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The additional benefit of residual spraying and insecticide-treated curtains for dengue control over current best practice in Cuba: Evaluation of disease incidence in a cluster randomized trial in a low burden setting with intensive routine control
- Source :
- PLoS Neglected Tropical Diseases, Vol 11, Iss 11, p e0006031 (2017), PLOS NEGLECTED TROPICAL DISEASES, PLoS Neglected Tropical Diseases
- Publication Year :
- 2017
- Publisher :
- Public Library of Science (PLoS), 2017.
-
Abstract
- Background Aedes control interventions are considered the cornerstone of dengue control programmes, but there is scarce evidence on their effect on disease. We set-up a cluster randomized controlled trial in Santiago de Cuba to evaluate the entomological and epidemiological effectiveness of periodical intra- and peri-domiciliary residual insecticide (deltamethrin) treatment (RIT) and long lasting insecticide treated curtains (ITC). Methodology/Principal findings Sixty three clusters (around 250 households each) were randomly allocated to two intervention (RIT and ITC) and one control arm. Routine Aedes control activities (entomological surveillance, source reduction, selective adulticiding, health education) were applied in the whole study area. The outcome measures were clinical dengue case incidence and immature Aedes infestation. Effectiveness of tools was evaluated using a generalized linear regression model with a negative binomial link function. Despite significant reduction in Aedes indices (Rate Ratio (RR) 0.54 (95%CI 0.32–0.89) in the first month after RIT, the effect faded out over time and dengue incidence was not reduced. Overall, in this setting there was no protective effect of RIT or ITC over routine in the 17months intervention period, with for house index RR of 1.16 (95%CI 0.96–1.40) and 1.25 (95%CI 1.03–1.50) and for dengue incidence RR of 1.43 (95%CI 1.08–1.90) and 0.96 (95%CI 0.72–1.28) respectively. The monthly dengue incidence rate (IR) at cluster level was best explained by epidemic periods (Incidence Rate Ratio (IRR) 5.50 (95%CI 4.14–7.31)), the IR in bordering houseblocks (IRR 1.03 (95%CI 1.02–1.04)) and the IR pre-intervention (IRR 1.02 (95%CI 1.00–1.04)). Conclusions Adding RIT to an intensive routine Aedes control programme has a transient effect on the already moderate low entomological infestation levels, while ITC did not have any effect. For both interventions, we didn’t evidence impact on disease incidence. Further studies are needed to evaluate impact in settings with high Aedes infestation and arbovirus case load.<br />Author summary This is the first cluster randomized controlled trial providing evidence on the effect of applying residual insecticide treatment and deploying insecticide treated curtains on clinical dengue case incidence. In a context of intensive routine control activities, low Aedes infestation and moderate transmission, we did not observe an entomological nor epidemiological effect of these interventions. Besides the epidemiological context, we hypothesized two factors to explain our results: the counteracting effect of multiple insecticides applied in the same place at the same time and the importance of human mobility in dengue transmission dynamics. The specific impact of residual insecticide treatment and insecticide treated curtains on dengue transmission should be unambiguously demonstrated in settings with more intense arbovirus transmission and/or with less intensive routine control measures in place, before making recommendations for their implementation in local vector control programs in such contexts.
- Subjects :
- Insecticides
Mosquito Control
VECTOR CONTROL
Epidemiology
Disease Vectors
Rate ratio
Mosquitoes
Geographical locations
law.invention
Dengue fever
Dengue
0302 clinical medicine
Randomized controlled trial
law
Aedes
PYRETHROID RESISTANCE
Medicine and Health Sciences
Medicine
030212 general & internal medicine
Cluster randomised controlled trial
Disease surveillance
biology
Incidence (epidemiology)
Incidence
lcsh:Public aspects of medicine
Cuba
Eukaryota
Agriculture
Insects
Treatment Outcome
Infectious Diseases
Practice Guidelines as Topic
VIRUS
INCREMENTAL COST
Agrochemicals
Research Article
medicine.medical_specialty
Drug Research and Development
lcsh:Arctic medicine. Tropical medicine
Arthropoda
Infectious Disease Control
TRANSMISSION
lcsh:RC955-962
030231 tropical medicine
DELTAMETHRIN
Disease Surveillance
Research and Analysis Methods
03 medical and health sciences
EPIDEMIC
Environmental health
Animals
Humans
Clinical Trials
AEDES-AEGYPTI CONTROL
SANTIAGO
Aerosols
Population Density
Pharmacology
Caribbean
business.industry
Public Health, Environmental and Occupational Health
Organisms
Biology and Life Sciences
lcsh:RA1-1270
biology.organism_classification
medicine.disease
EFFICACY
Invertebrates
Randomized Controlled Trials
Insect Vectors
Species Interactions
North America
THAILAND
Clinical Medicine
People and places
business
Zoology
Entomology
Subjects
Details
- Language :
- English
- ISSN :
- 19352735 and 19352727
- Volume :
- 11
- Issue :
- 11
- Database :
- OpenAIRE
- Journal :
- PLoS Neglected Tropical Diseases
- Accession number :
- edsair.doi.dedup.....e1ab1b3ec48a0212a30ebeb41ac3c7cf