在 iDEM 试验（马来西亚登革热流行病学干预）中，使用靶向户外滞留喷洒和自动传播装置的综合矢量管理对马来西亚城市登革热发病率的影响评估：一项基于群组的随机对照试验研究方案。

Measuring the effectiveness of integrated vector management with targeted outdoor residual spraying and autodissemination devices on the incidence of dengue in urban Malaysia in the iDEM trial (intervention for Dengue Epidemiology in Malaysia): study protocol for a cluster randomized controlled trial.

机构信息

Service Hygiène, Epidémiologie, Infection, Vigilance et Prévention, Centre Hospitalier Edouard Herriot, Hospices Civils de Lyon, Lyon, France.

CIRI, Centre International de Recherche en Infectiologie, (Equipe Laboratoire des Pathogènes Emergents), Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France.

出版信息

Trials. 2021 May 30;22(1):374. doi: 10.1186/s13063-021-05298-2.

DOI:10.1186/s13063-021-05298-2

PMID:34053466

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8166066/

Abstract

BACKGROUND

In common with many South East Asian countries, Malaysia is endemic for dengue. Dengue control in Malaysia is currently based on reactive vector management within 24 h of a dengue case being reported. Preventive rather than reactive vector control approaches, with combined interventions, are expected to improve the cost-effectiveness of dengue control programs. The principal objective of this cluster randomized controlled trial is to quantify the effectiveness of a preventive integrated vector management (IVM) strategy on the incidence of dengue as compared to routine vector control efforts.

METHODS

The trial is conducted in randomly allocated clusters of low- and medium-cost housing located in the Federal Territory of Kuala Lumpur and Putrajaya. The IVM approach combines: targeted outdoor residual spraying with K-Othrine Polyzone, deployment of mosquito traps as auto-dissemination devices, and community engagement activities. The trial includes 300 clusters randomly allocated in a 1:1 ratio. The clusters receive either the preventive IVM in addition to the routine vector control activities or the routine vector control activities only. Epidemiological data from monthly confirmed dengue cases during the study period will be obtained from the Vector Borne Disease Sector, Malaysian Ministry of Health e-Dengue surveillance system. Entomological surveillance data will be collected in 12 clusters randomly selected from each arm. To measure the effectiveness of the IVM approach on dengue incidence, a negative binomial regression model will be used to compare the incidence between control and intervention clusters. To quantify the effect of the interventions on the main entomological outcome, ovitrap index, a modified ordinary least squares regression model using a robust standard error estimator will be used.

DISCUSSION

Considering the ongoing expansion of dengue burden in Malaysia, setting up proactive control strategies is critical. Despite some limitations of the trial such as the use of passive surveillance to identify cases, the results will be informative for a better understanding of effectiveness of proactive IVM approach in the control of dengue. Evidence from this trial may help justify investment in preventive IVM approaches as preferred to reactive case management strategies.

TRIAL REGISTRATION

ISRCTN ISRCTN81915073 . Retrospectively registered on 17 April 2020.

摘要

背景

与许多东南亚国家一样，马来西亚是登革热的地方性流行区。马来西亚的登革热控制目前基于在报告登革热病例后 24 小时内对病媒进行反应性管理。结合干预措施的预防性而不是反应性病媒控制方法预计将提高登革热控制计划的成本效益。这项整群随机对照试验的主要目的是量化预防综合病媒管理（IVM）策略与常规病媒控制措施相比对登革热发病率的有效性。

方法

该试验在位于吉隆坡联邦直辖区和布城的低和中成本住房的随机分配群集中进行。IVM 方法结合了：有针对性的户外残留喷洒与 K-Othrine Polyzone、蚊诱捕器作为自动传播装置的部署，以及社区参与活动。该试验包括 300 个以 1:1 比例随机分配的群集。群集除了常规病媒控制活动外，还接受预防性 IVM 或仅接受常规病媒控制活动。研究期间每月从马来西亚卫生部电子登革热监测系统的虫媒疾病部门获得确认的登革热病例的流行病学数据。将从每个臂中随机选择的 12 个群集收集昆虫学监测数据。为了衡量 IVM 方法对登革热发病率的有效性，将使用负二项回归模型比较对照组和干预组的发病率。为了量化干预措施对主要昆虫学结果（诱卵器指数）的影响，将使用修正的普通最小二乘回归模型和稳健标准误差估计器来使用。