A verandah-trap hut for studying the house-frequenting habits of mosquitos and for assessing insecticides. 2. The effect of dichlorvos (DDVP) on egress and mortality of Anopheles gambiae Giles and Mansonia uniformis (Theo.) entering naturally

The fabric of life: what if mosquito nets were durable and widely available but insecticide-free?

BACKGROUND

Bed nets are the commonest malaria prevention tool and arguably the most cost-effective. Their efficacy is because they prevent mosquito bites (a function of physical durability and integrity), and kill mosquitoes (a function of chemical content and mosquito susceptibility). This essay follows the story of bed nets, insecticides and malaria control, and asks whether the nets must always have insecticides.

METHODS

Key attributes of untreated or pyrethroid-treated nets are examined alongside observations of their entomological and epidemiological impacts. Arguments for and against adding insecticides to nets are analysed in contexts of pyrethroid resistance, personal-versus-communal protection, outdoor-biting, need for local production and global health policies.

FINDINGS

Widespread resistance in African malaria vectors has greatly weakened the historical mass mosquitocidal effects of insecticide-treated nets (ITNs), which previously contributed communal benefits to users and non-users. Yet ITNs still achieve substantial epidemiological impact, suggesting that physical integrity, consistent use and population-level coverage are increasingly more important than mosquitocidal properties. Pyrethroid-treatment remains desirable where vectors are sufficiently susceptible, but is no longer universally necessary and should be re-examined alongside other attributes, e.g. durability, coverage, acceptability and access. New ITNs with multiple actives or synergists could provide temporary relief in some settings, but their performance, higher costs, and drawn-out innovation timelines do not justify singular emphasis on insecticides. Similarly, sub-lethal insecticides may remain marginally-impactful by reducing survival of older mosquitoes and disrupting parasite development inside the mosquitoes, but such effects vanish under strong resistance.

CONCLUSIONS

The public health value of nets is increasingly driven by bite prevention, and decreasingly by lethality to mosquitoes. For context-appropriate solutions, it is necessary to acknowledge and evaluate the potential and cost-effectiveness of durable untreated nets across different settings. Though ~ 90% of malaria burden occurs in Africa, most World Health Organization-prequalified nets are manufactured outside Africa, since many local manufacturers lack capacity to produce the recommended insecticidal nets at competitive scale and pricing. By relaxing conditions for insecticides on nets, it is conceivable that non-insecticidal but durable, and possibly bio-degradable nets, could be readily manufactured locally. This essay aims not to discredit ITNs, but to illustrate how singular focus on insecticides can hinder innovation and sustainability.

Bio-efficacy of DuraNet® long-lasting insecticidal nets against wild populations of Anopheles arabiensis in experimental huts

Background

Mosquitoes have developed resistance to multiple classes of insecticides for malaria vector control. A new generation of long-lasting insecticidal bed nets (LLINs) has been developed with increased efficacy against these resistant mosquitoes. The present study therefore evaluated the efficacy of the pyrethroid-based LLINs, DuraNet versus PermaNet 3.0, in an Eastern Africa hut design in Magugu in northern Tanzania where mosquitoes’ population higher proportion (69.3%) has been identified as Anopheles gambiae s.l.

Methods

Standard World Health Organization bioefficacy evaluations were conducted in both laboratory and experimental huts. Experimental hut evaluations were conducted in an area with high populations of Anopheles arabiensis. All nets used were subjected to laboratory cone bioassays and then to experimental hut trials. Mosquito mortality, blood-feeding inhibition, and personal protection rate were compared between untreated nets, unwashed LN, and LN that were washed 20 times.

Results

Standard WHO laboratory bioefficacy evaluations of DuraNet and PermaNet® 3.0 which were untreated, washed, or 20 times washed showed optimal knockdown and mortality for both net types against a susceptible strain of An. arabiensis. In standard experimental hut evaluations, the blood feeding inhibition for PermaNet® 3.0 unwashed and washed was 82.4% (76.3–88.6%) to 91.5% (84.1–98.8%) while for DuraNet was 98.3% (97.0–99.5%) to 96.0% (94.1–88.2%) respectively. The DuraNet LLINs showed a significantly higher killing effect than the other treatment of 90.0% (86.1–94.2%) and 94.0% (90.2–97.9%) for unwashed and washed nets respectively. No significant difference in deterrence or induced exophily was detected between the treatment arms. There were no adverse effects reported among sleepers in the experimental huts.

Conclusion

The findings of this study indicate that the pyrethroid-based net DuraNet LLINs attained required efficacy when evaluated against wild population of An. arabiensis from Northern Tanzania. This adds value to the existing vector control tool box which gives community wider choice for vector control.

Experimental hut to study the indoor behaviour and effects of insecticide-treated bednets on phlebotomine sand flies (Diptera: Psychodidae)

INTRODUCTION

Behavioural effects of insecticides on endophagic phlebotomine sand fly vectors of Leishmania are poorly understood mainly because of the lack of an experimental hut (EH) in which to study them.

OBJECTIVE

To build an EH to evaluate the effects of long-lasting insecticide-treated nets (LLINs) on Lutzomyia longiflocosa.

METHODS

The study had two phases: (1) Laboratory experiments using tunnel tests to select the traps for the EH; and (2) EH construction and evaluation of the effects of deltamethrin and lambda-cyhalothrin LLINs on L. longiflocosa females inside the EH.

FINDINGS

Phase 1: The horizontal-slit trap was the best trap. This trap collected the highest percentage of sand flies, and prevented them from escaping. Therefore, this trap was used in the EH. Phase 2: The main effects of LLINs on L. longiflocosa in the EH were: landing inhibition, inhibition from entering the bednet, induced exophily, and high mortality (total and inside exit traps).

CONCLUSIONS

The EH was effective for evaluating the effects of LLINs on endophagic sand flies. Although both types of LLINs showed high efficacy, the lambda-cyhalothrin-treated LLIN performed better. This is the first report of induced exophily in sand flies.

Relative performance of indoor vector control interventions in the Ifakara and the West African experimental huts

BACKGROUND

West African and Ifakara experimental huts are used to evaluate indoor mosquito control interventions, including spatial repellents and insecticides. The two hut types differ in size and design, so a side-by-side comparison was performed to investigate the performance of indoor interventions in the two hut designs using standard entomological outcomes: relative indoor mosquito density (deterrence), exophily (induced exit), blood-feeding and mortality of mosquitoes.

METHODS

Metofluthrin mosquito coils (0.00625% and 0.0097%) and Olyset® Net vs control nets (untreated, deliberately holed net) were evaluated against pyrethroid-resistant Culex quinquefasciatus in Benin. Four experimental huts were used: two West African hut designs and two Ifakara hut designs. Treatments were rotated among the huts every four nights until each treatment was tested in each hut 52 times. Volunteers rotated between huts nightly.

RESULTS

The Ifakara huts caught a median of 37 Culex quinquefasciatus/ night, while the West African huts captured a median of 8/ night (rate ratio 3.37, 95% CI: 2.30-4.94, P < 0.0001) and this difference in mosquito entry was similar for Olyset® Net and more pronounced for spatial repellents. Exophily was greater in the Ifakara huts with > 4-fold higher mosquito exit relative to the West African huts (odds ratio 4.18, 95% CI: 3.18-5.51, P < 0.0001), regardless of treatment. While blood-feeding rates were significantly higher in the West African huts, mortality appeared significantly lower for all treatments.

CONCLUSIONS

The Ifakara hut captured more Cx. quinquefasciatus that could more easily exit into windows and eave traps after failing to blood-feed, compared to the West African hut. The higher mortality rates recorded in the Ifakara huts could be attributable to the greater proportions of Culex mosquitoes exiting and probably dying from starvation, relative to the situation in the West African huts.

Efficacy of PermaNet® 3.0 and PermaNet® 2.0 nets against laboratory-reared and wild Anopheles gambiae sensu lato populations in northern Tanzania

BACKGROUND

Mosquitoes have developed resistance against pyrethroids, the only class of insecticides approved for use on long-lasting insecticidal nets (LLINs). The present study sought to evaluate the efficacy of the pyrethroid synergist PermaNet® 3.0 LLIN versus the pyrethroid-only PermaNet® 2.0 LLIN, in an East African hut design in Lower Moshi, northern Tanzania. In this setting, resistance to pyrethroid insecticides has been identified in Anopheles gambiae mosquitoes.

METHODS

Standard World Health Organization bioefficacy evaluations were conducted in both laboratory and experimental huts. Experimental hut evaluations were conducted in an area where there was presence of a population of highly pyrethroid-resistant An. arabiensis mosquitoes. All nets used were subjected to cone bioassays and then to experimental hut trials. Mosquito mortality, blood-feeding inhibition and personal protection rate were compared between untreated nets, unwashed LLINs and LLINs that were washed 20 times.

RESULTS

Both washed and unwashed PermaNet® 2.0 and PermaNet® 3.0 LLINs had knockdown and mortality rates of 100% against a susceptible strain of An. gambiae sensu stricto. The adjusted mortality rate of the wild mosquito population after use of the unwashed PermaNet® 3.0 and PermaNet® 2.0 nets was found to be higher than after use of the washed PermaNet® 2.0 and PermaNet® 3.0 nets.

CONCLUSIONS

Given the increasing incidence of pyrethroid resistance in An. gambiae mosquitoes in Tanzania, we recommend that consideration is given to its distribution in areas with pyrethroid-resistant malaria vectors within the framework of a national insecticide-resistance management plan.

Modified veranda-trap hut for improved evaluation of vector control interventions

Experimental huts with veranda traps have been used in Tanzania since 1963 for the study of residual insecticides for use with insecticide-treated nets and indoor residual spraying. Mosquitoes are allowed unrestricted entry through the eaves to facilitate the collection of an estimable proportion of mosquitoes that attempt to exit through the eave gaps, which are left open on two sides of the hut. This study was designed to validate the use of eave baffles to funnel entry and to prevent mosquito escape, and to determine biting times of Anopheles arabiensis (Patton) (Diptera: Culicidae). Anopheles arabiensis and Culex quinquefasciatus (Say) (Diptera: Culicidae) were released into the room at 20.30 hours and collected the following morning from veranda traps, window traps and the room. Centers for Disease Control light traps hung overnight next to volunteers were emptied every 2 h to determine peak biting times. A total of 55% of An. arabiensis were trapped before 22.30 hours and the highest peak in 'biting' was recorded during 18.30-20.30 hours. Of the released An. arabiensis that exited into veranda traps, 7% were captured in veranda traps entered through baffles and 93% were captured in traps entered through unmodified eaves. When veranda screens were left open to allow for escape outdoors, recapture rates were 68% for huts with eave baffles and 39% for huts with unmodified eaves. The comparison of open eaves with baffled eaves validated the assumption that in huts of the traditional non-baffled design, 50% of mosquitoes escape through open eaves. Eave baffles succeeded in reducing the potential for mosquito exit and produced more precise estimates of effect.

Review of insecticide resistance and behavioral avoidance of vectors of human diseases in Thailand

Physiological resistance and behavioral responses of mosquito vectors to insecticides are critical aspects of the chemical-based disease control equation. The complex interaction between lethal, sub-lethal and excitation/repellent ('excito-repellent') properties of chemicals is typically overlooked in vector management and control programs. The development of "physiological" resistance, metabolic and/or target site modifications, to insecticides has been well documented in many insect groups and disease vectors around the world. In Thailand, resistance in many mosquito populations has developed to all three classes of insecticidal active ingredients currently used for vector control with a majority being synthetic-derived pyrethroids. Evidence of low-grade insecticide resistance requires immediate countermeasures to mitigate further intensification and spread of the genetic mechanisms responsible for resistance. This can take the form of rotation of a different class of chemical, addition of a synergist, mixtures of chemicals or concurrent mosaic application of different classes of chemicals. From the gathered evidence, the distribution and degree of physiological resistance has been restricted in specific areas of Thailand in spite of long-term use of chemicals to control insect pests and disease vectors throughout the country. Most surprisingly, there have been no reported cases of pyrethroid resistance in anopheline populations in the country from 2000 to 2011. The precise reasons for this are unclear but we assume that behavioral avoidance to insecticides may play a significant role in reducing the selection pressure and thus occurrence and spread of insecticide resistance. The review herein provides information regarding the status of physiological resistance and behavioral avoidance of the primary mosquito vectors of human diseases to insecticides in Thailand from 2000 to 2011.

Comparison of Aedes aegypti (Diptera: Culicidae) resting behavior on two fabric types under consideration for insecticide treatment in a push-pull strategy

Aedes aegypti (L.), the primary vector of dengue and dengue hemorrhagic fever, breeds and rests predominately inside human dwellings. With no current vaccine available, vector control remains the mainstay for dengue management and novel approaches continue to be needed to reduce virus transmission. This requires a full understanding of Ae. aegypti ecology to design effective strategies. One novel approach is the use of contact irritants at target resting sites inside homes to make the surface unacceptable and cause vectors to escape before biting. The objective of the current study was to observe indoor resting behavior patterns of female Ae. aegypti within experimental huts in response to two fabrics under consideration for insecticide treatment: cotton and polyester. Results indicate that fabric type, coverage ratio of dark to light fabric and placement configuration (vertical vs. horizontal) all influenced the resting pattern of mosquito cohorts. Findings from this study will guide evaluations of a push-pull strategy designed to exploit contact irritant behaviors and drive Ae. aegypti out of homes prefeeding.

A modified experimental hut design for studying responses of disease-transmitting mosquitoes to indoor interventions: the Ifakara experimental huts

Differences between individual human houses can confound results of studies aimed at evaluating indoor vector control interventions such as insecticide treated nets (ITNs) and indoor residual insecticide spraying (IRS). Specially designed and standardised experimental huts have historically provided a solution to this challenge, with an added advantage that they can be fitted with special interception traps to sample entering or exiting mosquitoes. However, many of these experimental hut designs have a number of limitations, for example: 1) inability to sample mosquitoes on all sides of huts, 2) increased likelihood of live mosquitoes flying out of the huts, leaving mainly dead ones, 3) difficulties of cleaning the huts when a new insecticide is to be tested, and 4) the generally small size of the experimental huts, which can misrepresent actual local house sizes or airflow dynamics in the local houses. Here, we describe a modified experimental hut design - The Ifakara Experimental Huts- and explain how these huts can be used to more realistically monitor behavioural and physiological responses of wild, free-flying disease-transmitting mosquitoes, including the African malaria vectors of the species complexes Anopheles gambiae and Anopheles funestus, to indoor vector control-technologies including ITNs and IRS. Important characteristics of the Ifakara experimental huts include: 1) interception traps fitted onto eave spaces and windows, 2) use of eave baffles (panels that direct mosquito movement) to control exit of live mosquitoes through the eave spaces, 3) use of replaceable wall panels and ceilings, which allow safe insecticide disposal and reuse of the huts to test different insecticides in successive periods, 4) the kit format of the huts allowing portability and 5) an improved suite of entomological procedures to maximise data quality.

Combining indoor residual spraying and insecticide-treated nets for malaria control in Africa: a review of possible outcomes and an outline of suggestions for the future

Insecticide-treated nets (ITNs) and indoor residual spraying (IRS) are currently the preferred methods of malaria vector control. In many cases, these methods are used together in the same households, especially to suppress transmission in holoendemic and hyperendemic scenarios. Though widespread, there has been limited evidence suggesting that such co-application confers greater protective benefits than either ITNs or IRS when used alone. Since both methods are insecticide-based and intradomicilliary, this article hypothesises that outcomes of their combination would depend on effects of the candidate active ingredients on mosquitoes that enter or those that attempt to enter houses. It is suggested here that enhanced household level protection can be achieved if the ITNs and IRS have divergent yet complementary properties, e.g. highly deterrent IRS compounds coupled with highly toxic ITNs. To ensure that the problem of insecticide resistance is avoided, the ITNs and IRS products should preferably be of different insecticide classes, e.g. pyrethroid-based nets combined with organophosphate or carbamate based IRS. The overall community benefits would however depend also on other factors such as proportion of people covered by the interventions and the behaviour of vector species. This article concludes by emphasizing the need for basic and operational research, including mathematical modelling to evaluate IRS/ITN combinations in comparison to IRS alone or ITNs alone.

Human-landing patterns of Anopheles dirus sensu lato (Diptera: Culicidae) in experimental huts treated with DDT or deltamethrin

Anopheles dirus females landing on humans inside experimental huts treated with residual applications of DDT or deltamethrin were observed during the wet season in Pu Teuy Village, Kanchanaburi Province, western Thailand. Two identical experimental huts were constructed in the fashion of typical local rural Thai homes. Pretreatment (baseline) human-landing collections (HLC) in both huts showed an early evening peak of activity between 1900 and 2000 h with no significant difference in numbers of mosquitoes captured between huts over a period of 30 collection nights. During posttreatment HLC, female mosquitoes continued to show greater landing activity inside huts fitted with insecticide-treated panels during the first half of the evening compared with the second half. A greater number (proportion) of An. dirus females landed on humans in the hut treated with deltamethrin compared with DDT. Comparing pre- and posttreatment HLC, the DDT-treated hut showed a 79.4% decline in attempted blood feeding, whereas exposure to deltamethrin resulted in a 56.3% human-landing reduction. An odds ratio was performed to demonstrate the relative probability (risk) of mosquitoes entering and attempting to blood feed in the two treated huts compared with untreated control huts. Mosquitoes were approximately 0.47 times less likely to land on humans inside a DDT-treated hut compared with the deltamethrin-treated hut. Although both chemicals exerted strong excitatory responses, DDT appears to have a more pronounced and significant (P = 0.002) effect on behavior than deltamethrin, resulting in greater movement away from the insecticide source and thus potential reduction of blood-feeding activity.

Biting patterns of Anopheles minimus complex (Diptera: Culicidae) in experimental huts treated with DDT and deltamethrin

Biting patterns of natural populations of Anopheles minimus s.l. females entering experimental huts treated with DDT and deltamethrin were carried out at Pu Teuy Village, Sai Yok District, Kanchanaburi Province, western Thailand. Two experimental huts, control and treatment, were constructed in the fashion of local Thai homes. Pre-spray biting activity of An. minimus females peaked at 19:00-22:00. Post-treatment exposure continued to show greater landing activity during the first half of the evening. An overall greater proportion of An. minimus females entered the hut treated with deltamethrin compared to DDT. The hut fitted with DDT-treated net panels showed a 71.5% decline in attempted blood feeding, whereas exposure to deltamethrin-treated panels resulted in a 42.8% human-landing reduction. DDT exhibited significantly more pronounced (P < 0.05) effects in overall reduction of biting activity than did deltamethrin.

Assessment of methoxy-DDT as a residual spray against mosquitoes in verandahtrap huts at Magugu, Tanzania

The effects of residual sprays of methoxy-DDT wettable powder at 2 g/m2 on the mortality and behaviour of Anopheles gambiae Giles, Mansonia uniformis (Theo.) and Culex pipiens fatigans Wied. females were investigated in four verandah-trap huts, one of which was used as control. The overall mortality of no species ever exceeded 29%, and no consistent deterrent effect on entry was demonstrated. The proportions of mosquitoes in the exit traps were, for A. gambiae 80–90% in treated huts and 29–70% in the control, for M. uniformis 90–100% in treated and control huts, and for C. p. fatigans 26–84% in treated huts and 38–66% in the control. There were more unfed mosquitoes of all three species in the treated huts than in the control, for A. gambiae 35–64% and 10–53%, respectively, for M. uniformis 38–84% and 35–64%, respectively, and for C. p. fatigans 22–58% and 21–43%, respectively. Bioassays with wild-caught A. gambiae exposed to the treated surfaces for one hour, showed that the deposits remained highly toxic for 16 weeks on grass, six weeks on iron and two weeks, or less, on mud.