Quanitifying the Epidemiological Impact of Targeted Indoor Residual Spraying on Aedes-borne Diseases

量化有针对性的室内残留喷洒对伊蚊传播疾病的流行病学影响

• 批准号: 10373009
• 负责人: Gonzalo Martin Vazquez Prokopec
• 金额: $ 135.7万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10373009
• 关键词: Acute; Address; Adult; Aedes; Affect; Behavior; Censuses; Chikungunya virus; Child; Cities; Clinical; Clinics and Hospitals; Cluster randomized trial; Collection; Cox Proportional Hazards Models; Culicidae; Data; Dengue; Discipline of Nursing; Disease; Effectiveness; Endemic Diseases; Enrollment; Entomology; Enzyme-Linked Immunosorbent Assay; Epidemic; Epidemiology; Evaluation; Evidence based intervention; Exposure to; Fogs; Formulation; Furniture; Health; Home; Household; Human; Human Resources; Immunoglobulin G; Immunoglobulin M; Incidence; Individual; Infection; Insecticides; Interruption; Intervention; Laboratories; Logistic Regressions; Measures; Methods; Mexico; Modeling; Monitor; Mosquito Control; Neutralization Tests; Pediatric cohort; Persons; Pesticides; Population; Prevention; Procedures; Public Health; Publishing; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Residual state; Rest; Reverse Transcriptase Polymerase Chain Reaction; Running; Sampling; Seasons; Serology; Site; Surface; Surveys; System; Telephone; Testing; Therapeutic; Time; Training; Travel; Vaccines; Virus; Virus Diseases; Visit; Work; ZIKA; Zika Virus; aged; analytical tool; arm; chikungunya; combat; design; egg; evidence base; experience; indexing; infection rate; intervention delivery; mathematical model; mosquito-borne; multidisciplinary; novel; policy recommendation; prevent; primary endpoint; programs; prospective; randomized trial; response; secondary endpoint; seroconversion; serosurvey; standardize measure; stem; systematic review; transmission process; trial design; vector control; vector mosquito

Project Summary/Abstract Contemporaneous urban vector control (truck-mounted ultra-low volume spraying, thermal fogging, larviciding) has failed to contain dengue epidemics and to prevent the global range expansion of Aedes- borne viruses (ABVs: dengue, chikungunya, Zika). Part of the challenge in sustaining effective ABV control emerges from the remarkable paucity of evidence about the epidemiological impact of any vector control method. Furthermore, the classic deployment of interventions in response to clinical cases fails to account for the important contribution of out-of-home human mobility and asymptomatic infections. Novel vector control approaches and intervention delivery strategies to contain ABVs are urgently needed. Targeted indoor residual spraying (TIRS, applying residual insecticides on Aedes aegypti resting sites such as exposed low walls [<1.5m], under furniture, and on dark surfaces) is a rational vector control approach that exploits Ae. aegypti resting behavior to focalize insecticide applications with no loss in residual efficacy. Recently published systematic reviews have identified TIRS as a very promising approach for ABD prevention, but highlighted the limited evidence-base for this intervention due to the absence of efficacy estimates from randomized controlled trials with epidemiological endpoints performed in endemic settings. In response to such critical need, we will pursue a two-arm, parallel, unblinded cluster randomized trial to quantify the overall efficacy of TIRS in reducing the burden of laboratory- confirmed (virologically or serologically) ABV clinical disease (e.g., dengue, Zika or chikungunya) (primary endpoint). Secondary endpoints will include: a) Laboratory-confirmed (serologically) DENV, CHIKV or ZIKV seroconversion in children aged 2-15 at enrollment; b) Ae. aegypti mosquito infection rates with DENV, CHIKV or ZIKV; c) Ae. aegypti indoor entomological indices. The trial will be conducted in the city of Merida (Yucatan State, Mexico, population ~1million), where we will prospectively follow a population of 4,600 children 2-15 years at enrollment, distributed in 50 clusters of 5x5 city blocks each (~92 children per cluster), randomly allocated to receive either TIRS treatment (n=25) or not (n=25). Trained personnel from the Federal Ministry of Health will perform TIRS in all houses from the treatment clusters ~1-2 months prior to the beginning of the peak ABV transmission season. Active monitoring for symptomatic ABD infections will be performed by field nurses and doctors through weekly household visits and enhanced surveillance (phone calls, monitoring of suspected cases to Merida’s hospital/clinic system), whereas annual sero-surveys will be performed after each transmission season. If efficacious, TIRS will drive a paradigm shift in Aedes control by: considering Ae. aegypti behavior to guide insecticide applications; change to preemptive control (pre- ABV transmission season rather than in response to symptomatic cases); the use of insecticide formulations to which Ae. Aegypti is susceptible.

项目摘要/摘要 同时的城市矢量控制（卡车安装的超低音量喷涂，热雾， 幼虫）未能包含粉丝的发作，并防止艾德斯的全球扩张 - 传播病毒（ABVS：登革热，基孔肯雅，Zika）。维持有效ABV的挑战的一部分 控制源于关于任何的流行病学影响的显着证据 向量控制方法。此外，响应临床病例的经典干预措施的经典部署 无法解决人类流动性和无症状感染的重要贡献。 迫切需要新颖的矢量控制方法和干预措施的交付策略。 有针对性的室内残留喷涂（TIRS，在伊蚊上施加残余杀虫剂 诸如裸露的低壁[<150万]，在家具和黑暗表面上）是一个理性的矢量 利用AE的控制方法。埃及静止行为，以焦点的杀虫剂应用 剩余效率没有损失。最近发表的系统评论已将TIR确定为非常 预防ABD的有前途的方法，但强调了由于 没有进行流行病学终点的随机对照试验的效率估计值 在内在设置中。为了响应如此关键的需求，我们将追求两臂，平行的，无盲的 聚类随机试验，以量化TIR的总体效率，以减少实验室的燃烧 确认（病毒学或血清学）ABV临床疾病（例如登革热，Zika或Chikungunya） （主要终点）。次要终点将包括：a）实验室确认（在血清学上）DENV，CHIKV 或入学时2-15岁儿童的ZIKV血清转化； b）AE。埃及蚊子感染率 Denv，Chikv或Zikv； c）AE。埃及室内昆虫学指数。审判将在城市进行 梅里达（墨西哥尤卡坦州，人口约100万），我们可能会跟随人口 4,600名儿童2-15岁时入学，分布在50个5x5城市街区的群集中（每个约92个儿童 群集），随机分配以接受TIRS治疗（n = 25）或不接受（n = 25）。受过训练的人 联邦卫生部将在治疗集群的所有房屋中进行TIRS，然后 峰值ABV传输季节的开始。对有症状的ABD感染的主动监测将 由野外护士和医生通过每周的家庭访问和增强监视（电话）进行（电话 电话，对梅里达医院/诊所系统对可疑病例的监视），而年度血清疗法将是 在每个传输季节之后进行。如果高效，TIRS将通过： 考虑AE。埃及行为指导杀虫剂的应用；更改为先发制人（预先ABV） 传输季节，而不是响应有症状的情况）；使用杀虫剂配方 哪个Ae。埃及很容易受到影响。