Field trial on a novel control method for the dengue vector, Aedes aegypti by the systematic use of Olyset® Net and pyriproxyfen in Southern Vietnam

Comparison of Aedes aegypti arbovirus transmission thresholds in two communities with differing water supply infrastructure

BACKGROUND

To assess whether the 'economic boom' in the tropical seaport city of Barranquilla improved tapped water supplies to socio-economically poor neighbourhoods resulting in: (1) their reduced use for domestic water-storage in large (> 1,000-litre) custom-made cement tanks which are their principal Aedes aegypti breeding sites and (2) their pupae/person index (PPI) values to below their established 0.5-1.5 PPI arbovirus transmission-threshold value, compared to matched neighbourhoods in the: (a) pre-economic boom (2004) period in Barranquilla and (b) economically-neglected seaport city of Buenaventura.

METHODS

The simple, accurate and robust water surface sweep-net/calibration factor or total count methods were used to determine the total Ae. aegypti pupae numbers in greater or less than 20-litre water-holding container types located 'inside' or 'outside' these neighbourhood premises. The women residents also participated in questionnaire-based responses about their domestic water supplies, water-storage and maintenance and mosquito life stages and disease transmission knowledge, to subsequently plan appropriate resident education programmes. Microsoft Excel 8.0 with OpenEpi was used to determine the samples sizes and the statistical values.

RESULTS

Tapped water supplies to the three poor Barranquilla neighbourhoods were dramatically increased from 2004 to 2023 resulting in their residents significantly reducing their: (a) large cement water-storage tanks from 1 per 6.9 (2004) to 1 per 31.2 (2020) premises (z = 10.5: p = 0) and (b) PPI values to 0.16, 0.19 and 0.53 (mean: 0.29: 95% CI ± 0.4) in each study neighbourhood. In contrast, tapped water supplies remained inadequate in the Buenaventura neighborhoods, thereby resulting in their continued use of many large (> 1,000-litre) water-storage containers (Barranquilla: 1 per 31.2 and Buenaventura: 1 per 1.5 premises: z = - 9.26: p = 0), with unacceptably high 0.81, 0.88 and 0.99 PPI values in each study neighbourhood (mean 0.89: 95% CI ± 0.12).

CONCLUSIONS

Improved tapped water supplies resulted in reduced numbers of large custom-made stoneware water-containers, as are employed by poor residents throughout the world, as well as their Ae. aegypti PPI transmission threshold values which, together with appropriate residents' education programmes, are also urgently to reduce to prevent/reduce Ae. aegypti transmitted human diseases globally.

Community preferred drug delivery approaches for pilot roll-out of a potential novel paediatric schistosomiasis treatment option in two endemic counties of Kenya: A mixed methods study

Treating preschool age children (PSAC) for schistosomiasis has remained a challenge due to lack of a pediatric formulation. In response to this unmet need, the Paediatric Praziquantel Consortium has developed a potential novel paediatric treatment option. In advance to its roll-out to follow regulatory response, we conducted a social science study to gather information on preferred drug delivery approaches to inform implementation. A cross-sectional study was conducted in eight villages in two purposively selected Kenyan counties. A questionnaire was administered on 690 parents/guardians of PSAC at household level. Preferred drug delivery approaches were analyzed using frequencies and proportions. We conducted key informant interviews with 17 opinion leaders and 28 healthcare workers, and 12 focus group discussions with parents/guardians of PSAC and 7 with community health volunteers (CHVs). Thematic analysis was performed on the qualitative data. Majority of the 690 respondents were women 594 (86.1%) with a mean age of 34.1 (SD = 11.3, min-max = 18-86). Community-based mass drug administration (cMDA) was the most preferred drug delivery method by 598 participants (86.7%), followed by health facility/fixed points by 398 participants (57.7%). Similarly, in the qualitative data participants indicated they prefer cMDA since the CHVs who would distribute the medication are familiar with households with PSAC and are trusted to explain the drug effects. Health facilities/fixed points were the second most preferred drug delivery approach, but some health workers we interviewed expressed concern about potential understaffing and overcrowding of facilities. Appropriate timing of the drug distribution, not to interfere with farming activities, was considered critical, irrespective of the approach used. All profiles of study participants preferred cMDA over the other delivery approaches due to the convenience of receiving drugs at home and providing explanations about the new drug. For positive outcomes, adequate planning, proper timings and community involvement are highly recommended.

Multigenerational effects of the insecticide Pyriproxyfen and recovery in Daphnia magna

In the present study, an ecotoxicological approach to the evaluation of the insecticide Pyriproxifen in the crustacean Daphnia magna was done. Acute toxicity tests (48 h), feeding behavior test (5 h) and chronic toxicity test (21 days) were carried out on a parental daphnid generation (F0). Pyriproxifen D. magna EC50 value in our experimental conditions was 336.47 μg/L. Based on this result, sublethal test concentrations were selected for the feeding study and the F0 chronic experiment. Filtration and ingestion rates of D. magna exposed animals did not show any significant difference respect to control daphnids. However, daphnids from the parental F0 generation when exposed to the insecticide during 21 days showed a decreased in all the reproductive parameters tested (mean total neonates per female, mean brood size, time to first brood, and mean number of broods per female) as well as in the population statistic growth rate (r), although survival was not affected. On the other hand, offspring from F0 females exposed to the highest Pyriproxifen concentration (14.02 μg/L) were separated in two F1 generation experiments. One group was transferred during 21 days to a medium free of toxicant (F1 generation-TC group) while the other group was exposed during 21 days to the same insecticide concentration as their mothers (14.02 μg/L) (F1 generation-TT group). Results from both experiments determined a decreased in most of the reproductive parameters which was higher in the F1-TT group, although some of them were recovered in the F1-TC group. On the other hand, the morphological analysis of the daphnids showed that the coloration pattern was altered in the daphnids exposed to the insecticide, together with a significant size decreased, and neonates from F0 progeny with the same morphological abnormality. Finally, we determined that the insecticide caused the appearance of males among the offspring generated by the F0.

Interventions against Aedes/dengue at the household level: a systematic review and meta-analysis

BACKGROUND

Because the evidence for the role of structural housing and combinations of interventions (domestic or peri-domestic) against Aedes mosquitoes or dengue is still lacking, this systematic review and meta-analysis aimed to analyse and synthesize research focusing on the household as the unit of allocation.

METHODS

We searched MEDLINE, LILACS, and Web of Science databases until February 2023 using three general keyword categories: (1) "Aedes" or "dengue"; (2) structural housing interventions including "house", "water", or "drainage"; and (3) vector control interventions of potential relevance and their combinations. We performed a qualitative content analysis and a meta-analysis for 13 entries on dengue seroconversion data.

FINDINGS

14,272 articles were screened by titles, 615 by abstracts, 79 by full-text. 61 were selected. Satisfactory data quality allowed for detailed content analysis. Interventions at the household level against the immature mosquito stages (21 studies, 34%) showed positive or mixed results in entomological and epidemiological outcomes (86% and 75% respectively). Combined interventions against immature and adult stages (11 studies, 18%) performed similarly (91% and 67%) while those against the adult mosquitoes (29 studies, 48%) performed less well (79%, 22%). A meta-analysis on seroconversion outcomes showed a not-statistically significant reduction for interventions (log odds-ratio: -0.18 [-0.51, 0.14 95% CI]).

INTERPRETATION

No basic research on housing structure or modification was eligible for this systematic review but many interventions with clear impact on vector indices and, to a lesser extent, on dengue were described. The small and not-statistically significant effect size of the meta-analysis highlights the difficulty of proving effectiveness against this highly-clustered disease and of overcoming practical implementation obstacles (e.g. efficacy loss, compliance). The long-term success of interventions depends on suitability, community commitment and official support and promotion. The choice of a specific vector control package needs to take all these context-specific aspects into consideration.

FUNDING

This work was funded by a grant from the World Health Organization (2021/1121668-0, PO 202678425, NTD/VVE).

Efficacy Assessment of Autodissemination Using Pyriproxyfen-Treated Ovitraps in the Reduction of Dengue Incidence in Parañaque City, Philippines: A Spatial Analysis

Dengue is one of the most important vector-borne diseases worldwide and is a significant public health problem in the tropics. Mosquito control continues to be the primary approach to reducing the disease burden and spread of dengue virus (DENV). Aside from the traditional larviciding and adulticiding interventions, autodissemination using pyriproxyfen-treated (AD-PPF) ovitraps is one of the promising methods to complement existing vector control strategies. Our paper assessed the efficacy of AD-PPF in reducing DENV infections in two barangays in Parañaque City. Using saliva samples from the participants from both the control and intervention sites, we collected the seroprevalence data for three months in each of the two years. Spatial analysis was conducted to determine hotspot areas and identify DENV infection distributions across the trial periods. The results showed that the intervention site was identified as having a clustering of DENV infections in Month 0 of Year 1 and shifted to a random dispersion of dengue cases at the end of Month 3 in Year 2. The disappearance of the clustering of the intervention site translates to a decrease in the cases of DENV infection relative to the control site. Furthermore, we also identified that DENV transmission occurred at a small-scale level that did not go beyond 86 m. In conclusion, AD-PPF is suggested to be an effective strategy and may be used as an additional vector control approach, albeit based on this short-term implementation.

Mosquitoes and Mosquito-Borne Diseases in Vietnam

Mosquito-borne diseases pose a significant threat to humans in almost every part of the world. Key factors such as global warming, climatic conditions, rapid urbanisation, frequent human relocation, and widespread deforestation significantly increase the number of mosquitoes and mosquito-borne diseases in Vietnam, and elsewhere around the world. In southeast Asia, and notably in Vietnam, national mosquito control programmes contribute to reducing the risk of mosquito-borne disease transmission, however, malaria and dengue remain a threat to public health. The aim of our review is to provide a complete checklist of all Vietnamese mosquitoes that have been recognised, as well as an overview of mosquito-borne diseases in Vietnam. A total of 281 mosquito species of 42 subgenera and 22 genera exist in Vietnam. Of those, Anopheles, Aedes, and Culex are found to be potential vectors for mosquito-borne diseases. Major mosquito-borne diseases in high-incidence areas of Vietnam include malaria, dengue, and Japanese encephalitis. This review may be useful to entomological researchers for future surveys of Vietnamese mosquitoes and to decision-makers responsible for vector control tactics.

The Effectiveness of Net to Reduce the Entomological Indices in Dengue-Endemic Areas in Balikpapan, Indonesia

BACKGROUND: Drums and cisterns are ubiquitous water storages in Indonesian households, seldom being drained and left open to create access for the rainwater, providing a favorable breeding site for dengue vector. The bigger the container, the more it produces immature mosquitoes that are soon to be mature, increasing the entomological indices and raising the potency of cases in the area. Previous studies revealed that the net covering the reservoir was able to effectively protect the water from mosquito oviposition; therefore, a modification of the net was made. AIM: The aim of this study is to discover whether the net as a cover for water containers is effective in reducing the entomological indices in dengue-endemic areas. METHODS: The quasi-experimental study with pretest and posttest control group design, involved 3 intervention and 3 control clusters, 150 houses which have 672 water-holding containers with 116 large containers were intervened with non-insecticide tulle nets for 3 months. The larval presence data were performed by larval survey. RESULTS: It revealed that net reduced the container index (CI) in intervened large containers 18%–84% as well as the environment entomological indices in general in study areas: CI decreased 75%–79%, house index decreased 65%–70%, and Breteau index decreased 75.5%–78.7%, while Free Larva Index rose 73.7%–88%. CONCLUSIONS: The nets had lowered the CI in the intervened large container and affected the entomological indices of the surrounding environment, by blocking the mosquitos-water contact and preventing the young mosquitos that had developed in the containers from flying out.

Toxicity and fate of chiral insecticide pyriproxyfen and its metabolites in zebrafish (Danio rerio)

Pyriproxyfen is a juvenile hormone analogue insecticide used worldwide. At present, the potential threat of pyriproxyfen to aquatic organism has not been well explored. In this work, the bioaccumulation, metabolic profile and toxicity of pyriproxyfen and its metabolites to zebrafish were studied, and the enantioselectivity of pyriproxyfen and the major chiral metabolites were also determined. Sixteen metabolites of pyriproxyfen in zebrafish were identified. Hydroxylation, ether linkage cleavage and oxidation in phase I metabolism, followed by sulfate and glucuronic acid conjugation. The bioconcentration factors ranged from 1175 to 1246. Hydroxylation metabolites of pyriproxyfen showed enantioselective behavior in zebrafish with enantiomer fractions (EFs) of 4'-OH- pyriproxyfen and 5″-OH- pyriproxyfen ranged from 0.50 to 0.71. Toxicological indexes including acute toxicity, joint toxicity and oxidative stress were tested. Among all the metabolites, 4'-OH- pyriproxyfen was found 2 folds more toxic to zebrafish than pyriproxyfen. (-)-Pyriproxyfen was found 2 folds more toxic than rac- and (+)-pyriproxyfen. Antagonistic effects were found in binary joint toxicity of pyriproxyfen and its hydroxylated metabolites. Pyriproxyfen and its metabolites also showed oxidative stress damage by inhibiting the activity of CAT and SOD and increasing MDA. This work provided deep insight into the metabolism and the potential risks of pyriproxyfen to aquatic organisms.

Use of effective lids reduces presence of mosquito larvae in household water storage containers in urban and peri-urban Zika risk areas of Guatemala, Honduras, and El Salvador

BACKGROUND

In 2015, an outbreak of Zika virus spread across Latin America and the Caribbean (LAC). Public health programs promoted vector control behaviors, including covering water storage containers with lids. Such approaches disrupt Zika transmission by eliminating the habitats of the Aedes aegypti mosquito, which breeds in stagnant water.

METHODS

A quantitative household survey and observation checklist with trained enumerators were undertaken between August and October 2018 in selected urban/peri-urban USAID implementation communities in El Salvador, Guatemala, and Honduras. The survey included questions regarding knowledge, attitudes, and practices related to Zika virus. An accompanying checklist was implemented to observe water storage containers, including for short-term and long-term water use. The characteristics of these containers were tabulated, including the presence of a lid. The lids were examined for key features to determine their potential effectiveness to prevent mosquito breeding: fully covering and sealing the container, not having holes, and not having water on them (potentially creating a secondary breeding site). Multivariate logistic regression was used to estimate the effectiveness of lid types and characteristics on the presence of larvae.

RESULTS

Overall, in adjusted models, using an effective lid versus no lid was associated with a 94% decrease in odds of larval presence in long-term water storage containers (odds ratio = 0.06; 95% confidence interval [0.029, 0.152]); however, similar impacts were not observed for washbasins in the adjusted models. Models adjusted for household wealth, receiving a visit from a vector control technician, scrubbing the container in the last 7 days, and perception of more mosquitoes around.

CONCLUSIONS

Effective lids, if made available and coupled with complementary behavioral messaging, may reduce transmission of Zika and other Aedes mosquito-borne diseases in the LAC region.

Use of pyriproxyfen in control of Aedes mosquitoes: A systematic review

Dengue is the most rapidly spreading arboviral disease in the world. The current lack of fully protective vaccines and clinical therapeutics creates an urgent need to identify more effective means of controlling Aedes mosquitos, principally Aedes aegypti, as the main vector of dengue. Pyriproxyfen (PPF) is an increasingly used hormone analogue that prevents juvenile Aedes mosquitoes from becoming adults and being incapable of transmitting dengue. The objectives of the review were to (1) Determine the effect of PPF on endpoints including percentage inhibition of emergence to adulthood, larval mortality, and resistance ratios; and (2) Determine the different uses, strengths, and limitations of PPF in control of Aedes. A systematic search was applied to Pubmed, EMBASE, Web of Science, LILACS, Global Health, and the Cochrane database of Systematic Reviews. Out of 1,369 records, 90 studies met the inclusion criteria. Nearly all fit in one of the following four categories 1) Efficacy of granules, 2) Auto-dissemination/horizontal transfer, 3) use of ultra-low volume thermal fogging (ULV), thermal fogging (TF), or fumigant technologies, and 4) assessing mosquito resistance. PPF granules had consistently efficacious results of 90-100% inhibition of emergence for up to 90 days. The evidence is less robust but promising regarding PPF dust for auto-dissemination and the use of PPF in ULV, TF and fumigants. Several studies also found that while mosquito populations were still susceptible to PPF, the lethal concentrations increased among temephos-resistant mosquitoes compared to reference strains. The evidence is strong that PPF does increase immature mortality and adult inhibition in settings represented in the included studies, however future research should focus on areas where there is less evidence (e.g. auto-dissemination, sprays) and new use cases for PPF. A better understanding of the biological mechanisms of cross-resistance between PPF, temephos, and other insecticides will allow control programs to make better informed decisions.

Efficacy of Long-lasting Insecticidal Nets With Declining Physical and Chemical Integrity on Aedes aegypti (Diptera: Culicidae)

Fitting long-lasting insecticidal nets (LLIN) as screens on doors/windows has a significant impact on indoor-adult Aedes aegypti (L.), with entomological reductions measured in a previous study being significant for up to 2 yr post-installation, even in the presence of pyrethroid-resistant Aedes populations. To better understand the mode of LLIN protection, bioassays were performed to evaluate the effects of field deployment (0, 6, and 12 mo) and damage type (none, central, lateral, and multiple) on LLIN efficacy. Contact bioassays confirmed that LLIN residual activity (median knockdown time, in minutes, or MKDT) decreased significantly over time: 6.95 (95% confidence interval [CI]: 5.32-8.58) to 9.24 (95% CI: 8.69-9.79) MKDT at 0- and 12-mo age, respectively, using a pyrethroid-susceptible Aedes strain. Tunnel tests (exposing human forearm for 40 min as attractant) showed that deployment time affected negatively Aedes passage inhibition from 54.9% (95% CI: 43.5-66.2) at 0 mo to 35.7% (95% CI: 16.3-55.1) at 12 mo and blood-feeding inhibition from 65.2% (95% CI: 54.2-76.2) to 48.9% (95% CI: 26.4-71.3), respectively; both the passage/blood-feeding inhibition increased by a factor of 1.8-2.9 on LLINs with multiple and central damages compared with nets with lateral damage. Mosquito mortality was 74.6% (95% CI: 65.3-83.9) at 0 mo, 72.3% (95% CI: 64.1-80.5) at 6 mo, and 59% (95% CI: 46.7-71.3) at 12 mo. Despite the LLIN physical integrity could be compromised over time, we demonstrate that the remaining chemical effect after field conditions would still contribute to killing/repelling mosquitoes.

Alternative strategies for mosquito-borne arbovirus control

Background

Mosquito-borne viruses—such as Zika, chikungunya, dengue fever, and yellow fever, among others—are of global importance. Although vaccine development for prevention of mosquito-borne arbovirus infections has been a focus, mitigation strategies continue to rely on vector control. However, vector control has failed to prevent recent epidemics and arrest expanding geographic distribution of key arboviruses, such as dengue. As a consequence, there has been increasing necessity to further optimize current strategies within integrated approaches and advance development of alternative, innovative strategies for the control of mosquito-borne arboviruses.

Methods and findings

This review, intended as a general overview, is one of a series being generated by the Worldwide Insecticide resistance Network (WIN). The alternative strategies discussed reflect those that are currently under evaluation for public health value by the World Health Organization (WHO) and represent strategies of focus by globally recognized public health stakeholders as potential insecticide resistance (IR)-mitigating strategies. Conditions where these alternative strategies could offer greatest public health value in consideration of mitigating IR will be dependent on the anticipated mechanism of action. Arguably, the most pressing need for endorsement of the strategies described here will be the epidemiological evidence of a public health impact.

Conclusions

As the burden of mosquito-borne arboviruses, predominately those transmitted by Aedes aegypti and A. albopictus, continues to grow at a global scale, new vector-control tools and integrated strategies will be required to meet public health demands. Decisions regarding implementation of alternative strategies will depend on key ecoepidemiological parameters that each is intended to optimally impact toward driving down arbovirus transmission.

International public health workers are challenged by the burden of arthropod-borne viral diseases, to include mosquito-borne arboviruses transmitted by Aedes aegypti and A. albopictus due in part to lack of sustainable vector control and insecticide resistance (IR), as well as the inability to scale up and sustain existing interventions for prevention of urban epidemics. As a consequence, there has been increasing interest to advance the development of alternative methods. This review provides a general overview of alternative vector-control strategies under development for the control of arbovirus mosquito vectors and highlights how each could offer innovative public health value. Considerations to regulations, acceptance, and sustainability are also provided.

Prevalence and Risk Factors of Dengue Infection in Khanh Hoa Province, Viet Nam: A Stratified Cluster Sampling Survey

Background

Dengue is a clinically important arthropod-borne viral disease with increasing global incidence. Here we aimed to estimate the prevalence of dengue infections in Khanh Hoa Province, central Viet Nam, and to identify risk factors for infection.

Methods

We performed a stratified cluster sampling survey including residents of 3–60 years of age in Nha Trang City, Ninh Hoa District and Dien Khanh District, Khanh Hoa Province, in October 2011. Immunoglobulin G (IgG) and immunoglobulin M (IgM) against dengue were analyzed using a rapid test kit. Participants completed a questionnaire exploring clinical dengue incidence, socio-economic status, and individual behavior. A household checklist was used to examine environment, mosquito larvae presence, and exposure to public health interventions.

Results

IgG positivity was 20.5% (urban, 16.3%; rural, 23.0%), IgM positivity was 6.7% (urban, 6.4%; rural, 6.9%), and incidence of clinically compatible dengue during the prior 3 months was 2.8 per 1,000 persons (urban, 1.7; rural, 3.4). For IgG positivity, the adjusted odds ratio (AOR) was 2.68 (95% confidence interval [CI], 1.24–5.81) for mosquito larvae presence in water pooled in old tires and was 3.09 (95% CI, 1.75–5.46) for proximity to a densely inhabited area. For IgM positivity, the AOR was 3.06 (95% CI, 1.50–6.23) for proximity to a densely inhabited area.

Conclusions

Our results indicated rural penetration of dengue infections. Control measures should target densely inhabited areas, and may include clean-up of discarded tires and water-collecting waste.

Quantitative Outcomes of a One Health approach to Study Global Health Challenges

Having gained momentum in the last decade, the One Health initiative promotes a holistic approach to address complex global health issues. Before recommending its adoption to stakeholders, however, it is paramount to first compile quantitative evidence of the benefit of such an approach. The aim of this scoping review was to identify and summarize primary research that describes monetary and non-monetary outcomes following adoption of a One Health approach. An extensive literature search yielded a total of 42,167 references, of which 85 were included in the final analysis. The top two biotic health issues addressed in these studies were rabies and malaria; the top abiotic health issue was air pollution. Most studies described collaborations between human and animal (n = 42), or human and environmental disciplines (n = 41); commonly reported interventions included vector control and animal vaccination. Monetary outcomes were commonly expressed as cost-benefit or cost-utility ratios; non-monetary outcomes were described using disease frequency or disease burden measurements. The majority of the studies reported positive or partially positive outcomes. This paper illustrates the variety of health challenges that can be addressed using a One Health approach, and provides tangible quantitative measures that can be used to evaluate future implementations of the One Health approach.

Assessing dengue transmission risk and a vector control intervention using entomological and immunological indices in Thailand: study protocol for a cluster-randomized controlled trial

Background

Dengue fever is the most common and widespread mosquito-borne arboviral disease in the world. There is a compelling need for cost-effective approaches and practical tools that can reliably measure real-time dengue transmission dynamics that enable more accurate and useful predictions of incidence and outbreaks. Sensitive surveillance tools do not exist today, and only a small handful of new control strategies are available. Vector control remains at the forefront for combating dengue transmission. However, the effectiveness of many current vector control interventions is fraught with inherent weaknesses. No single vector control method is effective enough to control both vector populations and disease transmission. Evaluations of novel larval and adult control interventions are needed.

Methods/design

A cluster-randomized controlled trial will be carried out between 2017 and 2019 in urban community clusters in Khon Kaen and Roi Et cities, northeastern Thailand. The effectiveness of a pyriproxyfen/spinosad combination treatment of permanent water storage containers will be evaluated on epidemiological and entomological outcomes, including dengue incidence, number of female adult dengue vectors infected or not infected with dengue virus (DENV), human exposure to Aedes mosquito bites, and several other indices. These indices will also be used to develop predictive models for dengue transmission and impending outbreaks. Epidemiological and entomological data will be collected continuously for 2 years, with the intervention implemented after 1 year.

Discussion

The aims of the trial are to simultaneously evaluate the efficacy of an innovative dengue vector control intervention and developing predictive dengue models. Assessment of human exposure to mosquito bites by detecting antibodies generated against Aedes saliva proteins in human blood samples has, so far, not been applied in dengue epidemiological risk assessment and disease surveillance methodologies. Likewise, DENV detection in mosquitoes (adult and immature stages) has not been used in any practical way for routine disease surveillance strategies. The integration of multiple outcome measures will assist health authorities to better predict outbreaks for planning and applying focal and timely interventions. The trial outcomes will not only be important for Thailand, but also for the entire Southeast Asian region and further afield.

Trial registration

ISRCTN, ISRCTN73606171. Registered on 23 June 2017.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2490-1) contains supplementary material, which is available to authorized users.

Community effectiveness of pyriproxyfen as a dengue vector control method: A systematic review

Background

Vector control is the only widely utilised method for primary prevention and control of dengue. The use of pyriproxyfen may be promising, and autodissemination approach may reach hard to reach breeding places. It offers a unique mode of action (juvenile hormone mimic) and as an additional tool for the management of insecticide resistance among Aedes vectors. However, evidence of efficacy and community effectiveness (CE) remains limited.

Objective

The aim of this systematic review is to compile and analyse the existing literature for evidence on the CE of pyriproxyfen as a vector control method for reducing Ae. aegypti and Ae. albopictus populations and thereby human dengue transmission.

Methods

Systematic search of PubMed, Embase, Lilacs, Cochrane library, WHOLIS, Web of Science, Google Scholar as well as reference lists of all identified studies. Removal of duplicates, screening of abstracts and assessment for eligibility of the remaining studies followed. Relevant data were extracted, and a quality assessment conducted. Results were classified into four main categories of how pyriproxyfen was applied: - 1) container treatment, 2) fumigation, 3) auto-dissemination or 4) combination treatments,–and analysed with a view to their public health implication.

Results

Out of 745 studies 17 studies were identified that fulfilled all eligibility criteria. The results show that pyriproxyfen can be effective in reducing the numbers of Aedes spp. immatures with different methods of application when targeting their main breeding sites. However, the combination of pyriproxyfen with a second product increases efficacy and/or persistence of the intervention and may also slow down the development of insecticide resistance. Open questions concern concentration and frequency of application in the various treatments. Area-wide ultra-low volume treatment with pyriproxyfen currently lacks evidence and cannot be recommended. Community participation and acceptance has not consistently been successful and needs to be further assessed. While all studies measured entomological endpoints, only two studies measured the reduction in human dengue cases, with inconclusive results.

Conclusions

Although pyriproxyfen is highly effective in controlling the immature stages of dengue transmitting mosquitoes, and–to a smaller degree–adult mosquitoes, there is weak evidence for a reduction of human dengue cases. More well designed larger studies with appropriate standardised outcome measures are needed before pyriproxyfen is incorporated in routine vector control programmes. Additionally, resistance to pyriproxyfen has been reported and needs investigation.

There is evidence that pyriproxyfen may effectively reduce the density of immature mosquito stages when applied to identified breeding sites. Various formulations are commercially available, and easy to use without a health threat to the user. However, questions remain regarding its use as a single agent in a community setting. Considering its mode of action, it would not be the product of choice for use in an acute outbreak setting. However, for a sustainable community approach, especially slow-release pyriproxyfen formulations seem promising, because they are the longest lasting choice. The analysis suggests, that combination with a second vector control chemical, preferably an adulticide tackling different stages of mosquito development, increases the efficacy of pyriproxyfen and prolongs the duration of a single application. This systematic literature review clearly shows that there is a need for further studies, preferably utilising cluster-randomised controlled (cRCT) designs, to investigate the community effectiveness of pyriproxyfen and to link entomological outcomes to human dengue transmission.

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.

Pyriproxyfen is metabolized by P450s associated with pyrethroid resistance in An. gambiae

Pyrethroid resistance is widespread in the malaria vector Anopheles gambiae leading to concerns about the future efficacy of bednets with pyrethroids as the sole active ingredient. The incorporation of pyriproxyfen (PPF), a juvenile hormone analogue, into pyrethroid treated bednets is being trialed in Africa. Pyrethroid resistance is commonly associated with elevated levels of P450 expression including CYPs 6M2, 6P2, 6P3, 6P4, 6P5, 6Z2 and 9J5. Having expressed these P450s in E. coli we find all are capable of metabolizing PPF. Inhibition of these P450s by permethrin, deltamethrin and PPF was also examined. Deltamethrin and permethrin were moderate inhibitors (IC₅₀ 1-10 μM) of diethoxyfluorescein (DEF) activity for all P450s apart from CYP6Z2 (IC₅₀ > 10 μM), while PPF displayed weaker inhibition of all P450s (IC₅₀ > 10 μM) except CYP's 6Z2 and 6P2 (IC₅₀ 1-10 μM). We found evidence of low levels of cross resistance between PPF and other insecticide classes by comparing the efficacy of PPF in inhibiting metamorphosis and inducing female sterility in an insecticide susceptible strain of An. gambiae and a multiple resistant strain from Cote d'Ivoire.

New Paradigms for Virus Detection, Surveillance and Control of Zika Virus Vectors in the Settings of Southeast Asia

Zika virus (ZIKV) has now become a global public health concern. The vectors for ZIKV are Aedes aegypti and A. albopictus. Both these mosquitoes are predominant in Southeast Asia and are also responsible for the spread of other arboviral diseases like dengue virus and chikungunya virus. The incidence of dengue has been increasing over the years and this is of concern to public health workers. Simple laboratory tools for the detection of ZIKV is also lacking. In the absence of drugs and vaccine for these arboviral diseases, vector control is the main option for surveillance and control. Aedes larval surveys have been the hallmark of dengue control along with larviciding and fogging when cases are reported. However, we need new paradigms and options for control of these vectors. The current situation in Southeast Asia clearly proves that effective strategies for vector control need to be proactive and not reactive. This will be the way forward to control epidemics of these diseases inclusive of ZIKV until a vaccine becomes available.

Effect of Olyset Net on Mosquito Larvae and Their Heteroptera Predators in Water Jars in Southern Vietnam

Residents of Vietnam living in areas with water shortages collect and store tap water, when it is available, in containers, such as jars, which is then used for their daily activities. Although these water jars are important breeding sites for mosquitoes, Vietnam legislation prohibits the use of chemical larvicides in such containers. The effect of Olyset Net on the abundance of mosquito larvae and their Heteroptera predators (Micronecta spp. and Veliidae) in jars was evaluated via field experiments conducted in Tan Chanh, Long An, Vietnam. The number of Aedes larvae decreased when the jars were covered with the Olyset Net, while the numbers of non-Aedes mosquito larvae (Culex and Anopheles), and those of Micronecta and Veliidae, did not vary until the end of the experiment. However, Micronecta population increased after removing the Olyset Net from the jars, and consequently Aedes larvae decreased due to these changes in the Micronecta, 26 days after the Olyset Net was removed. Incomplete use of Olyset Net failed to control mosquitoes in water jars based on the invasion of adult mosquitoes, and in water transferred by residents among the jars, which might contain larvae. These results suggest that Micronecta, as well as Olyset Net, can be considered as control agents for mosquito larvae.

Is Dengue Vector Control Deficient in Effectiveness or Evidence?: Systematic Review and Meta-analysis

BACKGROUND

Although a vaccine could be available as early as 2016, vector control remains the primary approach used to prevent dengue, the most common and widespread arbovirus of humans worldwide. We reviewed the evidence for effectiveness of vector control methods in reducing its transmission.

METHODOLOGY/PRINCIPAL FINDINGS

Studies of any design published since 1980 were included if they evaluated method(s) targeting Aedes aegypti or Ae. albopictus for at least 3 months. Primary outcome was dengue incidence. Following Cochrane and PRISMA Group guidelines, database searches yielded 960 reports, and 41 were eligible for inclusion, with 19 providing data for meta-analysis. Study duration ranged from 5 months to 10 years. Studies evaluating multiple tools/approaches (23 records) were more common than single methods, while environmental management was the most common method (19 studies). Only 9/41 reports were randomized controlled trials (RCTs). Two out of 19 studies evaluating dengue incidence were RCTs, and neither reported any statistically significant impact. No RCTs evaluated effectiveness of insecticide space-spraying (fogging) against dengue. Based on meta-analyses, house screening significantly reduced dengue risk, OR 0.22 (95% CI 0.05-0.93, p = 0.04), as did combining community-based environmental management and water container covers, OR 0.22 (95% CI 0.15-0.32, p<0.0001). Indoor residual spraying (IRS) did not impact significantly on infection risk (OR 0.67; 95% CI 0.22-2.11; p = 0.50). Skin repellents, insecticide-treated bed nets or traps had no effect (p>0.5), but insecticide aerosols (OR 2.03; 95% CI 1.44-2.86) and mosquito coils (OR 1.44; 95% CI 1.09-1.91) were associated with higher dengue risk (p = 0.01). Although 23/41 studies examined the impact of insecticide-based tools, only 9 evaluated the insecticide susceptibility status of the target vector population during the study.

CONCLUSIONS/SIGNIFICANCE

This review and meta-analysis demonstrate the remarkable paucity of reliable evidence for the effectiveness of any dengue vector control method. Standardised studies of higher quality to evaluate and compare methods must be prioritised to optimise cost-effective dengue prevention.

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.

Long-lasting insecticide-treated house screens and targeted treatment of productive breeding-sites for dengue vector control in Acapulco, Mexico

Background

Long-lasting insecticidal net screens (LLIS) fitted to domestic windows and doors in combination with targeted treatment (TT) of the most productive Aedes aegypti breeding sites were evaluated for their impact on dengue vector indices in a cluster-randomised trial in Mexico between 2011 and 2013.

Methods

Sequentially over 2 years, LLIS and TT were deployed in 10 treatment clusters (100 houses/cluster) and followed up over 24 months. Cross-sectional surveys quantified infestations of adult mosquitoes, immature stages at baseline (pre-intervention) and in four post-intervention samples at 6-monthly intervals. Identical surveys were carried out in 10 control clusters that received no treatment.

Results

LLIS clusters had significantly lower infestations compared to control clusters at 5 and 12 months after installation, as measured by adult (male and female) and pupal-based vector indices. After addition of TT to the intervention houses in intervention clusters, indices remained significantly lower in the treated clusters until 18 (immature and adult stage indices) and 24 months (adult indices only) post-intervention.

Conclusions

These safe, simple affordable vector control tools were well-accepted by study participants and are potentially suitable in many regions at risk from dengue worldwide.

Evidence-based vector control? Improving the quality of vector control trials

Vector-borne diseases (VBDs) such as malaria, dengue, and leishmaniasis cause a high level of morbidity and mortality. Although vector control tools can play a major role in controlling and eliminating these diseases, in many cases the evidence base for assessing the efficacy of vector control interventions is limited or not available. Studies assessing the efficacy of vector control interventions are often poorly conducted, which limits the return on investment of research funding. Here we outline the principal design features of Phase III vector control field studies, highlight major failings and strengths of published studies, and provide guidance on improving the design and conduct of vector control studies. We hope that this critical assessment will increase the impetus for more carefully considered and rigorous design of vector control studies.

Aedes aegypti (Diptera: Culicidae): evaluation of natural long-lasting materials containing pyriproxyfen to improve control strategies

Natural materials such as beeswax or a paraffin/stearin mixture containing pyriproxyfen and used as a slow release formulation may convert any breeding place into a larvicidal ovitrap for Aedes aegypti (L.) control. Effectiveness and residual activity of beeswax and paraffin/stearin 1:1 discs containing from 10(-5) to 10(-1) % pyriproxyfen and sticked at the bottom of plastic jars were evaluated for adult emergence inhibition (EI) on late 3rd or early 4th instar A. aegypti larvae. At the initial time t = 0, the EI was 100% for vessels containing beeswax or paraffin/stearin 1:1 discs containing up to 10(-4)% pyriproxyfen. For the lowest pyriproxyfen concentration of 10(-5)%, paraffin/stearin mixture gave a higher EI% value than beeswax (100 and 50%, respectively). Jars were kept at room temperature, and water was totally replaced every 15 days. Bioassays for residual activity repeated monthly showed that at 30 days and for pyriproxyfen 10(-5) % and both matrices, the EI values were low and comparable to control values. For pyriproxyfen 10(-4) %, EI remained above 95% for at least 90 days and around 75% up to 180 days. The EI values are always higher for paraffin/stearin mixture than for beeswax. For all other higher concentrations, 100% EI was obtained at least during 300 days. In a semi-field trial, paraffin/stearin/sand O-rings (2:1:2), containing pyriproxyfen 1%, were sunken in 200-l water-storage tanks and held outdoors in a shadow place. After 72 h, a 250-ml aliquot was taken (t = 0) obtaining 100 % EI. Water level was completed to 200 l every 15 days and bioassays repeated monthly as before. Residual activity remains with 100% EI at least for 6 months.

Canine heartworm disease (Dirofilaria immitis) in Western Europe: survey of veterinary awareness and perceptions

Background

This survey examines the experience and opinion of veterinarians with canine heartworm (HW; Dirofilaria immitis) infection in non-endemic and endemic areas of Europe.

Methods

A questionnaire was distributed by e-mail to veterinary practitioners within non-endemic countries including UK, Germany, and Netherlands,non-endemic regions of France, Spain, Italy and endemic regions of France, Spain and Italy. The main questions were about the HW cases seen in the last 12 months, if the number of cases had changed over the last 5 years and practitioner awareness of the ESCAAP Guidelines on HW. Additional questions examined practitioner perception regarding the risk of HW for pets travelling in endemic areas and the use of preventatives including veterinary perception of pet owner compliance.

Results

Overall 584 responses, 389 from non-endemic countries and regions and 195 from endemic regions were obtained. Most of the cases were seen in endemic regions, although in Germany 20% of veterinarians reported cases of HW infection. Overall, 10% of practitioners in non-endemic areasand 12% in endemic areas, respectively, reported an increasing number of cases. The practitioner awareness of ESCCAP guidelines is low. Veterinarians responded that preventative drugs were prescribed to most client dogs in endemic areas and most practitioners rated owner compliance as good or excellent in following the veterinarian’s guidance for HW prevention. Overall 63% of veterinarians responded that owners are more or less aware of the HW risk traveling with their dogs in endemic areas. Forty four percent of responders in non-endemic regions considered it somewhat likely to very likely that HW infection will become endemic in their regions.

Conclusions

In both non-endemic and endemic countries at least 1 responding practitioner admitted seeing a case of canine HW infection and has shown awareness regarding infection. Ten percent of practitioners stated that the number of cases is increasing. Although the number of owners traveling with their dogs was low, the perception of surveyed veterinarians was that owners were quite aware of the HW risk for their dogs. Several veterinary practitioners believe that HW infection could become endemic in their non-endemic area within the next 10 years.