Multi-modalAedes aegyptimosquito reduction interventions and dengue fever prevention

Mosquito and global dengue cases in a warming world

Dengue presents a significant global health challenge, affecting 50-100 symptomatic infections every year and placing immense strain on healthcare systems in tropical and subtropical regions. However, future projections of dengue infections in a warming world remain unclear. We used the support vector machine (SVM) and artificial neural network (ANN) models with Aedes mosquitoes and dengue records from 1960 to 2019 to comprehensively assess the effects of climate change and socioeconomic conditions on the distribution of mosquitoes and the global dengue incidence rate. The SVM and ANN models were applied to project the global future incidence rate and infections during 2021-2040, 2041-2060 and 2061-2080 under various climate change and socioeconomic conditions in a 5 km spatial resolution. We found a geographical distribution expansion of Aedes mosquitoes and dengue in future years, especially in higher latitudes such as North America and Europe. It was estimated that 77 (confidence interval: 40 to 198) million yearly global infections will occur during 2041-2060 under the Shared Socio-economic Pathway SSP2-4.5, a 57% increase of 49 (26-127) million compared with 2000-2019. The rise in annual infections is primarily attributed to the growing incidence rates driven by rising temperatures and the enhanced suitability of Aedes aegypti, and an expanding human population. Our high-resolution projection provides support to local control measures to minimise health impacts from dengue. Specifically, the Aedes mosquito control programmes such as eliminating the Ae. aegypti breeding sites are recommended in Africa and South Asia, where dengue is particularly severe in all climate change and socioeconomic conditions.

Response to An Outbreak of Locally Transmitted Dengue in Key Largo, FL, by The Florida Keys Mosquito Control District

Dengue virus (DENV) is an ever-increasing threat to the residents of South Florida. Seventy-two cases of locally acquired dengue were contracted by residents and visitors of Key Largo, FL, in 2020. The primary vector, Aedes aegypti, has been a large focus of the Florida Keys Mosquito Control District's (FKMCD) control measures for over a decade. This paper recounts the 2020 outbreak of DENV in Key Largo, FL, and the FKMCD's Ae. aegypti operational response. The overall House Index (13.43%) during the outbreak was considered high (>5%) risk for local transmission. Larval habitat characterized from property inspections was similar to previous larval (τ = 0.78, P < 0.005) and pupal (τ = 0.745, P < 0.005) habitat studies. Adult surveillance of the active dengue transmission area provided 3 positive pools out of 1,518 mosquitoes tested resulting in a minimum infection rate of 1.976. Increased personnel response with long-term larvicide formulations and increased aerial, truck, and handheld ultra-low-volume adulticide control measures quickly reduced the Ae. aegypti surveillance numbers below the action threshold. No active cases of dengue have been reported since October 2020.

Predicting Culex pipiens/restuans Population Dynamics Using a Weather-Driven Dynamic Compartmental Population Model

Mosquitoes of the genus Culex are important vectors of a variety of arthropod-borne viral infections. In most of the northern parts of the USA, Cx. pipiens/restuans is the predominant representative of this genus. As vectors, they play a key role in the spreading of arboviruses and thus, knowledge of the population dynamic of mosquitoes is important to understand the disease ecology of these viruses. As poikilotherm animals, the vital rates of mosquitoes are highly dependent on ambient temperature, and also on precipitation. We present a compartmental model for the population dynamics of Cx. pipiens/restuans. The model is driven by temperature, precipitation, and daytime length (which can be calculated from the geographic latitude). For model evaluation, we used long-term mosquito capture data, which were averaged from multiple sites in Cook County, Illinois. The model fitted the observation data and was able to reproduce between-year differences in the abundance of the Cx. pipiens/restuans mosquitoes, as well as the different seasonal trends. Using this model, we evaluated the effectiveness of targeting different vital rates for mosquito control strategies. The final model is able to reproduce the weekly mean Cx. pipiens/restuans abundance for Cook County with a high accuracy, and over a long time period of 20 years.

Evaluation of insecticide treated window curtains and water container covers for dengue vector control in a large-scale cluster-randomized trial in Venezuela

BACKGROUND

Following earlier trials indicating that their potential in dengue vector control was constrained by housing structure, a large-scale cluster-randomized trial of insecticide treated curtains (ITCs) and water jar covers (ITJCs) was undertaken in Venezuela.

METHODS

In Trujillo, Venezuela, 60 clusters (6223 houses total) were randomized so that 15 clusters each received either PermaNet insecticide-treated window curtains (ITCs), permanent insecticide-treated water storage jar covers (ITJCs), a combination of both ITCs and ITJCs, or no insecticide treated materials (ITMs). A further 15 clusters located at least 5km from the edge of the study site were selected to act as an external control. Entomological surveys were carried out immediately before and after intervention, and then at 6-month intervals over the following 27 months. The Breteau and House indices were used as primary outcome measures and ovitrap indices as secondary. Negative binomial regression models were used to compare cluster-level values of these indices between the trial arms.

RESULTS

Reductions in entomological indices followed deployment of all ITMs and throughout the trial, indices in the external control arm remained substantially higher than in the ITM study arms including the internal control. Comparing the ratios of between-arm means to summarise the entomological indices throughout the study, the combined ITC+ITJC intervention had the greatest impact on the indices, with a 63% difference in the pupae per person indices between the ITC+ITJC arm and the internal control. However, coverage had fallen below 60% by 14-months post-intervention and remained below 40% for most of the remaining study period.

CONCLUSIONS

ITMs can impact dengue vector populations in the long term, particularly when ITCs and ITJCs are deployed in combination.

TRIAL REGISTRATION

ClinicalTrials.gov ISRCTN08474420; www.isrctn.com.

No Evidence of Acute Dengue Virus Infections at a Rural Site in Western Kenya, 2011 and 2013

The incidence and spread of dengue virus (DENV) have increased rapidly in recent decades. Dengue is underreported in Africa, but recent outbreaks and seroprevalence data suggest that DENV is widespread there. A lack of ongoing surveillance limits knowledge about its spatial reach and hinders disease control planning. We sought to add data on dengue distribution in Kenya through diagnostic testing of serum specimens from persons with an acute febrile illness (AFI) attending an outpatient clinic in rural western Kenya (Asembo) during rainy seasons. Patients with symptoms not likely to be misclassified as dengue (e.g., diarrhea and anemia), those with a positive diagnostic laboratory results which explained their febrile illness, or those with serum collected more than 5 days after fever onset were excluded. However, febrile patients with a positive malaria smear were included in the study. We used reverse transcription polymerase chain reaction (RT-PCR) to test for DENV and IgM anti-DENV to test for recent infection. Of the 615 serum specimens available for testing, none were dengue positive by either RT-PCR or IgM anti-DENV testing. Dengue did not appear to be a cause of febrile illness in this area of western Kenya, although our relatively small sample size may not have identified DENV infections occurring at low incidence. A more widespread AFI surveillance system that includes dengue diagnostic testing by RT-PCR and antibody-based methods is required to more definitively gauge the size and geographic distribution of DENV infection in western Kenya.

Effectiveness of an intervention for Aedes aegypti control scaled-up under an inter-sectoral approach in a Colombian city hyper-endemic for dengue virus

Aedes aegypti transmitted arboviral diseases are of significant importance in Colombia, particularly since the 2014/2015 introduction of chikungunya and Zika in the Americas and the increasing spread of dengue. In response, the Colombian government initiated the scaling-up of a community-based intervention under inter and multi-sector partnerships in two out of four sectors in Girardot, one of the most hyper-endemic dengue cities in the country. Using a quasi-experimental research design a scaled-up community-led Aedes control intervention was assessed for its capacity to reduce dengue from January 2010 to August 2017 in Girardot, Colombia. Reported dengue cases, and associated factors were analysed from available data sets from the Colombian disease surveillance systems. We estimated the reduction in dengue cases before and after the intervention using, Propensity Score Matching and an Autoregressive Moving Average model for robustness. In addition, the differences in dengue incidence among scaling-up phases (pre-implementation vs sustainability) and between treatment groups (intervention and control areas) were modelled. Evidence was found in favour of the intervention, although to maximise impact the scaling-up of the intervention should continue until it covers the remaining sectors. It is expected that a greater impact of the intervention can be documented in the next outbreak of dengue in Girardot.

Dengue Virus

Dengue virus (DENV) belongs to the family Flaviviridae, genus Flavivirus. It is a single-stranded positive-sense ribonucleic acid virus with 10,700 bases. The genus Flavivirus includes other arthropod borne viruses such as yellow fever virus, West Nile virus, Zika virus, tick-borne encephalitis virus. It infects ~50–200 million people annually, putting over 3.6 billion people living in tropical regions at risk and causing ~20,000 deaths annually. The expansion of dengue is attributed to factors such as the modern dynamics of climate change, globalization, travel, trade, socioeconomics, settlement, and also viral evolution. There are four antigenically different serotypes of DENV based on the differences in their viral structural and nonstructural proteins. DENV infection causes a spectrum of illness ranging from asymptomatic to dengue fever to severe dengue shock syndrome. Infection with one serotype confers lifelong immunity against that serotype, but heterologus infection leads to severe dengue hemorrhagic fever due to antibody-dependent enhancement. Diagnosis of dengue infections is based mainly on serological detection of either antigen in acute cases or antibodies in both acute and chronic infection. Viral detection and real-time PCR detection though helpful is not feasible in resource poor setup. Treatment of dengue depends on symptomatic management along with fluid resuscitation and may require platelet transfusion. Although vaccine development is in late stages of development, developing a single vaccine against four serotypes often causes serious challenges to researchers; hence, the main stay of prevention is vector control and management.

Effectiveness of the intervention program for dengue hemorrhagic fever prevention among rural communities in Thailand

Purpose

The purpose of this paper is to evaluate the effectiveness of the intervention program for dengue fever prevention among people in rural communities.

Design/methodology/approach

A quasi-experimental study was designed for two groups. The intervention group received five weeks of dengue hemorrhagic prevention program consisted of knowledge broadcast, campaign, model house contest and group education. The control group received only the usual care of health promoting hospitals. The primary expected outcomes were changes in knowledge, perceived susceptibility, perceived severity, perceived benefit, perceived barriers and preventive action from baseline data, post-intervention and three-month follow-up, along with a comparison between the two groups. The secondary expected outcomes were changes in house index (HI) from baseline to post-intervention and three-month follow-up, along with a comparison between the two groups.

Findings

From the total of 64 participants, 32 were randomly assigned to the control group and 32 were randomly assigned to the intervention group. There were significant differences in knowledge, perceived susceptibility, perceived severity, perceived benefit, perceived barriers, preventive action and HI in the intervention group after received the five-week intervention program and at three-month follow-up (p<0.05).

Originality/value

Dengue hemorrhagic prevention program based on the Health Belief Model was effective in lowering HI and improving knowledge, perceived susceptibility, perceived severity, perceived benefit, perceived barriers and preventive action among people in rural communities. The intervention program may be beneficial in primary care in such a rural community.

House screening with insecticide-treated netting provides sustained reductions in domestic populations of Aedes aegypti in Merida, Mexico

BACKGROUND

There is a need for effective methods to control Aedes aegypti and prevent the transmission of dengue, chikungunya, yellow fever and Zika viruses. Insecticide treated screening (ITS) is a promising approach, particularly as it targets adult mosquitoes to reduce human-mosquito contact.

METHODOLOGY/PRINCIPAL FINDINGS

A cluster-randomised controlled trial evaluated the entomological efficacy of ITS based intervention, which consisted of the installation of pyrethroid-impregnated long-lasting insecticide-treated netting material fixed as framed screens on external doors and windows. A total of 10 treatment and 10 control clusters (100 houses/cluster) were distributed throughout the city of Merida, Mexico. Cross-sectional entomological surveys quantified indoor adult mosquito infestation at baseline (pre-intervention) and throughout four post-intervention (PI) surveys spaced at 6-month intervals corresponding to dry/rainy seasons over two years (2012-2014). A total of 844 households from intervention clusters (86% coverage) were protected with ITS at the start of the trial. Significant reductions in the indoor presence and abundance of Ae. aegypti adults (OR = 0.48 and IRR = 0.45, P<0.05 respectively) and the indoor presence and abundance of Ae. aegypti female mosquitoes (OR = 0.47 and IRR = 0.44, P<0.05 respectively) were detected in intervention clusters compared to controls. This high level of protective effect was sustained for up to 24 months PI. Insecticidal activity of the ITS material declined with time, with ~70% mortality being demonstrated in susceptible mosquito cohorts up to 24 months after installation.

CONCLUSIONS/SIGNIFICANCE

The strong and sustained entomological impact observed in this study demonstrates the potential of house screening as a feasible, alternative approach to a sustained long-term impact on household infestations of Ae. aegypti. Larger trials quantifying the effectiveness of ITS on epidemiological endpoints are warranted and therefore recommended.

Clinical, Serological, and Molecular Observations from a Case Series Study during the Asian Lineage Zika Virus Outbreak in Grenada during 2016

This paper describes the spatial and temporal distribution of cases, demographic characteristics of patients, and clinical manifestations of Zika virus (ZIKV) during the 2016 outbreak in Grenada. The first reported case was recorded in St. Andrew Parish in April, and the last reported case was seen in November, with peak transmission occurring in the last week of June, based on test results. Data were collected from a total of 514 patients, of whom 207 (40%) tested positive for ZIKV. No evidence was found that testing positive for ZIKV infection was related to age, gender, or pregnancy status. Clinical presentation with rash (OR = 2.4, 95% CI = 1.5 to 3.7) or with lymphadenopathy (OR = 1.7, 95% CI = 1.0 to 2.9) were the only reported symptoms consistent with testing positive for ZIKV infection. During the Zika outbreak, the infection rate was 20 clinical cases per 10,000 in the population compared to 41 cases per 10,000 during the chikungunya outbreak in Grenada in 2014 and 17 cases per 10,000 during the dengue outbreak in 2001-2002. Even though the country has employed vector control programs, with no apparent decrease in infection rates, it appears that new abatement approaches are needed to minimize morbidity in future arbovirus outbreaks.

Assessing the effects of interventions for Aedes aegypti control: systematic review and meta-analysis of cluster randomised controlled trials

Background

The Aedes aegypti mosquito is the vector for dengue fever, yellow fever, chikungunya, and zika viruses. Inadequate vector control has contributed to persistence and increase of these diseases. This review assesses the evidence of effectiveness of different control measures in reducing Aedes aegypti proliferation, using standard entomological indices.

Methods

A systematic search of Medline, Ovid, BVS, LILACS, ARTEMISA, IMBIOMED and MEDIGRAPHIC databases identified cluster randomised controlled trials (CRCTs) of interventions to control Aedes aegypti published between January 2003 and October 2016. Eligible studies were CRCTs of chemical or biological control measures, or community mobilization, with entomological indices as an endpoint. A meta-analysis of eligible studies, using a random effects model, assessed the impact on household index (HI), container index (CI), and Breteau index (BI).

Results

From 848 papers identified by the search, eighteen met the inclusion criteria: eight for chemical control, one for biological control and nine for community mobilisation. Seven of the nine CRCTs of community mobilisation reported significantly lower entomological indices in intervention than control clusters; findings from the eight CRCTs of chemical control were more mixed. The CRCT of biological control reported a significant impact on the pupae per person index only. Ten papers provided enough detail for meta-analysis. Community mobilisation (four studies) was consistently effective, with an overall intervention effectiveness estimate of −0.10 (95%CI -0.20 – 0.00) for HI, −0.03 (95%CI -0.05 – -0.01) for CI, and −0.13 (95%CI -0.22 – -0.05) for BI. The single CRCT of biological control had effectiveness of −0.02 (95%CI -0.07– 0.03) for HI, −0.02 (95%CI -0.04– -0.01) for CI and −0.08 (95%CI -0.15– -0.01) for BI. The five studies of chemical control did not show a significant impact on indices: the overall effectiveness was −0.01 (95%CI -0.05– 0.03) for HI, 0.01 (95% CI -0.01– 0.02) for CI, and 0.01 (95%CI -0.03 – 0.05) for BI.

Conclusion

Governments that rely on chemical control of Aedes aegypti should consider adding community mobilization to their prevention efforts. More well-conducted CRCTs of complex interventions, including those with biological control, are needed to provide evidence of real life impact. Trials of all interventions should measure impact on dengue risk.

Pupal productivity in rainy and dry seasons: findings from the impact survey of a randomised controlled trial of dengue prevention in Guerrero, Mexico

Background

The follow-up survey of a cluster-randomised controlled trial of evidence-based community mobilisation for dengue control in Nicaragua and Mexico included entomological information from the 2012 rainy and dry seasons. We used data from the Mexican arm of the trial to assess the impact of the community action on pupal production of the dengue vector Aedes aegypti in both rainy and dry seasons.

Methods

Trained field workers inspected household water containers in 90 clusters and collected any pupae or larvae present for entomological examination. We calculated indices of pupae per person and pupae per household, and traditional entomological indices of container index, household index and Breteau index, and compared these between rainy and dry seasons and between intervention and control clusters, using a cluster t-test to test significance of differences.

Results

In 11,933 houses in the rainy season, we inspected 40,323 containers and found 7070 Aedes aegypti pupae. In the dry season, we inspected 43,461 containers and counted 6552 pupae. All pupae and entomological indices were lower in the intervention clusters (IC) than in control clusters (CC) in both the rainy season (RS) and the dry season (DS): pupae per container 0.12 IC and 0.24 CC in RS, and 0.10 IC and 0.20 CC in DS; pupae per household 0.46 IC and 0.82 CC in RS, and 0.41 IC and 0.83 CC in DS; pupae per person 0.11 IC and 0.19 CC in RS, and 0.10 IC and 0.20 CC in DS; household index 16% IC and 21% CC in RS, and 12.1% IC and 17.9% CC in DS; container index 7.5% IC and 11.5% CC in RS, and 4.6% IC and 7.1% CC in DS; Breteau index 27% IC and 36% CC in RS, and 19% IC and 29% CC in DS. All differences between the intervention and control clusters were statistically significant, taking into account clustering.

Conclusions

The trial intervention led to significant decreases in pupal and conventional entomological indices in both rainy and dry seasons.

Trial registration

ISRCTN27581154.

Avaliabilidade do Projeto de Mobilização Social para Prevenção e Controle da Dengue no Estado da Bahia

RESUMO Foi realizado um estudo de avaliabilidade do Projeto de Mobilização Social para Prevenção e Controle da Dengue no Estado da Bahia, assim como foi descrito o modelo de intervenção prático. Foram conduzidas entrevistas junto a informantes-chave, análise documental e observação participante. Os resultados apontam que o Projeto pode ser considerado implementado, e seus principais resultados se situaram em torno da mudança do enfoque sobre dengue na pauta da mídia, bem como da maior integração dos entes federados e entre os Agentes Comunitários de Saúde e os Agentes de Endemias. Aspectos relacionados ao contexto municipal foram vistos como obstáculos para o alcance dos resultados esperados.

An integrated pest control strategy against the Asian tiger mosquito in northern Italy: a case study

BACKGROUND

In Europe, Aedes albopictus is an invasive mosquito species known to be a major nuisance as well as a vector of a range of arboviruses. A number of studies have indicated that community participation programmes are an effective pest control tool to reduce mosquito populations. However, few studies have evaluated the effectiveness of a community-based approach in Europe. In this study, we examined two Ae. albopictus control strategies that implemented a community-based approach in northern Italy: one was a partial intervention that included a public education campaign and the larviciding of public spaces, and the other was a full intervention that additionally included a door-to-door campaign. This latter consisted of going door to door actively to educate residents about control measures and deliver larvicide tablets for treating catch basins at home. A site where no intervention measures were carried out was used as a control.

RESULTS

In the site where a full intervention was carried out, Ae. albopictus egg density was 1.6 times less than at the site that received partial intervention, and 1.9 times less than at the non-intervention site. No significant reduction in egg density was achieved in the partial intervention site.

CONCLUSIONS

In our study, Ae. albopictus populations were most effectively reduced by larviciding both public and private catch basins. Door-to-door education was effective in convincing residents to apply control measures on their property; however, this method was labour intensive and costly. It may be possible to reduce personnel costs by involving volunteers or using a 'hot spot' approach. © 2016 Society of Chemical Industry.

Public Health Interventions for Aedes Control in the Time of Zikavirus- A Meta-Review on Effectiveness of Vector Control Strategies

BACKGROUND

There is renewed interest in effective measures to control Zika and dengue vectors. A synthesis of published literature with a focus on the quality of evidence is warranted to determine the effectiveness of vector control strategies.

METHODOLOGY

We conducted a meta-review assessing the effectiveness of any Aedes control measure. We searched Scopus and Medline for relevant reviews through to May 2016. Titles, abstracts and full texts were assessed independently for inclusion by two authors. Data extraction was performed in duplicate and validity of the evidence was assessed using GRADE criteria.

FINDINGS

13 systematic reviews that investigated the effect of control measures on entomological parameters or disease incidence were included. Biological controls seem to achieve better reduction of entomological indices than chemical controls, while educational campaigns can reduce breeding habitats. Integrated vector control strategies may not always increase effectiveness. The efficacy of any control programme is dependent on local settings, intervention type, resources and study duration, which may partly explain the varying degree of success between studies. Nevertheless, the quality of evidence was mostly low to very low due to poor reporting of study design, observational methodologies, heterogeneity, and indirect outcomes, thus hindering an evidence-based recommendation.

CONCLUSIONS

The evidence for the effectiveness of Aedes control measures is mixed. Chemical control, which is commonly used, does not appear to be associated with sustainable reductions of mosquito populations over time. Indeed, by contributing to a false sense of security, chemical control may reduce the effectiveness of educational interventions aimed at encouraging local people to remove mosquito breeding sites. Better quality studies of the impact of vector control interventions on the incidence of human infections with Dengue or Zika are still needed.

Factors Associated with Correct and Consistent Insecticide Treated Curtain Use in Iquitos, Peru

Dengue is an arthropod-borne virus of great public health importance, and control of its mosquito vectors is currently the only available method for prevention. Previous research has suggested that insecticide treated curtains (ITCs) can lower dengue vector infestations in houses. This observational study investigated individual and household-level socio-demographic factors associated with correct and consistent use of ITCs in Iquitos, Peru. A baseline knowledge, attitudes, and practices (KAP) survey was administered to 1,333 study participants, and ITCs were then distributed to 593 households as part of a cluster-randomized trial. Follow up KAP surveys and ITC-monitoring checklists were conducted at 9, 18, and 27 months post-ITC distribution. At 9 months post-distribution, almost 70% of ITCs were hanging properly (e.g. hanging fully extended or tied up), particularly those hung on walls compared to other locations. Proper ITC hanging dropped at 18 months to 45.7%. The odds of hanging ITCs correctly and consistently were significantly greater among those participants who were housewives, knew three or more correct symptoms of dengue and at least one correct treatment for dengue, knew a relative or close friend who had had dengue, had children sleeping under a mosquito net, or perceived a change in the amount of mosquitoes in the home. Additionally, the odds of recommending ITCs in the future were significantly greater among those who perceived a change in the amount of mosquitoes in the home (e.g. perceived the ITCs to be effective). Despite various challenges associated with the sustained effectiveness of the selected ITCs, almost half of the ITCs were still hanging at 18 months, suggesting a feasible vector control strategy for sustained community use.

Dengue is an arthropod-borne virus of great public health importance. Vector control is currently the only available method for dengue prevention. This cluster-randomized trial investigated individual and household-level socio-demographic factors associated with correct and consistent use of insecticide-treated curtains (ITCs)—one promising vector control method—in Iquitos, Peru. Most people preferred to hang the ITCs in doorways and as room dividers, but also hung them as curtains on windows and on their walls. We assessed who still had their ITCs hanging or tied up at 9 months and 18 months after distribution, and found that use of the ITCs decreased over time to about half. When we explored who was more likely to be using the ITCs correctly (having them hanging in place, or tied up in place, or washed without bleach and avoiding direct sunlight), we found that those who knew more about dengue, knew someone who had dengue, had young children in their homes sleeping under an insecticide treated mosquito net, or who perceived the ITCs to work well, were more likely to be using their ITCs than others. Despite various challenges in sustained ITC effectiveness in this study, the fact that almost half of the homes still had the ITCs hanging at 18 months suggests this vector control strategy is feasible for long term community use.

Meta-analysis of studies on chemical, physical and biological agents in the control of Aedes aegypti

Background

Aedes aegypti is a vector of international concern because it can transmit to humans three important arboviral diseases: yellow fever, dengue and chikungunya. Epidemics that are repeated year after year in a variety of urban centers indicate that there are control failures, allowing the vector to continue expanding.

Methods

To identify the most effective vector control strategies and the factors that contributed to the success or failure of each strategy, we carried out a systematic review with meta-analysis of articles published in 12 databases, from 1974 to the month of December 2013. We evaluated the association between the use of whatever chemical substance, mechanical agent, biological or integrated actions against A. aegypti and the control of the vector, as measured by 10 indicators.

Results

We found 2,791 articles, but after careful selection, only 26 studies remained for analysis related to control interventions implemented in 15 countries, with 5 biological, 5 chemical, 3 mechanical and 13 integrated strategies. The comparison among all of them, indicated that the control of A. aegypti is significantly associated with the type of strategy used, and that integrated interventions consist of the most effective method for controlling A. aegypti.

Conclusions

The most effective control method was the integrated approach, considering the influence of eco-bio-social determinants in the virus-vector-man epidemiological chain, and community involvement, starting with community empowerment as active agents of vector control.

Prevention and control of neglected tropical diseases: overview of randomized trials, systematic reviews and meta-analyses

OBJECTIVE

To analyse evidence from randomized controlled trials (RCTs) on the prevention and control of neglected tropical diseases (NTDs) and to identify areas where evidence is lacking.

METHODS

The Cochrane Central Register of Controlled Trials and PubMed were searched for RCTs and the Cochrane Database of Systematic Reviews and PubMed were searched for meta-analyses and systematic reviews, both from inception to 31 December 2012.

FINDINGS

Overall, 258 RCTs were found on American trypanosomiasis, Buruli ulcer, dengue, geohelminth infection, leishmaniasis, leprosy, lymphatic filariasis, onchocerciasis, rabies, schistosomiasis or trachoma. No RCTs were found on cysticercosis, dracunculiasis, echinococcosis, foodborne trematodes, or human African trypanosomiasis. The most studied diseases were geohelminth infection (51 RCTs) and leishmaniasis (46 RCTs). Vaccines, chemoprophylaxis and interventions targeting insect vectors were evaluated in 113, 99 and 39 RCTs, respectively. Few addressed how best to deliver preventive chemotherapy, such as the choice of dosing interval (10) or target population (4), the population coverage needed to reduce transmission (2) or the method of drug distribution (1). Thirty-one publications containing 32 systematic reviews (16 with and 16 without meta-analyses) were found on American trypanosomiasis, dengue, geohelminths, leishmaniasis, leprosy, lymphatic filariasis, onchocerciasis, schistosomiasis or trachoma. Together, they included only 79 of the 258 published RCTs (30.6%). Of 36 interventions assessed, 8 were judged effective in more than one review.

CONCLUSION

Few RCTs on the prevention or control of the principal NTDs were found. Trials on how best to deliver preventive chemotherapy were particularly rare.

The relationship between economic status, knowledge on dengue, risk perceptions and practices

The reemergence of dengue as an important public health problem reflects the difficulties in sustaining vertically organized, effective, control programs and the need for community-based strategies for Aedes aegypti control that result in behavioral change. We aimed to disentangle the relationships between underlying determinants of dengue related practices. We conducted a cross-sectional study in 780 households in La Lisa, Havana, Cuba. A questionnaire and an observation guide were administrated to collect information on variables related to economic status, knowledge on dengue, risk perception and practices associated with Aedes aegypti breading sites. To test a conceptual model that hypothesized direct relationships among all these constructs, we first used Exploratory Factor Analysis with Principal Component Analysis to establish the relationship between observed variables and the underlying latent variables. Subsequently, we tested whether the observed data supported the conceptual model through Confirmatory Factor Analysis. Exploratory Factor Analysis indicated that the items measured could be reduced into five factors with an eigenvalue >1.0: Knowledge on dengue, Intradomiciliar risk practices, Peridomiciliar risk practices, Risk perception and Economic status. The proportion of the total variance in the data explained by these five factors was 74.3%. The Confirmatory Factor Analysis model differed from our hypothesized conceptual model. Only Knowledge on dengue had a significant, direct, positive, effect on Practices. There was also a direct association of Economic status with Knowledge on dengue, but not with Risk perception and Practices. Clarifying the relationship between direct and indirect determinants of dengue related practices contributes to a better understanding of the potential effect of Information Education and Communication on practices and on the reduction of Aedes aegypti breeding sites and provides inputs for designing a community based strategy for dengue control.

Control of the Asian tiger mosquito (Aedes albopictus) in a firmly established area in Spain: risk factors and people's involvement

BACKGROUND

The tiger mosquito is a competent vector of dengue and chikungunya in Europe. Therefore, evaluating control strategies is a priority. In this work we aimed to determine the key factors affecting Aedes albopictus production, the preferred larval habitats, and we explored the involvement of the citizens in Sant Cugat, Spain.

METHODS

A source-reduction campaign including door-to-door visits and interviews to local inhabitants (2008-2010) and larval surveys (2010) was carried out.

RESULTS

Civil workers inspected 3720 premises and interviewed 820 local inhabitants. Larval habitats, detected in 7.2% of the premises (n=266), were negatively associated with primary residence OR=0.4 (95% CI 0.3-0.6); and positively associated with schools OR=2.4 (95% CI 1.1-5.0), solid waste OR=5.1 (95% CI 3.0-8.9), scuppers OR=5.0 (95% CI 3.5-7.3) among other variables. Preventive measures were taken by 83.2% of householders (n=682). In 2010, 10.3% more citizens claimed to avoid having stagnant water compared with 2008. Simultaneously another 10.3% stopped using insecticides.

CONCLUSION

Solid waste, scuppers and vegetable gardens were found to be important factors characterizing premises with larval habitats. People claimed to know about this insect and they considered it to be an important issue that diminished their quality of life.

Mediational effects of self-efficacy dimensions in the relationship between knowledge of dengue and dengue preventive behaviour with respect to control of dengue outbreaks: a structural equation model of a cross-sectional survey

BACKGROUND

Dengue fever is endemic in Malaysia, with frequent major outbreaks in urban areas. The major control strategy relies on health promotional campaigns aimed at encouraging people to reduce mosquito breeding sites close to people's homes. However, such campaigns have not always been 100% effective. The concept of self-efficacy is an area of increasing research interest in understanding how health promotion can be most effective. This paper reports on a study of the impact of self-efficacy on dengue knowledge and dengue preventive behaviour.

METHODS AND FINDINGS

We recruited 280 adults from 27 post-outbreak villages in the state of Terengganu, east coast of Malaysia. Measures of health promotion and educational intervention activities and types of communication during outbreak, level of dengue knowledge, level and strength of self-efficacy and dengue preventive behaviour were obtained via face-to-face interviews and questionnaires. A structural equation model was tested and fitted the data well (χ(2) = 71.659, df = 40, p = 0.002, RMSEA = 0.053, CFI = 0.973, TLI = 0.963). Mass media, local contact and direct information-giving sessions significantly predicted level of knowledge of dengue. Level and strength of self-efficacy fully mediated the relationship between knowledge of dengue and dengue preventive behaviours. Strength of self-efficacy acted as partial mediator in the relationship between knowledge of dengue and dengue preventive behaviours.

CONCLUSIONS

To control and prevent dengue outbreaks by behavioural measures, health promotion and educational interventions during outbreaks should now focus on those approaches that are most likely to increase the level and strength of self-efficacy.

Developing a vulnerability mapping methodology: applying the water-associated disease index to dengue in Malaysia

The Water-associated Disease Index (WADI) was developed to identify and visualize vulnerability to different water-associated diseases by integrating a range of social and biophysical determinants in map format. In this study vulnerability is used to encompass conditions of exposure, susceptibility, and differential coping capacity to a water-associated health hazard. By assessing these conditions, the tool is designed to provide stakeholders with an integrated and long-term understanding of subnational vulnerabilities to water-associated disease and contribute to intervention strategies to reduce the burden of illness. The objective of this paper is to describe and validate the WADI tool by applying it to dengue. A systemic ecohealth framework that considers links between people, the environment and health was applied to identify secondary datasets, populating the index with components including climate conditions, land cover, education status and water use practices. Data were aggregated to create composite indicators of exposure and of susceptibility in a Geographic Information System (GIS). These indicators were weighted by their contribution to dengue vulnerability, and the output consisted of an overall index visualized in map format. The WADI was validated in this Malaysia case study, demonstrating a significant association with dengue rates at a sub-national level, and illustrating a range of factors that drive vulnerability to the disease within the country. The index output indicated high vulnerability to dengue in urban areas, especially in the capital Kuala Lumpur and surrounding region. However, in other regions, vulnerability to dengue varied throughout the year due to the influence of seasonal climate conditions, such as monsoon patterns. The WADI tool complements early warning models for water-associated disease by providing upstream information for planning prevention and control approaches, which increasingly require a comprehensive and geographically broad understanding of vulnerability for implementation.

The effectiveness of public health interventions to reduce the health impact of climate change: a systematic review of systematic reviews

BACKGROUND

Climate change is likely to be one of the most important threats to public health in the coming years. Yet despite the large number of papers considering the health impact of climate change, few have considered what public health interventions may be of most value in reducing the disease burden. We aimed to evaluate the effectiveness of public health interventions to reduce the disease burden of high priority climate sensitive diseases.

METHODS AND FINDINGS

For each disease, we performed a systematic search with no restriction on date or language of publication on Medline, Web of Knowledge, Cochrane CENTRAL and SCOPUS up to December 2010 to identify systematic reviews of public health interventions. We retrieved some 3176 records of which 85 full papers were assessed and 33 included in the review. The included papers investigated the effect of public health interventions on various outcome measures. All interventions were GRADE assessed to determine the strength of evidence. In addition we developed a systematic review quality score. The interventions included environmental interventions to control vectors, chemoprophylaxis, immunization, household and community water treatment, greening cities and community advice. For most reviews, GRADE showed low quality of evidence because of poor study design and high heterogeneity. Also for some key areas such as floods, droughts and other weather extremes, there are no adequate systematic reviews of potential public health interventions.

CONCLUSION

In conclusion, we found the evidence base to be mostly weak for environmental interventions that could have the most value in a warmer world. Nevertheless, such interventions should not be dismissed. Future research on public health interventions for climate change adaptation needs to be concerned about quality in study design and should address the gap for floods, droughts and other extreme weather events that pose a risk to health.

Modeling dengue vector dynamics under imperfect detection: three years of site-occupancy by Aedes aegypti and Aedes albopictus in urban Amazonia

Aedes aegypti and Ae. albopictus are the vectors of dengue, the most important arboviral disease of humans. To date, Aedes ecology studies have assumed that the vectors are truly absent from sites where they are not detected; since no perfect detection method exists, this assumption is questionable. Imperfect detection may bias estimates of key vector surveillance/control parameters, including site-occupancy (infestation) rates and control intervention effects. We used a modeling approach that explicitly accounts for imperfect detection and a 38-month, 55-site detection/non-detection dataset to quantify the effects of municipality/state control interventions on Aedes site-occupancy dynamics, considering meteorological and dwelling-level covariates. Ae. aegypti site-occupancy estimates (mean 0.91; range 0.79–0.97) were much higher than reported by routine surveillance based on ‘rapid larval surveys’ (0.03; 0.02–0.11) and moderately higher than directly ascertained with oviposition traps (0.68; 0.50–0.91). Regular control campaigns based on breeding-site elimination had no measurable effects on the probabilities of dwelling infestation by dengue vectors. Site-occupancy fluctuated seasonally, mainly due to the negative effects of high maximum (Ae. aegypti) and minimum (Ae. albopictus) summer temperatures (June-September). Rainfall and dwelling-level covariates were poor predictors of occupancy. The marked contrast between our estimates of adult vector presence and the results from ‘rapid larval surveys’ suggests, together with the lack of effect of local control campaigns on infestation, that many Aedes breeding sites were overlooked by vector control agents in our study setting. Better sampling strategies are urgently needed, particularly for the reliable assessment of infestation rates in the context of control program management. The approach we present here, combining oviposition traps and site-occupancy models, could greatly contribute to that crucial aim.

Genetics and morphology of Aedes aegypti (Diptera: Culicidae) in septic tanks in Puerto Rico

Dengue viruses, primarily transmitted by the mosquito Aedes aegypti (L.), affect an estimated 50-100 million people yearly. Traditional approaches to control mosquito population numbers, such as the use of pesticides, have had only limited success. Atypical mosquito behavior may be one reason why current vector control efforts have been less efficacious than expected. In Puerto Rico, for example, adult Ae. aegypti have been observed emerging from septic tanks. Interestingly, adults emerging from septic tanks are larger on average than adults collected from surface containers. To determine whether adults colonizing septic tanks constitute a separate Ae. aegypti population, we used 12 previously validated microsatellite loci to examine adult mosquitoes collected from both septic tanks and surface containers, but found no evidence to suggest genetic differentiation. Size differences between septic tank and surface mosquitoes were reduced when nutrient levels were held constant across experimental groups. Despite the absence of evidence suggesting a genetic difference between experimental groups in this study, Ae. aegypti emerging from septic tanks may still represent a more dangerous phenotype and should be given special consideration when developing vector control programs and designing public health interventions in the future.

The value of educational messages embedded in a community-based approach to combat dengue Fever: a systematic review and meta regression analysis

Background

The effects of various dengue control measures have been investigated in previous studies. The aim of this review was to investigate the relative effectiveness (RE) of different educational messages embedded in a community-based approach on the incidence of Aedes aegypti larvae using entomological measures as outcomes.

Methods and Findings

A systematic electronic search using Medline, Embase, Web of Science and the Cochrane Library was carried out to March 2010. Previous systematic reviews were also assessed. Data concerning interventions, outcomes, effect size and study design were extracted. Basic meta-analyses were done for pooled effect size, heterogeneity and publication bias using Comprehensive Meta-analysis. Further analysis of heterogeneitity was done by multi-level modelling using MLwiN. 21 publications with 22 separate studies were included in this review. Meta-analysis of these 22 pooled studies showed an RE of 0.25 (95% CI 0.17–0.37), but with substantial heterogeneity (Cochran's Q = 1254, df = 21, p = <0.001,). Further analysis of this heterogeneity showed that over 60% of between study variance could be explained by just two variables; whether or not studies used historic or contemporary controls and time from intervention to assessment. When analyses were restricted to those studies using contemporary control, there was a polynomial relationship between effectiveness and time to assessment. Whether or not chemicals or other control measures were used did not appear have any effect on intervention effectiveness.

Conclusion

The results suggest that such measures do appear to be effective at reducing entomological indices. However, those studies that use historical controls almost certainly overestimate the value of interventions. There is evidence that interventions are most effective some 18 to 24 months after the intervention but then subsequently decline.

Dengue fever is a mosquito-borne viral infection that is widespread in the tropics. Each year there are an estimated 50 million infections worldwide. Preventing infection relies on controlling the mosquitoes that spread disease. Unfortunately it is still not clear what does and does not work in the control of the mosquito vector. There have been several systematic reviews into control of dengue fever but still no consensus has been reached. This lack of consensus reflects the substantial heterogeneity in published effectiveness of studies of dengue control interventions. Prior systematic reviews have not adequately addressed this heterogeneity. We used multi-level modelling meta regression to investigate what variables modify the effectiveness of studies of educational messages embedded in a community-based approach. Most of the between study variation was explained by two variables, study design and time from intervention to assessment. In particular, studies using historic controls substantially overestimated the effectiveness of the intervention compared to those studies using contemporary controls. When the analysis was restricted to just those studies using contemporary controls, effectiveness was highest about 12 to 24 months after intervention but then declined.

Exploring the relationships between dengue fever knowledge and Aedes aegypti breeding in St Catherine Parish, Jamaica: a pilot of enhanced low-cost surveillance

PURPOSE

Dengue fever has re-emerged as an increasingly significant global health threat amid diminishing resources pledged for its control in developing nations. Efforts to limit breeding of the dengue vector Aedes aegypti are often hampered by lack of community awareness of the disease.

METHODS

Sixty-eight households in St Catherine Parish, Jamaica completed a pilot knowledge, attitude, and practice questionnaire as part of a routine container survey for presence of A. aegypti larvae.

RESULTS

Infestation levels were high according to traditional Stegomyia indices (Breteau index = 325); however, general knowledge of dengue symptoms, A. aegypti breeding sites, and preventive practices was low. After examining the links between demographic characteristics, dengue knowledge, and the number of breeding sites per house, higher educational achievement was associated with higher dengue knowledge, but also with more unprotected containers. Overall dengue knowledge was not associated with household container counts. Spatial statistics identified weak clustering of larvae-positive containers, and larvae were concentrated in three key container types.

CONCLUSION

Residents may only understand the role of certain container types, and significant gaps in general knowledge of the disease may inhibit vector control. This pilot demonstrates the feasibility of conducting inexpensive, rapid assessment of community knowledge and breeding levels for local governments lacking the resources for a more methodologically robust vector assessment strategy.

The cost of routine Aedes aegypti control and of insecticide-treated curtain implementation

Insecticide-treated curtains (ITCs) are promoted for controlling the Dengue vector Aedes aegypti. We assessed the cost of the routine Aedes control program (RACP) and the cost of ITC implementation through the RACP and health committees in Venezuela and through health volunteers in Thailand. The yearly cost of the RACP per household amounted to US$2.14 and $1.89, respectively. The ITC implementation cost over three times more, depending on the channel used. In Venezuela the RACP was the most efficient implementation-channel. It spent US$1.90 (95% confidence interval [CI]: 1.83; 1.97) per curtain distributed, of which 76.9% for the curtain itself. Implementation by health committees cost significantly (P = 0.02) more: US$2.32 (95% CI: 1.93; 2.61) of which 63% for the curtain. For ITC implementation to be at least as cost-effective as the RACP, at equal effectiveness and actual ITC prices, the attained curtain coverage and the adulticiding effect should last for 3 years.

A new strategy for Aedes aegypti (Diptera: Culicidae) control with community participation using a new fumigant formulation

Dengue and dengue hemorrhagic fever are mosquito-borne viral diseases that coincide with the distribution of Aedes aegypti (L.), the primary vector in the tropical and semitropical world. With no available vaccine, controlling the dengue vector is essential to avoid epidemics. This study evaluates the efficacy of a new smoke-generating formulation containing pyriproxyfen and permethrin in Puerto Libertad, Misiones, Argentina. A fumigant tablet (FT) was applied inside the houses by the community members and compared with a professional application. A treatment combining the application of fumigant tablets indoors and ultralow volume fumigation outdoors was also assessed. The community perceptions and practices about dengue disease and the acceptance of this new nonprofessional FT were evaluated through surveys. Results show >90% adult emergence inhibition and 100% adult mortality with these treatments. More than 80% of the residents applied the FT and preferred participating in a vector control program by using a nonprofessional mosquito control tool, instead of attending meetings and workshops promoting cultural changes.

The dengue vector Aedes aegypti: what comes next

Aedes aegypti is the urban vector of dengue viruses worldwide. While climate influences the geographical distribution of this mosquito species, other factors also determine the suitability of the physical environment. Importantly, the close association of A. aegypti with humans and the domestic environment allows this species to persist in regions that may otherwise be unsuitable based on climatic factors alone. We highlight the need to incorporate the impact of the urban environment in attempts to model the potential distribution of A. aegypti and we briefly discuss the potential for future technology to aid management and control of this widespread vector species.