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EVALUATION OF CONTROL METHODS IN LARGE-SCALE FIELD TRIALS 1. Site selection

Iyaloo et al.171 have provided guidelines for selecting sites for mosquito control trials. Before implementing an area-wide integrated IMS-control strategy, similar paired sites should be selected according to the vector population (in terms of isolation, density, presence of competing species, etc.) and ecological factors (climate, landscape, etc.). It is recommended to target a vector population that is naturally isolated from immigration, and if possible, with a sole IMS species.

Indeed, the presence of other IMS increases the workload of monitoring based on larval/pupal indices or on egg counts in ovitraps as it implies the identification of Aedes species at immature stages (see 7.2). The selected sites should also be ecologically representative of the region to potentially expand the integrated IMS-control strategy, as well as stable, so that the variability of environmental conditions will not affect the results.171 In urban or suburban areas, socio-economic parameters should also be considered. In New Jersey, high poverty and a low education level were positively associated with a high abundance of Ae. albopictus.174 Practical considerations should also be taken into account, such as existing facilities, a manageable site size and access to the whole site. Finally, the social, ethical and legal aspects of the integrated IMS-control strategy need to be considered before implementation.171

7.2. Monitoring of Aedes mosquitoes

The monitoring of Aedes mosquitoes is crucial in order to compare infestation levels between different sites and to evaluate the effectiveness of an integrated IMS-control strategy. Several indices are traditionally used in developing countries to evaluate Aedes populations: house index

(percentage of houses with at least one active breeding sites), container index (percentage of containers with larvae), Breteau index (number of active breeding sites per 100 premises) and ovitraps index (average proportion of ovitraps with eggs).38 However, larval indices are of limited value in European countries because of differences in socio-economic and structural conditions characterizing human dwellings and the availability of breeding sites in public areas.38 The PPI (number of pupae per premise) and PHI (number of pupae per hectare) seem to be more appropriate for European urban areas, particularly the latter one applicable to public and private areas.38 Moreover, pupal indices exploit the strong correlation between the number of pupae and the number of adults in a defined area based on the low natural mortality of the pupae.

Ovitraps are the most widely used methods to monitor Aedes mosquito populations as they are inexpensive, sensitive and practical for area-wide surveys.20 Indeed, the mean number of Ae.

albopictus eggs in ovitraps was found to be positively correlated with counts from PPI, PHI and human landing catches in Italy during the chikungunya outbreak in 2007.19 In areas where several IMS occur, species must be identified from eggs, involving time-consuming labor in the laboratory (egg storage, egg hatching, larval rearing). Alternatively, MALDI-TOF MS (matrix-assisted laser desorption/ionization time of flight mass spectrometry) has been developed for easy and rapid identification of IMS.172

Sticky traps collect ovipositing and resting females, and allow direct identification of Aedes sp.

Estimates of adult populations from sticky traps were demonstrated to be highly positively correlated with estimates from ovitraps.53 Sticky traps have been used successfully worldwide for the monitoring of Ae. albopictus and Ae. aegypti.53,54,173 In Italy, the efficacy of insecticide applications has been evaluated using sticky traps and mosquito emerging traps which consist in adhesive traps designed for the collection of adults visiting and emerging from catch basins.21 BGS traps which attract mostly host-seeking adult females can also be set to monitor Aedes mosquito populations during integrated IMS-control programs.174 In New-Jersey, Ae. albopictus populations were surveyed weekly with BGS traps and ovitraps to examine the efficacy of active source reduction, insecticide applications and public education.25 BGS traps were more sensitive than ovitraps to detect Ae. albopictus early in the season and to compare treated and untreated sites. However, the deployment of BGS traps over a wide area is costly and unpractical due to need of a power-supply.

To overcome some of the limitations of entomological indicators, recent studies have been done to develop simple, rapid, and highly sensitive complementary indicators to evaluate the level of human exposure to Aedes bites and the efficacy of control strategies.175 When a female mosquito bites, it injects saliva containing highly immunogenic molecules. Human antibody responses, such as IgG, to one Aedes species saliva can be measured to assess the specific exposure of individuals to this Aedes species. Specific biomarkers for Ae. albopictus and Ae. aegypti saliva proteins are being developed and have been validated in La Réunion Island and in Bolivia, respectively.175,176 Even if these biomarkers are species-specific, a cross-reactivity has been observed between Ae. albopictus and Ae. aegypti, especially in high immune responders.175

7.3. Implementing an integrated IMS-control strategy

The implementation of an integrated IMS-control strategy in Europe should take into account the target species, its ecology and the public health concern, i.e. nuisance or disease transmission.177 In the latter case, insecticide treatments and fine-scale removal of breeding sites are recommended in the areas around the reported foci as it has been already implemented in Europe to limit the transmission of chikungunya or dengue by Ae. albopictus.178,179 On the other hand, when the aim of an integrated IMS-control strategy is to achieve a medium/long-term population reduction in order to decrease the biting nuisance and the risk of an arbovirus outbreak, the timing and choice of the treatment should be determined by the population dynamics of the target species.177 For instance, methods such as insecticide spraying are more effective for rapidly reducing high-density mosquito populations or in the phase of major expansion,21 while genetic methods such as SIT are more effective at controlling low-density populations.171 The choice of the control method should consider its effectiveness, specificity, residual effect, selection for resistance and ecological impact. For example, the use of larvicides is one of the most effective methods if treatment is focused on the most productive breeding sites in an area; this may differ in urban, suburban and rural areas. Source reduction methods, which are costly and time-consuming, should involve the public in a community-based approach. More generally, the success of an integrated IMS-control strategy relies on cooperation between political decision-makers, public authorities, scientists and the general public.177,180 Finally, the implementation of an integrated IMS-control strategy has to be in line with financial and human resources.

7.4. Modeling approaches and cost-effectiveness analyses

Recently, modeling approaches have proved very helpful in optimizing integrated IMS-control strategies by testing several control methods at a theoretical level.161 Modeling studies have investigated the effectiveness of different control methods such as genetic techniques (e.g. RIDL, SIT), source reduction and/or insecticides, applied alone or in combination.161,181-183 Models have also been used to assess the effectiveness of insecticides in reducing Ae. aegypti adult abundance and to predict the evolution of insecticide resistance in mosquito populations.184 In this way, Luz et al.184 demonstrated that larval and adult controls were optimal at the beginning of the dengue season. In addition, spatial and space−time modeling approaches are very helpful in planning the implementation of an integrated IMS-control strategy (e.g. in terms of site selection and timing of treatment) by mapping the spatio-temporal distribution of IMS and exploring the influence of environmental factors.185 The effects of spatial clustering of integrated IMS-control strategies can also be assessed according to different levels of spatial coverage and control method combinations.186 Finally, cost-effectiveness analyses facilitate comparisons between integrated IMS-control strategies and can inform policy decisions.187 Several studies have underlined the benefits of a real-time vector monitoring system to orientate the vector control campaign alongside a community-based approach using with routine vertical Aedes control, including source reduction and larvicide and adulticide applications.188,189

8. CONCLUSIONS

The implementation and evaluation of integrated IMS-control strategies against Aedes mosquitoes, especially Ae. albopictus, are warranted in Europe, particularly through large-scale field trials. Of the IMS-control methods discussed in this review, several have been successfully used against Ae albopictus mainly outside of Europe. These include source reduction (2), predation by copepods (4.2), larvicide application (4.3, 4.4, 4.5, 5.1), adulticide spraying (5.2) and SIT (6.1). Mechanical methods (3) have been evaluated in large areas, but only against Ae. aegypti; lethal ovitraps or gravid traps should also be effective against Ae. albopictus. New approaches such as pyriproxyfen auto-dissemination (5.1), ATSB (5.2) or IIT (4.6) based on Wolbachia infection have shown promising results in laboratory conditions or semi-field experiments, supporting their potential for future

implementation at a larger scale. Lastly, emerging genetic methods need to be developed for Ae.

albopictus; so far only Ae. aegypti mosquitoes have been genetically modified.

As underlined in previous studies, before implementing an integrated IMS-control strategy, entomological surveys are necessary to monitor the IMS and to select similar paired sites for large-scale trials. This allows the efficacy of control methods to be evaluated by determining if there has been a decrease in the adult population and/or egg oviposition in the treated site compared to the control site. Finally, tools such as mapping and modeling should be developed in order to optimize integrated IMS-control strategy, and cost-effectiveness analyses should be carried out to guide policy decisions.

In conclusion, there is a large range of vector control methods against Aedes mosquitoes.

Traditional methods such as source reduction, public education and insecticide application are routinely implemented by municipilaties to reduce Aedes populations, but with limited success, probably because of a poor participation of communities, and a lack of coordination and syncronised implementation. Innovative approaches such as pyriproxyfen auto-dissemination, genetic or Wolbachia based methods have to be sufficiently developped to demonstrate their efficacy and sustainability, and could be considered in programs of combined implementation afterwards.

As a general rule, an integrated IMS-control strategy requires the coordinated involvement of local authorities, private partners, organized society and communities. A high level of public cooperation is necessary from the beginning of integrated IMS-control programs, and only a continued support from both communities and local authorities can achieve a long-term effect. A key to success might be to customize integrated IMS-control strategy to each community according to the local Aedes infestations (key containers, infestation level, seasonal activity) and the specific socioeconomics characteristics of the locality.

ACKNOWLEDGMENTS

This work was funded by the Autonomous Province of Trento (Italy), Research funds for Grandi Progetti, Project LExEM (Laboratory of Excellence for Epidemiology and Modelling, http://www.lexem.eu). It was also partially funded by EU Grant FP7-261504 EDENext and is catalogued by the EDENext Steering Committee as EDENext337 (http://www.edenext.eu). The

contents of this publication are the sole responsibility of the authors and do not necessarily reflect the views of the European Commission.

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