested in experimental huts gave adequate personal protection the 20 times washed CTN did not.

CONCLUSIONS

More than 80% Interceptor LN fulfilled the WHOPES Phase III criteria at 36 months and thus the LLIN was granted full WHO recommendation. Phase III outcomes at 36 months were anticipated by Phase II outcomes after 20 standardized washes.

Entomological evaluation of PermaNet 2.0® and K-O Tab 1-2-3® treated nets in comparison to nets conventionally treated with deltamethrin, after repeated washing

The residual insecticidal power of two types of ITNs (PermaNet 2.0® (PN2) and K-O Tab 1-2-3® (KO 123)), compared to K-O Tab® (KO) treated nets, was assessed. The nets were tested unwashed, and after being washed, by hand 5, 15 and 21 times, respectively. After each wash, the nets were dried vertically on a line, in the shade. Two types of bioassays (mean median knock down times (MMKDT) and mortality 24 hours after a 3-minute exposure (%mortality)) were used, along with reared female Anopheles stephensi. The number of washes had a great impact on MMKDT and %mortality of all types of nets. This impact was greater for conventionally treated nets, indicating that PN2 and KO 123 nets are significantly more wash resistant than KO nets after 21 washes. There was no significant difference between PN2 and KO 123 with respect to %mortality 24 hours after a 3-minute exposure at 0, 15 and 21 washes. Similarly, the same results were obtained for MMKDT, and the differences between PN2 and KO 123 were not statistically significant. This study demonstrates that the efficacy of KO 123 nets is as beneficial as the efficacy of PN2 nets up to 21 washes.

Laboratory evaluation of Fendona 6SC treated bednets and Interceptor long-lasting nets against Anopheles gambiae s.l. in Burkina Faso

Insecticide-treated bednets play a cornerstone role in the efforts to control malaria. Bednets entomological efficacy is the determinant factor of their use to control malaria. In this study, we compared under laboratory conditions, the efficacy of two long-lasting nets (PermaNet versus Interceptor) and two treatments kits K-O TAB (deltamethrin) versus Fendona 6SC (alpha-cypermethrin) against Anopheles gambiae s.l. malaria vectors. The efficacy of washed and unwashed bednets was assessed by contact bioassays using World Health Organization (WHO) cones. Three to five-days-old mosquitoes were exposed to the netting for 3 min; the median and 95% knockdown time, the after 24 h mortality was recorded for each type of bednet. The mortality after 24 h was equivalent for the Fendona 6SC treated bednets and the K-O TAB treated bednets [79.4% confidence limits (CL) (73.9-84.6) and 74% CL (68.3-80.0), respectively]. However, the Fendona 6SC treated bednets were superior in 50% knockdown time to the K-O TAB treated bednets [7.8 min, CL (6.5-9.0) and 15. 2 min, CL (14.0-16.4), respectively]. Washed Interceptor and PermaNet bednets showed similar efficacy in terms of 50% knockdown times. Mortality after 24 h was similar from the fifth to the twentieth wash, but PermaNet performed better than Interceptor for the first four washes and for unwashed bednets. This study showed that Fendona 6SC kit and the Interceptor bednets have exhibited consistent comparable efficacy in the laboratory compared to the well known and in use K-O TAB kit and PermaNet bednets.

Evaluation of the long-lasting insecticidal net Interceptor LN: laboratory and experimental hut studies against anopheline and culicine mosquitoes in northeastern Tanzania

Background

Long lasting insecticidal nets (LN) are a primary method of malaria prevention. Before new types of LN are approved they need to meet quality and efficacy standards set by the WHO Pesticide Evaluation Scheme. The process of evaluation has three phases. In Phase I the candidate LN must meet threshold bioassay criteria after 20 standardized washes. In Phase II washed and unwashed LNs are evaluated in experimental huts against wild, free flying anopheline mosquitoes. In Phase III the LN are distributed to households in malaria endemic areas, sampled over three years of use and tested for continuing insecticidal efficacy. Interceptor® LN (BASF Corporation, Germany) is made of polyester netting coated with a wash resistant formulation of alpha-cypermethrin.

Methods

Interceptor LN was subjected to bioassay evaluation and then to experimental hut trial against pyrethroid-susceptible Anopheles gambiae and An. funestus and resistant Culex quinquefasciatus. Mosquito mortality, blood feeding inhibition and personal protection were compared between untreated nets, conventional alpha-cypermethrin treated nets (CTN) washed 20 times and LNs washed 0, 20 and 30 times.

Results

In Phase I Interceptor LN demonstrated superior wash resistance and efficacy to the CTN. In the Phase II hut trial the LN killed 92% of female An. gambiae when unwashed and 76% when washed 20 times; the CTN washed 20 times killed 44%. The LN out-performed the CTN in personal protection and blood-feeding inhibition. The trend for An. funestus was similar to An. gambiae for all outcomes. Few pyrethroid-resistant Cx. quinquefasciatus were killed and yet the level of personal protection (75-90%) against Culex was similar to that of susceptible An. gambiae (76-80%) even after 20 washes. This protection is relevant because Cx. quinquefasciatus is a vector of lymphatic filariasis in East Africa. After 20 washes and 60 nights’ use the LN retained 27% of its initial insecticide dose.

Conclusions

Interceptor LN meets the approval criteria set by WHO and is recommended for use in disease control against East African vectors of malaria and filariasis. Some constraints associated with the phase II evaluation criteria, in particular the washing procedure, are critically reviewed.

Evaluation of new tools for malaria vector control in Cameroon: focus on long lasting insecticidal nets

Background

From 2006 to 2011, biological activity of insecticides for Indoor Residual Spraying (IRS), conventional treatment of nets (CTNs) or long lasting insecticidal nets (LLINs) was evaluated before their approval in Cameroon. The objective of the study was to select the best tools for universal malaria vector control coverage.

Methodology

Bioassays were performed using WHO cones and the Kisumu susceptible strain of Anopheles gambiae s.s.. Among tested products, residual activity and wash resistance of Alpha-cypermethrin LLINs (Interceptor) and CTNs (Fendona) were assessed during 5 months in the Ntougou neighborhood.

Principal Findings

All the 14 tested products were found effective (95–100% knockdown and mortality rates), although a significant decrease of efficacy was seen with lambda-cyhalothrinWP IRS, alpha-cypermethrin CTNs and LLINs (p< 0.05). However, the efficacy of Interceptor nets did not decrease during the 5 months evaluation, even after 25 washes (0.07<p< 0.9). Meanwhile Fendona SC nets displayed a drastic decrease of activity after 5 washes, odds ratio was 3.07 (1.0–8.59).

Conclusion

This study provided useful data for decision making and community education toward universal coverage of malaria vector control in Cameroon.

Effectiveness and durability of Interceptor® long-lasting insecticidal nets in a malaria endemic area of central India

BACKGROUND

In the present study, Interceptor®, long-lasting polyester net, 75 denier and bursting strength of minimum 250 kPa coated with alpha-cypermethrin @ 200 mg/m² was evaluated for its efficacy in reducing the mosquito density, blood feeding inhibition and malaria incidence in a tribal dominated malaria endemic area in Chhattisgarh state, central India. Its durability, washing practices and usage pattern by the community was also assessed up to a period of three years.

METHODS

The study was carried out in two phases. In the first phase (September 2006 to August 2007), 16 malaria endemic villages in district Kanker were randomized into three groups, viz. Interceptor net (LN), untreated polyester net (100 denier) and without net. Malaria cases were detected by undertaking fortnightly surveillance by home visits and treated as per the national drug policy. Mosquito collections were made by hand catch and pyrethrum space spray methods from human dwellings once every month. Slide positivity rate (SPR) and malaria incidence per 1000 population (PI) were compared between the three study arms to assess the impact of use of Interceptor nets. Simultaneously, wash resistance studies were carried out in the laboratory by doing cone bioassays on Interceptor LNs washed up to 20 times. Activities undertaken in second Phase (April 2008 to October 2009) after an interval of about 18 months post-net distribution included questionnaire based surveys at every six months, i.e. 18, 24, 30 and 36 months to observe durability, usage pattern of LNs and washing practices by the community. After 36 months of field use, 30 nets were retrieved and sampled destructively for chemical analysis.

RESULTS

Interceptor nets were found effective in reducing the density, parity rate and blood feeding success rate of main malaria vector Anopheles culicifacies as compared to that in untreated net and no net villages. SPR in LN villages was 3.7% as compared to 6.5% in untreated and 11% in no net villages. PI in LN villages was 16.4 in comparison to 24.8 and 44.2 in untreated polyester net and no net villages respectively. In surveys carried out after three years of initial distribution, 78.7% (737/936) nets were still in possession with the households, of which 68% were used every night. An. culicifacies mortality was >80% in cone bioassays done on LNs washed up to 20 times in laboratory. Mean alpha-cypermethrin content was 43.5 ± 31.7 mg/m² on Interceptor LNs withdrawn after three years of household use against the baseline specification of 200 mg/m². A gradual increase in the proportion of holed nets was observed with the increased period of usage.

CONCLUSION

Interceptor nets were highly effective in reducing vector densities as well as malaria incidence in the study villages. Availability of 78% nets with the households in usable condition clearly indicated durability of Interceptor LNs up to three years in the rural setting of India. The nets were found to contain an effective concentration of alpha-cypermethrin against malaria vector after three years of household use.

Residual activity and integrity of PermaNet® 2.0 after 24 months of household use in a community randomised trial of long lasting insecticidal nets against visceral leishmaniasis in India and Nepal

The World Health Organization (WHO) recommends several brands of long lasting insecticidal net (LN) for protection against insect vectors but also advises national programmes to monitor and evaluate performance under local conditions to help them select the most suitable LN for their setting. During the course of a community randomised trial of LNs against visceral leishmaniasis in northern India and Nepal, opportunity arose to assess the efficacy of PermaNet 2.0 (Vestergaard-Frandsen, Denmark) after two years of use against sandfly vectors. Between 63% (India) and 78% (Nepal) of LNs became holed over the course of two years, deltamethrin residues fell from 55 mg/m(2) to an average of 11.6 mg/m(2) (India) and 27.9 mg/m(2) (Nepal), but on the basis of bioassay criteria all LNs tested still met the WHO Pesticide Evaluation Scheme standard for LN effectiveness. Nets had on average only been washed 2.5 times (India) and 0.6 times (Nepal) by householders over the course of two years. The loss of insecticide was attributed to factors which had little or nothing to do with washing, such as handling, friction and torsion during daily use. Under conditions pertaining in this region of south Asia, and for two years at least, this brand of net continues to meet the criteria established by WHO for LNs.

Evidence for a useful life of more than three years for a polyester-based long-lasting insecticidal mosquito net in Western Uganda

BACKGROUND

Long-lasting insecticidal nets (LLIN) are now standard for the prevention of malaria. However, only products with recommendation for public use from the World Health Organization should be used and this evaluation includes the assessment of net effectiveness after three years of field use. Results for one of the polyester-based products, Interceptor is presented.

METHODS

In five villages, 190 LLIN and 90 nets conventionally treated with the insecticide alpha-cypermethrin at 25 mg/m2 were distributed randomly and used by the families. Following a baseline household survey a net survey was carried out every six months to capture use, washing habits and physical condition of the nets. Randomly selected nets were collected after 6, 12, 24, 36 and 42 months and tested for remaining insecticide content and ability to knock-down and kill malaria transmitting mosquitoes.

RESULTS

During the three and a half years of observation only 16 nets were lost to follow-up resulting in an estimated attrition rate of 12% after three and 20/% after 3.5 years. Nets were used regularly and washed on average 1.5 times per year. After three and a half years 29% of the nets were still in good condition while 13% were seriously torn with no difference between the LLIN and control nets. The conventionally treated nets quickly lost insecticide and after 24 months only 7% of the original dose remained (1.6 mg/m2). Baseline median concentration of alpha-cypermethrin for LLIN was 194.5 mg/m2 or 97% of the target dose with between and within net variation of 11% and 4% respectively (relative standard deviation). On the LLIN 73.8 mg/m2 alpha-cypermethrin remained after three years of use and 56.2 mg/m2 after three and a half and 94% and 81% of the LLIN still had > 15 mg/m2 left respectively. Optimal effectiveness in bio-assays (≥ 95% 60 minute knock-down or ≥ 80% 24 hour mortality) was found in 83% of the sampled LLIN after three and 71% after three and a half years.

CONCLUSIONS

Under conditions in Western Uganda the tested long-lasting insecticidal net Interceptor fulfilled the criteria for phase III of WHO evaluations and, based on preliminary criteria of the useful life, this product is estimated to last on average between three and four years.

Laboratory wash-resistance and field evaluation of deltamethrin incorporated long-lasting polyethylene netting (Netprotect(®)) against malaria transmission in Assam, north-east India

North-east India is co-endemic for Plasmodium falciparum and P. vivax malaria, and disease transmission is perennial and persistent. This study reports the results of a field-based village scale trial of deltamethrin incorporated long-lasting polyethylene netting (Netprotect(®)) conducted in P. falciparum predominant pocket of Assam, north-east India to assess operational feasibility, acceptability and sustainability against disease vectors and malaria transmission. The study monitored the residual efficacy of the long-lasting net in relation to serial washings in the laboratory and malaria prevalence in experimental villages for the first year of investigations from September 2008 to June 2009. The mosquito vector populations of Anopheles minimus were observed to be highly susceptible to deltamethrin (0.05%), and follow up investigations revealed that the vector mosquito had virtually disappeared in Netprotect(®) intervention villages. Concurrently, there was consistent decline in malaria cases in Netprotect(®) villages and transmission reduction was statistically significant compared to untreated net (net without insecticide) and no-net control villages for the corresponding study period. The contact cone-bioassay investigations against malaria transmitting mosquito species revealed that the bioavailability of the insecticide on the net fiber was persistent up to 20th serial wash resulting in ≥80% mortality. Community compliance and acceptance were high, and users reported decreased nuisance due to biting mosquitoes. It was concluded that deltamethrin incorporated polyethylene long-lasting netting was safe, wash-resistant, and assessed to be an operationally feasible, community-based intervention for sustainable management of disease vectors to prevent malaria transmission.