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

Comparison of cone bioassay estimates at two laboratories with different Anopheles mosquitoes for quality assurance of pyrethroid insecticide-treated nets

Background

Quality assurance (QA) of insecticide-treated nets (ITNs) delivered to malaria-endemic countries is conducted by measuring physiochemical parameters, but not bioefficacy against malaria mosquitoes. This study explored utility of cone bioassays for pre-delivery QA of pyrethroid ITNs to test the assumption that cone bioassays are consistent across locations, mosquito strains, and laboratories.

Methods

Double-blinded bioassays were conducted on twenty unused pyrethroid ITNs of 4 brands (100 nets, 5 subsamples per net) that had been delivered for mass distribution in Papua New Guinea (PNG) having passed predelivery inspections. Cone bioassays were performed on the same net pieces following World Health Organization (WHO) guidelines at the PNG Institute of Medical Research (PNGIMR) using pyrethroid susceptible Anopheles farauti sensu stricto (s.s.) and at Ifakara Health Institute (IHI), Tanzania using pyrethroid susceptible Anopheles gambiae s.s. Additionally, WHO tunnel tests were conducted at IHI on ITNs that did not meet cone bioefficacy thresholds. Results from IHI and PNGIMR were compared using Spearman’s Rank correlation, Bland–Altman (BA) analysis and analysis of agreement. Literature review on the use of cone bioassays for unused pyrethroid ITNs testing was conducted.

Results

In cone bioassays, 13/20 nets (65%) at IHI and 8/20 (40%) at PNGIMR met WHO bioefficacy criteria. All nets met WHO bioefficacy criteria on combined cone/tunnel tests at IHI. Results from IHI and PNGIMR correlated on 60-min knockdown (KD60) (r_s = 0.6,p = 0.002,n = 20) and 24-h mortality (M24) (r_s = 0.9,p < 0.0001,n = 20) but BA showed systematic bias between the results. Of the 5 nets with discrepant result between IHI and PNGIMR, three had confidence intervals overlapping the 80% mortality threshold, with averages within 1–3% of the threshold. Including these as a pass, the agreement between the results to predict ITN failure was good with kappa = 0.79 (0.53–1.00) and 90% accuracy.

Conclusions

Based on these study findings, the WHO cone bioassay is a reproducible bioassay for ITNs with > 80% M24, and for all ITNs provided inherent stochastic variation and systematic bias are accounted for. The literature review confirms that WHO cone bioassay bioefficacy criteria have been previously achieved by all pyrethroid ITNs (unwashed), without the need for additional tunnel tests. The 80% M24 threshold remains the most reliable indicator of pyrethroid ITN quality using pyrethroid susceptible mosquitoes. In the absence of alternative tests, cone bioassays could be used as part of pre-delivery QA.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12936-022-04217-3.

Patterns of human exposure to early evening and outdoor biting mosquitoes and residual malaria transmission in Ethiopia

Ethiopia has shown a notable progress in reducing malaria burden over the past decade, mainly due to the scaleup of vector control interventions such as long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS). Based on the progress, the country has set goals to eliminate malaria by 2030. However, residual malaria transmission due to early evening and outdoor biting vectors could pose a challenge to malaria elimination efforts. This study assessed vector behavior, patterns of human exposure to vector bites and residual malaria transmission in southwestern Ethiopia. Anopheles mosquitoes were collected monthly from January to December 2018 using human landing catches (HLCs), human-baited double net traps, CDC light traps and pyrethrum spray catches. Human behavior data were collected using questionnaire to estimate the magnitude of human exposure to mosquito bites occurring indoors and outdoors at various times of the night. Enzyme-linked immunosorbent assay (ELISA) was used to determine mosquito blood meal sources and sporozoite infections. A total of 2,038 female Anopheles mosquitoes comprising Anopheles arabiensis (30.8%), An. pharoensis (40.5%), An. coustani (28.1%), An. squamosus (0.3%) and An. funestus group (0.2%) were collected. Anopheles arabiensis and An. pharoensis were 2.4 and 2.5 times more likely to seek hosts outdoors than indoors, respectively. However, 66% of human exposure to An. arabiensis and 39% of exposure to An. pharoensis bites occurred indoors for LLIN non-users. For LLIN users, 75% of residual exposure to An. arabiensis bites occurred outdoors while 23% occurred indoors before bed time. Likewise, 84% of residual exposure to An. pharoensis bites occurred outdoors while 15% occurred indoors before people retired to bed. Anopheles arabiensis and An. pharoensis were 4.1 and 4.8 times more likely to feed on bovine than humans, respectively. Based on the HLC, an estimated indoor and outdoor EIR of An. arabiensis was 6.2 and 1.4 infective bites/person/year, respectively, whereas An. pharoensis had an estimated outdoor EIR of 3.0 infective bites/person/year. In conclusion, An. arabiensis and An. pharoensis showed exophagic and zoophagic behavior. Human exposure to An. arabiensis bites occurred mostly indoors for LLIN non-users, while most of the exposure to both An. arabiensis and An. pharoensis bites occurred outdoors for LLIN users. Malaria transmission by An. arabiensis occurred both indoors and outdoors, whereas An. pharoensis contributed exclusively to outdoor transmission. Additional control tools targeting early-evening and outdoor biting malaria vectors are required to complement the current control interventions to control residual transmission and ultimately achieve malaria elimination.

Increased prevalence of insecticide resistance in Anopheles coluzzii populations in the city of Yaoundé, Cameroon and influence on pyrethroid-only treated bed net efficacy

In Cameroon, pyrethroid-only long-lasting insecticidal nets (LLINs) are still largely used for malaria control. The present study assessed the efficacy of such LLINs against a multiple-resistant population of the major malaria vector, Anopheles coluzzii, in the city of Yaoundé via a cone bioassay and release-recapture experimental hut trial. Susceptibility of field mosquitoes in Yaoundé to pyrethroids, DDT, carbamates and organophosphate insecticides was investigated using World Health Organization (WHO) bioassay tube tests. Mechanisms of insecticide resistance were characterised molecularly. Efficacy of unwashed PermaNet^® 2.0 was evaluated against untreated control nets using a resistant colonised strain of An. coluzzii. Mortality, exophily and blood feeding inhibition were estimated. Field collected An. coluzzii displayed high resistance with mortality rates of 3.5% for propoxur (0.1%), 4.16% for DDT (4%), 26.9% for permethrin (0.75%), 50.8% for deltamethrin (0.05%), and 80% for bendiocarb (0.1%). High frequency of the 1014F west-Africa kdr allele was recorded in addition to the overexpression of several detoxification genes, such as Cyp6P3, Cyp6M2, Cyp9K1, Cyp6P4 Cyp6Z1 and GSTe2. A low mortality rate (23.2%) and high blood feeding inhibition rate (65%) were observed when resistant An. coluzzii were exposed to unwashed PermaNet^® 2.0 net compared to control untreated net (p < 0.001). Furthermore, low personal protection (52.4%) was observed with the resistant strain, indicating reduction of efficacy. The study highlights the loss of efficacy of pyrethroid-only nets against mosquitoes exhibiting high insecticide resistance and suggests a switch to new generation bed nets to improve control of malaria vector populations in Yaoundé.

Field evaluation of Veeralin, an alpha-cypermethrin + PBO long-lasting insecticidal net, against natural populations of Anopheles funestus in experimental huts in Muheza, Tanzania

The success of long-lasting insecticidal nets (LLIN) as the primary method for preventing malaria is threatened by pyrethroid resistance in Anopheles vectors. New generation long-lasting nets incorporating PBO synergist (piperonyl butoxide) with pyrethroid are designed to control insecticide-resistant mosquitoes. The efficacy of Veeralin® PBO LLINs was evaluated in experimental huts against wild free-flying pyrethroid-resistant Anopheles funestus (s.l.). Mosquito mortality, blood-feeding inhibition and personal protection were compared between untreated nets, standard LLINs and PBO/pyrethroid combination nets. Blood-feeding rates recorded with 20-times washed Veeralin were not significantly different from those with 20-times washed PermaNet 3.0 LLIN, a WHO Pre-Qualification Team (PQT) approved PBO/pyrethroid LLIN. This provides evidence that Veeralin LLIN provides similar blood-feeding inhibition to the standard approved LLIN and thus meets WHO PQT criteria for blood-feeding. Results show significantly higher mortality for Veeralin PBO LLINs against pyrethroid-resistant Anopheles funestus (s.l.) compared to DuraNet, a WHO PQT approved standard pyrethroid-only LLIN, both when unwashed and washed 20 times. The improved efficacy over a standard pyrethroid-only LLIN can be attributed to the effect of PBO in the Veeralin LLIN, hence meeting the Vector Control Advisory Group (VCAG) criteria for a resistance breaking LLIN.

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Long-lasting insecticidal nets with PBO play a key role in blood-feeding and mortality of mosquitoes.

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Incorporating PBO in LLIN enhanced the efficacy of LLINs against wild populations of Anopheles mosquitoes.

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Understanding the impact of LLINs ​+ ​PBO on mortality, repellency, knockdown could be an asset in vector control toolbox.

Comparing the durability of the long-lasting insecticidal nets DawaPlus® 2.0 and DuraNet© in northwest Democratic Republic of Congo

Background

Anecdotal reports from DRC suggest that long-lasting insecticidal nets (LLIN) distributed through mass campaigns in DRC may not last the expected average three years. To provide the National Malaria Control Programme with evidence on physical and insecticidal durability of nets distributed during the 2016 mass campaign, two brands of LLIN, DawaPlus^® 2.0 and DuraNet©, were monitored in neighbouring and similar health zones in Sud Ubangi and Mongala Provinces.

Methods

This was a prospective cohort study of representative samples of households from two health zones recruited at baseline, 2 months after the mass campaign. All campaign nets in these households were labelled, and followed up over a period of 31 months. Primary outcome was the “proportion of nets surviving in serviceable condition” based on attrition and integrity measures and the median survival in years. The outcome for insecticidal durability was determined by bio-assay from subsamples of campaign nets.

Results

A total of 754 campaign nets (109% of target) from 240 households were included in the study. Definite outcomes could be determined for 67% of the cohort nets in Sud Ubangi and 74% in Mongala. After 31 months all-cause attrition was 57% in Sud Ubangi and 76% in Mongala (p = 0.005) and attrition due to wear and tear was 26% in Sud Ubangi and 48% in Mongala (p = 0.0009). Survival in serviceable condition at the last survey was 37% in Sud Ubangi and 17% in Mongala (p = 0.003). Estimated median survival was 1.6 years for the DawaPlus^® 2.0 in Mongala (95% CI 1.3–1.9) and 2.2 years for the DuraNet in Sud Ubangi (95% CI 2.0–2.4). Multivariable Cox proportionate hazard models suggest that the difference between sites was mainly attributable to the LLIN brand. Insecticidal effectiveness was optimal for DuraNet©, but significantly dropped after 24 months for DawaPlus^® 2.0.

Conclusions

In the environment of northwest DRC the polyethylene LLIN DuraNet© performed significantly better than the polyester LLIN DawaPlus^® 2.0, but both were below a three-year median survival. Improvement of net care behaviours should be able to improve physical durability.

Bio-efficacy and wash resistance of MAGNet long-lasting insecticidal net against wild populations of Anopheles funestus in experimental huts in Muheza, Tanzania

Background

The decline in malaria cases and vectors is major milestone in fighting against malaria. The efficacy of MAGNet long-lasting insecticidal nets (MAGNet LLIN), an alpha-cypermethrin incorporated long-lasting net, with the target dose ± 25% of 5.8 g active ingredient (AI)/kg (4.35–7.25 g AI/kg) was evaluated in six veranda-trap experimental huts in Muheza, Tanzania against freely flying wild population of Anopheles funestus.

Methods

MAGNet LLINs were tested against wild, free-flying, host-seeking An. funestus mosquitoes over a period of 6 weeks (total of 36 nights in the huts). MAGNet LLIN efficacy was determined in terms of mosquito mortality, blood-feeding inhibition, deterrence, induced exiting, personal protection, and insecticidal killing over 20 washes according to WHO standardized procedures. Efficacy was compared with reference to a WHOPES recommended approved LLINs (DuraNet) and to a net conventionally treated (CTN) treated with alpha-cypermethrin at WHO-recommended dose and washed to just before cut-off point. The efficacy of MAGNet was evaluated in experimental huts against wild, free-flying, pyrethroid-resistant An. funestus. The WHO-susceptibility method was used to detect resistance in wild Anopheles exposed to 0.75% permethrin. Mosquito mortality, blood-feeding inhibition and personal protection were compared between untreated nets and standard LLINs. Blood-feeding rates were recorded and compared between the 20 times washed; blood-feeding rates between 20 times washed MAGNet LLIN and 20 times washed WHOPES-approved piperonyl butoxide (PBO)/pyrethroid were not statistically different (p > 0.05).

Results

The results have evidently shown that MAGNet LLIN provides similar blood-feeding inhibition, exophily, mortality, and deterrence to the standard approved LLIN, thus meeting the WHOPES criteria for blood feeding. The significantly high feeding inhibition and personal protection over pyrethroid-resistant An. funestus recorded by both unwashed and 20 times washed MAGNet compared to the unwashed DuraNet, the WHOPES-approved standard pyrethroid-only LLIN provides proof of MAGNet meeting Phase II WHOPES criteria for a LLIN.

Conclusion

Based on this study, MAGNet has been shown to have a promising impact on protection when 20 times washed against a highly resistant population of An. funestus.