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: 10598006
• 负责人: Gonzalo Martin Vazquez Prokopec
• 金额: $ 128.23万
• 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/10598006
• 关键词: Acute; Address; Adult; Aedes; Affect; Behavior; Censuses; Child; Cities; Clinical; Clinics and Hospitals; Cluster randomized trial; Collection; Cox Proportional Hazards Models; Credentialing; Culicidae; Darkness; Data; Dengue; Dengue Virus; Discipline of Nursing; Disease; Effectiveness; Endemic Diseases; Enrollment; 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; Predisposition; Prevention; Procedures; Public Health; Publishing; Random Allocation; Randomized; Randomized, Controlled Trials; Residual state; Rest; Reverse Transcriptase Polymerase Chain Reaction; Running; Sampling; Seasons; Serology; Site; Surface; 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; randomized, clinical trials; response; secondary endpoint; seroconversion; serosurvey; standardize measure; stem; systematic review; transmission process; trial design; vector control; vector mosquito; viral transmission

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.

项目概要/摘要 城市同期矢量控制（车载超低量喷洒、热雾、 杀幼虫）未能遏制登革热流行并阻止伊蚊在全球范围内扩张 传播的病毒（ABV：登革热、基孔肯雅热、寨卡病毒）是维持有效 ABV 的挑战之一。 控制措施源于关于任何流行病学影响的证据明显缺乏 此外，针对临床病例的经典干预措施部署。 未能考虑到外出人员流动和无症状感染的重要贡献。 迫切需要新的病媒控制方法和干预措施来遏制ABV。 室内定向滞留喷洒（TIRS，对休息的埃及伊蚊施用滞留杀虫剂） 暴露的矮墙 [<1.5m]、家具下方和黑暗表面等场所）是有理向量 利用埃及伊蚊的休息行为来集中杀虫剂应用的控制方法。 最近发表的系统评价表明 TIRS 是一种非常有效的方法。 ABD 预防方法很有前景，但强调了这种干预措施的证据基础有限，因为 缺乏流行病学终点随机对照试验的疗效估计 为了满足这种迫切的需求，我们将寻求双臂、平行、非盲的方法。 整群随机试验量化 TIRS 在减轻实验室负担方面的总体功效 确诊（病毒学或血清学）ABV 临床疾病（例如登革热、寨卡病毒或基孔肯雅热） （主要终点）包括： a) 实验室确认的（血清学）DENV、CHIKV。 或 2-15 岁儿童入组时的 ZIKV 血清转化率； b) 埃及伊蚊感染率； DENV、CHIKV 或 ZIKV；c) 埃及伊蚊室内昆虫学指标。 梅里达（墨西哥尤卡坦州，人口约 100 万），我们将前瞻性地跟踪那里的人口 4,600 名 2-15 岁入学儿童，分布在 50 个 5x5 城市街区的集群中（每个集群约 92 名儿童） 组），随机分配接受 TIRS 治疗（n=25）或不接受 TIRS 治疗（n=25）。 联邦卫生部将在治疗前约 1-2 个月对治疗集群的所有房屋进行 TIRS ABV 传播高峰季节的开始，将积极监测有症状的 ABD 感染。 由现场护士和医生通过每周家访和加强监测（电话 电话、向梅里达医院/诊所系统监测疑似病例），而年度血清调查将 如果有效，TIRS 将通过以下方式推动伊蚊控制模式的转变： 考虑埃及伊蚊的行为来指导杀虫剂的应用； 传播季节而不是针对有症状的病例）； 埃及伊蚊易感。