An active and targeted survey reveals asymptomatic malaria infections among high-risk populations in Mondulkiri, Cambodia.

BACKGROUND: Malaria is a mosquito-borne disease that is one of the most serious public health issues globally and a leading cause of mortality in many developing countries worldwide. Knowing the prevalence of both symptomatic and asymptomatic malaria on a subnational scale allows for the estimation of the burden of parasitaemia present in the transmission system, enabling targeting and tailoring of resources towards greater impact and better use of available capacity. This study aimed to determine the PCR-based point prevalence of malaria infection, by parasite species, among three high-risk populations in Mondulkiri province, Cambodia: forest rangers, forest dwellers, and forest goers. METHODS: A cross-sectional survey was performed during the transmission season in November and December 2021. Blood samples collected on filter paper from participants (n = 1301) from all target groups were screened for Plasmodium spp using PCR. RESULTS: Malaria prevalence among all study participants was 6.7% for any Plasmodium species. Malaria prevalence in the forest ranger group was 8.1%, was 6.8% in forest goers, and 6.4% in forest dwellers; all infections were asymptomatic. Plasmodium vivax was detected in all participant groups, while the few Plasmodium falciparum infections were found in goers and dwellers. 81% of all infections were due to P. vivax, 9% were due to P. falciparum, 3% due to Plasmodium cynomolgi, and the rest (7%) remained undefined. Gender was associated with malaria infection prevalence, with male participants having higher odds of malaria infection than female participants (OR = 1.69, 95% CI 1.08-2.64). Passively collected malaria incidence data from the Cambodian government were also investigated. Health facility-reported malaria cases, based on rapid diagnostic tests, for the period Jan-Dec 2021 were 521 Plasmodium vivax (0.89% prevalence), 34 P. falciparum (0.06%) and four P. falciparum + mixed (0.01%)-a total of 559 cases (0.95%) for all of Mondulkiri. CONCLUSION: This reservoir of asymptomatic parasitaemia may be perpetuating low levels of transmission, and thus, new strategies are required to realize the goal of eliminating malaria in Cambodia by 2025.

Scientific achievements and reflections after 20 years of vector biology and control research at the Pu Teuy mosquito field research station, Thailand.

Additional vector control tools are needed to supplement current strategies to achieve malaria elimination and control of Aedes-borne diseases in many settings in Thailand and the Greater Mekong Sub-region. Within the next decade, the vector control community, Kasetsart University (KU), and the Ministry of Higher Education, Science, Research and Innovation must take full advantage of these tools that combine different active ingredients with different modes of action. Pu Teuy Mosquito Field Research Station (MFRS), Department of Entomology, Faculty of Agriculture, Kasetsart University (KU), Thailand was established in 2001 and has grown into a leading facility for performing high-quality vector biology and control studies and evaluation of public health insecticides that are operationally relevant. Several onsite mosquito research platforms have been established including experimental huts, a 40-m long semi-field screening enclosure, mosquito insectary, field-laboratory, and living quarters for students and researchers. Field research and assessments ranged from 'basic' investigations on mosquito biology, taxonomy and genetics to more 'applied' studies on responses of mosquitoes to insecticides including repellency, behavioural avoidance and toxicity. In the course of two decades, 51 peer-reviewed articles have been published, and 7 masters and 16 doctoral degrees in Entomology have been awarded to national and international students. Continued support of key national stakeholders will sustain MFRS as a Greater Mekong Subregion centre of excellence and a resource for both insecticide trials and entomological research.

Residual Malaria Transmission in Select Countries of Asia-Pacific Region: Old Wine in a New Barrel.

BACKGROUND: Despite substantial reductions in malaria burden and improvement in case management, malaria remains a major public health challenge in the Asia-Pacific region. Residual malaria transmission (RMT) is the fraction of total transmission that persists after achievement of full operational coverage with effective insecticide-treated bed nets (ITNs)/long-lasting insecticidal nets (LLINs) and/or indoor residual spray interventions. There is a critical need to standardize and share best practices for entomological, anthropological, and product development investigative protocols to meet the challenges of RMT and elimination goals. METHODS: A systematic review was conducted to describe when and where RMT is occurring, while specifically targeting ownership and usage of ITN/LLINs, indoor residual spray application, insecticide susceptibility of vectors, and human and vector biting behavior, with a focus on nighttime activities. RESULTS: Sixty-six publications from 1995 to present met the inclusion criteria for closer review. Associations between local vector control coverage and use with behaviors of human and mosquito vectors varied by locality and circumstance. Consequently, the magnitude of RMT is insufficiently studied and analyzed with sparse estimates of individual exposure in communities, insufficient or incomplete observations of ITN/LLIN use, and the local human population movement into and from high-risk areas. CONCLUSIONS: This review identified significant gaps or deficiencies that require urgent attention, namely, developing standardized procedures and methods to estimate risk exposure beyond the peridomestic setting, analytical approaches to measure key human-vector interactions, and seasonal location-specific agricultural or forest use calendars, and establishing the collection of longitudinal human and vector data close in time and location.

Correction to: Transmission risk beyond the village: entomological and human factors contributing to residual malaria transmission in an area approaching malaria elimination on the Thailand-Myanmar border.

Following publication of the original article [1], the authors advised of two errors present in the article: one concerning two author names and the other missing funding details.

Transmission risk beyond the village: entomological and human factors contributing to residual malaria transmission in an area approaching malaria elimination on the Thailand-Myanmar border.

BACKGROUND: A mixed methods study was conducted to look at the magnitude of residual malaria transmission (RMT) and factors contributing to low (< 1% prevalence), but sustained transmission in rural communities on the Thai-Myanmar border. METHODS: A cross-sectional behaviour and net survey, observational surveys and entomological collections in both villages and forested farm huts frequented by community members for subsistence farming practices were conducted. RESULTS: Community members frequently stayed overnight at subsistence farm huts or in the forest. Entomological collections showed higher biting rates of primary vectors in forested farm hut sites and in a more forested village setting compared to a village with clustered housing and better infrastructure. Despite high levels of outdoor biting, biting exposure occurred predominantly indoors, particularly for non-users of long-lasting insecticidal nets (LLINs). Risk of biting exposure was exacerbated by sub-optimal coverage of LLINs, particularly in subsistence farm huts and in the forest. Furthermore, early waking hours when people had left the safety of their nets coincided with peaks in biting in later morning hours. CONCLUSIONS: Entomological and epidemiological findings suggest drivers and modulators of sustained infection prevalence in the area to be: higher mosquito abundance in forested areas where LLINs were used less frequently or could not be used; late sleeping and waking times coinciding with peak biting hours; feeding preferences of Anopheles taking them away from contact with LLIN and indoor residual spraying (IRS), e.g. exophagy and zoophagy; non-use of LLIN and use of damaged/torn LLIN; high population movement across the border and into forested areas thereby increasing risk of exposure, decreasing use of protection and limiting access to healthcare; and, Plasmodium vivax predominance resulting in relapse(s) of previous infection. The findings highlight gaps in current intervention coverage beyond the village setting.

Acceptability of insecticide-treated clothing for malaria prevention among migrant rubber tappers in Myanmar: a cluster-randomized non-inferiority crossover trial.

BACKGROUND: Insecticide-treated clothing (ITC) has long been used for military and outdoor recreational purposes and there is substantial evidence to show that it can protect against arthropod biting. As a complementary vector control measure, ITC could be used to address outdoor transmission of malaria, particularly among mobile and migrant populations and night-time workers such as rubber tappers, who may be beyond the reach of core interventions. However, more information is required on acceptability and preferences of target groups towards ITC to understand whether it could be a viable strategy in Myanmar. METHODS: A cluster-randomized, double-blind, non-inferiority crossover trial was performed to determine acceptability of ITC versus identical, untreated clothing (NTC) among migrant rubber tappers. The study took place between January and May 2015 with 234 participants in 16 clusters in Thanbyuzayat Township, Mon State, Myanmar. Participants were randomly assigned to the order of clothing distribution and followed up at 2, 4 and 6 week intervals. Acceptability was assessed through structured questionnaires, focus group discussions and in-depth interviews. A cluster-level non-inferiority analysis was conducted using STATA, while qualitative data were digitally recorded, transcribed and content-analysed to identify patterns and themes, and managed thematically in Excel 2010®. RESULTS: Acceptability of both types of clothing was high. ITC was deduced to be non-inferior to NTC for seven out of eight indicators regarding perceptions (looks nice, is durable, is pleasant to wear for nighttime work, reduces mosquito bites, would recommend the clothing, would buy the clothing, like the clothing overall). A high proportion of respondents reported that the clothing reduced mosquito bites (ITC-98%; NTC-94%). Clothing was worn regularly (about 11 times in the previous two weeks). The most common reasons for not wearing the clothing every night were that it was being washed or dried, or the participant did not go to work. CONCLUSIONS: The high level of acceptability suggests that ITC could be an appropriate strategy for personal protection amongst migrant rubber tappers in outdoor transmission settings in Myanmar. However, more research is needed into the feasibility and protective efficacy of ITC before it can be considered for wider roll-out. Trial registration Clinical trials ACTRN12615000432516.

Genetic mutations in Plasmodium falciparum and Plasmodium vivax dihydrofolate reductase (DHFR) and dihydropteroate synthase (DHPS) in Vanuatu and Solomon Islands prior to the introduction of artemisinin combination therapy.

BACKGROUND: Plasmodium falciparum and Plasmodium vivax are endemic in Vanuatu and the Solomon Islands. While both countries have introduced artemether-lumefantrine (AL) as first-line therapy for both P. falciparum and P. vivax since 2008, chloroquine and sulphadoxine-pyrimethamine (SP) were used as first-line therapy for many years prior to the introduction of AL. Limited data are available on the extent of SP resistance at the time of policy change. METHODS: Blood spots were obtained from epidemiological surveys conducted on Tanna Island, Tafea Province, Vanuatu and Temotu Province, Solomon Islands in 2008. Additional samples from Malaita Province, Solomon Islands were collected as part of an AL therapeutic efficacy study conducted in 2008. Plasmodium vivax and P. falciparum dhfr and dhps genes were sequenced to detect nucleotide polymorphisms. RESULTS: All P. falciparum samples analysed (n=114) possessed a double mutant pfdhfr allele (C59R/S108N). Additionally, mutation A437G in pfhdps was detected in a small number of samples 2/13, 1/17 and 3/26 from Tanna Island, Vanuatu and Temotu and Malaita Provinces Solomon Islands respectively. Mutations were also common in pvdhfr from Tanna Island, Vanuatu, where 33/51 parasites carried the double amino acid substitution S58R/S117N, while in Temotu and Malaita Provinces, Solomon Islands 32/40 and 39/46 isolates carried the quadruple amino acid substitution F57L/S58R/T61M/S117T in DHFR respectively. No mutations in pvdhps (n=108) were detected in these three island groups. CONCLUSION: Prior to the introduction of AL, there was a moderate level of SP resistance in the P. falciparum population that may cause SP treatment failure in young children. Of the P. vivax isolates, a majority of Solomon Islands isolates carried quadruple mutant pvdhfr alleles while a majority of Vanuatu isolates carried double mutant pvdhfr alleles. This suggests a higher level of SP resistance in the P. vivax population in Solomon Islands compared to the sympatric P. falciparum population and there is a higher level of SP resistance in P. vivax parasites from Solomon Islands than Vanuatu. This study demonstrates that the change of treatment policy in these countries from SP to ACT was timely. The information also provides a baseline for future monitoring.

Genetic mutations in pfcrt and pfmdr1 at the time of artemisinin combination therapy introduction in South Pacific islands of Vanuatu and Solomon Islands.

BACKGROUND: Chloroquine (CQ), alone or in combination with sulphadoxine-pyrimethamine, was widely used for the treatment of Plasmodium falciparum and Plasmodium vivax for several decades in both Vanuatu and Solomon Islands prior to the introduction of artemether-lumefantrine (AL) in 2008. However, the effect of chloroquine selection on parasite population, which may affect the efficacy of lumefantrine or other partner drugs of artemisinin, has not been well assessed. This study aims to provide baseline data on molecular markers (pfcrt and pfmdr1), along with the origins of pfcrt, prior to the introduction of AL. METHODS: Blood spots were obtained from epidemiological surveys conducted on Tanna Island, Tafea Province, Vanuatu and Temotu Province, Solomon Islands in 2008. Additional samples from Malaita Province, Solomon Islands were collected as part of an artemether-lumefantrine efficacy study in 2008. Plasmodium falciparum pfcrt and pfmdr1 genes were examined for polymorphisms. Microsatellite markers flanking pfcrt were also examined to ascertain origins of CQ resistance. RESULTS: Pfcrt analysis revealed 100% of parasites from Tafea Province, Vanuatu and Malaita Province, Solomon Islands and 98% of parasites from Temotu Province, Solomon Islands carried the K76T polymorphism that confers CQ resistance. Comparison of pfcrt allelic patterns and microsatellite markers flanking pfcrt revealed six haplotypes with more than 70% of isolates possessing haplotypes very similar to those observed in Papua New Guinea. The dominant (98.5%) pfmdr1 allele across all island groups was YYCND. CONCLUSIONS: Prior to the introduction of AL in the Solomon Islands and Vanuatu, P. falciparum isolates possessed point mutations known to confer CQ resistance and possibly associated with a decreased susceptibility to quinine and halofantrine, but an increased susceptibility to artemisinin and lumefantrine. Overall, pfcrt allelic types and the flanking microsatellite markers exhibited similarities to those of Papua New Guinea, suggesting these parasites share a common ancestry. The current use of AL for both P. falciparum and P. vivax infections will enable changes in these markers, in the absence of CQ pressure, to be monitored.

Effects of transfluthrin-treated jute and cotton clothing against resistant and susceptible Aedes aegypti (Diptera: Culicidae) in a semifield system.

Volatile pyrethroids exert a range of both lethal and behavioral effects on mosquitoes through the passive release of insecticides into the atmosphere. We investigated the protective efficacy (PE) of transfluthrin-treated jute (TI-jute) and cotton (TI-cotton) fabrics, worn at the back of a protective black vest, against laboratory-reared pyrethroid susceptible and resistant strains of Aedes aegypti (L.) in a semifield system (SFS). Each fabric (1,029 cm2) was treated with 1.79 mg/cm2 of transfluthrin as the intervention. Human landing collections were conducted by 2 collectors seated in designated treatment and control compartments of the SFS. The trials were conducted for 41 days, with 16 days partitioned into morning and evening phases. Furthermore, we examined blood feeding behavior and fecundity of the surviving mosquitoes post-exposure. Results showed that in the morning, the PE of TI-jute (49.4%) was higher than that of TI-cotton (36.8%). TI-jute demonstrated a lower PE of 9.6% against the transfluthrin-resistant strain. Remarkably, a significantly higher number of eggs were laid by the transfluthrin-resistant mosquitoes that survived the intervention (36.5 eggs/female) compared to the control group (11.8 eggs/female). These findings suggest that TI-jute can help protect against bites and alter the life traits of Ae. aegypti. The study highlights that the timing of the intervention during the day affected the efficacy of TI-jute and TI-cotton, while sublethal exposure to transfluthrin stimulated egg production in the resistant strain. These are critical challenges that warrant attention in vector control strategies. Investigating this phenomenon in mosquito reproduction necessitates future research at a molecular level.

Effects of mosquito age and batch size on knockdown and mortality of laboratory-reared Anopheles dirus, Anopheles minimus, and wild-caught Anopheles harrisoni (Diptera: Culicidae) exposed to transfluthrin using WHO tube and CDC bottle bioassays.

WHO tube and CDC bottle bioassays are currently available for insecticide resistance monitoring and malaria transmission research. Multiple parameters including mosquito density, age, and nutritional status may affect the readout in these bioassays' tests. This study aims to assess the effects of experimental factors on knockdown and mortality measurements in dominant malaria vectors in Thailand following exposure to sublethal and lethal doses of transfluthrin. The effects of (i) 3 different mosquito batch sizes (5, 10, and 20 individuals) and (ii) 2 age groups (3-5 and 20-23 days old) on outcomes measured using the WHO tube (14.7 µg/cm2) and CDC bottle bioassay discriminating concentration (0.006 µg/cm2) against 2 laboratory strains: Anopheles dirus Peyton & Harrison and Anopheles minimus Theobald (species A) and wild-caught Anopheles harrisoni Harbach & Manguin (species C). Our results showed higher knockdown at 1-h exposure using WHO tube and CDC bottle bioassays containing 20 individuals compared to batches containing 10 and 5 individuals. Older mosquitoes showed greater susceptibility than younger test population, especially for An. mininus. Our study supports WHO recommendations for using 3- to 5-day-old mosquitoes. It also validates Praulin et al. (2022) proposal to divide the cohort into smaller batches with more test replicates when it is not practicable to test 25 mosquitoes per replicate.

Malaria vectors in the Greater Mekong Subregion: overview of malaria vectors and remaining challenges.

Malaria transmission in the Greater Mekong Subregion depends on, among other factors, vector behavior and ecology, and the degree of contact between humans and the Anopheles mosquitoes. This chapter will review and update knowledge presented in the 2003 Mekong Malaria monograph for planning and implementing evidence-based vector control programs. Collation of 150 publications and reports showed that the highest number of vector species reported included An. minimus Theobald complex (26.74%), An. dirus Peyton and Harrison (14.26%), An. sundaicus (Rodenwaldt) (5.65%), An. sinensis Wiedemann (4.29%), An. maculatus Theobald (4.23%), An. philippinensis Ludlow (1.62%), An. annularis Van der Wulp (0.37%), An. campestris Reid (0.25%), and An. lesteri Baisas and Hu (=anthropophagus) (0.045%). Other Anopheles species accounted for 44.44%. Anopheles dirus was incriminated as a vector of Plasmodium knowlesi malaria in Viet Nam for the first time, but remained a suspected simian vector in other countries in the region. Well-designed trials of innovative strategies in intractable and difficult situations are needed, including a better understanding of the various causal relations and interactions between physiology, environment, and vector bionomics. While current front-line vector control interventions have contributed significantly to a worldwide decrease of malaria, indoor residual spraying and insecticide-treated bednets/ long lasting insecticidal bednets have had variable impact on exophilic/exophagic and/or early biting vectors. As vectors' responses to control measures vary in different areas, entomological studies on the efficacy of insecticide-treated bednets and other innovative control tools to ensure that strategies are tailored to local circumstances. Given that current tools are insufficient to break transmission cycles, more strategic investments into research on outdoor transmission, monitoring of insecticide resistance, vector species identities, vector mapping, target profiles of new control technologies and delivery systems are required.

Aedes aegypti and Aedes albopictus (Diptera: Culicidae) ecology, biology, behaviour, and implications on arbovirus transmission in Thailand: Review.

Aedes aegypti and Aedes albopictus (Aedes) transmit highly pathogenic viruses such as dengue, chikungunya, yellow fever, and Zika which can cause life-threatening diseases in humans. They are the most important vectors of arboviruses in Thailand. Their vectorial capacity (VC) is highly complex mainly due to the interplay between biotic and abiotic factors that vary in time and space. A literature survey was conducted to collate and discuss recent research regarding the influence of Aedes vector biology, behaviour, and ecology on arbovirus transmission in Thailand. The survey followed guidelines of preferred reporting items of systematic reviews and meta-analyses (PRISMA). All fields, keyword search was conducted in the Web of Science database for the period of 2000-2021. The search yielded 821 records on Ae. aegypti and 293 records on Aedes albopictus, of which 77 were selected for discussion. Genomic studies showed that there is a high genetic variation in Aedes albopictus whereas Ae. aegypti generally shows low genetic variation. Along with genetically unstable arboviruses, the interaction between Aedes and arboviruses is largely regulated by genomic events such as genetic mutations and immune response protein factors. Temperature and precipitation are the major climatic events driving arbovirus transmission. Human exposure risk factors are mainly due to multiple feeding patterns, including endophagy by Aedes albopictus and zoophagic behaviour of Ae. aegypti as well as diverse human-associated breeding sites. Integration of the One Health approach in control interventions is a priority with a rigorous focus on Aedes-arbovirus surveillance as a complementary strategy.

Transfluthrin and Metofluthrin as Effective Repellents against Pyrethroid-Susceptible and Pyrethroid-Resistant Aedes aegypti (L.) (Diptera: Culicidae).

Aedes aegypti is a major vector of dengue fever in tropical regions. Spatial repellents (SRs) have shown promise in delaying pesticide resistance. Methods for discriminating concentrations (DCs) are well established using various bioassay tools, while data for high-throughput screening system (HITSS) toxicity bioassay (TOX) are absent. In this study, we compared and optimized lethal (LCs) and sub-lethal concentrations (SLCs) of transfluthrin (TFT) and metofluthrin (MFT) on pyrethroid-susceptible (USDA) and pyrethroid-resistant (Pu-Teuy) Ae. aegypti (L.) strains, using the HITSS-TOX. Mean mortality (MT) was 100% at LC99 and DC, compared to LC50 (45.0 ± 3.7%) and LC75 (65.8 ± 7.0%) for the USDA strain. However, the resistant strain (Pu-Teuy) showed reduced susceptibility against TFT and a significantly lower MT at LC50 (12.5 ± 4.4%; t = 5.665, df = 10, p < 0.001), LC75 (9.2 ± 3.5%; t = 4.844, df = 10, p = 0.001), LC99 (55.0 ± 9.9%; t = 4.538, df = 5, p = 0.006), and DC (75.0 ± 5.2%; U = 3.0, p = 0.007). The DC of TFT (0.15222%) was 4.7-fold higher than for MFT (0.03242%) in USDA strain. The baseline DCs established are useful to better understand susceptibility and the efficacy of various repellents against field populations of Ae. aegypti.

The effect of transfluthrin-treated jute and cotton emanator vests on human landing and fecundity of Anopheles minimus in Thailand.

Complementary approaches to tackle outdoor and early evening biting mosquitoes are urgently required. Transfluthrin (TFT) is a volatile pyrethroid capable of altering mosquito feeding behavior. This study investigated the efficacy of TFT-treated jute (TFT-J) and cotton (TFT-C) fabrics on human landing activity, feeding and fecundity of Anopheles minimus in Thailand. Jute and cotton fabrics each measuring 1024 cm2 were impregnated with 7.34 × 10-4 g/cm2 TFT (20%, w/v), and evaluated in a semi-field screen house system. Two collectors, wearing an untreated control or TFT-treated vests, conducted human-landing collections of released 100 laboratory-reared adult females of An. minimus from 18:00-00:00 h for 16 consecutive nights. Recaptured mosquitoes were given a blood meal for 30 min. with a membrane feeding system for assessment of blood feeding and fecundity. TFT-J, relative to control, significantly reduced human landings (Odds Ratio (OR) =0.27 (95% Confidence Interval (CI) [0.10-0.74], p = 0.011)), however no significant reduction was observed for TFT-C (OR=0.67 [95% CI 0.24-1.82], p = 0.43). Blood feeding was significantly lower among mosquitoes exposed to TFT-J (12.45% [95% CI, 2.04-22.85], p = 0.029) and TFT-C (13% [95% CI, 0.99-26.84], p = 0.016) relative to control. Impregnated fabrics had no effect on the mean number of egg oviposition. However, egg hatchability was reduced in TFT-J (49.5% [95% CI, 21.74-77.26], p = 0.029) and TFT-C (40.2% [95% CI, 17.21-63.19], p = 0.008) relative to control. TFT-J significantly reduced the landing, blood feeding, and fertility of An. minimus. Further studies are needed to evaluate different treatment methods on fabrics and their incorporation in integrated mosquito management.

Comparable Outcomes Between Native and Periprosthetic Fractures of the Distal Femur.

Despite the rising prevalence of arthroplasty and aging population, limited data exist regarding differences in periprosthetic fracture clinical outcomes compared with native counterparts. This study compares differences in hospital treatment, morbidity, and mortality associated with periprosthetic distal femur fractures at an urban level 1 trauma center. We retrospectively reviewed all adult AO/OTA type 33 fractures (526) that presented to our institution between 2009 and 2018. In total, 54 native and 54 periprosthetic fractures were matched by age and gender. We recorded demographics, operative measures, length of stay (LOS), discharge disposition, and mortality. We used McNemar's and paired t-tests for analysis where appropriate (p < 0.05) (IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY; IBM Corp.). The average age at injury was 74 years ± 12 (native) compared with 73 years ± 12 (periprosthetic). After 1:1 matching, the groups had similar body mass index (31.01 vs. 32.98, p = 0.966 for native and periprosthetic, respectively) and mechanisms of injury with 38 native and 44 periprosthetic (p = 0.198) fractures from low-energy falls. Both groups had 51/54 fractures managed with open reduction internal fixation with a locking plate. The remaining were managed via amputation or intramedullary nail fixation. Mean operative time (144 minutes (±64) vs. 132 minutes (±62), p = 0.96) and estimated blood loss (319 mL (±362) vs. 289 mL (±231), p = 0.44) were comparable between the native and periprosthetic groups, respectively. LOS: 9 days ± 7 (native) versus 7 days ± 5 (periprosthetic, p = 0.31); discharge disposition (to skilled nursing facility/rehab): n = 47 (native) versus n = 43 (periprosthetic, p = 0.61); and mortality: n = 6 (native) versus n = 8 (periprosthetic, p = 0.55). No significant differences were observed. We found no statistical differences in morbidity and mortality in periprosthetic distal femur fractures treated over 10 years at a level 1 trauma center. Native and periprosthetic AO/OTA type 33 distal femur fractures are serious injuries with similar outcomes at a level 1 trauma center.

Operational efficiency and sustainability of vector control of malaria and dengue: descriptive case studies from the Philippines.

BACKGROUND: Analysis is lacking on the management of vector control systems in disease-endemic countries with respect to the efficiency and sustainability of operations. METHODS: Three locations were selected, at the scale of province, municipality and barangay (i.e. village). Data on disease incidence, programme activities, and programme management were collected on-site through meetings and focus group discussions. RESULTS: Adaptation of disease control strategies to the epidemiological situation per barangay, through micro-stratification, brings gains in efficiency, but should be accompanied by further capacity building on local situational analysis for better selection and targeting of vector control interventions within the barangay. An integrated approach to vector control, aiming to improve the rational use of resources, was evident with a multi-disease strategy for detection and response, and by the use of combinations of vector control methods. Collaboration within the health sector was apparent from the involvement of barangay health workers, re-orientation of job descriptions and the creation of a disease surveillance unit. The engagement of barangay leaders and use of existing community structures helped mobilize local resources and voluntary services for vector control. In one location, local authorities and the community were involved in the planning, implementation and evaluation of malaria control, which triggered local programme ownership. CONCLUSIONS: Strategies that contributed to an improved efficiency and sustainability of vector control operations were: micro-stratification, integration of vector control within the health sector, a multi-disease approach, involvement of local authorities, and empowerment of communities. Capacity building on situational analysis and vector surveillance should be addressed through national policy and guidelines.

Semi-field evaluation of human landing catches versus human double net trap for estimating human biting rate of Anopheles minimus and Anopheles harrisoni in Thailand.

Background: Whilst the human landing catch (HLC) technique is considered the 'gold standard' for estimating human-biting rates, it is labor-intensive and fraught with potential risk of exposure to infectious mosquito bites. This study evaluated the feasibility and performance of an alternative method, the human double net trap (HDNT) relative to HLC for monitoring host-seeking malaria vectors of the Anopheles minimus complex in a semi-field system (SFS). Methods: HDNT and HLC were positioned in two rooms, 30 m apart at both ends of the SFS. Two human volunteers were rotated between both traps and collected released mosquitoes (n = 100) from 6:00 pm till 6:00 am. Differences in Anopheles mosquito densities among the trapping methods were compared using a generalized linear model based on a negative binomial distribution. Results: There were 82.80% (2,136/2,580) of recaptures of wild-caught and 94.50% (2,835/3,000) of laboratory-reared mosquitoes that were molecularly identified as An. harrisoni and An. minimus, respectively. Mean density of An. harrisoni was significantly lower in HNDT (15.50 per night, 95% CI [12.48-18.52]) relative to HLC (25.32 per night (95% CI [22.28-28.36]), p < 0.001). Similarly, the mean density of a laboratory strain of An. minimus recaptured in HDNT was significantly lower (37.87 per night, 95% CI [34.62-41.11]) relative to HLC (56.40 per night, 95% CI [55.37-57.43]), p < 0.001. Relative sampling efficiency analysis showed that HLC was the more efficient trap in collecting the An. minimus complex in the SFS. Conclusion: HDNT caught proportionately fewer An. minimus complex than HLC. HDNT was not sensitive nor significantly correlated with HLC, suggesting that it is not an alternative method to HLC.

Comparison of Vector Trapping Methods for Outdoor Biting Malaria Vector Surveillance in Thailand and Vietnam.

The performances of the human-baited double net trap (HDNT) and the human-baited host decoy trap (HDT) methods were compared against the outdoor human landing catch (OHLC) method in Thailand and Vietnam. Two study sites were selected in each country: a rural village and a nearby forest setting. The three outdoor trap methods were rotated nightly between three set trapping positions, in a pre-assigned Latin square design. Volunteers were rotated following the trap rotation to avoid bias. The greatest number of adult mosquitoes was collected from the forest sites in both countries, showing Anopheles minimus (s.s.) Theobald (96.54%) and Anopheles dirus (s.s.) Peyton & Harrison (25.71%) as the primary malaria vectors in Thailand and Vietnam, respectively. At the Thai forest site, OHLC collected significantly more anopheline mosquitoes per trap night than HDNT and HDT, with mean ± standard error values of 14.17 ± 4.42, 4.83 ± 1.56, and 4.44 ± 1.45, respectively, whilst HDNT and HDT were significantly less productive at 0.34 times and 0.31 times, respectively, than OHLC in capturing anopheline mosquitoes. However, there were no significant differences among the three methods of trapping malaria vectors for the village site. At the Vietnamese forest site, HDNT achieved the highest performance in collecting Anopheline mosquitoes at 1.54 times compared to OHLC, but there was no significant difference between the two traps. The results suggested HDNT could be a possible alternative trap to OHLC in this area. Although HDT was less efficient at attracting Anopheline mosquitoes, it was highly efficient at trapping culicine mosquitoes.

Entomological outcomes of cluster-randomised, community-driven dengue vector-suppression interventions in Kampong Cham province, Cambodia.

Cambodia has one of the highest dengue infection rates in Southeast Asia. Here we report quantitative entomological results of a large-scale cluster-randomised trial assessing the impact on vector populations of a package of vector control interventions including larvivorous guppy fish in household water containers, mosquito trapping with gravid-ovitraps, solid waste management, breeding-container coverage through community education and engagement for behavioural change, particularly through the participation of school children. These activities resulted in major reductions in Container Index, House Index, Breteau Index, Pupal Index and Adult Index (all p-values 0.002 or lower) in the Intervention Arm compared with the Control Arm in a series of household surveys conducted over a follow-up period of more than one year, although the project was not able to measure the longer-term sustainability of the interventions. Despite comparative reductions in Adult Index between the study arms, the Adult Index was higher in the Intervention Arm in the final household survey than in the first household survey. This package of biophysical and community engagement interventions was highly effective in reducing entomological indices for dengue compared with the control group, but caution is required in extrapolating the reduction in household Adult Index to a reduction in the overall population of adult Aedes mosquitoes, and in interpreting the relationship between a reduction in entomological indices and a reduction in the number of dengue cases. The package of interventions should be trialled in other locations.