Abstract
BackgroundThe Aedes aegypti mosquito is the vector for dengue fever, yellow fever, chikungunya, and zika viruses. Inadequate vector control has contributed to persistence and increase of these diseases. This review assesses the evidence of effectiveness of different control measures in reducing Aedes aegypti proliferation, using standard entomological indices.MethodsA systematic search of Medline, Ovid, BVS, LILACS, ARTEMISA, IMBIOMED and MEDIGRAPHIC databases identified cluster randomised controlled trials (CRCTs) of interventions to control Aedes aegypti published between January 2003 and October 2016. Eligible studies were CRCTs of chemical or biological control measures, or community mobilization, with entomological indices as an endpoint. A meta-analysis of eligible studies, using a random effects model, assessed the impact on household index (HI), container index (CI), and Breteau index (BI).ResultsFrom 848 papers identified by the search, eighteen met the inclusion criteria: eight for chemical control, one for biological control and nine for community mobilisation. Seven of the nine CRCTs of community mobilisation reported significantly lower entomological indices in intervention than control clusters; findings from the eight CRCTs of chemical control were more mixed. The CRCT of biological control reported a significant impact on the pupae per person index only. Ten papers provided enough detail for meta-analysis. Community mobilisation (four studies) was consistently effective, with an overall intervention effectiveness estimate of −0.10 (95%CI -0.20 – 0.00) for HI, −0.03 (95%CI -0.05 – -0.01) for CI, and −0.13 (95%CI -0.22 – -0.05) for BI. The single CRCT of biological control had effectiveness of −0.02 (95%CI -0.07– 0.03) for HI, −0.02 (95%CI -0.04– -0.01) for CI and −0.08 (95%CI -0.15– -0.01) for BI. The five studies of chemical control did not show a significant impact on indices: the overall effectiveness was −0.01 (95%CI -0.05– 0.03) for HI, 0.01 (95% CI -0.01– 0.02) for CI, and 0.01 (95%CI -0.03 – 0.05) for BI.ConclusionGovernments that rely on chemical control of Aedes aegypti should consider adding community mobilization to their prevention efforts. More well-conducted CRCTs of complex interventions, including those with biological control, are needed to provide evidence of real life impact. Trials of all interventions should measure impact on dengue risk.
Highlights
The Aedes aegypti mosquito is the vector for dengue fever, yellow fever, chikungunya, and zika viruses
In 2013, Bhatt and colleagues estimated 390 million dengue infections worldwide each year, with 96 million of these producing some clinical manifestation [1]. They estimated that Asia accounts for 70% of these infections, India alone accounting for 34%; 14% occur in the Americas, more than half of which occur in Brazil and Mexico; 16% occur in Africa, and only 0.2% in Oceania [1]
Search strategy In 2013 we carried out a systematic search for articles published between January 2003 and June 2013 assessing the impact of chemical control, biological control and/or community mobilization as strategies for Aedes aegypti vector control
Summary
The Aedes aegypti mosquito is the vector for dengue fever, yellow fever, chikungunya, and zika viruses. In 2013, Bhatt and colleagues estimated 390 million dengue infections worldwide each year, with 96 million of these producing some clinical manifestation [1]. They estimated that Asia accounts for 70% of these infections, India alone accounting for 34%; 14% occur in the Americas, more than half of which occur in Brazil and Mexico; 16% occur in Africa, and only 0.2% in Oceania [1]. Apart from dengue virus, Aedes aegypti is the vector for transmission of other viruses presenting serious public health threats: chikungunya [8, 9], zika [10] and yellow fever [11]. There is a huge shortfall in funding for the WHO response programme [13]; with limited funding there is an urgent need to identify the most effective interventions for Aedes aegypti vector control
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