This meeting was designed to follow up on a first workshop concerning the status of new dengue control strategies, held in November 2013. Participants reviewed currently available dengue control tools and strategies, providing expert opinion on the most effective ones targeting the primary urban dengue vector, Aedes aegypti, which can be utilized in combination with vaccination.
Continuing to focus on the vector control approach with the largest impact
The workshop’s overriding goal was to reach consensus on what vector control tools and strategies have the biggest impact on the reduction of DENV transmission. Another objective of the meeting was to address the design of trials, either alone or in combination with vaccination.
A triple focus to advance scientific understanding
The workshop was organized around three pillars:
A questionnaire was used to obtain expert opinion on the relative effectiveness of vector control interventions
Reviews of major dengue and malaria control interventions, dengue epidemiology, dengue vaccines, and trial design were presented
A recommendation on currently available vector control strategies that should be coupled with dengue vaccination was presented
Workshop outcomes
Of currently available methods, indoor residual spraying (termed “targeted IRS” or TIRS, to distinguish it from malaria IRS interventions) was thought to be most effective, although insecticide resistance would reduce efficacy in certain situations and must be prospectively evaluated. Experts concluded that TIRS is the best available strategy to control urban populations of Ae. aegypti and prevent dengue. While there is evidence TIRS significantly reduces populations of adult Ae. aegypti, randomized controlled trials (RCTs) with epidemiological-endpoint data have not been conducted. Moreover, TIRS associated with larvae control could provide the highest effectiveness.
It was agreed that the “gold standard” trial design is an RCT. The working group also made several other recommendations.
Progress towards reducing transmission of the virus
PDC’s expectation is that when an effective DENV vaccine is commercially available, the public health community will continue to rely on vector control because the two strategies complement and enhance one another. The work accomplished by workshop participants supports efforts to determine which vector control approaches, when utilized in combination with vaccination, will have the greatest impact on reduction of DENV transmission.
Nicole Achee, Uniformed Services University of the Health Sciences / University of Notre Dame
Kate Antrobus, Lion’s Head
Roberto Barrera, CDC
Thomas Burkot, James Cook University
David Chadee, University of the West Indies
Greg Devine, Queensland Institute of Medical Research
Benjamin D’Hont, PDC
Catherine Dutel, PDC
Timothy Endy, Upstate Medical University
Duane Gubler, PDC / Duke University
Joachim Hombach, WHO
Immo Kleinschmidt, London School of Hygiene & Tropical Medicine
Andrew Lane, LANE medical writing services
Audrey Lenhart, CDC
Steve Lindsay, Durham University
Mathias Mondy, IVCC
Amy Morrison, University of California
Alan Perkins, University of California
Robert Reiner, Indiana University
Paul Reiter, Pasteur Institute
Scott Ritchie, James Cook University
Peter Ryan, Monash University
Mitra Saadatian-Elahi, PDC
Thomas W. Scott, University of California
François Simondon, IRD
Daniel Strickman, Bill & Melinda Gates Foundation
Rémy Teyssou, PDC
Kirsten Vannice, WHO
Gonzalo Vazquez-Prokopec, Emory University
Raman Velayudhan, WHO
Simon Warner, OXITEC Ltd
Program – Day 1
09h00 – 12h00
General opening session and introduction (T. Scott)
Conclusions from 2013 ASTMH meeting (Washington) (N. Achee)
Prioritized list of vector control for dengue control:
Feasibility matrices (S. Ritchie, G. Devine, D. Chadee)
New insecticide formulations/methods in development (A. Lenhart)
Lessons learned from vector control assessments for malaria (T. Burkot)
13h00 – 17h00
Measuring epidemiological impact for assessing efficacy (S. Lindsay)
Lessons learned from dengue prevention programs:
Traditional dengue control (A. Morrison)
Wolbachia (P. Ryan)
Spatial repellants (N. Achee)
Lethal ovitraps (R. Barrera)
RIDL (S. Warner)
How to define and implement appropriate metrics (D. Smith)
Program – Day 2
09h00 – 10h30
Develop a study design (T. Scott)
The vaccine perspective (T. Endy)
The vector control perspective (S. Ritchie)
11h00 – 12h00
Study design options and considerations (Part 1) (R. Reiner)
13h00 – 16h30
Study design options and considerations (Part 2) (R. Reiner)
16h30 – 17h00
Conclusions
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This meeting was designed to follow up on a first workshop concerning the status of new dengue control strategies, held in November 2013. Participants reviewed currently available dengue control tools and strategies, providing expert opinion on the most effective ones targeting the primary urban dengue vector, Aedes aegypti, which can be utilized in combination with vaccination.
Continuing to focus on the vector control approach with the largest impact
The workshop’s overriding goal was to reach consensus on what vector control tools and strategies have the biggest impact on the reduction of DENV transmission. Another objective of the meeting was to address the design of trials, either alone or in combination with vaccination.
A triple focus to advance scientific understanding
The workshop was organized around three pillars:
A questionnaire was used to obtain expert opinion on the relative effectiveness of vector control interventions
Reviews of major dengue and malaria control interventions, dengue epidemiology, dengue vaccines, and trial design were presented
A recommendation on currently available vector control strategies that should be coupled with dengue vaccination was presented
Workshop outcomes
Of currently available methods, indoor residual spraying (termed “targeted IRS” or TIRS, to distinguish it from malaria IRS interventions) was thought to be most effective, although insecticide resistance would reduce efficacy in certain situations and must be prospectively evaluated. Experts concluded that TIRS is the best available strategy to control urban populations of Ae. aegypti and prevent dengue. While there is evidence TIRS significantly reduces populations of adult Ae. aegypti, randomized controlled trials (RCTs) with epidemiological-endpoint data have not been conducted. Moreover, TIRS associated with larvae control could provide the highest effectiveness.
It was agreed that the “gold standard” trial design is an RCT. The working group also made several other recommendations.
Progress towards reducing transmission of the virus
PDC’s expectation is that when an effective DENV vaccine is commercially available, the public health community will continue to rely on vector control because the two strategies complement and enhance one another. The work accomplished by workshop participants supports efforts to determine which vector control approaches, when utilized in combination with vaccination, will have the greatest impact on reduction of DENV transmission.
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