Anti-larval measures for malaria control in The Gambia

描述（由申请人提供）：拟开展的研究重点是评估2种幼虫控制剂，即芽孢杆菌（Bacillus sphaericus, Bs）和苏云金芽孢杆菌（Bacillus thuringiensis var. israelensis, Bti） (VectoLex（r)和Vectobac(r), Valent Biosciences，美国）减少儿童临床疟疾的能力。在热带不同地区，有效的疟疾控制受到药物和杀虫剂耐药性的威胁，控制幼虫可能为有效控制提供新的选择。从历史上看，控制幼虫是成功的，但在过去50年里，它在很大程度上被忽视了。最近已证明，有希望的苯乙杆菌和苯乙杆菌的新配方对非洲疟疾的主要媒介具有良好的控制作用。使用这些产品比化学杀幼虫剂更好，因为它们有多种作用，并且在一起使用时似乎不会引起抗药性的演变。迄今为止，很少有试验测量了用bbs和Bti杀死幼虫的临床影响，这些试验受到聚类样本量小和缺乏聚类复制的限制，因此统计效力较低。迫切需要进行一项具有可重复性的更大规模的干预研究，以证明控制幼虫是一种有效的疟疾控制工具的概念，并使国际决策者能够根据控制幼虫的相对优点做出明智的决策。因此，我们建议在冈比亚开展一项大型集群随机干预试验，以调查控制幼虫降低儿童疟疾发病率的能力。这项研究的结果将对量化使用b和Bti在防治疟疾中的重要性作出重大贡献。

DESCRIPTION (provided by applicant): The proposed research focuses on the assessment of the ability of 2 larval control agents, Bacillus sphaericus (Bs) and B. thuringiensis var. israelensis (Bti) (VectoLex(r) and Vectobac(r), Valent Biosciences, USA) to reduce clinical malaria in children. Effective malaria control is under threat from drug and insecticide resistance in different parts of the tropics, and larval control may offer a new alternative for effective control. Larval control has been historically successful, but has been largely neglected over the last 50 years. Promising new formulations of Bs and Bti have recently been shown to give excellent control of the major vectors of malaria in Africa. Use of these products is better than chemical larvicides since they have multiple actions and do not appear to elicit the evolution of resistance when used together. To date few trials have measured the clinical impact of larviciding with Bs and Bti and these have been hampered by small sample size within clusters and a lack of replication of clusters and hence, low statistical power. A larger intervention study with replication is urgently required to demonstrate the proof of concept that larval control is an effective malaria control tool and to allow informed decision making by international policy makers of the relative merits of larval control. We therefore propose to carry out a large cluster-randomised intervention trial in The Gambia to investigate the ability of larval control to reduce malaria morbidity in children. The results from this study will make a major contribution to quantifying the importance of the use of Bs and Bti in the fight against malaria.