Is Dengue Vector Control Deficient in Effectiveness or Evidence?: Systematic Review and Meta-analysis.
Is Dengue Vector Control Deficient in Effectiveness or Evidence?: Systematic Review and Meta-analysis.
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DOI：
10.1371/journal.pntd.0004551
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发表时间：
2016-03
影响因子：
3.8
通讯作者：
McCall PJ
中科院分区：
文献类型：
--
作者：
Bowman LR;Donegan S;McCall PJ
虽然疫苗最早可能在2016年问世，但病媒控制仍然是预防登革热的主要方法，登革热是全球人类最常见和最广泛的虫媒病毒。我们回顾了病媒控制方法在减少其传播方面有效性的证据。1980年以来发表的任何设计的研究，如果评价了针对埃及伊蚊或Ae的方法，则纳入。白纹伊蚊至少3个月。主要结果是登革热发病率。根据科克伦和PRISMA小组指南，数据库检索得到960份报告，41份符合纳入条件，19份提供了荟萃分析的数据。研究持续时间范围为5个月至10年。评价多种工具/方法的研究（23项记录）比单一方法更常见，而环境管理是最常见的方法（19项研究）。只有9/41份报告是随机对照试验（RCT）。在评估登革热发病率的19项研究中，有2项是随机对照试验，均未报告任何统计学显著影响。没有随机对照试验评估杀虫剂空间喷洒（雾化）对登革热的有效性。根据荟萃分析，房屋筛查显著降低了登革热风险，OR 0.22（95% CI 0.05-0.93，p = 0.04），结合社区环境管理和水容器覆盖，OR 0.22（95% CI 0.15-0.32，p<0.0001）。室内滞留喷洒（IRS）对感染风险没有显著影响（OR 0.67; 95% CI 0.22-2.11; p = 0.50）。皮肤驱避剂、驱虫蚊帐或诱捕器没有影响（p>0.5），但杀虫剂气雾剂（OR 2.03; 95% CI 1.44-2.86）和蚊香（OR 1.44; 95% CI 1.09-1.91）与较高的登革热风险相关（p = 0.01）。尽管23/41项研究检查了基于杀虫剂的工具的影响，但只有9项研究在研究期间评估了目标病媒群体的杀虫剂敏感性状态。本综述和荟萃分析表明，任何登革热病媒控制方法的有效性的可靠证据都非常缺乏。必须优先考虑更高质量的标准化研究，以评估和比较方法，以优化具有成本效益的登革热预防。登革热在过去50年中急剧增加，今天是最广泛的蚊媒虫媒病毒疾病，影响了128个国家近一半的世界人口。在疫苗问世之前，控制伊蚊媒介一直是预防登革热感染的唯一方法。随着登革热疫情发生的频率和强度不断增加，我们对文献进行了系统回顾和荟萃分析，以评估目前可用的病媒控制策略的有效性。41项研究（持续时间从5个月到10年）被纳入综述。大多数研究调查了方法的组合，但只有9项研究是随机对照试验（RCT）。值得注意的是，没有随机对照试验评估杀虫剂空间喷洒（室外雾化）对登革热的有效性，这是全球范围内对登革热疫情的主要应对措施。然而，有限的证据表明，房屋筛查和在较小程度上，以社区为基础的环境管理与水容器盖可以减少登革热感染的风险。然而，驱蚊剂、蚊帐和捕蚊器没有效果，而杀虫剂气雾剂和蚊香与较高的登革热风险有关。然而，符合纳入条件的少数研究的质量总体上很差，证据基础非常薄弱，损害了就提供适当和有效控制提出建议的知识基础。由于缺乏可靠的证据，高质量的标准化研究现在必须优先考虑。
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. 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<0.0001). Indoor residual spraying (IRS) did not impact significantly on infection risk (OR 0.67; 95% CI 0.22–2.11; p = 0.50). Skin repellents, insecticide-treated bed nets or traps had no effect (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. 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. Dengue fever has increased dramatically over the past 50 years and today is the most widespread mosquito-borne arboviral disease, affecting nearly half the world’s population in 128 countries. Until the arrival of a vaccine, control of its Aedes vectors has been the only method to prevent dengue infection. With dengue outbreaks occurring at increasing frequency and intensity, we undertook a systematic review and meta-analysis of the literature, to evaluate the evidence for effectiveness of vector control strategies currently available. Forty-one studies (from 5 months to 10 years duration) were included in the review. Most studies investigated combinations of approaches but only 9 studies were randomized controlled trials (RCTs). Remarkably, no RCTs evaluated effectiveness against dengue of insecticide space-spraying (outdoor fogging), the main response to dengue outbreaks used worldwide. Nevertheless, there was limited evidence indicating that house screening and to a lesser extent, community-based environmental management with water container covers could reduce risk of dengue infection. However, skin repellents, bed nets and mosquito traps had no effect while insecticide aerosols and mosquito coils were associated with higher dengue risk. However, the quality of the few studies eligible for inclusion was poor overall, and the evidence base is very weak, compromising the knowledge base for making recommendations on delivery of appropriate and effective control. Given this paucity of reliable evidence, standardised studies of higher quality must now be a priority.