Prevention of the transmission of Chagas' disease with pyrethroid-impregnated materials.

Interrupting the transmission of Chagas' disease using insecticide-treated materials could be a cost-effective option, particularly for sylvatic vectors, which enter houses at night. A randomized trial was undertaken that included all houses in two communities in regions endemic for this disease, one in Venezuela (50 houses) and one in Colombia (47 houses). After a baseline study (including a short questionnaire survey, entomologic assessment, and Chagas' disease serology), each household was randomly allocated to either the intervention group, which used pyrethroid-impregnated bed nets, or the control group, which used unimpregnated bed nets. Serologic analysis of children in the baseline study showed active transmission of Chagas' disease in the Venezuelan community (10.7% of 103 children were positive), but none in the Colombian community (0% of 100 children were positive). Vectors were sylvatic and bugs entered the houses at night in both communities. The efficacy of pyrethroids against triatomine vectors was tested in Venezuela by exposing Rhodnius prolixus to lambdacyhalothrin-impregnated fabrics and in Colombia by residual house spraying with deltamethrin. This randomized trial showed that in both countries users of impregnated bed nets were well protected from vector bites (immediate benefit). The long-term effect on the community was high vector mortality. In Venezuela, all 62 vectors detected (mainly R. robustus) died within 72 hours of contact with impregnated bed nets. In houses that used unimpregnated nets, only 24.5% (13 of 53) of the vectors died (P < 0.001). The vectors most likely came from infested palm trees and they maintained transmission of the disease in this community (28.1% of 629 R. robustus were positive for Trypanosoma cruzi). Bioassays showed that the mortality rate of R. prolixus was 100% on lambda-cyhalothrin-impregnated materials. In addition, in Colombia (the main vector was R. prolixus), the effect of repellent on vectors (driving them away from impregnated nets) was significant. Thus, users of impregnated bed nets are well protected from transmission of Chagas' disease, and vector reduction or elimination can potentially be achieved in areas infested with R. prolixus and R. robustus.

Wash resistance of insecticide-treated materials.

The effectiveness of insecticide-treated materials (ITMs) for malaria control is reduced by washing them. This research in Colombia and Bolivia investigated the resistance of different insecticide formulations and, in particular, a commercially available impregnated bednet (PermaNet) which provides chemical protection for the insecticide. The fabrics studied were all polyester; the pyrethroids used for impregnation were deltamethrin (tablet and suspension concentrate both at 25 mg/m2 target dose), lambdacyhalothrin (capsule suspension at 15 mg/m2; laboratory study only), alphacypermethrin (suspension concentrate at 40 mg/m2) and, in the case of PermaNet, deltamethrin (55 mg/m2). The indicator of wash resistance was Anopheles spp. mortality (using the bioassay cone method) before and after different numbers and intensities of washing. When the fabrics were washed under controlled conditions, gently with water and a bar of soap, the wash resistance of all formulations was good (100% Anopheles mortality after 3 washes). However, when the impregnated nets were soaked for 30-60 min and washed with soap powder and tap water by local women in the usual way, the mortality after 4 washes declined considerably (43.5% and 41.3% for deltamethrin tablets and liquid respectively when washing every second day). Alphacypermethrin showed slightly better results after 3 washes every 7th day compared to deltamethrin tablets (63.8% and 43.3% mortality, respectively). The wash resistance offered by PermaNet was much better and longer lasting: Anopheles mortality after 4 washes was 92.6%, after 10 washes 83.7% and after 20 washes 87.1%. The limitations of commercially available wash-resistant nets are, however, their limited accessibility and the difficulty of replacing all existing bednets with a new product.