Dengue control

Chemical control

Larvicides
Although chemicals are widely used to treat Ae. aegypti larval habitats, larviciding should be
considered as complementary to environmental management and except in emergencies
should be restricted to containers that cannot otherwise be eliminated or managed.
Larvicides may be impractical to apply in hard-to-reach natural sites such as leaf axils and tree
holes, which are common habitats of Ae. albopictus, or in deep wells. The difficulty of accessing
indoor larval habitats of Ae. aegypti (e.g. water-storage containers, plant vases, saucers) to apply
larvicides is a major limitation in many urban contexts.
Larvicides in water-storage containers should have low toxicity to other species and should not
significantly change the taste, odour or colour of the water.
More information on safety, quality control, guidelines for testing, insecticide resistance and
application of larvicides is available from WHOPES.
Adulticides
Methods of chemical control that target adult vectors are intended to impact on mosquito densities,
longevity and other transmission parameters. Adulticides are applied either as residual surface
treatments or as space treatments.
Residual treatment
Perifocal treatment, as described above, has both adulticiding and larviciding effects. Suitable
insecticides can be applied with hand-operated compression sprayers. Care must be taken not to
treat containers used to store potable water.
Indoor residual spraying (IRS) is the application of long-acting chemical insecticides on the walls
and roofs of all houses and domestic animal shelters in a given area, in order to kill the adult
vector mosquitoes that land and rest on these surfaces.
More information on safety, quality control, guidelines for testing, insecticide resistance and
application of residual treatments is available from WHOPES.
Space sprays
Space spraying is recommended for control only in emergency situations to suppress an ongoing
epidemic or to prevent an incipient one. The objective of space spraying is the massive, rapid
destruction of the adult vector population.
Any control method that reduces the number of infective adult mosquitoes, even for a short time,
should reduce virus transmission during that time, but it remains unclear whether the transient
impact of space treatments is epidemiologically significant in the long run.
If space spraying is used early in an epidemic and on a sufficiently large scale, the intensity of
transmission may be reduced, which would give time for the application of other vector control
measures that provide longer-term control, including larviciding and community-based source
reduction.
Thus, if disease surveillance is sensitive enough to detect cases in the early stages of an
epidemic, and if the resources are available, emergency space spraying can be initiated at the
same time as source reduction measures and larviciding are intensified.
Space spraying efficiency is dependent on:
Method of release (aircraft, vehicle, hand-held equipment);
Fog types (cold or thermal);
Droplet size, application rate, climatic conditions;
Building structures, configuration and penetration of space sprays;
Target area size;
Terrain and accessibility;
Peak flight times.

More information on safety, quality control, guidelines for testing, insecticide resistance and
application of space spraying is available from WHOPES.
Treatment cycle
The treatment cycle of larvicide will depend on the species of mosquito, seasonality of
transmission, patterns of rainfall, duration of efficacy of the larvicide and types of larval habitat.
Two or three application rounds carried out annually in a timely manner with proper monitoring of
efficacy may suffice, especially in areas where the main transmission season is short.
When a rapid reduction in vector density is essential, such as in emergencies, space treatment
should ideally be carried out every 23 days for 10 days. Further applications should then be made
once or twice a week to sustain suppression of the adult vector population. Continuous
entomological and epidemiological surveillance should be conducted to determine the appropriate
application schedule and the effectiveness of the control strategy.

Controlling Dengue Outbreaks

Introduction
Because there is currently no effective vaccine against dengue and no specific treatment for the disease,
controlling and preventing dengue fever outbreaks are essential steps for keeping people healthy. What
methods are presently used or being developed to control dengue outbreaks in regions where the threat of
dengue is high?

Environmental Management of Dengue Mosquito Populations

Figure 1: Aedes aegypti container habitats

Aedes aegypti lay their eggs in containers such as
bottles, tires, fountains, barrels, and pots. By removing
these habitats, mosquitoes have fewer opportunities to
lay eggs. This strategy is called source reduction.
The primary preventative measure to reduce dengue
infections is the control of mosquito populations.
Because the transmission of dengue requires
mosquitoes as vectors, the spread of dengue can be
limited by reducing mosquito populations. What can
people at risk of dengue infections do to reduce the size of mosquito populations? One practical and
recommended environmental management strategy is to eliminate unnecessary container habitats that collect
water (such as plastic jars, bottles, cans, tires, and buckets) in which Aedes aegypti can lay their eggs (Figure
1). This strategy is called source reduction. When container habitats are removed and water storage
containers are covered with a fine mesh to prevent mosquitoes from getting inside them, mosquitoes have
fewer opportunities to lay eggs and cannot develop through their aquatic life stages. Source reduction can be
effective when performed regularly, especially when members of a community are mobilized and educated
about vector control.

Environmental management initiatives can also include major changes in a community, such as
installing water systems with direct connections to residences and replacing wells and other waterstorage containers, which can be mosquito-breeding habitats. Smaller-scale environmental changes
can also be effective. For example, mosquito populations can be reduced when all members of a
community clear blocked gutters and street drains and keep their yards free of containers with
standing water. Any open containers should be emptied and cleaned each week to eliminate
mosquito eggs and larvae. These efforts can reduce the number of mosquitoes living in an area.

What other measures can members of a community take to reduce mosquito populations?
Community-based approaches must go hand in hand with educational initiatives that teach people
about mosquito vectors and the risks of having mosquito-breeding habitats near their homes.
Educational initiatives can encourage people to take an active role in participating in source
reduction. Communities that understand the need to make behavioral changes are the most effective
in controlling dengue. In addition to steps that communities can take, what can individuals do to
protect themselves from dengue?

Personal Actions to Reduce Contact with Mosquitoes

People can reduce the risk of mosquitoes entering their homes by using window and door screens or by
keeping their doors and windows closed and using air conditioning to keep their homes cool. Aedes
aegypti typically bite people during the day, so wearing long pants and long-sleeved shirts can reduce
mosquito bites when spending time outdoors. In addition, mosquito repellents can be applied to exposed skin
and clothing to lower the risk of mosquito bites. The Centers for Disease Control recommends mosquito
repellents that contain DEET, picaridin, lemon eucalyptus oil, or IR3535 as the active ingredient. Sleeping
under a mosquito net can also provide protection from being bitten, particularly in areas where people rest in
the afternoon or in houses with infants. What about other methods of reducing mosquito populations?

Traps

Figure 2: Ovitrap
An ovitrap is a mosquito trap. It is a black, cylindrical container filled
with water that appears to be an ideal location for a female Aedes
aegypti to lay eggs. The female lays her eggs on the cardboard
paddles. The eggs then fall through the mesh into the water, where
the larvae hatch and develop into pupas. When the adult
mosquitoes emerge, they are trapped beneath the mesh and are
unable to escape from the ovitrap.
Another method of reducing Aedes aegypti is to use ovitraps
(Figure 2). What are ovitraps, and how do they work? These
devices are black, cylindrical containers filled with water. The top of
the ovitrap is fitted with a circular wire mesh and a floatation ring
that floats on the surface of the water in the container. Above the
mesh, two paddles are mounted. To Aedes aegypti, ovitraps appear
to be ideal locations to lay their eggs. The female lays its eggs on
the paddles. The eggs then fall beneath the mesh, where the
mosquitoes develop through the immature larval and pupal stages.

When the adult mosquitoes emerge, however, they are trapped beneath the mesh and are unable to escape
from the ovitrap. Some ovitraps have been adapted to include sticky surfaces that entrap adult mosquitoes,
and others include the use of a pesticide on the device. Ovitraps can be also used for mosquito surveillance.
When sufficient numbers of ovitraps are used and frequently maintained, the vector population can be
diminished. One successful example is in Singapore, where ovitraps were used to eliminate mosquitoes at the
international airport. Traps have limitations they require constant supervision and monitoring to prevent
them from becoming productive breeding habitats.

Chemical Control of Dengue Mosquitoes

Chemical control can be effective in controlling mosquito populations. For instance, insecticides can be used to
kill mosquito larvae or adult mosquitoes. Can insecticides be widely and routinely used? The use of
insecticides is recommended in emergency situations during dengue epidemics or when there is evidence that
an epidemic is emerging. On a regular basis, however, sustainable, coordinated, community-based
environmental approaches are favored over chemical methods for controlling mosquitoes, and limited reliance
on these chemicals is preferred. Why are environmental management approaches favored? One reason is that
mosquitoes can develop resistance to insecticides. In addition, insecticides are expensive, and high doses can
be toxic to humans and other species. Therefore, it is best to be cautious about applying these chemicals.

Bioinsecticides
Could safer insecticides be used to kill mosquitoes? Bioinsecticides are a combination of biological
controls and insecticides. One example of a bioinsecticide is Bacillus thuringiensis israelensis (Bti),
which is a naturally occurring soil bacterium that can effectively kill mosquito larvae present in water.
There are many strains of Bacillus thuringiensis, each having unique toxicity characteristics, and Bti is
very specific for mosquitoes. Bti is available in small, slow-release bricks called "mosquito dunks" that
float on the water surface and are effective in treating deep water. Other bioinsecticides, such as
pyriproxyfen and methoprene, act as juvenile hormone analogues that prevent mosquito larvae from
metamorphosizing into adults.
Recently, researchers used mosquitoes to transfer insecticides to larval habitats. They noticed that
after taking a blood meal, female Aedes aegypti enjoy resting in damp and dark areas. To take
advantage of this behavior, the researchers set up dark, damp stations dusted with a bioinsecticide
that targets larvae. When the mosquitoes came to rest on the stations, their legs picked up the
bioinsecticide and transferred it to the aquatic mosquito habitats where they laid their eggs. This
method was effective in killing the mosquito larvae and reducing the number of adult mosquitoes. Are
there any nonchemical approaches to reducing mosquito populations?

Biological Control of Dengue Mosquitoes

Figure 3: Mosquitofish eating mosquito larvae

Mosquitofish (Gambusia affinis) can be placed in
decorative ponds and other large container habitats to
prey on mosquito larvae and effectively prevent mosquito
development.

Biological approaches are also being considered as alternatives to control mosquito populations. For example,
predatory crustaceans called copepods and many varieties of fish, including mosquitofish and goldfish, eat
mosquito larvae (Figure 3). When these organisms are placed in container habitats, decorative ponds, and
pools, they prey on mosquito larvae, effectively preventing mosquito development. The addition of copepods
into large water-storage tanks was successful in limiting dengue transmission in Vietnam. Other live predators
such as dragonflies, small aquatic turtles, and beetle larvae have also been shown to be effective in
killingAedes aegypti.

New genetic approaches are also being considered as ways to control mosquito populations.
Researchers at the University of Oxford and Oxitec genetically engineered female mosquitoes that
cannot fly. Being flightless is a huge genetic disadvantage. The flightless female mosquitoes are
unable to "sing" and court with male mosquitoes using their wing oscillation "song." Predators can
more easily prey on flightless female mosquitoes. The researchers theorize that these genetically
engineered mosquitoes could be used to control mosquito populations and reduce dengue
transmission. The same group of researchers recently genetically modified male mosquitoes to be
sterile, and they released these mosquitoes in a trial in Grand Cayman, a Caribbean island, to wipe
out dengue fever.
Dr. Scott O'Neill and his colleagues at the University of Queensland, Australia, came up with another
innovative approach to control dengue transmission. These scientists infected mosquitoes with
bacteria called Wolbachia pipientis, a parasite that shortens the lives of fruit flies. They hypothesized
that Wolbachia could also shorten the lives of dengue-infected mosquitoes. Instead of eradicating
mosquitoes, the scientists aimed to use the bacteria to shift the age of the mosquito population.
Although mosquitoes would still be around, they would have shorter life spans than they do now. How
would a shorter mosquito life span affect dengue transmission? When a mosquito is infected with
dengue, eight to twelve days must pass before the mosquito can infect another healthy person, and

after that period, the mosquito can continue to infect people for the rest of its life, generally three to
four weeks. If its life span is shorter, an infected mosquito would have fewer opportunities to transmit
dengue. O'Neill and his colleagues are currently testing anotherWolbachia strain that seems to kill the
dengue virus inside Aedes aegypti, which could serve as a dengue vaccine for mosquitoes.

Summary
In the absence of an effective vaccine that protects humans from dengue, limiting contact between people and
vectors is the most effective way to prevent dengue infections. Environmental management approaches
involve eliminating the container habitats in whichAedes aegypti lay their eggs. Chemical control involves the
use of insecticides to kill immature or adult mosquitoes. New chemical, biological, and genetic approaches are
also being developed and may provide promising alternatives to control mosquito populations and prevent
dengue infections.

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