Alvarado-Castro Víctor, Paredes-Solís Sergio, Nava-Aguilera Elizabeth, Morales-Pérez Arcadio, Alarcón-Morales Lidia, Balderas-Vargas Norma Alejandra, Andersson Neil
Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, Mexico.
Unidad Académica de Matemáticas, Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, Mexico.
BMC Public Health. 2017 May 30;17(Suppl 1):384. doi: 10.1186/s12889-017-4290-z.
The Aedes aegypti mosquito is the vector for dengue fever, yellow fever, chikungunya, and zika viruses. Inadequate vector control has contributed to persistence and increase of these diseases. This review assesses the evidence of effectiveness of different control measures in reducing Aedes aegypti proliferation, using standard entomological indices.
A systematic search of Medline, Ovid, BVS, LILACS, ARTEMISA, IMBIOMED and MEDIGRAPHIC databases identified cluster randomised controlled trials (CRCTs) of interventions to control Aedes aegypti published between January 2003 and October 2016. Eligible studies were CRCTs of chemical or biological control measures, or community mobilization, with entomological indices as an endpoint. A meta-analysis of eligible studies, using a random effects model, assessed the impact on household index (HI), container index (CI), and Breteau index (BI).
From 848 papers identified by the search, eighteen met the inclusion criteria: eight for chemical control, one for biological control and nine for community mobilisation. Seven of the nine CRCTs of community mobilisation reported significantly lower entomological indices in intervention than control clusters; findings from the eight CRCTs of chemical control were more mixed. The CRCT of biological control reported a significant impact on the pupae per person index only. Ten papers provided enough detail for meta-analysis. Community mobilisation (four studies) was consistently effective, with an overall intervention effectiveness estimate of -0.10 (95%CI -0.20 - 0.00) for HI, -0.03 (95%CI -0.05 - -0.01) for CI, and -0.13 (95%CI -0.22 - -0.05) for BI. The single CRCT of biological control had effectiveness of -0.02 (95%CI -0.07- 0.03) for HI, -0.02 (95%CI -0.04- -0.01) for CI and -0.08 (95%CI -0.15- -0.01) for BI. The five studies of chemical control did not show a significant impact on indices: the overall effectiveness was -0.01 (95%CI -0.05- 0.03) for HI, 0.01 (95% CI -0.01- 0.02) for CI, and 0.01 (95%CI -0.03 - 0.05) for BI.
Governments that rely on chemical control of Aedes aegypti should consider adding community mobilization to their prevention efforts. More well-conducted CRCTs of complex interventions, including those with biological control, are needed to provide evidence of real life impact. Trials of all interventions should measure impact on dengue risk.
埃及伊蚊是登革热、黄热病、基孔肯雅热和寨卡病毒的传播媒介。媒介控制不力导致这些疾病持续存在并蔓延。本综述使用标准昆虫学指标评估不同控制措施在减少埃及伊蚊繁殖方面的有效性证据。
对Medline、Ovid、BVS、LILACS、ARTEMISA、IMBIOMED和MEDIGRAPHIC数据库进行系统检索，以确定2003年1月至2016年10月期间发表的关于控制埃及伊蚊干预措施的整群随机对照试验（CRCT）。符合条件的研究为以昆虫学指标为终点的化学或生物控制措施或社区动员的CRCT。使用随机效应模型对符合条件的研究进行荟萃分析，评估对家庭指数（HI）、容器指数（CI）和布雷图指数（BI）的影响。
在检索到的848篇论文中，18篇符合纳入标准：8篇关于化学控制，1篇关于生物控制，9篇关于社区动员。9项社区动员CRCT中的7项报告干预组的昆虫学指标显著低于对照组；8项化学控制CRCT的结果则更为复杂。生物控制的CRCT仅报告了对每人蛹指数有显著影响。10篇论文提供了足够的详细信息用于荟萃分析。社区动员（4项研究）始终有效，HI的总体干预效果估计为-0.10（95%CI -0.20 - 0.00），CI为-0.03（95%CI -0.05 - -0.01），BI为-0.13（95%CI -0.22 - -0.05）。生物控制的单项CRCT中，HI的有效性为-0.02（95%CI -0.07 - 0.03），CI为-0.02（95%CI -0.04 - -0.01），BI为-0.08（95%CI -0.15 - -0.01）。5项化学控制研究未显示对指数有显著影响：HI的总体有效性为-0.01（95%CI -0.05 - 0.03），CI为0.01（95%CI -0.01 - 0.02），BI为0.01（95%CI -0.03 - 0.05）。
依赖化学方法控制埃及伊蚊的政府应考虑在其预防措施中增加社区动员。需要更多开展良好的复杂干预措施的CRCT，包括那些采用生物控制的措施，以提供实际影响的证据。所有干预措施的试验都应测量对登革热风险的影响。
