Dengue cases and Aedes aegypti indices in Trinidad, West Indies.

This study was conducted to determine whether any relationships exist between Aedes aegypti indices, dengue seroprevalence and dengue transmission in County Victoria, Trinidad, West Indies. The cardinal points surveillance method was used to evaluate 50 suspected dengue fever (DF) cases. Thirty-three (33) confirmed DF cases were fully investigated within 48h of clinical diagnosis. Using retrospective data collected during the previous year (2003-2004) and study data, key premises and key containers were determined. Ninety-two percent of the houses were considered key premises, and 66% (22/33) of the houses with dengue positive cases harboured Ae. aegypti immature stages. These results showed that significantly (P<0.001) more adults (1050 vs 493) and immatures were collected during dengue case investigations than during routine inspection and treatment cycles. In addition, when the DF diagnosis was made the pupae per person rates increased from 0.65 to 1.35 with significantly (P<0.001) larger numbers of Ae. aegypti females emerging daily, increasing from 221 to 472.5. That is, the mosquito density required for DF transmission may be high for Trinidad given the high seroprevalence rates (94% among pregnant women). These results suggest that dengue transmission occurs, not at a fixed entomologic figure/quantity but rather at a variable level based on numerous factors including seroprevalence, mosquito density and climate. These findings have implications for effective programs: by combining cardinal points and the key premises approaches; vector control programs can now target the most productive containers in key premises thus reducing dengue transmission levels.