Search

Additional file 3. SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protocol and related documents.

Additional file 1. WHO Trial Registration Data Set (Version 1.3.1): checklist.

Additional file 2.

Dengue, Chikungunya and Zika are arboviruses transmitted by Ae. aegypti with significant public health impact. In the first trimester of 2015, autochthonous Zika transmission was reported in Mexico. The state of Yucatan is an endemic region where pregnant women with acute infection and related congenital abnormalities in fetus and newborns were observed. We describe results from a cohort of pregnant women and their babies followed up in Yucatan during the first Zika transmission outbreak (2016–2018). Clinical manifestations of acute ZIKV infection, persistence of viral RNA in pregnant women, as well as congenital abnormalities were observed. In addition, we describe the phenotype of newborns from confirmed or suspected ZIKV prenatal infection.

Innovative control tools for the dengue, chikungunya and Zika vector Aedes aegypti, such as genetically modified mosquitoes and biological control and manipulation with the bacteria Wolbachia, are now becoming available and their incorporation into institutional vector control programs is imminent. The objective of this chapter is to examine the technical and organizational mechanisms together with the necessary processes for their introduction and implementation, as well as the indispensable indicators to measure their entomological effect on vector populations and their epidemiological impact in the short, medium and long term as part of an integrated vector management approach.

The Wolbachia-based approach is under evaluation as a control strategy against Aedes aegypti in Mexico. From 2017 to 2019, we performed a pilot study to evaluate an open-field mass-release of wAlbB-infected Ae. aegypti male mosquitoes, as part of an integrated vector management (IVM) plan led by the Ministry of Health in Mexico to suppress natural populations of Ae. aegypti in southern Mexico. Community engagement and social evaluation were part of the key activities conducted. Overall, results showed the positive benefits of this Wolbachia-based method in the reduction of Aedes mosquitoes (90%). Mosquito’s nuisance at bedtime and the increasing circulation of mosquitoes during the releasing days were reported as the negative perceptions of this method. Importantly, participants understood the difference between wild mosquitoes and those released as part of the project, as well as the importance of the IVM. A significant number of the population accepted and supported the project, and feedback was given to improve future mosquito-releasing activities. The social license was a key factor in the success of the intervention and should be part of innovative paradigms for mosquito-vector control strategies involving community engagement. We outline the Mexican experience of community engagement and social assessment in implementing a Wolbachia-based strategy.

Dengue is the most prevalent emerging mosquito-borne viral disease, affecting more than 40% of the human population worldwide. Many symptomatic dengue virus (DENV) infections result in a relatively benign disease course known as dengue fever (DF). However, a small proportion of patients develop severe clinical manifestations, englobed in two main categories known as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Secondary infection with any of the four dengue virus serotypes (DENV1, -2, -3, and -4) is a risk factor to develop severe forms of dengue disease. DSS is primarily characterized by sudden and abrupt endothelial dysfunction, resulting in vascular leak and organ impairment, which may progress to hypovolemic shock and death. Severe DENV disease (DHF/DSS) is thought to follow a complex relationship between distinct immunopathogenic processes involving host and viral factors, such as the serotype cross-reactive antibody-dependent enhancement (ADE), the activation of T cells and complement pathways, the phenomenon of the cytokine storm, and the newly described viral toxin activity of the nonstructural protein 1 (NS1), which together play critical roles in inducing vascular leak and virus pathogenesis. In this chapter that is divided in two parts, we will outline the recent advances in our understanding of DENV pathogenesis, highlighting key viral-host interactions and discussing how these interactions may contribute to DENV immunopathology and the development of vascular leak, a hallmark of severe dengue. Part I will address the general features of the DENV complex, including the virus structure and genome, epidemiology, and clinical outcomes, followed by an updated review of the literature describing the host innate immune strategies as well as the viral mechanisms acting against and in favor of the DENV replication cycle and infection.