哪种干预措施更有利于疟疾媒介控制：杀虫剂混合长效杀虫蚊帐还是与室内滞留喷洒相结合的标准拟除虫菊酯蚊帐？
Which intervention is better for malaria vector control: insecticide mixture long-lasting insecticidal nets or standard pyrethroid nets combined with indoor residual spraying?
机构信息
London School of Hygiene and Tropical Medicine (LSHTM), London, UK.
Centre de Recherches Entomologiques de Cotonou (CREC), Cotonou, Benin.
出版信息
Malar J. 2017 Aug 16;16(1):340. doi: 10.1186/s12936-017-1987-5.
BACKGROUND
Malaria control today is threatened by widespread insecticide resistance in vector populations. The World Health Organization (WHO) recommends the use of a mixture of unrelated insecticides for indoor residual spraying (IRS) and long-lasting insecticidal nets (LNs) or as a combination of interventions for improved vector control and insecticide resistance management. Studies investigating the efficacy of these different strategies are necessary.
METHODS
The efficacy of Interceptor G2 LN, a newly developed LN treated with a mixture of chlorfenapyr (a pyrrole) and alpha-cypermethrin (a pyrethroid), was compared to a combined chlorfenapyr IRS and Interceptor LN (a standard alpha-cypermethrin LN) intervention in experimental huts in Cove Southern Benin, against wild, free-flying, pyrethroid-resistant Anopheles gambiae s.l. A direct comparison was also made with a pyrethroid-only net (Interceptor LN) alone and chorfenapyr IRS alone.
RESULTS
WHO resistance bioassays performed during the trial demonstrated a pyrethroid resistance frequency of >90% in the wild An. gambiae s.l. from the Cove hut site. Mortality in the control (untreated net) hut was 5%. Mortality with Interceptor LN (24%) was lower than with chlorfenapyr IRS alone (59%, P < 0.001). The combined Interceptor LN and chlorfenapyr IRS intervention and the mixture net (Interceptor G2 LN) provided significantly higher mortality rates (73 and 76%, respectively) and these did not differ significantly between both treatments (P = 0.15). Interceptor LN induced 46% blood-feeding inhibition compared to the control untreated net, while chlorfenapyr IRS alone provided none. Both mixture/combination strategies also induced substantial levels of blood-feeding inhibition (38% with combined interventions and 30% with Interceptor G2 LN). A similar trend of improved mortality of pyrethroid-resistant An. gambiae s.l. from Cove was observed with Interceptor G2 LN (79%) compared to Interceptor LN (42%, P < 0.001) in WHO tunnel tests.
CONCLUSION
The use of chlorfenapyr and alpha-cypermethrin together as a mixture on nets (Interceptor G2 LN) or a combined chlorfenapyr IRS and pyrethroid LN intervention provides improved control of pyrethroid-resistant malaria vectors by inducing significantly higher levels of mortality through the chlorfenapyr component and providing personal protection through the pyrethroid component. Both strategies are comparable in their potential to improve the control of malaria transmitted by pyrethroid resistant mosquito vectors.
背景
今天，由于媒介种群中广泛存在的杀虫剂抗性，疟疾控制受到了威胁。世界卫生组织（WHO）建议将不相关的杀虫剂混合使用，用于室内滞留喷洒（IRS）和长效杀虫蚊帐（LN），或作为改进病媒控制和杀虫剂抗性管理的干预措施组合。有必要开展研究，以评估这些不同策略的效果。
方法
在贝宁南部 Cove 的实验性小屋中，比较了新开发的氯氟氰菊酯（吡咯）和 alpha-氯氰菊酯（拟除虫菊酯）混合物处理的 LN（Interceptor G2 LN）与氯氟氰菊酯 IRS 和Interceptor LN（标准 alpha-氯氰菊酯 LN）联合干预措施对野外、自由飞行、对拟除虫菊酯具有抗性的冈比亚按蚊复合体的效果。还直接比较了单独使用拟除虫菊酯网（Interceptor LN）和单独使用氯氟氰菊酯 IRS 的效果。
结果
试验期间进行的 WHO 抗药性生物测定表明， Cove 小屋地点的野生冈比亚按蚊复合体对拟除虫菊酯的抗药性频率超过 90%。对照（未处理的蚊帐）小屋中的死亡率为 5%。Interceptor LN（24%）的死亡率低于氯氟氰菊酯 IRS 单独使用（59%，P<0.001）。Interceptor LN 和氯氟氰菊酯 IRS 联合干预以及混合网（Interceptor G2 LN）提供了更高的死亡率（分别为 73%和 76%），两种处理之间的死亡率没有显著差异（P=0.15）。Interceptor LN 诱导的血液摄入量抑制率为 46%，与对照未处理的蚊帐相比，而氯氟氰菊酯 IRS 单独使用则没有抑制作用。两种混合/组合策略还诱导了相当高的血液摄入量抑制率（联合干预措施为 38%，Interceptor G2 LN 为 30%）。在 WHO 隧道试验中，与使用 Interceptor LN（42%，P<0.001）相比，Cove 的耐拟除虫菊酯冈比亚按蚊复合体的死亡率得到了类似的改善，使用氯氟氰菊酯和 alpha-氯氰菊酯混合物的 G2 LN（79%）。
结论
氯氟氰菊酯和 alpha-氯氰菊酯混合使用（Interceptor G2 LN）或氯氟氰菊酯 IRS 和拟除虫菊酯 LN 联合干预措施将两者结合使用，通过氯氟氰菊酯成分显著提高死亡率，并通过拟除虫菊酯成分提供个人保护，从而对耐拟除虫菊酯的疟疾媒介进行更好的控制。这两种策略在改善耐拟除虫菊酯蚊虫传播的疟疾控制方面具有可比性。
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