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      Social-ecological factors and preventive actions decrease the risk of dengue infection at the household-level: Results from a prospective dengue surveillance study in Machala, Ecuador

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          Abstract

          Background

          In Ecuador, dengue virus (DENV) infections transmitted by the Aedes aegypti mosquito are among the greatest public health concerns in urban coastal communities. Community- and household-level vector control is the principal means of controlling disease outbreaks. This study aimed to assess the impact of knowledge, attitudes, and practices (KAPs) and social-ecological factors on the presence or absence of DENV infections in the household.

          Methods

          In 2014 and 2015, individuals with DENV infections from sentinel clinics in Machala, Ecuador, were invited to participate in the study, as well as members of their household and members of four neighboring households located within 200 meters. We conducted diagnostic testing for DENV on all study participants; we surveyed heads of households (HOHs) regarding demographics, housing conditions and KAPs. We compared KAPs and social-ecological factors between households with (n = 139) versus without (n = 80) DENV infections, using bivariate analyses and multivariate logistic regression models with and without interactions.

          Results

          Significant risk factors in multivariate models included proximity to abandoned properties, interruptions in piped water, and shaded patios (p<0.05). Significant protective factors included the use of mosquito bed nets, fumigation inside the home, and piped water inside the home (p<0.05). In bivariate analyses (but not multivariate modeling), DENV infections were positively associated with HOHs who were male, employed, and of younger age than households without infections (p<0.05). DENV infections were not associated with knowledge, attitude, or reported barriers to prevention activities.

          Discussion

          Specific actions that can be considered to decrease the risk of DENV infections in the household include targeting vector control in highly shaded properties, fumigating inside the home, and use of mosquito bed nets. Community-level interventions include cleanup of abandoned properties, daily garbage collection, and reliable piped water inside houses. These findings can inform interventions to reduce the risk of other diseases transmitted by the Ae. aegypti mosquito, such as chikungunya and Zika fever.

          Author summary

          Dengue, chikungunya and Zika viruses are transmitted to people primarily by the Aedes aegypti mosquitoes in tropical and subtropical regions. Diseases transmitted by the Ae. aegypti mosquito are a growing public health concern. Mosquito control is the principal means of preventing and controlling disease outbreaks. In this study, we compared the characteristics of households with and without DENV infections in the city of Machala, Ecuador. We found that risk factors for DENV infection included proximity to abandoned properties, interruptions in the piped water supply, and a highly shaded patio. Protective factors included the use of mosquito bed nets, fumigation inside the home, and piped water inside the home. These findings can be used to inform targeted interventions by the public health sector at the household and community levels.

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          Most cited references 60

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          Detecting the impact of temperature on transmission of Zika, dengue, and chikungunya using mechanistic models

          Recent epidemics of Zika, dengue, and chikungunya have heightened the need to understand the seasonal and geographic range of transmission by Aedes aegypti and Ae. albopictus mosquitoes. We use mechanistic transmission models to derive predictions for how the probability and magnitude of transmission for Zika, chikungunya, and dengue change with mean temperature, and we show that these predictions are well matched by human case data. Across all three viruses, models and human case data both show that transmission occurs between 18–34°C with maximal transmission occurring in a range from 26–29°C. Controlling for population size and two socioeconomic factors, temperature-dependent transmission based on our mechanistic model is an important predictor of human transmission occurrence and incidence. Risk maps indicate that tropical and subtropical regions are suitable for extended seasonal or year-round transmission, but transmission in temperate areas is limited to at most three months per year even if vectors are present. Such brief transmission windows limit the likelihood of major epidemics following disease introduction in temperate zones.
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            Is Dengue Vector Control Deficient in Effectiveness or Evidence?: Systematic Review and Meta-analysis

            Background Although a vaccine could be available as early as 2016, vector control remains the primary approach used to prevent dengue, the most common and widespread arbovirus of humans worldwide. We reviewed the evidence for effectiveness of vector control methods in reducing its transmission. Methodology/Principal Findings Studies of any design published since 1980 were included if they evaluated method(s) targeting Aedes aegypti or Ae. albopictus for at least 3 months. Primary outcome was dengue incidence. Following Cochrane and PRISMA Group guidelines, database searches yielded 960 reports, and 41 were eligible for inclusion, with 19 providing data for meta-analysis. Study duration ranged from 5 months to 10 years. Studies evaluating multiple tools/approaches (23 records) were more common than single methods, while environmental management was the most common method (19 studies). Only 9/41 reports were randomized controlled trials (RCTs). Two out of 19 studies evaluating dengue incidence were RCTs, and neither reported any statistically significant impact. No RCTs evaluated effectiveness of insecticide space-spraying (fogging) against dengue. Based on meta-analyses, house screening significantly reduced dengue risk, OR 0.22 (95% CI 0.05–0.93, p = 0.04), as did combining community-based environmental management and water container covers, OR 0.22 (95% CI 0.15–0.32, p 0.5), but insecticide aerosols (OR 2.03; 95% CI 1.44–2.86) and mosquito coils (OR 1.44; 95% CI 1.09–1.91) were associated with higher dengue risk (p = 0.01). Although 23/41 studies examined the impact of insecticide-based tools, only 9 evaluated the insecticide susceptibility status of the target vector population during the study. Conclusions/Significance This review and meta-analysis demonstrate the remarkable paucity of reliable evidence for the effectiveness of any dengue vector control method. Standardised studies of higher quality to evaluate and compare methods must be prioritised to optimise cost-effective dengue prevention.
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              Insecticide resistance in the major dengue vectors Aedes albopictus and Aedes aegypti

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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: Writing – original draftRole: Writing – review & editing
                Role: InvestigationRole: Project administrationRole: Validation
                Role: Project administrationRole: Validation
                Role: Funding acquisitionRole: Supervision
                Role: ConceptualizationRole: InvestigationRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Supervision
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS Negl Trop Dis
                PLoS Negl Trop Dis
                plos
                plosntds
                PLoS Neglected Tropical Diseases
                Public Library of Science (San Francisco, CA USA )
                1935-2727
                1935-2735
                18 December 2017
                December 2017
                : 11
                : 12
                Affiliations
                [1 ] Center for Global Health & Translational Sciences, SUNY Upstate Medical University, Syracuse, NY, United States of America
                [2 ] Facultad de Medicina, Universidad Técnica de Machala, Machala, El Oro Province, Ecuador
                [3 ] Facultad de Ingeniería Marítima, Ciencias Biológicas, Oceánicas y Recursos Naturales, Escuela Superior Politecnica del Litoral (ESPOL), Guayaquil, Ecuador
                [4 ] Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States of America
                [5 ] Department of Geography, University of Florida, Gainesville, FL, United States of America
                [6 ] Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States of America
                [7 ] College of Life Sciences, University of Kwazulu-Natal, Durban, South Africa
                [8 ] Department of Microbiology & Immunology, SUNY Upstate Medical University, Syracuse, NY, United States of America
                Oregon Health and Science University, UNITED STATES
                Author notes

                The authors have declared that no competing interests exist.

                Article
                PNTD-D-17-00758
                10.1371/journal.pntd.0006150
                5771672
                29253873
                © 2017 Kenneson et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 1, Tables: 3, Pages: 19
                Product
                Funding
                Funded by: U.S. Department of Defense Global Emerging Infection Surveillance (GEIS)
                Award ID: P0220_13_OT
                Award Recipient :
                Funded by: State University of New York Upstate Medical University (US)
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000076, Directorate for Biological Sciences;
                Award ID: 1518681
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000076, Directorate for Biological Sciences;
                Award ID: 1641145
                Award Recipient :
                Funded by: National Secretary of Higher Education, Science, Technology, and Innovation (SENESCYT) of Ecuador
                Award ID: Prometeo Fellowship
                Award Recipient :
                This study was supported in part by the U.S. Department of Defense Global Emerging Infection Surveillance (GEIS) grant (P0220_13_OT) and the Department of Medicine of SUNY Upstate Medical University. AMSI and SJR were additionally supported by NSF DEB EEID 1518681 and NSF DEB RAPID 1641145. Additional support was provided to AMSI through the Prometeo program of the National Secretary of Higher Education, Science, Technology, and Innovation (SENESCYT) of Ecuador. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Infectious Diseases
                Infectious Disease Control
                Biology and life sciences
                Organisms
                Viruses
                RNA viruses
                Flaviviruses
                Dengue Virus
                Biology and Life Sciences
                Microbiology
                Medical Microbiology
                Microbial Pathogens
                Viral Pathogens
                Flaviviruses
                Dengue Virus
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Pathogens
                Microbial Pathogens
                Viral Pathogens
                Flaviviruses
                Dengue Virus
                Biology and Life Sciences
                Organisms
                Viruses
                Viral Pathogens
                Flaviviruses
                Dengue Virus
                Ecology and Environmental Sciences
                Natural Resources
                Water Resources
                People and places
                Geographical locations
                South America
                Ecuador
                Medicine and Health Sciences
                Public and Occupational Health
                Medicine and Health Sciences
                Infectious Diseases
                Disease Vectors
                Insect Vectors
                Mosquitoes
                Biology and Life Sciences
                Species Interactions
                Disease Vectors
                Insect Vectors
                Mosquitoes
                Biology and Life Sciences
                Organisms
                Eukaryota
                Animals
                Invertebrates
                Arthropoda
                Insects
                Mosquitoes
                Medicine and Health Sciences
                Infectious Diseases
                Disease Vectors
                Insect Vectors
                Mosquitoes
                Aedes Aegypti
                Biology and Life Sciences
                Species Interactions
                Disease Vectors
                Insect Vectors
                Mosquitoes
                Aedes Aegypti
                Biology and Life Sciences
                Organisms
                Eukaryota
                Animals
                Invertebrates
                Arthropoda
                Insects
                Mosquitoes
                Aedes Aegypti
                Earth Sciences
                Geography
                Human Geography
                Housing
                Social Sciences
                Human Geography
                Housing
                Custom metadata
                vor-update-to-uncorrected-proof
                2018-01-17
                Since the publication includes confidential patient information, we cannot make the datasets fully available with the paper. This would be in violation of confidentiality as expressed in the Informed Consent approved by U.S. and Ecuadorian IRBs. This study reports the results of a two-year arbovirus surveillance study, where we collected sensitive patient information including demographics, clinical presentation, home address, and final disease diagnosis. The de-identified datasets in the current study are available from Lisa Ware at warel@ 123456upstate.edu on reasonable request.

                Infectious disease & Microbiology

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