Radiological Findings in the Lungs of Premature Infants

Abstract

<h3>Abstract</h3> <h3>Background</h3> The introduction of the bacterium <i>Wolbachia</i> (<i>w</i>Mel strain) into <i>Aedes aegypti</i> mosquitoes reduces their capacity to transmit dengue and other arboviruses. Evidence of a reduction in dengue case incidence following field releases of <i>w</i>Mel-infected <i>Ae. aegypti</i> has been reported previously from a cluster randomised controlled trial in Indonesia, and quasi-experimental studies in Indonesia and northern Australia. <h3>Methods</h3> Following a period of intensive community engagement, deployments of adult <i>w</i>Mel-infected <i>Ae. aegypti</i> mosquitoes were conducted in Niterói, Brazil during 2017 – 2019. Deployments were phased across four release zones, with a total area of 83 km² and a residential population of approximately 373,000. A quasi-experimental design was used to evaluate the effectiveness of <i>w</i>Mel deployments in reducing dengue and chikungunya incidence. An untreated control zone was pre-defined, which was comparable to the intervention area in historical dengue trends. The <i>w</i>Mel intervention effect was estimated by controlled interrupted time series analysis of monthly dengue and chikungunya case notifications to the public health surveillance system before, during and after releases, from release zones and the control zone. <h3>Results</h3> Three years after commencement of releases, <i>w</i>Mel introgression into local <i>Ae. aegypti</i> populations was heterogeneous throughout Niterói, reaching a high prevalence (&gt;80%) in the earliest release zone, and more moderate levels (prevalence 40–70%) elsewhere. Despite this spatial heterogeneity in entomological outcomes, the <i>w</i>Mel intervention was associated with a 69% reduction in dengue incidence (95% confidence interval 54%, 80%) and a 60% reduction in chikungunya incidence (95%CI 21%, 80%), in the aggregate release area compared with the pre-defined control area. This significant intervention effect on dengue was replicated across all four release zones, and in three of four zones for chikungunya. <h3>Conclusions</h3> We demonstrate that <i>w</i>Mel <i>Wolbachia</i> can be successfully introgressed into <i>Ae. aegypti</i> populations in a large and complex urban setting, and that a significant public health benefit from reduced incidence of dengue and chikungunya accrues even where the prevalence of <i>w</i>Mel in local mosquito populations is moderate and spatially heterogeneous. These findings are consistent with the results of randomised and non-randomised field trials in Indonesia and northern Australia, and demonstrate the effectiveness of the <i>Wolbachia</i> biocontrol method as a multivalent intervention against both dengue and chikungunya.