Efficacy of an attractive lethal ovitrap to reduce populations of Aedes mosquitoes: a controlled trial in Iquitos, Peru

IntroductionDengue, one of the most important arboviral infections worldwide, is transmitted primarily by the mosquito Aedes aegypti, a vector closely associated with human habitations. Because vector control is the primary prevention strategy for this disease novel tools are urgently needed. We evaluated an Attractive Lethal OviTrap (ALOT) that targets epidemiologically relevant gravid female mosquitoes for public health impact against dengue disease. MethodsWe conducted a proof-of-concept field efficacy trial in the Amazonian city of Iquitos, Peru, to quantify the reduction of vector density, parity, and sex ratio and symptomatic human dengue infection over a 3.5 year follow-up period. After three baseline entomological surveys in core (753 houses), and buffer (1,549 houses) areas where traps were placed in and around homes, and a control (1,233 houses) area without traps, entomological surveys were carried out every 2 months, and household residents were monitored for dengue disease 3 times a week. Trap maintenance was conducted at 2-3 week intervals by study staff during the first 2.5 years and by residents in the final year. ResultsTotal and female Ae. aegypti abundance demonstrated a strong initial effect with 52% and 47% fewer mosquitoes after trap placement, respectively (Total: RR = 0.48, 95% CI: 0.40 - 0.58, p < 0.001; Females: RR = 0.53, 95% CI: 0.43 - 0.66, p < 0.001). The effect diminished significantly, however, over the study period (interaction coefficient = 0.035 per month, p < 0.001; interaction coefficient = 0.030 per month, p < 0.001). Female-to-male ratio decreased after trap deployment and impact on non-Aedes abundance was like that of Aedes. Cumulative symptomatic dengue incidence was 1.40% (95% CI: 1.00%-1.70%) in the ALOT area versus 3.20% (95% CI: 2.60%-3.80%) in the control area, a 56% relative reduction (log-rank {chi}{superscript 2}=30.0, p<0.001). Restricted mean survival time analysis showed participants in the intervention area on average remained dengue-free for 15.5 additional days (95% CI: 11.1-20.0, p<0.001). ConclusionsThe ALOT strategy functioned as predicted, decreasing but not eliminating female vector densities, with a clear public health impact, lowering dengue disease in areas where traps were deployed. Our study also illustrates the challenges associated with conducting large-scale vector control trials and the need to consider programmatic implementation early in the process of bringing a new product to market. Author SummaryDengue is one of the most important mosquito transmitted infections worldwide. Aedes aegypti, the most important species involved, has a unique biology living in containers associated with households. New methods to control this mosquito are needed and we present our evaluation of a novel trap called the Attractive Lethal OviTrap (ALOT) that targets older female mosquitoes that are the most important for dengue disease transmission. We conducted a trial in the Amazonian city of Iquitos, Peru, to measure reductions in mosquito numbers, age, and sex ratio and symptomatic human dengue infections over a 3.5 years. After baseline entomological surveys prior to placing ALOT traps in homes in a treatment area, which included a central core area with 753 houses and a protective buffer area with 1,549 houses areas. We also had a control area without any traps in 1,233 houses. Mosquito surveys were carried out every 2 months, and household residents were monitored for dengue disease 3 times per week. Trap maintenance was conducted at 2 - 3 week intervals by study staff during the first 2.5 years and by residents in the final year. The number of all Ae. aegypti were initially reduced by 52% after trap placement whereas females were reduced by 47%. The effect diminished significantly, however, over the study period. Female-to-male ratio decreased after trap deployment and impact on other mosquito species was like that of Aedes. Dengue incidence was 56% less in the area with traps compared to the control area, estimating that participants in the intervention area on average remained dengue-free for 15.5 additional days. The ALOT strategy functioned as predicted, decreasing but not eliminating female mosquitos and had a clear public health impact, lowering dengue disease in areas where traps were deployed. Our study also illustrates the challenges associated with conducting large-scale vector control trials and the need to consider programmatic implementation early in the process of bringing a new product to market.