Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO 80523, USA.
J Med Entomol. 2009 Nov;46(6):1245-55. doi: 10.1603/033.046.0601.
Despite tremendous efforts by public health organizations in dengue-endemic countries, it has proven difficult to achieve effective and sustainable control of the primary dengue virus vector Aedes aegypti (L.) and to effectively disrupt dengue outbreaks. This problem has multiple root causes, including uncontrolled urbanization, increased global spread of dengue viruses, and vector and dengue control programs not being provided adequate resources. In this forum article, we give an overview of the basic elements of a vector and dengue control program and describe a continuous improvement cyclical model to systematically and incrementally improve control program performance by regular efforts to identify ineffective methods and inferior technology, and then replacing them with better performing alternatives. The first step includes assessments of the overall resource allocation among vector/dengue control program activities, the efficacy of currently used vector control methods, and the appropriateness of technology used to support the program. We expect this will reveal that 1) some currently used vector control methods are not effective, 2) resource allocations often are skewed toward reactive vector control measures, and 3) proactive approaches commonly are underfunded and therefore poorly executed. Next steps are to conceptualize desired changes to vector control methods or technologies used and then to operationally determine in pilot studies whether these changes are likely to improve control program performance. This should be followed by a shift in resource allocation to replace ineffective methods and inferior technology with more effective and operationally tested alternatives. The cyclical and self-improving nature of the continuous improvement model will produce locally appropriate management strategies that continually are adapted to counter changes in vector population or dengue virus transmission dynamics. We discuss promising proactive vector control approaches and the continued need for the vector and dengue control community to incorporate emerging technologies and to partner with academia, business and the community-at-large to identify new solutions that reduce dengue.
尽管登革热流行国家的公共卫生组织做出了巨大努力，但要实现有效和可持续地控制主要登革热病毒载体埃及伊蚊（Aedes aegypti）（L.）并有效阻断登革热疫情，事实证明这非常困难。这个问题有多个根本原因，包括城市化失控、登革热病毒的全球传播增加，以及病媒控制和登革热控制计划没有得到足够的资源。在这篇论坛文章中，我们概述了病媒和登革热控制计划的基本要素，并描述了一个持续改进的循环模型，通过定期努力识别无效方法和劣质技术，并以性能更好的替代方案取而代之，系统地、逐步地改进控制计划的绩效。第一步包括评估病媒/登革热控制计划活动之间的总体资源分配、当前使用的病媒控制方法的效果以及支持该计划的技术的适当性。我们预计这将揭示出：1）一些当前使用的病媒控制方法效果不佳；2）资源分配往往偏向于反应性病媒控制措施；3）主动方法通常资金不足，因此执行不力。接下来的步骤是构思对病媒控制方法或所使用技术的理想改变，然后在试点研究中确定这些改变是否有可能改善控制计划的绩效。接下来应将资源分配转向用更有效和经过操作测试的替代方案来取代无效方法和劣质技术。持续改进模型的循环和自我改进性质将产生适合当地的管理策略，这些策略将不断适应病媒种群或登革热病毒传播动态的变化。我们讨论了有前途的主动病媒控制方法，以及病媒和登革热控制界继续需要将新技术纳入其中，并与学术界、企业界和广大社区合作，以找到减少登革热的新解决方案。
