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Dos Santos Andrade AT, Tavares CPDS, Ferreira FADS, de Oliveira AC, Lima SC, do Nascimento Neto JF, Pereira BGV, Rodrigues GO, da Silva JS, Pinheiro VCS, Roque RA. Effect of pyriproxyfen on biological parameters and morphometry of Aedes aegypti Linnaeus, 1762 (Diptera: Culicidae) in the city of Manaus, Amazonas. Acta Trop 2025; 265:107609. [PMID: 40185218 DOI: 10.1016/j.actatropica.2025.107609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2025] [Revised: 03/27/2025] [Accepted: 03/29/2025] [Indexed: 04/07/2025]
Abstract
In Brazil, Aedes aegypti is the primary vector of arboviruses, and its control relies mainly on insecticide use. However, excessive application on these products has led to the selection of resistant populations. To address this challenge, products like Pyriproxyfen (PPF), an insect growth regulator, have been used as a viable alternative. In this context, the present study evaluated the susceptibility, resistance ratio, and biological changes of A. aegypti exposed to PPF. Samples were collected in eight neighborhoods using oviposition traps, and the Rockefeller strain was used as a susceptibility standard. Fecundity tests recorded a hatching rate of 72.4 % in the PPF groups, compared to 89.2 % in the control (p < 0.05), and fertility of 72.4 % for PPF compared to 89.2 % in the control (t = 204.5, df = 4, p < 0.05). Longevity was assessed in males, females, and couples (χ² = 20.35, df = 5, p > 0.05). Wing morphometric analyses were reinforced by Mahalanobis distance (1.7127; p < 0.001), Procrustes analysis (0.0064; p = 0.5027), and canonical variable analyses. The width of the cephalic capsules was greater in mosquitoes exposed to PPF (Mann-Whitney U = 369; p < 0.0099). The emergence inhibition rate ranged from 65.33 ± 4 to 100 ± 0 for the Rockefeller strain and from 59.33 ± 4 to 88.66 ± 2 for the field population, with a resistance ratio of 0.68. The study concludes that the A. aegypti population in Manaus, remains susceptible to PPF, and the observed alterations were not significant enough to compromise the vector's biology.
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Affiliation(s)
- Aylane Tamara Dos Santos Andrade
- Programa de Pós-Graduação, Rede de Biodiversidade e Biotecnologia da Amazônia Legal-BIONORTE, Manaus, Amazonas, Brasil; Laboratório de Controle Biológico e Biotecnologia da Malária e da Dengue, Instituto Nacional de Pesquisas da Amazônia - INPA, Manaus, Amazonas, Brasil.
| | - Cláudia Patrícia da Silva Tavares
- Programa de Pós-Graduação, Rede de Biodiversidade e Biotecnologia da Amazônia Legal-BIONORTE, Manaus, Amazonas, Brasil; Laboratório de Controle Biológico e Biotecnologia da Malária e da Dengue, Instituto Nacional de Pesquisas da Amazônia - INPA, Manaus, Amazonas, Brasil
| | | | - André Correa de Oliveira
- Laboratório de Controle Biológico e Biotecnologia da Malária e da Dengue, Instituto Nacional de Pesquisas da Amazônia - INPA, Manaus, Amazonas, Brasil; Programa de Pós-Graduação em Ciências Biológicas (Entomologia), Manaus, Amazonas, Brasil
| | - Suelen Costa Lima
- Laboratório de Controle Biológico e Biotecnologia da Malária e da Dengue, Instituto Nacional de Pesquisas da Amazônia - INPA, Manaus, Amazonas, Brasil; Programa de Pós-Graduação em Ciências Biológicas (Entomologia), Manaus, Amazonas, Brasil
| | - Joaquim Ferreira do Nascimento Neto
- Laboratório de Controle Biológico e Biotecnologia da Malária e da Dengue, Instituto Nacional de Pesquisas da Amazônia - INPA, Manaus, Amazonas, Brasil
| | - Bianca Geovana Viana Pereira
- Laboratório de Controle Biológico e Biotecnologia da Malária e da Dengue, Instituto Nacional de Pesquisas da Amazônia - INPA, Manaus, Amazonas, Brasil; Programa de Pós-Graduação em Ciências Biológicas (Entomologia), Manaus, Amazonas, Brasil
| | - Genilson Oliveira Rodrigues
- Laboratório de Controle Biológico e Biotecnologia da Malária e da Dengue, Instituto Nacional de Pesquisas da Amazônia - INPA, Manaus, Amazonas, Brasil; Programa de Pós-Graduação em Ciências Biológicas (Entomologia), Manaus, Amazonas, Brasil
| | | | | | - Rosemary Aparecida Roque
- Laboratório de Controle Biológico e Biotecnologia da Malária e da Dengue, Instituto Nacional de Pesquisas da Amazônia - INPA, Manaus, Amazonas, Brasil
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Gadji M, Kengne-Ouafo JA, Tchouakui M, Wondji MJ, Mugenzi LMJ, Hearn J, Boyomo O, Wondji CS. Genome-wide association studies unveil major genetic loci driving insecticide resistance in Anopheles funestus in four eco-geographical settings across Cameroon. BMC Genomics 2024; 25:1202. [PMID: 39695386 PMCID: PMC11654272 DOI: 10.1186/s12864-024-11148-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Accepted: 12/11/2024] [Indexed: 12/20/2024] Open
Abstract
BACKGROUND Insecticide resistance is jeopardising malaria control efforts in Africa. Deciphering the evolutionary dynamics of mosquito populations country-wide is essential for designing effective and sustainable national and subnational tailored strategies to accelerate malaria elimination efforts. Here, we employed genome-wide association studies through pooled template sequencing to compare four eco-geographically different populations of the major vector, Anopheles funestus, across a South North transect in Cameroon, aiming to identify genomic signatures of adaptive responses to insecticides. RESULTS Our analysis revealed limited population structure within Northern and Central regions (FST<0.02), suggesting extensive gene flow, while populations from the Littoral/Coastal region exhibited more distinct genetic patterns (FST>0.049). Greater genetic differentiation was observed at known resistance-associated loci, resistance-to-pyrethroids 1 (rp1) (2R chromosome) and CYP9 (X chromosome), with varying signatures of positive selection across populations. Allelic variation between variants underscores the pervasive impact of selection pressures, with rp1 variants more prevalent in Central and Northern populations (FST>0.3), and the CYP9 associated variants more pronounced in the Littoral/Coastal region (FST =0.29). Evidence of selective sweeps was supported by negative Tajima's D and reduced genetic diversity in all populations, particularly in Central (Elende) and Northern (Tibati) regions. Genomic variant analysis identified novel missense mutations and signatures of complex genomic alterations such as duplications, deletions, transposable element (TE) insertions, and chromosomal inversions, all associated with selective sweeps. A 4.3 kb TE insertion was fixed in all populations with Njombe Littoral/Coastal population, showing higher frequency of CYP9K1 (G454A), a known resistance allele and TE upstream compared to elsewhere. CONCLUSION Our study uncovered regional variations in insecticide resistance candidate variants, emphasizing the need for a streamlined DNA-based diagnostic assay for genomic surveillance across Africa. These findings will contribute to the development of tailored resistance management strategies crucial for addressing the dynamic challenges of malaria control in Cameroon.
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Affiliation(s)
- Mahamat Gadji
- Centre for Research in Infectious Diseases (CRID), P.O. BOX 13591, Yaoundé, Cameroon.
- The University of Yaoundé 1, P.O BOX 812, Yaoundé, Cameroon.
| | - Jonas A Kengne-Ouafo
- Centre for Research in Infectious Diseases (CRID), P.O. BOX 13591, Yaoundé, Cameroon
| | - Magellan Tchouakui
- Centre for Research in Infectious Diseases (CRID), P.O. BOX 13591, Yaoundé, Cameroon
| | - Murielle J Wondji
- Centre for Research in Infectious Diseases (CRID), P.O. BOX 13591, Yaoundé, Cameroon
- Liverpool School of Tropical Medicine, Pembroke Place Liverpool L3 5QA UK, Liverpool, UK
| | - Leon M J Mugenzi
- Syngenta Crop Protection, Werk Stein, Schaffhauserstrasse, Stein, Switzerland
| | - Jack Hearn
- Centre for Epidemiology and Planetary Health, Scotland's Rural College (SRUC), RAVIC, 9 Inverness Campus, Inverness, UK
| | - Onana Boyomo
- The University of Yaoundé 1, P.O BOX 812, Yaoundé, Cameroon
| | - Charles S Wondji
- Centre for Research in Infectious Diseases (CRID), P.O. BOX 13591, Yaoundé, Cameroon.
- Liverpool School of Tropical Medicine, Pembroke Place Liverpool L3 5QA UK, Liverpool, UK.
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Yaméogo F, Sombié A, Oté M, Saiki E, Sakurai T, Wangrawa DW, McCall PJ, Weetman D, Kanuka H, Badolo A. Three years of insecticide resistance evolution and associated mechanisms in Aedes aegypti populations of Ouagadougou, Burkina Faso. PLoS Negl Trop Dis 2024; 18:e0012138. [PMID: 39621769 PMCID: PMC11637278 DOI: 10.1371/journal.pntd.0012138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 12/12/2024] [Accepted: 11/05/2024] [Indexed: 12/13/2024] Open
Abstract
BACKGROUND Resistance to insecticides is spreading among populations of Aedes aegypti, the primary vector of important human arboviruses. The escalating insecticide resistance poses a significant threat to dengue vector control, with an expanding number of countries affected by the disease. To gain a deeper insight into the evolution of insecticide resistance, it is essential to have longitudinal surveillance results, which are currently lacking, particularly from African Ae. aegypti populations. Here we report on three-years of surveillance of Ae. aegypti susceptibility to insecticide resistance phenotypes and associated kdr mutations in Burkina Faso, a country with regular dengue outbreaks. METHODS Ae. aegypti susceptibility to insecticides and the V410L, V1016I, and F1534C kdr target site mutations linked to pyrethroid insecticide resistance were monitored in Ouagadougou from 2016 to 2018. Larvae were collected from artificial containers at two sites and reared to adulthood in an insectary. Bioassays were conducted on female adults, along with a laboratory-susceptible strain, following standard WHO protocols. Allele-specific PCR genotyping assays were utilized to identify the V410L, V1016I, and F1534C kdr pyrethroid target site mutations. RESULTS Bioassays revealed a high level of resistance to permethrin and deltamethrin that progressively increased over the three-year period in both localities. The 1534C mutation was nearly fixed throughout the three years at each locality, and while the closely-related 410L and 1016I mutations did not vary between localities, their frequency notably increased from 2016 to 2018. Interestingly, Ae. aegypti populations in both areas remained susceptible to bendiocarb, fenitrothion, and malathion. Modelling the mortality data further confirmed the escalating resistance trend over the years and emphasized the significant role played by the three kdr mutations in conferring resistance to pyrethroids. CONCLUSION Mortality rates indicate that Ae. aegypti populations from Ouagadougou are becoming increasingly resistant to pyrethroid insecticides, likely due to an increase in the frequencies of the 410L and 1016I kdr mutations. Organophosphate insecticides are likely to be better alternative options for control.
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Affiliation(s)
- Félix Yaméogo
- Laboratoire d’Entomologie Fondamentale et Appliquée, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Aboubacar Sombié
- Laboratoire d’Entomologie Fondamentale et Appliquée, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Manabu Oté
- Center for Medical Entomology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Tropical Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Erisha Saiki
- Center for Medical Entomology, The Jikei University School of Medicine, Tokyo, Japan
- Laboratory Animal Facilities, The Jikei University School of Medicine, Tokyo, Japan
| | - Tatsuya Sakurai
- Center for Medical Entomology, The Jikei University School of Medicine, Tokyo, Japan
- Laboratory Animal Facilities, The Jikei University School of Medicine, Tokyo, Japan
| | - Dimitri W. Wangrawa
- Laboratoire d’Entomologie Fondamentale et Appliquée, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
- Université Norbert Zongo, Koudougou, Burkina Faso
| | - Philip J. McCall
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - David Weetman
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Hirotaka Kanuka
- Center for Medical Entomology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Tropical Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Athanase Badolo
- Laboratoire d’Entomologie Fondamentale et Appliquée, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
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Kamgang B, Acântara J, Tedjou A, Keumeni C, Yougang A, Ancia A, Bigirimana F, Clarke SE, Gil VS, Wondji C. Entomological surveys and insecticide susceptibility profile of Aedes aegypti during the dengue outbreak in Sao Tome and Principe in 2022. PLoS Negl Trop Dis 2024; 18:e0011903. [PMID: 38829904 PMCID: PMC11175431 DOI: 10.1371/journal.pntd.0011903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 06/13/2024] [Accepted: 05/13/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND The first dengue outbreak in Sao Tome and Principe was reported in 2022. Entomological investigations were undertaken to establish the typology of Aedes larval habitats, the distribution of Ae. aegypti and Ae. albopictus, the related entomological risk and the susceptibility profile of Ae. aegypti to insecticides, to provide evidence to inform the outbreak response. METHODOLOGY/PRINCIPAL FINDINGS Entomological surveys were performed in all seven health districts of Sao Tome and Principe during the dry and rainy seasons in 2022. WHO tube and synergist assays using piperonyl butoxide (PBO) and diethyl maleate (DEM) were carried out, together with genotyping of F1534C/V1016I/V410L mutations in Ae. aegypti. Aedes aegypti and Ae. albopictus were found in all seven health districts of the country with high abundance of Ae. aegypti in the most urbanised district, Agua Grande. Both Aedes species bred mainly in used tyres, discarded tanks and water storage containers. In both survey periods, the Breteau (BI > 50), house (HI > 35%) and container (CI > 20%) indices were higher than the thresholds established by WHO to indicate high potential risk of dengue transmission. The Ae. aegypti sampled were susceptible to all insecticides tested except dichlorodiphenyltrichloroethane (DDT) (9.2% mortality, resistant), bendiocarb (61.4% mortality, resistant) and alpha-cypermethrin (97% mortality, probable resistant). A full recovery was observed in Ae. aegypti resistant to bendiocarb after pre-exposure to synergist PBO. Only one Ae. aegypti specimen was found carrying F1534C mutation. CONCLUSIONS/SIGNIFICANCE These findings revealed a high potential risk for dengue transmission throughout the year, with the bulk of larval breeding occurring in used tyres, water storage and discarded containers. Most of the insecticides tested remain effective to control Aedes vectors in Sao Tome, except DDT and bendiocarb. These data underline the importance of raising community awareness and implementing routine dengue vector control strategies to prevent further outbreaks in Sao Tome and Principe, and elsewhere in the subregion.
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Affiliation(s)
- Basile Kamgang
- Centre for Research in Infectious Diseases, Department of Medical Entomology, Yaoundé, Cameroon
| | - João Acântara
- Centro Nacional de Endemias, Ministério da Saúde de São Tomé e Príncipe, Agua Grande, São Tomé e Príncipe
| | - Armel Tedjou
- Centre for Research in Infectious Diseases, Department of Medical Entomology, Yaoundé, Cameroon
| | - Christophe Keumeni
- Centre for Research in Infectious Diseases, Department of Medical Entomology, Yaoundé, Cameroon
- Department of Animal Biology and Physiology, Faculty of Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Aurelie Yougang
- Centre for Research in Infectious Diseases, Department of Medical Entomology, Yaoundé, Cameroon
| | - Anne Ancia
- World Health Organization, Port Louis, Mauritius
| | | | - Sian E. Clarke
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Charles Wondji
- Centre for Research in Infectious Diseases, Department of Medical Entomology, Yaoundé, Cameroon
- Vector Biology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Matute DR, Cooper BS. Aedes albopictus is present in the lowlands of southern Zambia. Acta Trop 2024; 251:107115. [PMID: 38184292 PMCID: PMC11586621 DOI: 10.1016/j.actatropica.2023.107115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/12/2023] [Accepted: 12/27/2023] [Indexed: 01/08/2024]
Abstract
Identifying the current geographic range of disease vectors is a critical first step towards determining effective mechanisms for controlling and potentially eradicating them. This is particularly true given that historical vector ranges may expand due to changing climates and human activity. The Aedes subgenus Stegomyia contains over 100 species, and among them, Ae. aegypti and Ae. albopictus mosquitoes represent the largest concern for public health, spreading dengue, chikungunya, and zika viruses. While Ae. aegypti has been observed in the country of Zambia for decades, Ae. albopictus has not. In 2015 we sampled four urban and three rural areas in Zambia for Aedes species. Using DNA barcoding, we confirmed the presence of immature and adult Ae. albopictus at two sites: Siavonga and Livingstone. These genotypes seem most closely related to specimens previously collected in Mozambique based on mtDNA barcoding. We resampled Siavonga and Livingstone sites in 2019, again observing immature and adult Ae. albopictus at both sites. Relative Ae. albopictus frequencies were similar between sites, with the exception of immature life stages, which were higher in Siavonga than in Livingstone in 2019. While Ae. albopictus frequencies did not vary through time in Livingstone, both immature and adult frequencies increased through time in Siavonga. This report serves to document the presence of Ae. albopictus in Zambia, which will contribute to understanding the potential public health implications of this disease vector in southern Africa.
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Affiliation(s)
- Daniel R Matute
- Biology Department, University of North Carolina, 250 Bell Tower Drive, Genome Sciences Building, Chapel Hill, NC 27510, United States.
| | - Brandon S Cooper
- Division of Biological Sciences, University of Montana, 32 Campus Dr., Missoula, MT 59812, United States
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Wu H, Qian J, Xu Z, Yan R, Zhu G, Wu S, Chen M. Leucine to tryptophane substitution in the pore helix IIP1 confer sodium channel resistance to pyrethroids and DDT. PESTICIDE BIOCHEMISTRY AND PHYSIOLOGY 2023; 194:105490. [PMID: 37532317 DOI: 10.1016/j.pestbp.2023.105490] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 08/04/2023]
Abstract
Aedes aegypti is responsible for transmitting a variety of arboviral infectious diseases such as dengue and chikungunya. Insecticides, particularly pyrethroids, are used widely for mosquito control. However, intensive used of pyrethroids has led to the selection of kdr mutations on sodium channels. L982W, locating in the PyR1 (Pyrethroid receptor site 1), was first reported in Ae. aegypti populations collected from Vietnam. Recently, the high frequency of L982W was detected in pyrethroid-resistant populations of Vietnam and Cambodia, and also concomitant mutations L982W + F1534C was detected in both countries. However, the role of L982W in pyrethroid resistance remains unclear. In this study, we examined the effects of L982W on gating properties and pyrethroid sensitivity in Xenopus oocytes. We found that mutations L982W and L982W + F1534C shifted the voltage dependence of activation in the depolarizing direction, however, neither mutations altered the voltage dependence of inactivation. L982W significantly reduced channel sensitivity to Type I pyrethroids, permethrin and bifenthrin, and Type II pyrethroids, deltamethrin and cypermethrin. No enhancement was observed when synergized with F1534C. In addition, L982W and L982W + F1534C mutations reduced the channel sensitivity to DDT. Our results illustrate the molecular basis of resistance mediates by L982W mutation, which will be helpful to understand the interacions of pyrethroids or DDT with sodium channels and develop molecular markers for monitoring pest resistance to pyrethroids and DDT.
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Affiliation(s)
- Huiming Wu
- The Key Laboratory for Quality Improvement of Agricultural Products of Zhejiang Province, College of Advanced Agricultural Sciences, Zhejiang A&F University, Hangzhou, China
| | - Jiali Qian
- The Key Laboratory for Quality Improvement of Agricultural Products of Zhejiang Province, College of Advanced Agricultural Sciences, Zhejiang A&F University, Hangzhou, China
| | - Zhanyi Xu
- Institute of Pesticide and Environmental Toxicology, Zhejiang University, Hangzhou, China
| | - Ru Yan
- College of life sciences, Zhejiang University, Hangzhou, China
| | - Guonian Zhu
- Institute of Pesticide and Environmental Toxicology, Zhejiang University, Hangzhou, China
| | - Shaoying Wu
- Sanya Nanfan Research Institute, Hainan University, Sanya 572024, China.
| | - Mengli Chen
- The Key Laboratory for Quality Improvement of Agricultural Products of Zhejiang Province, College of Advanced Agricultural Sciences, Zhejiang A&F University, Hangzhou, China.
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Bauer IL. The oral repellent - science fiction or common sense? Insects, vector-borne diseases, failing strategies, and a bold proposition. Trop Dis Travel Med Vaccines 2023; 9:7. [PMID: 37381000 DOI: 10.1186/s40794-023-00195-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 06/09/2023] [Indexed: 06/30/2023] Open
Abstract
Over the last decades, unimaginable amounts of money have gone into research and development of vector control measures, repellents, treatment, and vaccines for vector borne diseases. Technological progress and scientific breakthroughs allowed for ever more sophisticated and futuristic strategies. Yet, each year, millions of people still die or suffer from potentially serious consequences of malaria or dengue to more recent infections, such as zika or chikungunya, or of debilitating consequences of neglected tropical diseases. This does not seem value for money. In addition, all current vector control strategies and personal protection methods have shortcomings, some serious, that are either destructive to non-target species or unsatisfactory in their effectiveness. On the other hand, the rapid decline in insect populations and their predators reflects decades-long aggressive and indiscriminate vector control. This major disruption of biodiversity has an impact on human life not anticipated by the well-meaning killing of invertebrates. The objective of this paper is to re-examine current control methods, their effectiveness, their impact on biodiversity, human and animal health, and to call for scientific courage in the pursuit of fresh ideas. This paper brings together topics that are usually presented in isolation, thereby missing important links that offer potential solutions to long-standing problems in global health. First, it serves as a reminder of the importance of insects to human life and discusses the few that play a role in transmitting disease. Next, it examines critically the many currently employed vector control strategies and personal protection methods. Finally, based on new insights into insect chemo-sensation and attractants, this perspective makes a case for revisiting a previously abandoned idea, the oral repellent, and its use via currently successful methods of mass-application. The call is out for focused research to provide a powerful tool for public health, tropical medicine, and travel medicine.
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Affiliation(s)
- Irmgard L Bauer
- College of Healthcare Sciences, Academy - Tropical Health and Medicine, James Cook University, Townsville, QLD, 4811, Australia.
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