Evaluation of insecticide treated window curtains and water container covers for dengue vector control in a large-scale cluster-randomized trial in Venezuela.

Guilherme S. Ribeiro,Audrey Lenhart,Elci Villegas,Carmen Elena Castillo,Veerle Vanlerberghe,Patrick van der Stuyft,Philip J. McCall,Neal Alexander

doi:10.1371/journal.pntd.0010135

Abstract

Following earlier trials indicating that their potential in dengue vector control was constrained by housing structure, a large-scale cluster-randomized trial of insecticide treated curtains (ITCs) and water jar covers (ITJCs) was undertaken in Venezuela. In Trujillo, Venezuela, 60 clusters (6223 houses total) were randomized so that 15 clusters each received either PermaNet insecticide-treated window curtains (ITCs), permanent insecticide-treated water storage jar covers (ITJCs), a combination of both ITCs and ITJCs, or no insecticide treated materials (ITMs). A further 15 clusters located at least 5km from the edge of the study site were selected to act as an external control. Entomological surveys were carried out immediately before and after intervention, and then at 6-month intervals over the following 27 months. The Breteau and House indices were used as primary outcome measures and ovitrap indices as secondary. Negative binomial regression models were used to compare cluster-level values of these indices between the trial arms. Reductions in entomological indices followed deployment of all ITMs and throughout the trial, indices in the external control arm remained substantially higher than in the ITM study arms including the internal control. Comparing the ratios of between-arm means to summarise the entomological indices throughout the study, the combined ITC+ITJC intervention had the greatest impact on the indices, with a 63% difference in the pupae per person indices between the ITC+ITJC arm and the internal control. However, coverage had fallen below 60% by 14-months post-intervention and remained below 40% for most of the remaining study period. ITMs can impact dengue vector populations in the long term, particularly when ITCs and ITJCs are deployed in combination. ClinicalTrials.gov ISRCTN08474420; www.isrctn.com.

Highlights

With a third of the global population at risk of infection, and an annual toll of nearly 400 million infections, dengue has become one of the most intractable public health challenges of recent decades [1,2]
Comparing the ratios of between-arm means to summarise the entomological indices throughout the study, the combined insecticide treated curtains (ITCs)+insecticide-treated water storage jar covers (ITJCs) intervention had the greatest impact on the indices, with a 63% difference in the pupae per person indices between the ITC+ITJC arm and the internal control
insecticide treated materials (ITMs) can impact dengue vector populations in the long term, when ITCs and ITJCs are deployed in combination

Summary

Introduction

With a third of the global population at risk of infection, and an annual toll of nearly 400 million infections, dengue has become one of the most intractable public health challenges of recent decades [1,2]. Neither safe effective vaccines nor prophylactic drugs suitable for mass protection are available and vector control is still the only option for the prevention or control of dengue outbreaks. Control strategies in dengue endemic countries typically include activities for reducing the abundance of potential sites where the immature stages can develop, and insecticide treatment of sites that cannot be eliminated. Without reliable strategies for preventing or responding to outbreaks, control programs lack efficacy and the magnitude of the global dengue public health problem has continued to grow [4–7]. Following earlier trials indicating that their potential in dengue vector control was constrained by housing structure, a large-scale cluster-randomized trial of insecticide treated curtains (ITCs) and water jar covers (ITJCs) was undertaken in Venezuela

Methods

Results

Conclusion