High efficacy of microbial larvicides for malaria vectors control in the city of Yaounde Cameroon following a cluster randomized trial

Larviciding for malaria control and elimination in Africa

BACKGROUND

Global progress toward malaria elimination and eradication goals has stagnated in recent years, with many African countries reporting increases in malaria morbidity and mortality. Insecticide-treated nets and indoor residual spraying are effective, but the emergence and increased intensity of insecticide resistance and the challenge of outdoor transmission are undermining their impact. New tools are needed to get back on track towards global targets. This Perspective explores the major challenges hindering wider-scale implementation of larviciding in Africa and identifies potential solutions and opportunities to overcome these barriers.

LARVICIDING IN AFRICA

OVERVIEW, CHALLENGES, AND SOLUTIONS: Larviciding is a valuable vector control tool with strong potential for regional scale-up. There is considerable evidence of its effectiveness, and the World Health Organization (WHO) recommends it as a supplemental intervention. However, malaria programmes hoping to implement larviciding face significant barriers, including (1) poor global technical, policy, and funding support; (2) fragmented implementation and experience; (3) high complexity of delivery and impact evaluation; and (4) limited access to the full range of WHO prequalified larvicide products. Strategic barriers related to global policy and donor hesitancy can be overcome through a coordinated demonstration of cost-effectiveness. Technological advancements and strengthened operational capacity have already overcome technical barriers related to larvicide delivery, targeting, coverage, and evaluation. Developing a Community of Practice platform for larviciding has strong potential to consolidate efforts, addressing the challenge of fragmented implementation and experience. Such a platform can serve as a resource center for African malaria programmes, collating and disseminating technical guidance, facilitating the exchange of best practices, and aiding malaria programmes and partners in designing and evaluating larviciding projects.

CONCLUSION

The global shift toward targeted and adaptive interventions enables the incorporation of larviciding into an expanded vector control toolbox. As more African countries implement larvicide programmes, establishing a regional Community of Practice platform for exchanging experiences and best practices is necessary to strengthen the evidence base for cost-effective implementation, advocate for support, and inform policy recommendations, thus supporting Africa's progress toward malaria elimination.

Evaluation of a long-lasting microbial larvicide against Culex quinquefasciatus and Aedes aegypti under laboratory and a semi-field trial

BACKGROUND

Microbial larvicides containing both LysiniBacillus sphaericus and Bacillus thuringiensis svar. israelensis (Bti) insecticidal crystals can display advantages for mosquito control. This includes a broader action against larvae that are refractory to the Binary (Bin) toxin from L. sphaericus, as Bin-resistant Culex quinquefasciatus and Aedes aegypti naturally refractory larvae, which often co-habit urban areas of endemic countries for arboviruses. Our principal goal was to assess the toxicity of a combined L. sphaericus/Bti larvicide (Vectomax FG™) to Cx. quinquefasciatus (susceptible CqS and Bin-resistant CqR) and Ae. aegypti (Rocke) and to determine its persistence in the breeding sites with those larvae.

METHODS

The toxicity of a combined L. sphaericus/Bti product (VectoMax FG™) to larvae was performed using bioassays, and persistence was evaluated in simulate field trials carried out under the shade, testing two label concentrations during 12 weeks. A laboratory strain SREC, established with CqS and CqR larvae, was kept during four generations to evaluate the ability of the L. sphaericus/Bti to eliminate resistant larvae.

RESULTS

The L. sphaericus/Bti showed toxicity (mg/L) to larvae from all strains with a decreasing pattern for CqS (LC50 = 0.006, LC90 = 0.030), CqR (LC50 = 0.009, LC90 = 0.069), and Rocke (LC50 = 0.042, LC90 = 0.086). In a simulated field trial, the larvicide showed a persistence of 6 weeks and 8 weeks, controlling larvae from all strains in containers with 100 L of water, using 2 g or 4 g per container (100 L), respectively. The treatment of SREC larvae with L. sphaericus/Bti showed its capacity to eliminate the Bin-resistant individuals using suitable concentrations to target those larvae.

CONCLUSIONS

Our results showed the high efficacy and persistence of the L. sphaericus/Bti larvicide to control Cx. quinquefasciatus and Ae. aegypti that might cohabit breeding sites. These findings demonstrated that such larvicides can be an effective tool for controlling those species in urban areas with a low potential for selecting resistance.

Impact of blood meals taken on ivermectin-treated livestock on survival and egg production of the malaria vector Anopheles coluzzii under laboratory conditions

Treatment of livestock with endectocides such as ivermectin is viewed as a complementary vector control approach to address residual transmission of malaria. However, efficacy of this treatment may vary between animal species. Hence, our purpose was to investigate the effects of ivermectin treatments of common livestock species on life history traits of the opportunistic malaria vector Anopheles coluzzii. Sheep, goats and pigs were treated using injectable veterinary ivermectin formulation at the species-specific doses (recommended dose for all species and high dose in pig). Mosquito batches were exposed to treated and control (not injected) animals at different days after treatment. Daily mosquito mortality was recorded and fecundity assessed through the count of gravid females and the number of eggs they developed. The recommended dose of ivermectin induced a significant decrease in mosquito survival for up to 7 days after injection (DAI), with a decrease of 89.7%, 66.7%, and 48.4% in treated pigs, goats and sheep, respectively, compared to control animals. In treated pigs, the triple therapeutic dose decreased mosquito survival of 68.97% relatively to controls up to 14 DAI. The average number in gravid females Anopheles that survived after feeding on treated animals were reduced when blood-meals were taken on sheep (2.57% and 42.03% at 2 and 7 DAI), or on goats (decrease of the 28.28% and 73.64% respectively at 2 and 7 DAI). This study shows that ivermectin treatments to animals negatively impacts An. coluzzii life history traits and could reduce vector densities in areas where livestock live near humans. However, due to short-term efficacy of single dose treatments, repeated treatments and potentially increased dosages would be required to span the transmission season. The use of long-acting ivermectin formulations is discussed as a mean for extending efficacy while remaining cost effective.

Level of awareness and utilization of insecticide-treated bed nets among medical students as measures for reducing malaria episodes

This study examined the level of awareness and utilization of insecticide-treated bed nets among medical students as measures for reducing malaria episodes in Delta State University, Abraka. It was a descriptive study with objectives and research questions formulated to achieve the study design. A sample size of 200 male and female students resident in the campus hostels were selected using random sampling technique. A self-structured questionnaire was designed and administered to the study participants, however, only 148 copies of the questionnaires were successfully retrieved and used for the study. Data generated were subjected to quantitative statistical analysis for frequencies, percentages, average mean and Chi-square testing. Findings revealed that the level of awareness was significantly associated with the role of health workers in the distribution of insecticide-treated bed nets in Delta State University, Abraka, although, factors hindering health workers from distributing insecticide-treated bed nets were identified. There was significant difference between perception of medical students and the utilization of insecticide-treated bed nets on risk of malaria spread. In addition, there was significant difference between the benefits of using insecticide-treated bed nets and the prevention and control of malaria. We therefore conclude that regular utilization of insecticide-treated bed nets due to adequate awareness eliminates contact with mosquitoes and prevents transmitting vectors of malaria from having contact with the users of insecticide-treated bed net. Massive health education campaign is recommended to further scale up the awareness and effective utilization of insecticide-treated bed nets towards prevention and control of malaria bites among students in Delta State University, Abraka.

Can the use of larviciding with biological compounds contribute in increasing Anopheles gambiae s.l. susceptibility to pyrethroid in a population expressing high resistance intensity?

BACKGROUND

Larviciding using non-insecticide compounds is considered appropriate for controlling outdoor biting mosquitoes and for managing insecticide resistance. However, there is still not enough information on the influence of larviciding in managing pyrethroid resistance. In the present study, we checked whether the introduction of larviciding using the biolarvicide VectoMax G in the city of Yaoundé is contributing in restoring the susceptibility of An. coluzzii populations to pyrethroids.

METHODOLOGY

The susceptibility status of field An. coluzzii population was evaluated at different time points before and during larviciding treatments. In addition, An. coluzzii larvae collected in the city of Yaoundé, were split into four groups and exposed to different selection regimes for many generations as follow; (i): deltamethrin 0.05%_only, (ii): Vectomax_only, (iii): Vectomax+deltamethrin 0.05%, (iv): VectoMax+deltamethrin 0.05% + susceptible. Life traits parameters were measured in the progeny and compared between colonies. The control was the susceptible laboratory strain "Ngousso". Kdr allele frequency and the profile of expression of different detoxification genes and oxidative stress genes was checked using qPCR analysis. Gene's expression was compared between the first and the last generation of each colony and in field populations collected before and during larviciding.

RESULTS

An increase in mosquito susceptibility to deltamethrin and permethrin was recorded for the field populations after larviciding implementation. Resistance intensity to deltamethrin was found to decrease from high to low in field populations. Only the colony vectomax+deltamethrin+susceptible presented a high susceptibility to deltamethrin after 21 generations. The kdr gene frequency was found to be unchanged in the field population and laboratory colonies. A significant decrease in the overexpression profile of Gste2 was detected in field population after larviciding implementation. Other genes showing a similar pattern though not significant were Cyp6z1, Cyp6p1 and Cyp6g16. Concerning fitness only the colony vectomax+deltamethrin+susceptible was found to display a fitness profile similar to the susceptible colony with high fecundity, high hatching rate, short development time and long adult survival rate.

CONCLUSION

The profile of the field population supported reversal of phenotypic resistance to pyrethroids however no reduction in the frequency of the kdr allele was recorded. Some detoxification genes were detected less overexpressed. The study suggest that reversal may take longer to achieve in a population expressing a very high resistance profile and under continuous insecticide selection pressure.

Assessment of the impact of the biological larvicide VectoMax G: Combination of Bacillus thuringiensis and Lysinibacillus sphaericus on non-target aquatic organisms in Yaoundé-Cameroon

There has been a renewed interest for larviciding during the recent decade. Although biological larvicides are considered not to be harmful to non-target organisms, there is still not sufficient data on the effect of new long-lasting larvicide formulations such as VectoMax G combining Bacillus thuringiensis israelensis and Lysinibacullus sphaericus on the environment especially on non-target organisms. The present study aimed to assess the possible influence of VectoMax G on the diversity and abundance of the aquatic fauna cohabiting with mosquito larvae in breeding habitats during a larviciding trial in the city of Yaoundé. Twelve districts of the city of Yaoundé divided into 6 intervention and 6 control sites were chosen for the study. In each district 4 semi-permanent or permanent aquatic habitats were followed. VectoMax G application was done once every two weeks during 6 months and aquatic organisms were collected 48 h after each treatment. All collected organisms were brought to the laboratory for identification. Physico-chemical parameters were recorded as well. A high diversity of the zooplankton was recorded in the intervention areas with 28 species collected against 14 species in the control areas. Cladocerans were the most represented group in both sites while Ostracods were found only in control sites. A total of 19 macro-invertebrates species were recorded in the control areas vs 16 species in the intervention areas. Gasteropods were the most represented groups of macro-invertebrates. Vertebrates such as larvivorous fishes and amphibians larvae were also found in approximately similar densities in both sites. The study indicated no significant influence of larviciding with VectoMax G on the diversity and abundance of the non-target aquatic fauna in the city of Yaoundé.

Larviciding intervention targeting malaria vectors also affects Culex mosquito distribution in the city of Yaoundé, Cameroon

Although Culex species are considered to be equally affected by control measures targeting malaria vectors, there is still not enough evidence of the impact of interventions such as larviciding on the distribution of these mosquito species. The present study assessed the impact of a larviciding trial targeting malaria vectors on Culex mosquito species in the city of Yaoundé, Cameroon. A cluster randomized trial comparing 13 treated clusters and 13 untreated clusters was implemented. Data were collected at baseline and during the larviciding intervention, from March 2017 to November 2020. The microbial larvicide VectoMax G was applied once every 2 weeks in the intervention areas. Adult mosquitoes were collected using CDC light traps in both intervention and non-intervention areas and compared between arms. Globally, larviciding intervention was associated with 69% reduction in aquatic habitats with Culex larvae and 36.65% reduction of adult Culex densities in houses. Adult Culex densities were reduced both indoors (35.26%) and outdoors (42.37%). No change in the composition of Culex species was recorded. The study suggests a high impact of larviciding on Culex mosquito species distribution. The impact of the intervention can be improved if typical Culex breeding habitats including pit latrines are targeted.

Malaria Transmission and Vector Resistance to Insecticides in a Changing Environment: Case of Simbock in Yaoundé-City, Cameroon

Ecological upheavals resulting from uncontrolled urbanization can lead to significant changes in vector borne diseases’ profiles, thus requiring a thorough revision of their prevention and control strategies. The current study aimed at characterizing malaria vector populations in the Simbock neighborhood of Yaoundé-city (Cameroon), in relation to its urbanization scheme. Adult mosquitoes were captured by human landing catches (HLC) in- and outdoors prior to (2000–2006) and during infrastructural development (2014–2016). Anophelines were morphologically identified and analyzed for Plasmodium (P.) falciparum circumsporozoite protein detection using the ELISA technique. Species of the Anopheles (An.) gambiae complex were identified using SINE-PCR. Adult An. gambiae s.l. from larvae collected between 2014 and 2017 were tested for susceptibility to insecticides (0.1% bendiocarb, 4% DDT, 0.75% permethrin and 0.05% deltamethrin) with or without piperonyl butoxide (PBO) synergist, using WHO standard bioassays. The Hot Oligonucleotide Ligation Assay was used to detect the knockdown resistance (kdr) L995F/S mutations. Overall, nine malaria vector species were identified in 2000-2006, mostly An. moucheti (49%), An. nili (13.5%) and An. gambiae s.l. (12%); the six remaining species were represented at less than 3% each. However, only three species were found in 2014-2016, with increasing proportions of An. gambiae s.l. (67%) and An. funestus (32%) (P<0.0001). An. gambiae s.l. consisted An. coluzzii (> 85%) and An. gambiae (<15%) species during the two study periods. Plasmodium falciparum infection rates were 2.1% and 1.0% in 2000-2006 and 2014-2016 respectively (P=0.4), with decreasing entomological inoculation rates (EIR) from 0.34 infective bites per man per night (ib/m/n) to 0.02 ib/m/n (P<0.0001). Anopheles gambiae s.l. was resistant to DDT and permethrin [<40% mortality rates (MR)], and deltamethrin (65-89% MR), but fully susceptible to bendiocarb (100% MR). Pre-exposure of mosquitoes to PBO resulted in 90-100% MR to deltamethrin but not to permethrin. Furthermore, the two kdr L995F/S resistance alleles were recorded at 0.64 and 0.006 frequencies respectively. This study highlights a shift from rural to urban malaria transmission in Simbock, coupled with DDT and pyrethroid resistance in An. gambiae s.l. Combination vector control interventions, e.g., PBO nets and bendiocarb indoor residual spraying are needed in such areas.

Larval mosquito management and risk to aquatic ecosystems: A comparative approach including current tactics and gene-drive Anopheles techniques

Genetic engineering of mosquitoes represents a promising tactic for reducing human suffering from malaria. Gene-drive techniques being developed that suppress or modify populations of Anopheles gambiae have the potential to be used with, or even possibly obviate, microbial and synthetic insecticides. However, these techniques are new and therefore there is attendant concern and uncertainty from regulators, policymakers, and the public about their environmental risks. Therefore, there is a need to assist decision-makers and public health stewards by assessing the risks associated with these newer mosquito management tactics so the risks can be compared as a basis for informed decision making. Previously, the effect of gene-drive mosquitoes on water quality in Africa was identified as a concern by stakeholders. Here, we use a comparative risk assessment approach for the effect of gene-drive mosquitoes on water quality in Africa. We compare the use of existing larvicides and the proposed genetic techniques in aquatic environments. Based on our analysis, we conclude that the tactic of gene-drive Anopheles for malaria management is unlikely to result in risks to aquatic environments that exceed current tactics for larval mosquitoes. As such, these new techniques would likely comply with currently recommended safety standards.