scholarly journals Validation of the Early Warning and Response System (EWARS) for dengue outbreaks: Evidence from the national vector control program in Mexico

2021 ◽  
Author(s):  
David Benitez-Valladares ◽  
Axel Kroeger ◽  
Gustavo Sánchez Tejeda ◽  
Laith Hussain-Alkhateeb
Keyword(s):  
Vector Control ◽  
Early Warning ◽  
National Level ◽  
Indoor Residual Spraying ◽  
False Alarms ◽  
Outbreak Response ◽  
Effective Response ◽  
Dengue Outbreak ◽  
Response System ◽  
Dengue Outbreaks

AbstractBackgroundDuring 2017, twenty health districts (locations) in Mexico implemented a dengue outbreak early warning and response system (EWARS) that uses epidemiological, meteorological and entomological variables (alarm indicators) to predict dengue outbreaks and triggers early response activities.Eleven of these districts were analyzed as they presented reliable information. Nine districts presented outbreak alarms but without subsequent outbreaks (“non-outbreak districts”) and two presented after the alarms dengue outbreaks (“outbreak districts”). This study is concerned with i) if the alarms without outbreaks were false alarms or if the control services had established effective response activities averting an outbreak and ii) if vector control activities can mitigate or even avert dengue outbreaks.MethodsFive components of dengue outbreak response (larval control, entomological studies with water container interventions, focal spraying, indoor residual spraying, space spraying) were quantitatively analyzed across two groups (”outbreak districts” and “non-outbreak districts”).ResultsThe average coverage of vector control and responses were higher in non-outbreak districts and across all five components. In the “outbreak districts” the response activities started late and were of much lower intensity compared to “non-outbreak districts”. District vector control teams demonstrated diverse compliance with local guidlines for ‘initial’, ‘early’ and ‘late’ responses to outbreak alarms which could explain the different outcomes observed following the outbreak alarms.Conclusionfindings from this study plausibly demonstrates important operational scenarios when succeeding or failing alarms signals generated by EWARS at national level. This study presents evidence warranting for further investigation into the effectiveness and cost-effectiveness of EWARS using gold-standard designs.

scholarly journals Validation of the Early Warning and Response System (EWARS) for dengue outbreaks: Evidence from the national vector control program in Mexico

2021 ◽  
Vol 15 (12) ◽  
pp. e0009261
Author(s):  
David Benitez-Valladares ◽  
Axel Kroeger ◽  
Gustavo Sánchez Tejeda ◽  
Laith Hussain-Alkhateeb
Keyword(s):  
Vector Control ◽  
Early Warning ◽  
Disease Transmission ◽  
Indoor Residual Spraying ◽  
Alarm Signals ◽  
Dengue Outbreak ◽  
Response System ◽  
Adequate Response ◽  
Dengue Outbreaks ◽  
The Impact

Background During 2017, twenty health districts (locations) implemented a dengue outbreak Early Warning and Response System (EWARS) in Mexico, which processes epidemiological, meteorological and entomological alarm indicators to predict dengue outbreaks and triggers early response activities. Out of the 20 priority districts where more than one fifth of all national disease transmission in Mexico occur, eleven districts were purposely selected and analyzed. Nine districts presented outbreak alarms by EWARS but without subsequent outbreaks (“non-outbreak districts”) and two presented alarms with subsequent dengue outbreaks (“outbreak districts”). This evaluation study assesses and compares the impact of alarm-informed response activities and the consequences of failing a timely and adequate response across the outbreak groups. Methods Five indicators of dengue outbreak response (larval control, entomological studies with water container interventions, focal spraying and indoor residual spraying) were quantitatively analyzed across two groups (”outbreak districts” and “non-outbreak districts”). However, for quality control purposes, only qualitative concluding remarks were derived from the fifth response indicator (fogging). Results The average coverage of vector control responses was significantly higher in non-outbreak districts and across all four indicators. In the “outbreak districts” the response activities started late and were of much lower intensity compared to “non-outbreak districts”. Vector control teams at districts-level demonstrated diverse levels of compliance with local guidelines for ‘initial’, ‘early’ and ‘late’ responses to outbreak alarms, which could potentially explain the different outcomes observed following the outbreak alarms. Conclusion Failing timely and adequate response of alarm signals generated by EWARS showed to negatively impact the disease outbreak control process. On the other hand, districts with adequate and timely response guided by alarm signals demonstrated successful records of outbreak prevention. This study presents important operational scenarios when failing or successding EWARS but warrants investigating the effectiveness and cost-effectiveness of EWARS using a more robust designs.

scholarly journals Detecting and Responding to a Dengue Outbreak: Evaluation of Existing Strategies in Country Outbreak Response Planning

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Julia Harrington ◽  
Axel Kroeger ◽  
Silvia Runge-Ranzinger ◽  
Tim O'Dempsey
Keyword(s):  
Routine Data ◽  
Early Response ◽  
Outbreak Detection ◽  
World Health ◽  
Outbreak Response ◽  
Effective Response ◽  
Dengue Outbreak ◽  
Response Planning ◽  
Health Organization ◽  
Context Specific

Background.Dengue outbreaks are occurring with increasing frequency and intensity. Evidence-based epidemic preparedness and effective response are now a matter of urgency. Therefore, we have analysed national and municipal dengue outbreak response plans.Methods.Thirteen country plans from Asia, Latin America and Australia, and one international plan were obtained from the World Health Organization. The information was transferred to a data analysis matrix where information was extracted according to predefined and emerging themes and analysed for scope, inconsistencies, omissions, and usefulness.Findings.Outbreak response planning currently has a considerable number of flaws. Outbreak governance was weak with a lack of clarity of stakeholder roles. Late timing of responses due to poor surveillance, a lack of combining routine data with additional alerts, and lack of triggers for initiating the response weakened the functionality of plans. Frequently an outbreak was not defined, and early response mechanisms based on alert signals were neglected. There was a distinct lack of consideration of contextual influences which can affect how an outbreak detection and response is managed.Conclusion.A model contingency plan for dengue outbreak prediction, detection, and response may help national disease control authorities to develop their own more detailed and functional context specific plans.

scholarly journals The Early Warning And Response System (EWARS-TDR) For Dengue Outbreaks: Can It Also Be Applied To Chikungunya And Zika Outbreak Warning?

2021 ◽  
Author(s):  
Rocio Cardenas ◽  
Laith Hussain-Alkhateeb ◽  
David Benitez-Valladares ◽  
Gustavo Sanchez-Tejeda ◽  
Axel Kroeger
Keyword(s):  
Positive Predictive Value ◽  
Early Warning ◽  
Predictive Value ◽  
Large City ◽  
High Sensitivity ◽  
Surveillance Systems ◽  
Insect Vector ◽  
Alarm Signals ◽  
Response System ◽  
Dengue Outbreaks

Abstract Background. In the Americas, endemic countries for Aedes-borne diseases such as dengue, chikungunya, and Zika face great challenges particularly since the recent outbreaks of CHIKV and ZIKV, all transmitted by the same insect vector Aedes aegypti and Ae. albopictus. The Special Program for Research and Training in Tropical Diseases (TDR- WHO) has developed together with partners an early warning and Response System (EWARS) for dengue outbreaks based on a variety of alarm signals with a high sensitivity and positive predictive value (PPV). The question is if this tool can also be used for the prediction of Zika and chikungunya outbreaks.Methodology. We conducted in nine districts of Mexico and one large city in Colombia a retrospective analysis of epidemiological data (for the outbreak definition) and of climate and entomological data (as potential alarm indicators) produced by the national surveillance systems for dengue, chikungunya and Zika outbreak prediction covering the following outbreak years: for dengue 2012-2016, for Zika 2015-2017, for chikungunya 2014-2016. This period was divided into a “run in period” (to establish the “historical” pattern of the disease) and an “analysis period” (to identify sensitivity and PPV of outbreak prediction). Results. In Mexico, the sensitivity of alarm signals for correctly predicting an outbreak was 92% for dengue, and 97% for Zika (chikungunya data could not be obtained in Mexico); the PPV was 68% for dengue and 100% for Zika. The time period between alarm and start of the outbreak (i.e. the time available for early response activities) was for dengue 6-8 weeks and for Zika 3-5 weeks. In Colombia the sensitivity of the outbreak prediction was 92% for dengue, 93% for chikungunya and 100% for Zika; the PPV was 68% for dengue, 92% for chikungunya and 54% for Zika; the prediction distance was for dengue 3-5 weeks, for chikungunya 10-13 weeks and for Zika 6-10 weeks. Conclusion. The implementation of an early warning and response system (EWARS) could predict outbreaks of three Aedes borne diseases with a high sensitivity and positive predictive value and with a lag time long enough for preparing an adequate outbreak response in order to reduce the magnitude or avert the occurrence of outbreaks with their elevated social and economic tolls.

scholarly journals Optimizing the deployment of ultra-low volume and targeted indoor residual spraying for dengue outbreak response

2020 ◽  
Vol 16 (4) ◽  
pp. e1007743 ◽  
Author(s):  
Sean M. Cavany ◽  
Guido España ◽  
Alun L. Lloyd ◽  
Lance A. Waller ◽  
Uriel Kitron ◽  
...  
Keyword(s):  
Indoor Residual Spraying ◽  
Outbreak Response ◽  
Dengue Outbreak ◽  
Low Volume

scholarly journals Early warning and response system (EWARS) for dengue outbreaks: Recent advancements towards widespread applications in critical settings

PLoS ONE ◽  
2018 ◽  
Vol 13 (5) ◽  
pp. e0196811 ◽  
Author(s):  
Laith Hussain-Alkhateeb ◽  
Axel Kroeger ◽  
Piero Olliaro ◽  
Joacim Rocklöv ◽  
Maquins Odhiambo Sewe ◽  
...  
Keyword(s):  
Early Warning ◽  
Response System ◽  
Dengue Outbreaks

scholarly journals Early Warning and Response System (EWARS) for chikungunya, zika and dengue outbreaks: The innovated WHO-TDR tool.

2019 ◽  
Author(s):  
Rocio Cardenas ◽  
Laith Hussain-Alkhateeb ◽  
David Benitez-Valladares ◽  
Gustavo Sanchez Tejeda ◽  
Axel Kroeger
Keyword(s):  
Early Warning ◽  
Urban Areas ◽  
High Sensitivity ◽  
Early Response ◽  
Surveillance Systems ◽  
Insect Vector ◽  
Predictive Values ◽  
Alarm Signals ◽  
Response System ◽  
Dengue Outbreaks

Abstract Background. In the Americas, endemic cities for Aedes-borne diseases such as chikungunya, Zika and dengue face great challenges particularly since the recent outbreaks of CHIKV and ZIKV, all transmitted by the same insect vector Aedes aegypti and albopictus. Areas, such as Colombia and Mexico with the highest incidence and most frequent outbreaks of the three diseases are located in tropical environments due to their favorable eco-epidemiological conditions for vector breeding. In Colombia, the city of Cúcuta on the border with Venezuela is one of such highly endemic areas. Likewise, in Mexico a number of municipalities has very similar environmental conditions. This is why these urban areas provide the opportunity to test the Early Warning and Response System (EWARS), developed originally for dengue outbreaks, also for the other two diseases (Chikungunya and Zika). Methodology. Through the retrospective analysis of epidemiological, climate and entomological data produced by the national surveillance systems in Colombia and Mexico, we intended to predict outbreaks with a high sensitivity and positive predictive value (PPV) through alarm signals by using the EWARS tool. The registered outbreaks of DENV 2012-2016, CHIKV 2014-2016 and ZIKV 2015-2016 were analyzed for 2 years retrospectively (“run in period”) and one year of analysis (“evaluation period”). Outbreak prediction for dengue and Zika was for both countries but for Chikungunya in Colombia only due to the availability of surveillance data. Results. In Mexico, the sensitivity of different alarm signals for correctly predicting an outbreak ranged between 74-92% for dengue, 77–93% for chikungunya and 78-97% for Zika. Their Positive Predictive Values ranged between 51-68% for dengue, 48-92% for chikungunya and 11-100% for Zika. The lag time between predictions and start of the outbreak (i.e. the time available for early response activities) was for dengue 3-5 weeks, for chikungunya 10-13 weeks and for Zika 3-5 weeks. Conclusion. The implementation of an early warning and response system (EWARS) could substantially reduce the magnitude and occurrence of outbreaks and the elevated social and economic toll.

scholarly journals Impact of seasonality and malaria control interventions on Anopheles density and species composition from three areas of Uganda with differing malaria endemicity

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Henry Ddumba Mawejje ◽  
Maxwell Kilama ◽  
Simon P. Kigozi ◽  
Alex K. Musiime ◽  
Moses Kamya ◽  
...  
Keyword(s):  
Species Composition ◽  
Vector Control ◽  
Malaria Control ◽  
Mosquito Species ◽  
Density Ratio ◽  
Indoor Residual Spraying ◽  
Sub Saharan Africa ◽  
Malaria Vector Control ◽  
Vector Density ◽  
Llin Distribution

Abstract Background Long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) are the malaria control interventions primarily responsible for reductions in transmission intensity across sub-Saharan Africa. These interventions, however, may have differential impact on Anopheles species composition and density. This study examined the changing pattern of Anopheles species in three areas of Uganda with markedly different transmission intensities and different levels of vector control. Methods From October 2011 to June 2016 mosquitoes were collected monthly using CDC light traps from 100 randomly selected households in three areas: Walukuba (low transmission), Kihihi (moderate transmission) and Nagongera (high transmission). LLINs were distributed in November 2013 in Walukuba and Nagongera and in June 2014 in Kihihi. IRS was implemented only in Nagongera, with three rounds of bendiocarb delivered between December 2014 and June 2015. Mosquito species were identified morphologically and by PCR (Polymerase Chain Reaction). Results In Walukuba, LLIN distribution was associated with a decline in Anopheles funestus vector density (0.07 vs 0.02 mosquitoes per house per night, density ratio [DR] 0.34, 95% CI: 0.18–0.65, p = 0.001), but not Anopheles gambiae sensu stricto (s.s.) nor Anopheles arabiensis. In Kihihi, over 98% of mosquitoes were An. gambiae s.s. and LLIN distribution was associated with a decline in An. gambiae s.s. vector density (4.00 vs 2.46, DR 0.68, 95% CI: 0.49–0.94, p = 0.02). In Nagongera, the combination of LLINs and multiple rounds of IRS was associated with almost complete elimination of An. gambiae s.s. (28.0 vs 0.17, DR 0.004, 95% CI: 0.002–0.009, p < 0.001), and An. funestus sensu lato (s.l.) (3.90 vs 0.006, DR 0.001, 95% CI: 0.0005–0.004, p < 0.001), with a less pronounced decline in An. arabiensis (9.18 vs 2.00, DR 0.15 95% CI: 0.07–0.33, p < 0.001). Conclusions LLIN distribution was associated with reductions in An. funestus s.l. in the lowest transmission site and An. gambiae s.s. in the moderate transmission site. In the highest transmission site, a combination of LLINs and multiple rounds of IRS was associated with the near collapse of An. gambiae s.s. and An. funestus s.l. Following IRS, An. arabiensis, a behaviourally resilient vector, became the predominant species, which may have implications for malaria vector control activities. Development of interventions targeted at outdoor biting remains a priority.

scholarly journals Malaria vector species composition and entomological indices following indoor residual spraying in regions bordering Lake Victoria, Tanzania

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Charles Kakilla ◽  
Alphaxard Manjurano ◽  
Karen Nelwin ◽  
Jackline Martin ◽  
Fabian Mashauri ◽  
...  
Keyword(s):  
Species Composition ◽  
Vector Control ◽  
Malaria Vector ◽  
Lake Victoria ◽  
Indoor Residual Spraying ◽  
Transmission Risk ◽  
Malaria Vectors ◽  
Vector Species ◽  
Sporozoite Rate ◽  
Pirimiphos Methyl

Abstract Background Vector control through long-lasting insecticidal nets (LLINs) and focal indoor residual spraying (IRS) is a major component of the Tanzania national malaria control strategy. In mainland Tanzania, IRS has been conducted annually around Lake Victoria basin since 2007. Due to pyrethroid resistance in malaria vectors, use of pyrethroids for IRS was phased out and from 2014 to 2017 pirimiphos-methyl (Actellic® 300CS) was sprayed in regions of Kagera, Geita, Mwanza, and Mara. Entomological surveillance was conducted in 10 sprayed and 4 unsprayed sites to determine the impact of IRS on entomological indices related to malaria transmission risk. Methods WHO cone bioassays were conducted monthly on interior house walls to determine residual efficacy of pirimiphos-methyl CS. Indoor CDC light traps with or without bottle rotator were hung next to protected sleepers indoors and also set outdoors (unbaited) as a proxy measure for indoor and outdoor biting rate and time of biting. Prokopack aspirators were used indoors to capture resting malaria vectors. A sub-sample of Anopheles was tested by PCR to determine species identity and ELISA for sporozoite rate. Results Annual IRS with Actellic® 300CS from 2015 to 2017 was effective on sprayed walls for a mean of 7 months in cone bioassay. PCR of 2016 and 2017 samples showed vector populations were predominantly Anopheles arabiensis (58.1%, n = 4,403 IRS sites, 58%, n = 2,441 unsprayed sites). There was a greater proportion of Anopheles funestus sensu stricto in unsprayed sites (20.4%, n = 858) than in sprayed sites (7.9%, n = 595) and fewer Anopheles parensis (2%, n = 85 unsprayed, 7.8%, n = 591 sprayed). Biting peaks of Anopheles gambiae sensu lato (s.l.) followed periods of rainfall occurring between October and April, but were generally lower in sprayed sites than unsprayed. In most sprayed sites, An. gambiae s.l. indoor densities increased between January and February, i.e., 10–12 months after IRS. The predominant species An. arabiensis had a sporozoite rate in 2017 of 2.0% (95% CI 1.4–2.9) in unsprayed sites compared to 0.8% (95% CI 0.5–1.3) in sprayed sites (p = 0.003). Sporozoite rates were also lower for An. funestus collected in sprayed sites. Conclusion This study contributes to the understanding of malaria vector species composition, behaviour and transmission risk following IRS around Lake Victoria and can be used to guide malaria vector control strategies in Tanzania.

Sign in / Sign up

Export Citation Format

Share Document