Community involvement in the control of Aedes aegypti.

In the past 15 years, there has been a dramatic resurgence of dengue and dengue hemorrhagic fever worldwide, with increased frequency of epidemics and geographic expansion of both the mosquito vectors and the viruses. The reasons for this resurgence are not well understood, but include uncontrolled and unplanned urbanization, increased movement of people and viruses by airplane and lack of effective control of Aedes aegypti, the principal mosquito vector of dengue viruses. The recommended method for Ae. aegypti control during the past 20 years has been ultra-low volume (ULV) application of insecticides, a method which targets the adult mosquito. Lack of efficacy of the ULV approach led to a reevaluation of recommended strategies for prevention and control of epidemic dengue and ultimately, resulted in development and widespread use of community-based, integrated approaches to Ae. aegypti control. This chapter reviews the use of community participation for controlling Ae. aegypti via larval source reduction and critically discusses programs in four countries from the standpoint of effectiveness and sustainability. It is concluded that a combination of vertically structured centralized and community-based approaches should provide short-term success as well as long-term sustainability.