Assessing the combined effects of household type and insecticide effectiveness for kala-azar vector control using indoor residual spraying: a case study from North Bihar, India

A comprehensive review of biological and genetic control approaches for leishmaniasis vector sand flies; emphasis towards promoting tools for integrated vector management

BACKGROUND

Leishmaniasis is a health problem in many regions with poor health and poor life resources. According to the World Health Organization (WHO), an estimated 700,000-1 million new cases arise annually. Effective control of sand fly vector populations is crucial for reducing the transmission of this disease. Therefore, this review aims to comprehensively examine and evaluate the current methods for controlling sand fly populations, focusing on biological and gene drive techniques.

METHODS AND FINDINGS

A detailed, comprehensive literature search was carried out using databases including Google Scholar, PubMed, ScienceDirect, and the National Library of Medicine (NIH). These searches were done using specific keywords related to the field of study. This current review identified several promising methods, including genetically modified sand flies, using transgenic approaches by taking advanced gene editing tools like Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR/Cas9) and genetic modification of symbiotic microorganisms for controlling sand fly populations, which appeared to be proven under laboratory and field settings.

CONCLUSION

Genetic control approaches have many benefits over chemical control, including long-lasting effects on targets, high specificity, and less environmental impact. Advances in genetic engineering technologies, particularly CRISPR/Cas9, sterile insect techniques, and gene drive insect modification, offer new avenues for precise and efficient sand fly management. Future research should prioritize optimizing rearing and sterilization techniques, conducting controlled field trials, and fostering collaboration across disciplines to realize the potential of genetic control strategies in combating leishmaniasis.

Addressing challenges in vector control: a review of current strategies and the imperative for novel tools in India's combat against vector-borne diseases

Vector-borne diseases (VBDs) exert a substantial burden across the world, especially in tropical countries. Malaria, chikungunya, dengue, visceral leishmaniasis, lymphatic filariasis and Japanese encephalitis are among the public health concerns for India. One of the major pillars for the containment of VBDs is vector control and different tools have been employed for several decades. These range from chemical insecticides used in indoor residual sprays, space sprays, fogging, treated bednets and larvicides to biological control methods such as larvivorus fishes and environmental control and modification measures such as source reduction. However, these methods are increasingly becoming less effective due to several reasons such as insecticide resistance, outdoor biting, behavioural changes in vectors for biting and resting, climate change, movement of population, vector incursion to newer areas and others. It is essential to develop and test new tools for vector control to surmount these challenges. Though focusing on India's public health concerns, the new tools enumerated here can be tested by any country with similar epidemiological and environmental conditions. The promising new vector control tools are insecticide-treated nets with synergist and/or pyrrole chlorfenapyr, alternatives/additions to synthetic pyrethroids like neonicotinoids, clothianidin for indoor residual spray, newer formulations such as Bacillus sphaericus for use in larvicides, attractive toxic sugar baits, especially to curtail outdoor transmission, endectocides like ivermectin for use in animals/humans, insecticidal paints, spatial repellents, insecticide-treated wearables and others. Genetic modification technologies (Sterile Insect Technique/Incompatible Insect Technique/Wolbachia transfection) are also upcoming strategies. Among the six VBDs, India is committed to the elimination of three (malaria, visceral leishmaniasis and lymphatic filariasis) and it will require additional and/or novel tools to overcome the roadblocks in our current journey to the goal of control/elimination of these VBDs.

Indoor residual spraying for the control of visceral leishmaniasis: A systematic review

Indoor Residual Spraying (IRS) is one of the interventions to control the vectors of Visceral Leishmaniasis (VL). Different insecticides are used in affected countries, also in the Regional Initiative for the Elimination of VL in South-East Asia. This systematic review assesses all available studies analysing the effectiveness of IRS on the key vectors of VL. The systematic review followed PRISMA guidelines, with a broad search strategy, applied to seven key databases. Inclusion criteria were studies focusing on 1) Visceral leishmaniasis 2) Indoor Residual Spraying (IRS) or synonyms, and 3) all primary research methods. 21 studies were included, five cluster randomised controlled trials (cRCTs), one randomised controlled trial (RCT), 11 intervention studies, also included were three modelling studies and one survey. 19 out of 21 included studies were published between 2009 and 2020. 18 of the studies were conducted in the context of the Regional Initiative. Effects of IRS on vector populations are positive, confirmed in terms of effectiveness and by the availability of studies. Deltamethrin and alpha-Cypermethrin reduce total sandfly counts, and/or Phlebotomus argentipes counts by up to 95% with an effect of a minimum of one month. Prolonged effects are not regularly seen. DDT has been used in India only: whereas in the 1990s a good effect could be measured, this effect waned over time. Two intervention studies, embedded in larger programmes in 2019 and 2020, replaced DDT with alpha-Cypermethrin throughout the study. Combinations of different interventions are not systematically researched, however showing some promising results, for example for the combination of IRS and Temephos. Constant monitoring of insecticide resistancies and quality delivery of IRS are confirmed as key issues for programmes. No human transmission data are available to directly relate an effect of IRS-although modelling studies confirm the effect of IRS on human transmission. Concluding, IRS continues to be an effective intervention for Phlebotomus argentipes control. Delivery requires constant monitoring and quality assurance. Further studies need to assess IRS in different geographical areas affected by VL and combinations of interventions.

Chemical control and insecticide resistance status of sand fly vectors worldwide

BACKGROUND

Phlebotomine sand flies are prominent vectors of Leishmania parasites that cause leishmaniasis, which comes second to malaria in terms of parasitic causative fatalities globally. In the absence of human vaccines, sand fly chemical-based vector control is a key component of leishmaniasis control efforts.

METHODS AND FINDINGS

We performed a literature review on the current interventions, primarily, insecticide-based used for sand fly control, as well as the global insecticide resistance (IR) status of the main sand fly vector species. Indoor insecticidal interventions, such as residual spraying and treated bed nets are the most widely deployed, while several alternative control strategies are also used in certain settings and/or are under evaluation. IR has been sporadically detected in sand flies in India and other regions, using non-standardized diagnostic bioassays. Molecular studies are limited to monitoring of known pyrethroid resistance mutations (kdr), which are present at high frequencies in certain regions.

CONCLUSIONS

As the leishmaniasis burden remains a major problem at a global scale, evidence-based rational use of insecticidal interventions is required to meet public health demands. Standardized bioassays and molecular markers are a prerequisite for this task, albeit are lagging behind. Experiences from other disease vectors underscore the need for the implementation of appropriate IR management (IRM) programs, in the framework of integrated vector management (IVM). The implementation of alternative strategies seems context- and case-specific, with key eco-epidemiological parameters yet to be investigated. New biotechnology-based control approaches might also come into play in the near future to further reinforce sand fly/leishmaniasis control efforts.

Kala-azar elimination in a highly-endemic district of Bihar, India: A success story

Background

Visceral leishmaniasis (VL) or Kala-azar has been a major public health problem in Bihar, India, for several decades. A few VL infected districts including Vaishali have reported >600 cases annually. Hence, in 2015, the Government of India entrusted ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, to implement an integrated control strategy for achieving the VL elimination target (<1 case per 10,000 people at the block level) in the Vaishali District of Bihar.

Methodology

This study was conducted between January 2015 and December 2016. An integrated control strategy including the spatio-temporal mapping of VL-case distribution, active case detection, chemical-based vector control using indoor residual spraying (IRS), community awareness campaigns, the training of IRS members, the training of medical doctors for effective treatment, daily monitoring and the supervision of IRS activities, logistic management, post-IRS quality assurance, epidemiological surveillance, and entomological monitoring was performed. An insecticide quantification test was performed for evaluating the IRS quality on sprayed walls. A modern compression pump was used to maintain spray quality on different wall surfaces. The impact of IRS was assessed through sand fly collection in human dwellings and cattle sheds in pre- and post-IRS. The insecticide susceptibility of local P. argentipes was performed before each IRS round (in February and June) during 2015–2016. Statistical analysis such as the mean, percentage, and 95% CI were used to summarize the results.

Findings

All 16 blocks of the Vaishali District achieved the VL elimination target in 2016. The integrated VL control strategy helped reduce the number of VL cases from 664 in 2014 to 163 in 2016 and the number of endemic villages from 282 in 2014 to 142 in 2016. The case reduction rate was increased from 22.6% in 2014 to 58.8% in 2016. On average, 74 VL infected villages became Kala-azar free each year from 2015 to 2016.

Conclusions

The results of this study suggest that the elimination of VL is possible from all endemic blocks of Bihar if the integrated Vaishali VL control strategy is applied under strong monitoring and supervision.

The World Health Organization (WHO) has set a target to eliminate visceral leishmaniasis (VL), commonly known as “Kala-azar,” as a public health problem in India by 2020. The elimination target is defined as achieving less than 1 case per 10,000 people at the block level. Although India has made substantial progress in the elimination of the disease since 2012, VL remains a stable public health problem in four middle-eastern states including Bihar. Bihar contributes >61% of the total Indian cases annually, and a few districts of the state have reported more than 600 cases annually. In this study, the results indicate that an intensive integrated VL control strategy including epidemiological analysis based on a geographical information system (GIS), hot-spot mapping, active case detection, vector control using the indoor residual spraying (IRS) of chemical insecticides, awareness campaigns, human resource development, the close monitoring of control activities, and active epidemiological surveillance and entomological monitoring can achieve the elimination target in the highly endemic region of Bihar. The elimination of VL from highly endemic zones is urgently required to control any new outbreak. Therefore, the implementation of the Vaishali VL control strategy is strongly recommended in all highly endemic districts of Bihar, India.