El 12 de mayo de 2017 celebramos en la Fundación Ramó Areces una jornada con IS Global y Unitaid sobre enfermedades transmitidas por vectores, como la malaria, entre otras.

1. Urban mosquito control
with mosquito-disseminated
pyriproxyfen
Fernando Abad-Franch
Sérgio LB Luz
Centro de Pesquisa René Rachou
Instituto Leônidas e Maria Deane
Bringing innovation to the frontline: new tools to advance the global response to vector-borne diseases
ISGlobal / UNITAID / WHO Madrid, May 2017

2. Mosquito-disseminated PPF
Dengue Chikungunya
Zika Yellow fever
~1500 cases
~240 deaths
>210,000 cases
>2500 microcephaly

3. Mosquito-disseminated PPF
Aedes aegypti
Aedes albopictus

4. Mosquito-disseminated PPF

5. Mosquito-disseminated PPF

6. Mosquito-disseminated PPF

7. Mosquito-disseminated PPF
• The problem (or at least a key issue)
• Cryptic and inaccessible breeding sites
• Surveillance and control

8. Mosquito-disseminated PPF

9. Mosquito-disseminated PPF

10. Mosquito-disseminated PPF

11. Mosquito-disseminated PPF

12. Question 1
Would it actually work at spatial
scales relevant to vector control?
In particular, we first asked,
• How far do mosquitoes carry PPF?
• What breeding-site coverage can we achieve?
• What effect will this have on juvenile mortality?
• What effect will this have on adult emergence?
Trial 1
Mosquito-disseminated PPF

13. Mosquito-disseminated PPF

14. SumiLarv®
Pyriproxyfen 0.5%
~5g

19. Dwelling-level coverage (%)
0 10050
3 – 400m
Mosquito-disseminated PPF
100%

20. Breeding site-level coverage
94.3%
Mosquito-disseminated PPF

21. Juvenile Aedes aegypti mortality
Mosquito-disseminated PPF
~95%
~5%

22. 0
200
400
600
800
1000
1200
1400
1600
Before During
Adult mosquito emergence
Adultsemerging
fromSBSspermonth
10-fold fall
Mosquito-disseminated PPF

23. Nice, but...
Our study site was a small island…
in an ocean of mosquitoes
Mosquito-disseminated PPF

24. In particular, we wanted to ask,
• What are the effects on house infestation?
• What are the effects on mosquito catches?
• What are the effects on juvenile mortality?
• What are the effects on adult emergence?
Trial 2
Question 2
Would it actually work
in a whole city?
Mosquito-disseminated PPF

25. Question 2
Would it actually work
in a whole city?
Mosquito-disseminated PPF

26. ~1 km
12m 5m 3m 3m
CONVENTIONAL CONTROL CITYWIDE FOCAL AFTER
MANACAPURU
• 60,000 people
• 13,500 dwellings
• 650 hectares
1000 DSs
Mosquito-disseminated PPF

27. Mosquito-disseminated PPF

28. House infestation (Aedes spp.)
95% CI
Before (2 surveys)
Before (1 survey)
After (2 surveys)
After (1 survey)
DISSEMINATION
(CONVENTIONAL
CONTROL)
9%
97%
CITYWIDE
FOCAL
Mosquito-disseminated PPF
10-fold fall

29. Aedes juvenile catch (# per SBS)
0.1
4.82 Before (2 surveys)
Before (1 survey)
After (2 surveys)
After (1 survey)
DISSEMINATION
(CONVENTIONAL
CONTROL)
Mosquito-disseminated PPF
>40-fold fall
CITYWIDE
FOCAL

30. Aedes juvenile mortality in SBSs
95% CI
96%
~5%
Before (2 surveys)
Before (1 survey)
After (2 surveys)
After (1 survey)
DISSEMINATION
(CONVENTIONAL
CONTROL)
Mosquito-disseminated PPF
CITYWIDE
FOCAL

31. Adult Aedes emergence (# per SBS)
Females
Males
Total
Mosquito-disseminated PPF
>100-fold fall

32. Females
Aedes albopictus
Females per house
1 500
Phase
CITYWIDE
DISSEMINATION
BEFORE
AFTER
(CONVENTIONAL
CONTROL)
FOCAL
DISSEMINATION

33. Females
Aedes aegypti
Females per house
1 500
Phase
CITYWIDE
DISSEMINATION
BEFORE
AFTER
(CONVENTIONAL
CONTROL)
FOCAL
DISSEMINATION

34. 0246810
Feb14
Mar14
Apr14
May14
Jun14
Jul14
Ago14
Sep14
Oct14
Dec14
Jan15
Feb15
Mar15
Apr15
May15
Jun15
Jul15
Ago15
Sep15
Oct15
Nov15
Dec15
Jan16
93-97%
Femalesperhouse
Aedes females – emergence
GLMMs
Mosquito-disseminated PPF
• Weather
• Repeated measures

35. >1 per person
~1 per 10 people
~1 per 100 people
~1 per 450 people
Mosquito-disseminated PPF
Before (2 surveys)
Before (1 survey)
After (2 surveys)
After (1 survey)
DISSEMINATION
(CONVENTIONAL
CONTROL)
Aedes females – emergence (# per person)
CITYWIDE
FOCAL
Ø

36. Naïve population
(100% susceptible)
Ross-Macdonald
Basic Reprodutive Number
EPIDEMIC
OUTBREAK
Each case
generates > 1 case
Each case
generates < 1 case
TRANSMISSION BLOCK
CONTROL
Would PPF block transmission?
Mosquito-disseminated PPF

37. • Juvenile mortality reaches 90 – 95%
Aedes spp. control with
mosquito-disseminated pyriproxyfen
In theory, this will block
epidemic transmission
• Mosquitoes carry PPF at least to 400m
• Breeding-site coverage is over 94%
• Mosquito catch falls over 40-fold
• Adult emergence falls over 100-fold
• Female emergence falls to <0.005/person-month
Mosquito-disseminated PPF

38. Will it really
block transmission?
How can we scale it up?
How can we improve it?
Urban mosquito control with
mosquito-disseminated pyriproxyfen
…more questions…
Mosquito-disseminated PPF

39. Mosquito-disseminated PPF

40. Matched-pair
Cluster
Randomized
Controlled
Trial
Minas Gerais Amazonas
Mosquito-disseminated PPF

41. Mosquito-disseminated PPF
Minas Gerais Amazonas

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SBSs
Aspiration
Sero-conversion
Mosquito-disseminated PPF

43. 6m 6m 6m 6m
S1 S2 S3 S4
   
Mosquito-disseminated PPF
Design – Protocols Partnerships

44. Mosquito-disseminated PPF
Operational research
Community involvement
Integrative strategies
Feasibility, cost-effectiveness…
Impact on infection and disease

45. Sérgio Luz Samael Padilla Gonçalo Ferraz Fernando AbadElvira Zamora
Urban mosquito control with
mosquito-disseminated pyriproxyfen
Bringing innovation to the frontline:
new tools to advance the global response to vector-borne diseases
ISGlobal / UNITAID / WHO 11-12 May 2017, Madrid, Spain

46. fernando.abad@cpqrr.fiocruz.br
abadfr@yahoo.com
Thanks
Bringing innovation to the frontline:
new tools to advance the global response to vector-borne diseases
ISGlobal / UNITAID / WHO 11-12 May 2017, Madrid, Spain