Proof of concept for eliminating Aedes aegypti production by means of integrated control including turtles, copepods, tilapia, larvicides, and community participation in Monte Verde, Honduras.

Monte Verde, a peri‑urban squatter community near San Pedro Sula, virtually eliminated Aedes aegypti production in all known larval habitats: wells; water storage containers including pilas (open concrete water tanks used for laundry), 200-liter drums, 1000-liter plastic "cisterns," buckets; and objects collecting rainwater. The project began in 2016 when Monte Verde was overrun with dengue, Zika, and chikungunya. During more than a year of experimentation, Monte Verde residents crafted an effective, sustainable, and environmentally friendly toolkit that was inexpensive but required full community participation. Biological control with copepods, turtles, and tilapia was at the core of the toolkit, along with a mix of other methods such as getting rid of unnecessary containers, scrubbing them to remove Ae. aegypti eggs, and covering them to exclude mosquitoes or rainwater. Environmentally friendly larvicides also had a limited but crucial role. Key design features: (1) toolkit components known to be nearly 100% effective at preventing Ae. aegypti production when fitted to appropriate larval habitats; (2) using Ae. aegypti larval habitats as a resource by transforming them into "egg sinks" to drive Ae. aegypti population decline; (3) dedicated community volunteers who worked with their neighbors, targeting 100% coverage of all known Ae. aegypti larval habitats with an appropriate control method; (4) monthly monitoring in which the volunteers visited every house to assess progress and improve coverage as an ongoing learning experience for both volunteers and residents. Taking pupae as an indicator of Ae. aegypti production, from September 2018 to the end of the record in December 2021 (except for a brief lapse during COVID lockdown in 2020), the monthly count of pupae fluctuated between zero and 0.6% of the 22,984 pupae counted in the baseline survey at the beginning of the project. Adult Ae. aegypti declined to low numbers but did not disappear completely. There were no recognizable cases of dengue, Zika, or chikungunya after June 2018, though the study design based on a single site did not provide a basis for rigorous confirmation that Monte Verde's Ae. aegypti control program was responsible. Nonetheless, Monte Verde's success at eliminating Ae. aegypti production can serve as a model for extending this approach to other communities. Key ingredients for success were outside stimulation and facilitation to foster shared community awareness and commitment regarding the problem and its solution, enduring commitment of local leadership, compatibility of the toolkit with the local community, overcoming social obstacles, rapid results with "success breeding success," and building resilience.