An immune System for the City: A New Paradigm for Surveillance and Control of Disease Vectors

Vector-borne pathogens continue to emerge, kill and harm humans with unrelenting regularity. Conventional strategies to controlling insect vectors grew out of the military; communication is hierarchical, responses unilateral, and regulation predetermined. We developed an alternative approach, modeled after the adaptive immune system, and compared the approaches through a cluster-randomized trial in the context of an ongoing urban Chagas disease vector control campaign in Arequipa, Peru. We report here early results from a pre-planned interim analysis. In the intervention (immune) arm 23 infested households were detected in 10 separate foci; in the control arm only 5 infested households were detected, and all were from the same focus. The immune approach was adaptive, and more effort was expended upon detection of an infestation (1085.2 person days in the immune arm vs 864.2 in the conventional; Rate ratio 23/1085.2:5/864.2 = 3.66 [1.35 12.38], p-value =0.0062). Vector surveillance approaches modeled after the immune system may be more effective than conventional approaches, especially in cities and other complex civilian environments. Author summaryVector-borne diseases kill and harm millions of people each year; many more infections are prevented through vector control campaigns. These have been developed in military contexts, and their hierarchical structures may be less effective in civilian settings. We developed an alternative approach to vector control, one that drew inspiration from the adaptive immune system, and show that it outperformed the conventional approach in the context of an ongoing Chagas disease vector control campaign in the city of Arequipa, Peru. Vector control strategies must work across scales, be flexible to shifting aims and budgets, and effectively harness the strengths of the communities they purport to protect. The immune system provides an effective model to achieve these aims.