Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
Malar J. 2011 Dec 13;10:353. doi: 10.1186/1475-2875-10-353.
As malaria declines in many African countries there is a growing realization that new interventions need to be added to the front-line vector control tools of long-lasting impregnated nets (LLINs) and indoor residual spraying (IRS) that target adult mosquitoes indoors. Larval source management (LSM) provides the dual benefits of not only reducing numbers of house-entering mosquitoes, but, importantly, also those that bite outdoors. Large-scale LSM was a highly effective method of malaria control in the first half of the twentieth century, but was largely disbanded in favour of IRS with DDT. Today LSM continues to be used in large-scale mosquito abatement programmes in North America and Europe, but has only recently been tested in a few trials of malaria control in contemporary Africa. The results from these trials show that hand-application of larvicides can reduce transmission by 70-90% in settings where mosquito larval habitats are defined but is largely ineffectual where habitats are so extensive that not all of them can be covered on foot, such as areas that experience substantial flooding. Importantly recent evidence shows that LSM can be an effective method of malaria control, especially when combined with LLINs. Nevertheless, there are a number of misconceptions or even myths that hamper the advocacy for LSM by leading international institutions and the uptake of LSM by Malaria Control Programmes. Many argue that LSM is not feasible in Africa due to the high number of small and temporary larval habitats for Anopheles gambiae that are difficult to find and treat promptly. Reference is often made to the Ross-Macdonald model to reinforce the view that larval control is ineffective. This paper challenges the notion that LSM cannot be successfully used for malaria control in African transmission settings by highlighting historical and recent successes, discussing its potential in an integrated vector management approach working towards malaria elimination and critically reviewing the most common arguments that are used against the adoption of LSM.
随着疟疾在许多非洲国家的发病率下降，人们越来越认识到，需要在长效驱虫蚊帐（LLINs）和室内滞留喷洒（IRS）等针对室内成蚊的一线病媒控制工具之外，增加新的干预措施。幼虫源管理（LSM）不仅可以减少进入室内的蚊子数量，而且还可以减少重要的室外叮咬蚊子数量，具有双重效益。在 20 世纪上半叶，大规模 LSM 是一种非常有效的疟疾控制方法，但后来主要被 DDT 支持的 IRS 所取代。如今，LSM 继续在北美和欧洲的大规模蚊虫防治计划中使用，但直到最近才在当代非洲的一些疟疾控制试验中进行测试。这些试验的结果表明，在蚊虫幼虫栖息地明确的情况下，手动施药可以将传播减少 70-90%，但在栖息地非常广泛以至于无法步行覆盖所有栖息地的情况下，效果不大，例如经常发生大面积洪水的地区。重要的是，最近的证据表明，LSM 可以是一种有效的疟疾控制方法，尤其是与 LLINs 结合使用时。然而，一些误解甚至神话阻碍了国际领先机构倡导 LSM 的行动，也阻碍了疟疾控制规划采用 LSM。许多人认为，由于冈比亚按蚊的大量小而临时的幼虫栖息地难以发现和及时处理，LSM 在非洲是不可行的。人们经常提到罗斯-麦克唐纳模型来强化幼虫控制无效的观点。本文通过强调历史和近期的成功案例，讨论其在综合病媒管理方法中的潜力，以消除疟疾为目标，并批判性地审查反对采用 LSM 的最常见论点，从而挑战了在非洲传播环境中无法成功使用 LSM 进行疟疾控制的观点。
