Efficacy of Wolbachia-Infected Mosquito Deployments for the Control of Dengue.
Efficacy of Wolbachia-Infected Mosquito Deployments for the Control of Dengue.
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DOI：
10.1056/nejmoa2030243
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发表时间：
2021-06-10
期刊：
影响因子：
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通讯作者：
AWED Study Group
中科院分区：
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作者：
Utarini A;Indriani C;Ahmad RA;Tantowijoyo W;Arguni E;Ansari MR;Supriyati E;Wardana DS;Meitika Y;Ernesia I;Nurhayati I;Prabowo E;Andari B;Green BR;Hodgson L;Cutcher Z;Rancès E;Ryan PA;O'Neill SL;Dufault SM;Tanamas SK;Jewell NP;Anders KL;Simmons CP;AWED Study Group
感染了管体沃尔巴克体（wMel株）的埃及伊蚊传播登革热病毒的可能性降低。我们进行了一项wmel感染Ae的集群随机试验。在印度尼西亚日惹市控制登革热。随机分配了24个地理集群，以接受wMel部署，作为当地蚊虫控制措施的辅助措施；或继续只采取本地灭蚊措施。采用阴性试验设计测量疗效。研究参与者为3-45岁，在初级保健诊所就诊的急性未分化发热患者。实验室检测确定了病毒学确诊的登革热病例和检测阴性对照。主要终点是wMel在减少由任何登革热病毒血清型引起的病毒学证实的有症状登革热发生率方面的疗效。在成功导入wMel后，8144名参与者被纳入干预组；3721例来自wmel处理的集群，4423例来自未处理的集群。在ITT分析中，经病毒学证实的登革热发生在wmel治疗组2905名参与者中的67名（2.3%）和未治疗组3401名参与者中的318名（9.4%）（OR 0.23, 95% CI， 0.15至0.35；P=0.004）：保护效果为77.1% （95% CI， 65.3至84.9）。四种血清型的保护效果相似。与未治疗组（102/3401,6.3%）相比，wMel治疗组（13/2905,2.8%）因病毒学证实的登革热住院的参与者较少：wMel对伊蚊的保护功效为86.2% （95% CI， 66.2至94.3）。埃及伊蚊种群有效地减少了有症状登革热的发病率，也减少了因登革热住院的人数。ClinicalTrials.gov标识符：NCT03055585和INA-A7OB6TW
Aedes aegypti mosquitoes infected with Wolbachia pipientis (wMel strain) have reduced potential to transmit dengue viruses. We conducted a cluster randomised trial of deployments of wMel-infected Ae. aegypti for control of dengue in Yogyakarta City, Indonesia. Twenty-four geographic clusters were randomly allocated to receive wMel deployments as an adjunct to local mosquito control measures; or to continue with local mosquito control measures only. A test-negative design was used to measure efficacy. Study participants were persons 3–45 years old attending primary care clinics with acute undifferentiated fever. Laboratory testing identified virologically-confirmed dengue cases and test-negative controls. The primary endpoint was efficacy of wMel in reducing the incidence of symptomatic, virologically-confirmed dengue, caused by any dengue virus serotype. Following successful introgression of wMel in intervention clusters, 8144 participants were enrolled; 3721 from wMel-treated clusters and 4423 from untreated clusters. In the ITT analysis virologically-confirmed dengue occurred in 67 of 2905 (2.3%) participants in the wMel-treated and 318 of 3401 (9.4%) in the untreated arm (OR 0.23, 95% CI, 0.15 to 0.35; P=0.004): protective efficacy of 77.1% (95% CI, 65.3 to 84.9). Protective efficacy was similar for the four serotypes. Hospitalisation for virologically-confirmed dengue was less frequent for participants resident in the wMel-treated (13/2905, 2.8%) compared to the untreated arm (102/3401, 6.3%): protective efficacy 86.2% (95% CI, 66.2 to 94.3) wMel introgression into Ae. aegypti populations was efficacious in reducing the incidence of symptomatic dengue, and also led to fewer dengue hospitalisations. ClinicalTrials.gov Identifier: NCT03055585 and INA-A7OB6TW