Designing effective control of dengue with combined interventions

Hladish, Thomas J., Pearson, Carl A. B., Toh, Kok Ben, Rojas, Diana Patricia, Manrique-Saide, Pablo, Vazquez-prokopec, Gonzalo M., Halloran, M. Elizabeth, and Longini, Ira M. (2020) Designing effective control of dengue with combined interventions. Proceedings of the National Academy of Sciences of the United States of America.

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Viruses transmitted by Aedes mosquitoes, such as dengue, Zika, and chikungunya, have expanding ranges and seem unabated by current vector control programs. Effective control of these pathogens likely requires integrated approaches. We evaluated dengue management options in an endemic setting that combine novel vector control and vaccination using an agent-based model for Yucatán, Mexico, fit to 37 y of data. Our intervention models are informed by targeted indoor residual spraying (TIRS) experiments; trial outcomes and World Health Organization (WHO) testing guidance for the only licensed dengue vaccine, CYD-TDV; and preliminary results for in-development vaccines. We evaluated several implementation options, including varying coverage levels; staggered introductions; and a one-time, large-scale vaccination campaign. We found that CYD-TDV and TIRS interfere: while the combination outperforms either alone, performance is lower than estimated from their separate benefits. The conventional model hypothesized for in-development vaccines, however, performs synergistically with TIRS, amplifying effectiveness well beyond their independent impacts. If the preliminary performance by either of the in-development vaccines is upheld, a one-time, large-scale campaign followed by routine vaccination alongside aggressive new vector control could enable short-term elimination, with nearly all cases avoided for a decade despite continuous dengue reintroductions. If elimination is impracticable due to resource limitations, less ambitious implementations of this combination still produce amplified, longer-lasting effectiveness over single-approach interventions.

Item ID: 62195
Item Type: Article (Research - C1)
ISSN: 1091-6490
Keywords: effectiveness, modeling, dengue, infectious diseases, epidemiology, vector control, dengue vaccines
Copyright Information: Copyright © 2020 the Author(s). Published by PNAS. This Open Access article is distributed under Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND).
Funders: NIH, National Science Foundation (USA)
Projects and Grants: NIH/National Institute of General Medical Sciences Grant U54 GM111274, NSF Grant Division of Environmental Biology/Ecology and Evolution of Infectious Diseases (DEB/EEID) 1640698
Research Data:,
Date Deposited: 04 Feb 2020 04:17
FoR Codes: 49 MATHEMATICAL SCIENCES > 4905 Statistics > 490510 Stochastic analysis and modelling @ 50%
42 HEALTH SCIENCES > 4202 Epidemiology > 420202 Disease surveillance @ 25%
32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320211 Infectious diseases @ 25%
SEO Codes: 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920404 Disease Distribution and Transmission (incl. Surveillance and Response) @ 100%
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