- Fustec, B., et al.
Complex relationships between Aedes vectors, socio-economics and dengue transmission-Lessons learned from a case-control study in northeastern Thailand
Ingår i: Plos Neglected Tropical Diseases. - 1935-2735. ; 14:10
- Background/Objectives Dengue fever is an important public health concern in most tropical and subtropical countries, and its prevention and control rest on vector surveillance and control. However, many aspects of dengue epidemiology remain unclear; in particular, the relationship between Aedes vector abundance and dengue transmission risk. This study aims to identify entomological and immunological indices capable of discriminating between dengue case and control (non-case) houses, based on the assessment of candidate indices, as well as individual and household characteristics, as potential risk factors for acquiring dengue infection. Methods This prospective, hospital-based, case-control study was conducted in northeastern Thailand between June 2016 and August 2019. Immature and adult stage Aedes were collected at the houses of case and control patients, recruited from district hospitals, and at patients' neighboring houses. Blood samples were tested by RDT and PCR to detect dengue cases, and were processed with the Nterm-34 kDa salivary peptide to measure the human immune response to Aedes bites. Socioeconomic status, and other individual and household characteristics were analyzed as potential risk factors for dengue. Results Study findings showed complex relationships between entomological indices and dengue risk. The presence of DENV-infected Aedes at the patient house was associated with 4.2-fold higher odds of dengue. On the other hand, Aedes presence (irrespective of infectious status) in the patient's house was negatively associated with dengue. In addition, the human immune response to Aedes bites, was higher in control than in case patients and Aedes adult abundance and immature indices were higher in control than in case houses at the household and the neighboring level. Multivariable analysis showed that children aged 10-14 years old and those aged 15-25 years old had respectively 4.5-fold and 2.9-fold higher odds of dengue infection than those older than 25 years. Conclusion DENV infection in female Aedes at the house level was positively associated with dengue infection, while adult Aedes presence in the household was negatively associated. This study highlights the potential benefit of monitoring dengue viruses in Aedes vectors. Our findings suggest that monitoring the presence of DENV-infected Aedes mosquitoes could be a better indicator of dengue risk than the traditional immature entomological indices. Author summary Dengue fever is a globally expanding arboviral disease, consisting of four distinct serotypes, transmitted primarily by synanthropic/peridomestic mosquitoes, Aedes aegypti and Aedes albopictus. Given the absence of specific treatment, and the incomplete protection provided by the currently available vaccine, vector surveillance and control remain the principal tool to prevent and control dengue transmission. However, vector surveillance through the monitoring of larval mosquito indices lacks consistency in addressing dengue risk. Surveillance based on pupal and adult stages is considered as more accurate to estimate dengue transmission risk, although monitoring is difficult to implement in routine. An alternative strategy is the use of the specific human antibody response to Aedes saliva to identify human exposure risk to Aedes bites. We conducted a hospital-based, case-control study in northeastern Thailand in order to identify risk factors for dengue infection using entomological and immunological indices, together with select individual and household characteristics. We found that people aged 10-25 years had significant higher odds of dengue than older adults (>25 years old). The presence of DENV-infected Aedes in the house was associated with 4.2-fold higher odds of dengue infection. Interestingly, Aedes adult abundance in the household was negatively associated with dengue revealing the complex role of Aedes density to dengue risk. This study highlights the potential benefit of monitoring dengue viruses in Aedes vectors to identify areas ("hot spots") and people ("hot pops") at higher risk of transmission.