Mitigating Diseases Transmitted by Aedes Mosquitoes: A Cluster-Randomised Trial of Permethrin-Impregnated School Uniforms
Mitigating Diseases Transmitted by Aedes Mosquitoes: A Cluster-Randomised Trial of Permethrin-Impregnated School Uniforms
复制标题
DOI：
10.1371/journal.pntd.0005197
复制
发表时间：
2017-01-01
影响因子：
3.8
通讯作者：
Wilder-Smith, Annelies
中科院分区：
文献类型：
--
作者：
Kittayapong, Pattamaporn;Olanratmanee, Phanthip;Wilder-Smith, Annelies
背景通过伊蚊传播的病毒性疾病正在上升，如寨卡病毒、登革热和基孔肯雅病。迫切需要减轻伊蚊传播疾病的新工具。我们测试了是否商业化的浸渍校服可以减少登革热发病率在学龄儿童。MethodsWe设计了一个集群随机对照试验在泰国。主要终点是实验室确认的登革热感染。次要终点是旷课率;和浸渍制服的1小时击倒和24小时蚊子死亡率，如通过标准化WHOPES生物测定锥试验在基线和重复洗涤后测量的。此外，昆虫学评估教室内和学校以外的地区进行了carried.ResultsWe招收了1,811名6-17岁的学生从5个干预和5个对照学校。从1，655名学生中获得了配对血清样本。在对照学校，24/641（3.7%）和干预学校33/1,014（3.3%）的学生在一个学期（5个月）内有新的登革热感染证据。在对学校聚集性进行调整后，干预学校和对照学校之间发生登革热感染的学生比例没有显著差异。WHOPES锥形试验显示，在基线和最多4次洗涤时，暴露于浸渍衣物的埃及伊蚊的击倒率和死亡率为100%，但在20次洗涤后，该效力迅速下降至低于20%，对应于击倒率和蚊子死亡率每周分别降低4.7%和4.4%。昆虫学评估的结果表明，在采用浸渍制服后的一个月内，干预学校教室内捕获的埃及伊蚊的平均数量显著减少，与对照学校的教室相比，（p = 0.04）的平均值结论昆虫学评估表明，干预措施对治疗学校内的伊蚊数量有一定的影响，而在杀虫活性下降之前。然而，没有血清学证据表明，在五个月的学期里，对登革热感染的保护，最好的解释是氯菊酯在4次洗涤后迅速洗掉。如果可以通过新的技术方法克服氯菊酯的快速冲洗，那么经杀虫剂处理的衣服可能成为一种潜在的具有成本效益和可扩展的干预措施，以防止登革热，寨卡和基孔肯雅等伊蚊传播的疾病。
BackgroundViral diseases transmitted via Aedes mosquitoes are on the rise, such as Zika, dengue, and chikungunya. Novel tools to mitigate Aedes mosquitoes-transmitted diseases are urgently needed. We tested whether commercially insecticide-impregnated school uniforms can reduce dengue incidence in school children.MethodsWe designed a cluster-randomised controlled trial in Thailand. The primary endpoint was laboratory-confirmed dengue infections. Secondary endpoints were school absenteeism; and impregnated uniforms' 1-hour knock-down and 24 hour mosquito mortality as measured by standardised WHOPES bioassay cone tests at baseline and after repeated washing. Furthermore, entomological assessments inside classrooms and in outside areas of schools were conducted.ResultsWe enrolled 1,811 pupils aged 6-17 from 5 intervention and 5 control schools. Paired serum samples were obtained from 1,655 pupils. In the control schools, 24/641 (3.7%) and in the intervention schools 33/1,014 (3.3%) students had evidence of new dengue infections during one school term (5 months). There was no significant difference in proportions of students having incident dengue infections between the intervention and control schools, with adjustment for clustering by school. WHOPES cone tests showed a 100% knock down and mortality of Aedes aegypti mosquitoes exposed to impregnated clothing at baseline and up to 4 washes, but this efficacy rapidly declined to below 20% after 20 washes, corresponding to a weekly reduction in knock-down and mosquito mortality by 4.7% and 4.4% respectively. Results of the entomological assessments showed that the mean number of Aedes aegypti mosquitoes caught inside the classrooms of the intervention schools was significantly reduced in the month following the introduction of the impregnated uniforms, compared to those collected in classrooms of the control schools (p = 0.04)ConclusionsEntomological assessments showed that the intervention had some impact on the number of Aedes mosquitoes inside treatment schools immediately after impregnation and before insecticidal activity declined. However, there was no serological evidence of protection against dengue infections over the five months school term, best explained by the rapid washing-out of permethrin after 4 washes. If rapid washing-out of permethrin could be overcome by novel technological approaches, insecticide-treated clothes might become a potentially cost-effective and scalable intervention to protect against diseases transmitted by Aedes mosquitoes such as dengue, Zika, and chikungunya.