Estimating the impact of city-wide Aedes aegypti population control: An observational study in Iquitos, Peru

Abstract

During the last 50 years, the geographic range of the mosquito Aedes aegypti has increased dramatically, in parallel with a sharp increase in the disease burden from the viruses it transmits, including Zika, chikungunya, and dengue. There is a growing consensus that vector control is essential to prevent Aedes-borne diseases, even as effective vaccines become available. What remains unclear is how effective vector control is across broad operational scales because the data and the analytical tools necessary to isolate the effect of vector-oriented interventions have not been available. We developed a statistical framework to model Ae. aegypti abundance over space and time and applied it to explore the impact of citywide vector control conducted by the Ministry of Health (MoH) in Iquitos, Peru, over a 12-year period. Citywide interventions involved multiple rounds of intradomicile insecticide space spray over large portions of urban Iquitos (up to 40% of all residences) in response to dengue outbreaks. Our model captured significant levels of spatial, temporal, and spatio-temporal variation in Ae. aegypti abundance within and between years and across the city. We estimated the shape of the relationship between the coverage of neighborhood-level vector control and reductions in female Ae. aegypti abundance; i.e., the dose-response curve. The dose-response curve, with its associated uncertainties, can be used to gauge the necessary spraying effort required to achieve a desired effect and is a critical tool currently absent from vector control programs. We found that with complete neighborhood coverage MoH intra-domicile space spray would decrease Ae. aegypti abundance on average by 67% in the treated neighborhood. Our framework can be directly translated to other interventions in other locations with geolocated mosquito abundance data. Results from our analysis can be used to inform future vector-control applications in Ae. aegypti endemic areas globally.\n\nAuthor SummaryDespite the growing threat of arboviruses, there is a dearth of best practices for the primary vector control tools used in the field. In the absence of cluster randomized control trials, evidence on the utility (or lack thereof) of vector control interventions must be gleaned from ongoing control programs. Motivated by 12 years of household-level Ae. aegypti abundance surveys and neighborhood-level space-spray campaign data from Iquitos, Peru, we developed a new framework to model mosquito abundance. In spite of significant spatial and temporal heterogeneity, we identified a statistically significant and practically important impact of the local Ministry of Health space-spray campaign, specifically, a reduction of mosquito abundance of 67% when coverage was optimal. Our framework can be directly applied to other locations with geolocated mosquito abundance data and our findings can be used to both optimize resources within Iquitos as well as inform future vector-control interventions in Ae. aegypti endemic areas globally.