Aedes aegypti breeding ecology in Guerrero: cross-sectional study of mosquito breeding sites from the baseline for the Camino Verde trial in Mexico

Where does Aedes albopictus (Diptera: Culicidae) really breed in a Mediterranean residential area? Results from a field study in Valencia, Eastern Spain

Since its introduction in Spain in 2004, Aedes albopictus has rapidly spread across the country. Its aggressive biting behaviour causes nuisance, limiting outdoor activities. Also, its role as a vector of several arboviruses implies a major public health risk, with several cases of autochthonous dengue having been reported nationwide over the past few years. Control strategies usually focus on interventions in breeding sites. As such, accurate knowledge of the main larval habitats becomes a major priority in infested areas. A detailed identification of breeding sites of Ae. albopictus was carried out in the outdoors of 60 residential properties during July-August 2022 in El Vedat de Torrent (Valencia, Eastern Spain), an area recently colonised by this species. A total of 1444 real and potential breeding sites were examined. The most abundant potential larval habitat were plant pot plates (6.48 units/house), although a low infestation level was found, both for larvae (2.06% positivity, x̄ = 30.5 larvae/container), and pupae (0.51%, x̄ = 2.5 pupae/container). A total of 7715 larvae and 205 pupae were found in a disused flooded water pool depuration system. Animal drinkers, buckets and irrigation water containers were found to be the most common positive containers. No statistical difference was observed among the different container materials. A general statistical increase of 1 larva per 11.7 ml of water in breeding sites was detected. Breeding sites of other species such as Culex pipiens (n = 2) and Culex modestus (n = 1) were also rarely found in this residential area. To our knowledge, this is the first aedic index study carried out in Europe, and it provides valuable information about the main domestic breeding habitats of Ae. albopictus, which can greatly improve control programmes.

The influence of gender and temephos exposure on community participation in dengue prevention: a compartmental mathematical model

BACKGROUND

The use of temephos, the most common intervention for the chemical control of Aedes aegypti over the last half century, has disappointing results in control of the infection. The footprint of Aedes and the diseases it carries have spread relentlessly despite massive volumes of temephos. Recent advances in community participation show this might be more effective and sustainable for the control of the dengue vector.

METHODS

Using data from the Camino Verde cluster randomized controlled trial, a compartmental mathematical model examines the dynamics of dengue infection with different levels of community participation, taking account of gender of respondent and exposure to temephos.

RESULTS

Simulation of dengue endemicity showed community participation affected the basic reproductive number of infected people. The greatest short-term effect, in terms of people infected with the virus, was the combination of temephos intervention and community participation. There was no evidence of a protective effect of temephos 220 days after the onset of the spread of dengue.

CONCLUSIONS

Male responses about community participation did not significantly affect modelled numbers of infected people and infectious mosquitoes. Our model suggests that, in the long term, community participation alone may have the best results. Adding temephos to community participation does not improve the effect of community participation alone.

Local Economic Conditions Affect Aedes albopictus Management

Invasive mosquitoes are an emerging public health issue, as many species are competent vectors for pathogens. We assessed how multiple environmental and socio-economic factors affected the engagement of municipalities in Italy (n = 7679) in actions against Aedes albopictus, an invasive mosquito affecting human health and well-being, between 2000 and 2020. We collected information about mosquito control from official documents and municipal websites and modeled the role played by multiple environmental and socioeconomic factors characterizing each municipality through the random forest algorithm. Municipalities are more prone to manage A. albopictus if more urbanized, in lowlands and with long infestation periods. Moreover, these variables are more predictive of management in municipalities with a high median income and thus more economic resources. Only 25.5% of Italian municipalities approved regulations for managing A. albopictus, and very few of them were in Southern Italy, the most deprived area of the country. Our findings indicate that local economic conditions moderate the effect of other drivers of mosquito control and ultimately can lead to better management of A. albopictus. If the management of invasive mosquitoes, or other forms of global change, is subjected to local economic conditions, economic inequalities will jeopardize the success of large-scale policies, also raising issues of environmental and climate justice.

House Condition Scoring Scale as a Risk Indicator of Infestation by Aedes in Two Mexican Localities

Mexico has shown an increase in dengue incidence rates. There are factors related to the location that determine housing infestation by Aedes. This study aimed to determine factors associated with housing infestation by immature forms of Aedes spp. in the dengue endemic localities of Axochiapan and Tepalcingo, Mexico, from 2014 to 2016. A cohort study was carried out. Surveys and inspections of front- and backyards were conducted every 6 months, looking for immature forms of Aedes spp. A house condition scoring scale was developed using three variables (house maintenance, tidiness of the front- and backyards, and shading of the front- and backyards). Multiple and multilevel regression logistic analysis were conducted considering the housing infestation as the outcome and the household characteristics observed 6 months before the outcome as factors; this was adjusted by time (seasonal and cyclical variations of the vector). The infestation oscillated between 5.8% of the houses in the second semester of 2015 and 29.3% in the second semester of 2016. The factors directly associated with housing infestation by Aedes were the house condition score (adjusted odds ratio [aOR]: 1.64; 95% CI: 1.40-1.91) and the previous record of housing infestation (aOR: 2.99; 95% CI: 2.00-4.48). Moreover, the breeding-site elimination done by house residents reduced the housing infestation odds by 81% (95% CI: 25-95%). These factors were independent of the seasonal and cyclical variations of the vector. In conclusion, our findings could help to focalize antivectorial interventions in dengue-endemic regions with similar demographic and socioeconomic characteristics.

Risk of dengue, Zika, and chikungunya transmission in the metropolitan area of Cucuta, Colombia: cross-sectional analysis, baseline for a cluster-randomised controlled trial of a novel vector tool for water containers

BACKGROUND

Arbovirus diseases such as dengue, Zika, and chikungunya are a public health threat in tropical and subtropical areas. In the absence of a vaccine or specific treatment, vector management (in this case the control of the primary vector Aedes aegypti) is the best practice to prevent the three diseases. A good understanding of vector behaviour, ecology, human mobility and water use can help design effective vector control programmes. This study collected baseline information on these factors for identifying the arbovirus transmission risk and assessed the requirements for a large intervention trial in Colombia.

METHODS

Baseline surveys were conducted in 5,997 households, randomly selected from 24 clusters (neighbourhoods with on average 2000 houses and 250 households inspected) in the metropolitan area of Cucuta, Colombia. The study established population characteristics including water management and mobility as well as larval-pupal indices which were estimated and compared in all clusters. Additionally, the study estimated disease incidence from two sources: self-reported dengue cases in the household survey and cases notified by the national surveillance system.

RESULTS

In all 24 study clusters similar social and demographic characteristics were found but the entomological indicators and estimated disease incidence rates varied. The entomological indicators showed a high vector infestation: House Index = 25.1%, Container Index = 12.3% and Breteau Index = 29.6. Pupae per person Index (PPI) as an indicator of the transmission risk showed a large range from 0.22 to 2.04 indicating a high transmission risk in most clusters. The concrete ground tanks for laundry -mostly outdoors and uncovered- were the containers with the highest production of Ae. aegypti as 86.3% of all 17,613 pupae were identified in these containers. Also, the annual incidence of dengue was high: 841.6 self-reported cases per 100,000 inhabitants and the dengue incidence notified by the National surveillance system was 1,013.4 cases per 100,000 in 2019. Only 2.2% of the households used container water for drinking. 40.3% of the study population travelled during the day (when Aedes mosquitoes bite) outside their clusters.

CONCLUSIONS

The production of Ae. aegypti mosquitoes occurred almost exclusively in concrete ground tanks for laundry (lavadero), the primary intervention target. The baseline study provides necessary evidence for the design and implementation of a cluster randomized intervention trial in Colombia.

Pupal productivity of larval habitats of Aedes aegypti in Msambweni, Kwale County, Kenya

Aedes aegypti is an important vector of several arboviruses including dengue and chikungunya viruses. Accurate identification of larval habitats of Ae. aegypti is considered an essential step in targeted control. This study determined Ae. aegypti productivity in selected larval habitats in Msambweni, Kwale County, Kenya. Three sequential larval habitat surveys were conducted. The first survey was habitat census (baseline) through which 83 representative larval habitats were identified and selected. The second and third surveys involved estimating daily productivity of the 83 selected larval habitats for 30 consecutive days during a wet and a dry season, respectively. Of 664 larval habitats examined at baseline, 144 larval habitats (21.7%) were found to be infested with Ae. aegypti larvae. At baseline, majority (71%) of the pupae were collected from two (2/6) larval habitat types, tires and pots. Multivariate analysis identified habitat type and the habitat being movable as the predictors for pupal abundance. During the 30-day daily pupal production surveys, only a few of the habitats harbored pupae persistently. Pupae were found in 28% and 12% of the larval habitats during the wet and dry seasons, respectively. In the wet season, drums, tires, and pots were identified as the key habitat types accounting for 85% of all pupae sampled. Three habitats (all drums) accounted for 80% of all the pupae collected in the dry season. Predictors for pupal productivity in the wet season were habitat type, place (whether the habitat is located at the back or front of the house), habitat purpose (use of the water in the habitat), and source of water. Although the multivariate model for habitat type did not converge, habitat type and habitat size were the only significant predictors during the dry season. Drums, pots, and tires were sources of more than 85% of Ae. aegypti pupae, reinforcing the "key container concept." Targeting these three types of habitats makes epidemiological sense, especially during the dry season.

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.

A Realist Synthesis of Community-Based Interventions in Vector-Borne Diseases

Randomized control trials have provided evidence that some community-based interventions (CBIs) work in vector-borne diseases (VBDs). Conversely, there is limited evidence on how well those CBIs succeed in producing specific outcomes in different contexts. To conduct a realist synthesis for knowledge translation on this topic, we examined the extent to which realist concepts (context, mechanisms, and outcomes) and their relationships are present in the existing literature on CBIs for VBDs. Articles on CBIs were identified from prior scoping reviews of health interventions for VBDs. Content of the articles was extracted verbatim if it referred either to realist concepts or CBI features. The number of articles and the average number of words extracted per category per CBI were quantified. Content of the articles was scrutinized to inductively gather qualitative evidence on the interactions between realist concepts. We reviewed 41 articles on 17 CBIs from 12 countries. The average number of words used for mechanisms was much lower than those used for outcomes and context (309,474, and 836, respectively). The average number of words used for mechanisms increased when a CBI was described in three or more articles. There were more extensive accounts on CBI features than on mechanisms. It was difficult to gather evidence on the interactions among realist concepts from the content of the articles. Scarce reporting on mechanisms in published articles limits conducting a realist synthesis of CBIs in VBDs. More transdisciplinary research that goes beyond the biomedical paradigm is needed to boost the development of intervention mechanisms in this field.

Risk factors for Aedes aegypti household pupal persistence in longitudinal entomological household surveys in urban and rural Kenya

Background

Aedes aegypti is an efficient vector of several arboviruses of public health importance, including Zika and dengue. Currently vector management is the only available avenue for disease control. Development of efficient vector control strategies requires a thorough understanding of vector ecology. In this study, we identified households that are consistently productive for Ae. aegypti pupae and determined the ecological and socio-demographic factors associated with the persistence and abundance of pupae in households in rural and urban Kenya.

Methods

We collected socio-demographic, environmental and entomological data monthly from July 2014 to June 2018 from 80 households across four sites in Kenya. Pupae count data were collected via entomological surveillance of households and paired with socio-demographic and environmental data. We calculated pupal persistence within a household as the number of months of pupal presence within a year. We used spatially explicit generalized additive mixed models (GAMMs) to identify the risk factors for pupal abundance, and a logistic regression to identify the risk factors for pupal persistence in households.

Results

The median number of months of pupal presence observed in households was 4 and ranged from 0 to 35 months. We identified pupal persistence in 85 house-years. The strongest risk factors for high pupal abundance were the presence of bushes or tall grass in the peri-domicile area (OR: 1.60, 95% CI: 1.13–2.28), open eaves (OR: 2.57, 95% CI: 1.33–4.95) and high habitat counts (OR: 1.42, 95% CI: 1.21–1.66). The main risk factors for pupal persistence were the presence of bushes or tall grass in the peri-domicile (OR: 4.20, 95% CI: 1.42–12.46) and high number of breeding sites (OR: 2.17, 95% CI: 1.03–4.58).

Conclusions

We observed Ae. aegypti pupal persistence at the household level in urban and rural and in coastal and inland Kenya. High counts of potential breeding containers, vegetation in the peri-domicile area and the presence of eaves were strongly associated with increased risk of pupal persistence and abundance. Targeting households that exhibit pupal persistence alongside the risk factors for pupal abundance in vector control interventions may result in more efficient use of limited resources.

Evidence-Based Process for Prioritizing Positive Behaviors for Promotion: Zika Prevention in Latin America and the Caribbean and Applicability to Future Health Emergency Responses

To maximize the impact of Zika prevention programming efforts, a prioritization process for social and behavior change programming was developed based on a combination of research evidence and programmatic experience. Prioritized behaviors were: application of mosquito repellent, use of condoms, removing unintentional standing water, covering and scrubbing walls of water storage containers, seeking prenatal care, and seeking counseling on family planning if not planning to get pregnant.

Since the 2015 Zika outbreak in Latin America and the Caribbean, a plethora of behavior change messages have been promoted to reduce Zika transmission. One year after the United States Agency for International Development (USAID) initiated its Zika response, more than 30 variants of preventive behaviors were being promoted. This situation challenged social and behavior change (SBC) programming efforts that require a coordinated response and agreed upon set of focus behaviors to be effective. To support USAID implementing partners in harmonizing prevention efforts to reduce Zika infection, we developed an evidence-based process to identify behaviors with the highest potential to reduce Zika infection and transmission. We compiled a full list of behaviors and selected the most promising for a full evidence review. The review included systematic keyword searches on Google Scholar, extraction of all relevant published articles on Aedes-borne diseases between 2012 and 2018, review of seminal papers, and review of gray literature. We examined articles to determine each behavior's potential effectiveness in preventing Zika transmission or reducing the Aedes aegypti population. We also developed assessment criteria to delineate the ease with which the target population could adopt each behavior, including: (1) required frequency; (2) feasibility of the behavior; and (3) accessibility and cost of the necessary materials in the setting. These behaviors were refined through a consensus-building process with USAID's Zika implementing partners, considering contextual factors. The resulting 7 evidence-based preventive behaviors have high potential to strengthen SBC programming's impact in USAID's Zika response: (1) apply mosquito repellent, (2) use condoms during pregnancy, (3) remove standing water, (4) cover water storage containers, (5) clean/remove mosquito eggs from water containers, (6) seek antenatal care, and (7) seek family planning counseling. This case study documents a flexible process that can be adapted to inform the prioritization of behaviors when there is limited evidence available, as during many emergency responses.

Role of container type, behavioural, and ecological factors in Aedes pupal production in Dhaka, Bangladesh: An application of zero-inflated negative binomial model

The container-inhabiting Aedes mosquitoes are the major vectors transmitting dengue and several other arboviral diseases such as chikungunya and zika across the tropical world. Surveillance for immature Aedes, particularly pupae, is an effective tool for measuring dengue outbreak risk. While in Bangladesh, the greatest burden of dengue fever and dengue hemorrhagic fever cases has periodically been occurring since the first major outbreak in 2000, very limited research has yet been pursued to understand the dynamics of Aedes pupal production in this country. In this backdrop, this study was carried out to i) identify containers at household premises contributing to dengue vector productivity; ii) measure the extent of pupae productivity of household containers; and, iii) determine the effects of household ecological factors upon productivity of pupae in the city of Dhaka, Bangladesh. During the monsoon months of 2013, a total of 1,033 containers (674 wet and 363 dry) in 727 household premises in 12 wards of the city of Dhaka were inspected to measure container productivity and collect household ecological, and human behavioural data. The results reveal that the majority of immature mosquitoes (73.52% larvae and 84.91% pupae) developed in containers located outdoor that are used mostly for household chores. Plastic containers (57.55% of all immature mosquito-positive containers) used for household chores produce most of the immature mosquitos. The results of the zero-inflated negative binomial (ZINB) model reveal that pupae production significantly varies by container type (p-value = 0.0136) for the count regression group. However, when considering container size along with container type, container size is found significant for pupae production (p-value = 0.0041), showing that container size is confounded with the container type and the pupae production. Containers greater than 50 litres (L) are likely to produce 4.9 times more pupae than containers with <1L. Two household ecological factors are found to be significant (shade: p-value = 0.005 in the count regression group and type of water: p-value = 0.001 in the excess zero group) for pupae production. We found that containers with partial shade produce 4.6 times more pupae than without any shade, whereas in the excess zero group the expected number of observed zero pupae count is 86.5% lower in containers filled with rain water than those with tap water, tube-well water, ring well water and water from other sources. The most commonly used plastic-made containers (i.e., refrigerator trays, drums, buckets) and flower tubs/trays are the most abundant immature mosquito-positive containers. These findings would help the concerned authorities to formulate programs for changing human behaviour targeting the most productive containers for Aedes habitat management and vector control in the city of Dhaka, Bangladesh.

Randomised controlled trials and changing public health practice

One reason for doing randomised controlled trials (RCTs) is that experiments can be convincing. Early epidemiological experimenters, such as Jenner and the smallpox vaccine and Snow and his famous Broad Street pump handle, already knew the answer they were demonstrating; they used the experiments as knowledge translation devices to convince others.

More sophisticated modern experiments include cluster randomised controlled trials (CRCTs) for experiments in the public health setting. The knowledge translation value remains: RCTs and CRCTs can potentially stimulate changes of practice among stakeholders. Capitalising on the knowledge translation value of RCTs requires more than the standard reporting of trials. Those who are convinced by a trial and want to act, need to know how the trial relates to their own context, what contributed to success, and what might make it even more effective. Implementation research unpacks the back-story, examining how and why an intervention worked.

The Camino Verde trial of community mobilisation for control of dengue reported a significant impact on entomological indices of the Aedes aegypti vector, and on serological dengue virus infection and self-reported dengue cases. This important study should lead to studies of similar interventions in other contexts, and ultimately to changes in dengue control practices. This supplement is the back-story of the trial, providing information to help researchers and planners to make use of the trial findings.

Background articles include the full protocol, a systematic review of CRCTs of approaches for Aedes aegypti control, epidemiological and entomological findings from the baseline survey, and how baseline findings were used to set up the intervention. Secondary analyses of the entomological findings examine associations with the use of the larvicide temephos, and the impact of the intervention in different conditions of water supply and seasons.

Other articles describe implementation and other impacts: the underlying approach; implementation in the trial’s different social contexts; the different impact in women and men; the effects of using fish for vector control; the impact on household costs of personal protection and of cases of dengue illness; and ethical issues.

We hope this supplement will increase the knowledge translation value of the Camino Verde trial.

Dengue occurrence relations and serology: cross-sectional analysis of results from the Guerrero State, Mexico, baseline for a cluster-randomised controlled trial of community mobilisation for dengue prevention

Background

The Mexican arm of the Camino Verde trial of community mobilisation for dengue prevention covered three coastal regions of Guerrero state: Acapulco, Costa Grande and Costa Chica. A baseline cross-sectional survey provided data for community mobilisation and for adapting the intervention design to concrete conditions in the intervention areas.

Methods

Trained field teams constructed community profiles in randomly selected clusters, based on observation and key informant interviews. In each household they carried out an entomological inspection of water containers, collected information on socio-demographic variables and cases of dengue illness among household members in the last year, and gathered paired saliva samples from children aged 3–9 years, which were subjected to ELISA testing to detect recent dengue infection. We examined associations with dengue illness and recent dengue infection in bivariate and then multivariate analysis.

Results

In 70/90 clusters, key informants were unable to identify any organized community groups. Some 1.9% (1029/55,723) of the household population reported dengue illness in the past year, with a higher rate in Acapulco region. Among children 3–9 years old, 6.1% (392/6382) had serological evidence of recent dengue infection. In all three regions, household use of anti-mosquito products, household heads working, and households having less than 5 members were associated with self-reported dengue illness. In Acapulco region, people aged less than 25 years, those with a more educated household head and those from urban sites were also more likely to report dengue illness, while in Costa Chica and Costa Grande, females were more likely to report dengue illness. Among children aged 3–9 years, those aged 3–4 years and those living in Acapulco were more likely to have evidence of recent dengue infection.

Conclusions

The evidence from the baseline survey provided important support for the design and implementation of the trial intervention. The weakness of community leadership and the relatively low rates of self-reported dengue illness were challenges that the Mexican intervention team had to overcome. The higher dengue illness occurrence among women in Costa Grande and Costa Chica may help explain why women participated more than men in activities during the Camino Verde trial.