ABSTRACT
BACKGROUND: Matings between male Aedes aegypti mosquitoes infected with wAlbB strain of Wolbachia and wildtype females yield non-viable eggs. We evaluated the efficacy of releasing wAlbB-infected Ae. aegypti male mosquitoes to suppress dengue. METHODS: We specified the protocol of a two-arm cluster-randomized test-negative controlled trial (cRCT) and emulated it using a nationally representative test-negative/positive database of individuals reporting for febrile illness to any public hospital, general practitioner or polyclinic. We retrospectively built a cohort of individuals who reside in Wolbachia locations versus a comparator control group who do not reside in Wolbachia locations, using a nationally representative database of all individuals whom report for febrile illness and were tested for dengue at the Environmental Health Institute/hospital laboratories/commercial diagnostic laboratories, through general practitioner clinic, polyclinic or public/private hospital from EW1 2019-EW 262022. We emulated a constrained randomization protocol used in cRCTs to balance dengue risk between intervention and control arms in the pre-intervention period. We used the inverse-probability weighting approach to further balance the intervention and control groups using a battery of algorithmically selected sociodemographic, environmental and anthropogenic variables. Intention-to-treat analyses was conducted to estimate the risk reduction of dengue given Wolbachia exposure. RESULTS: Intention-to-treat analyses revealed that, compared with controls, Wolbachia releases for 3, 6, 12 or more months was associated to 47%(95%CI:25-69%), 44%(33-77%) and 61%(38-78%) protective efficacy against dengue, respectively. When exposed to 12 or more months of Wolbachia releases, protective efficacies ranged from 49%(13-72%) to 77%(60-94%) across years. The proportion of virologically confirmed dengue cases was lower overall in the intervention arm. Protective efficacies were found across all years, age and sex subgroups, with higher durations of Wolbachia exposure associated to greater risk reductions of dengue. CONCLUSION: Results demonstrated that Wolbachia-mediated sterility can strengthen dengue control in tropical cities, where dengue burden is the greatest.
ABSTRACT
BACKGROUND: This trial is a parallel, two-arm, non-blinded cluster randomised controlled trial that is under way in Singapore, with the aim of measuring the efficacy of male Wolbachia-infected Aedes aegypti deployments in reducing dengue incidence in an endemic setting with all four dengue serotypes in circulation. The trial commenced in July 2022 and is expected to conclude in September 2024. The original study protocol was published in December 2022. Here, we describe amendments that have been made to the study protocol since commencement of the trial. METHODS: The key protocol amendments are (1) addition of an explicit definition of Wolbachia exposure for residents residing in intervention sites based on the duration of Wolbachia exposure at point of testing, (2) incorporation of a high-dimensional set of anthropogenic and environmental characteristics in the analysis plan to adjust for baseline risk factors of dengue transmission, and (3) addition of alternative statistical analyses for endpoints to control for post hoc imbalance in cluster-based environmental and anthropogenic characteristics. DISCUSSION: The findings from this study will provide the first experimental evidence for the efficacy of releasing male-Wolbachia infected mosquitoes to reduce dengue incidence in a cluster-randomised controlled trial. The trial will conclude in 2024 and results will be reported shortly thereafter. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT05505682. Registered on 16 August 2022. Retrospectively registered. Last updated 11 November 2023.
Subject(s)
Aedes , Dengue , Mosquito Vectors , Randomized Controlled Trials as Topic , Wolbachia , Dengue/prevention & control , Dengue/epidemiology , Dengue/transmission , Animals , Singapore/epidemiology , Male , Aedes/microbiology , Aedes/virology , Humans , Incidence , Mosquito Vectors/microbiology , Mosquito Vectors/virology , Mosquito Control/methods , Female , Pest Control, Biological/methodsABSTRACT
BACKGROUND: Due to the absence of available therapeutics and good vaccines, vector control solutions are needed to mitigate the spread of dengue. Matings between male Aedes aegypti mosquitoes infected with the wAlbB strain of Wolbachia and wildtype females yield non-viable eggs. We evaluated the efficacy of releasing wAlbB-infected A aegypti male mosquitoes to suppress dengue incidence. METHODS: In this synthetic control study, we conducted large-scale field trials in Singapore involving release of wAlbB-infected A aegypti male mosquitoes for dengue control via vector population suppression, from epidemiological week (EW) 27, 2018, to EW 26, 2022. We selected two large towns (Yishun and Tampines) to adopt an expanding release strategy and two smaller towns (Bukit Batok and Choa Chu Kang) to adopt a targeted-release approach. Releases were conducted two times a week in high-rise public housing estates. All intervention and control locations practised the same baseline dengue control protocol. The main outcome was weekly dengue incidence rate caused by any dengue virus serotype. We used incidence data collected by the Singapore Ministry of Health to assess the efficacy of the interventions. To compare interventions, we used the synthetic control method to generate appropriate counterfactuals for the intervention towns using a weighted combination of 30 control towns between EW 1, 2014 and EW 26, 2022. FINDINGS: Our study comprised an at-risk population of 607 872 individuals living in intervention sites and 3 894 544 individuals living in control sites. Interventions demonstrated up to 77·28% (121/156, 95% CI 75·81-78·58) intervention efficacy despite incomplete coverage across all towns until EW 26, 2022. Intervention efficacies increased as release coverage increased across all intervention sites. Releases led to 2242 (95% CI 2092-2391) fewer cases per 100 000 people in intervention sites during the study period. Secondary analysis showed that these intervention effects were replicated across all age groups and both sexes for intervention sites. INTERPRETATION: Our results demonstrated the potential of Wolbachia-mediated incompatible insect technique for strengthening dengue control in tropical cities, where dengue burden is the greatest. FUNDING: Singapore Ministry of Finance, Ministry of Sustainability, and the National Environment Agency, and the Singapore National Robotics Program.
Subject(s)
Aedes , Dengue , Mosquito Control , Mosquito Vectors , Wolbachia , Wolbachia/physiology , Dengue/prevention & control , Dengue/epidemiology , Dengue/transmission , Singapore/epidemiology , Animals , Aedes/microbiology , Aedes/virology , Incidence , Female , Male , Mosquito Control/methods , Mosquito Vectors/microbiology , Mosquito Vectors/virology , Humans , Dengue Virus , Pest Control, Biological/methodsABSTRACT
This study examined Static-99R normative data and cross-cultural validity in a sample of 811 Aboriginal and 3257 non-Aboriginal Australian men (N = 4068) serving custodial orders for sexual offences in New South Wales (NSW), Australia. Aboriginal men scored significantly higher on the Static-99R than non-Aboriginal men (M = 4.39 vs. 2.61) and were more likely to be represented in higher categories of risk. The Static-99R showed good discrimination performance for the total sample (AUC = .76; 95% CI = [.73-.80]) and acceptable calibration to expected reoffending rates for routine samples, with slight tendencies towards overestimation. Discrimination accuracy was lower for Aboriginal men (AUC = .68; 95% CI = [.60-77]) than non-Aboriginal men (AUC = .78; 95% CI = [.74-83]) although was significantly better than chance for both groups. Additional analyses indicated that cross-cultural differences in discrimination were partly associated with variance in sample composition between groups. This is the first Australian study to find evidence for significant predictive validity of the Static-99R with Aboriginal men, and while further research is needed, the results provide initial support for cross-cultural applications of the measure in local criminal justice settings.
ABSTRACT
We present a Cantonese emotional speech dataset that is suitable for use in research investigating the auditory and visual expression of emotion in tonal languages. This unique dataset consists of auditory and visual recordings of ten native speakers of Cantonese uttering 50 sentences each in the six basic emotions plus neutral (angry, happy, sad, surprise, fear, and disgust). The visual recordings have a full HD resolution of 1920 × 1080 pixels and were recorded at 50 fps. The important features of the dataset are outlined along with the factors considered when compiling the dataset. A validation study of the recorded emotion expressions was conducted in which 15 native Cantonese perceivers completed a forced-choice emotion identification task. The variability of the speakers and the sentences was examined by testing the degree of concordance between the intended and the perceived emotion. We compared these results with those of other emotion perception and evaluation studies that have tested spoken emotions in languages other than Cantonese. The dataset is freely available for research purposes.
ABSTRACT
BACKGROUND: Dengue is a severe environmental public health challenge in tropical and subtropical regions. In Singapore, decreasing seroprevalence and herd immunity due to successful vector control has paradoxically led to increased transmission potential of the dengue virus. We have previously demonstrated that incompatible insect technique coupled with sterile insect technique (IIT-SIT), which involves the release of X-ray-irradiated male Wolbachia-infected mosquitoes, reduced the Aedes aegypti population by 98% and dengue incidence by 88%. This novel vector control tool is expected to be able to complement current vector control to mitigate the increasing threat of dengue on a larger scale. We propose a multi-site protocol to study the efficacy of IIT-SIT at reducing dengue incidence. METHODS/DESIGN: The study is designed as a parallel, two-arm, non-blinded cluster-randomized (CR) controlled trial to be conducted in high-rise public housing estates in Singapore, an equatorial city-state. The aim is to determine whether large-scale deployment of male Wolbachia-infected Ae. aegypti mosquitoes can significantly reduce dengue incidence in intervention clusters. We will use the CR design, with the study area comprising 15 clusters with a total area of 10.9 km2, covering approximately 722,204 residents in 1713 apartment blocks. Eight clusters will be randomly selected to receive the intervention, while the other seven will serve as non-intervention clusters. Intervention efficacy will be estimated through two primary endpoints: (1) odds ratio of Wolbachia exposure distribution (i.e., probability of living in an intervention cluster) among laboratory-confirmed reported dengue cases compared to test-negative controls and (2) laboratory-confirmed reported dengue counts normalized by population size in intervention versus non-intervention clusters. DISCUSSION: This study will provide evidence from a multi-site, randomized controlled trial for the efficacy of IIT-SIT in reducing dengue incidence. The trial will provide valuable information to estimate intervention efficacy for this novel vector control approach and guide plans for integration into national vector control programs in dengue-endemic settings. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT05505682 . Registered on 16 August 2022. Retrospectively registered.
Subject(s)
Aedes , Dengue , Wolbachia , Animals , Male , Humans , Mosquito Control/methods , Dengue/epidemiology , Dengue/prevention & control , Mosquito Vectors , Incidence , Seroepidemiologic Studies , Singapore/epidemiology , Randomized Controlled Trials as TopicABSTRACT
Successful implementation of the sterile insect technique (SIT) against Aedes aegypti and Aedes albopictus relies on maintaining a consistent release of high-quality sterile males. Affordable, rapid, practical quality control tools based on the male's flight ability (ability to escape from a flight device) may contribute to meeting this requirement. Therefore, this study aims to standardize the use of the original FAO/IAEA rapid quality control flight test device (FTD) (version 1.0), while improving handling conditions and reducing the device's overall cost by assessing factors that could impact the subsequent flight ability of Aedes mosquitoes. The new FTD (version 1.1) is easier to use. The most important factors affecting escape rates were found to be tube color (or "shade"), the combined use of a lure and fan, mosquito species, and mosquito age and density (25; 50; 75; 100 males). Other factors measured but found to be less important were the duration of the test (30, 60, 90, 120 min), fan speed (normal 3000 rpm vs. high 6000 rpm), and mosquito strain origin. In addition, a cheaper version of the FTD (version 2.0) that holds eight individual tubes instead of 40 was designed and successfully validated against the new FTD (version 1.1). It was sensitive enough to distinguish between the effects of cold stress and high irradiation dose. Therefore, the eight-tube FTD may be used to assess Aedes' flight ability. This study demonstrated that the new designs (versions 1.1 and 2.0) of the FTD could be used for standard routine quality assessments of Aedes mosquitoes required for an SIT and other male release-based programs.
ABSTRACT
OBJECTIVES: Singapore experienced two major outbreaks of chikungunya in 2008-09 and 2013-14. Despite repeated virus introductions, fresh local outbreaks have not emerged after 2014. The present study reviews the success of chikungunya control in Singapore, despite repeated introduction of virus strains, presence of competent vectors and an immunologically naïve population. METHODS: Chikungunya virus (CHIKV) sequences (421 envelope 1 genes and 56 polyproteins) were analysed to distinguish the indigenous virus groups from 2008 to 2020. Vector surveillance data was used to incriminate the vector/s associated with local outbreaks. The population exposure to CHIKV was determined by assessing the seroprevalence status in three cohorts of sera collected in 2009 (n=2,008), 2013 (n=2,000) and 2017 (n=3,615). RESULTS: Four distinct groups of CHIKV of East, Central and South African genotype have mainly circulated since 2008, transmitted primarily by Aedes albopictus. The age weighted CHIKV IgG prevalence rates were low (1-5%) and showed a non-significant increase from 2009 to 2013, but a significant decrease in 2017. In contrast, the prevalence of CHIKV neutralising antibodies in the population increased significantly from 2009 to 2013, with no significant change in 2017, but the levels remained below 2%. CONCLUSIONS: The evidence suggested that surveillance and vector control strategies implemented were robust to avert severe epidemics, despite repeated introduction of virus strains, presence of competent vectors and an immunologically naïve population.
Subject(s)
Chikungunya virus , Epidemics , Chikungunya virus/genetics , Humans , Mosquito Vectors , Seroepidemiologic Studies , Singapore/epidemiology , Vulnerable PopulationsABSTRACT
Japanese encephalitis virus (JEV) and West Nile virus (WNV) are arboviruses primarily transmitted by Culex spp. mosquitoes. Birds are the primary hosts for JEV and WNV. Recent WNV outbreaks in Europe and United States and their association with migratory birds highlight the importance of understanding the feeding host preference of potential vectors for outbreak preparedness, especially in nonendemic settings. Singapore is nonendemic to JEV and WNV, but is a stopover site for migratory birds of the East Asian-Australasian Flyway. Therefore, we elucidated the feeding host range of Culex spp. mosquitoes captured in four natural (bird) habitats in Singapore from January 2011 to December 2012. We characterized feeding host DNA in field-caught mosquitoes using a PCR sequencing-based assay targeting the mitochondrial gene regions. Of 22,648 mosquitoes captured, 21,287 belonged to the Culex vishnui subgroup. The host DNA analysis showed that mosquitoes from the Cx. vishnui subgroup are opportunistic biters, feeding on a range of birds and mammals. Cx. vishnui subgroup, Culex sitiens and Culex bitaeniorhynchus, was primarily ornithophagic, although they fed opportunistically on mammals, including humans. Culex gelidus and Culex quinquefasciatus, in contrast, fed mainly on mammals. The presence of ornitho- and anthropophilic mosquito vectors and susceptible avian and mammalian hosts poses a risk spill-over transmission of JEV and WNV among humans, should these viruses be introduced through migratory birds and establish persistent transmission in resident birds and animal hosts in Singapore.
Subject(s)
Culex/physiology , Feeding Behavior , Mosquito Vectors/physiology , Animals , Birds/blood , Birds/genetics , Birds/parasitology , Encephalitis Virus, Japanese , Genes, Mitochondrial , Insect Bites and Stings , Mammals/blood , Mammals/genetics , Mammals/parasitology , Singapore , West Nile virusABSTRACT
House Index, Container Index, and Breteau Index are the most commonly used indices for dengue vector surveillance. However, these larval indices are a poor proxy for measuring the adult population-which is responsible for disease transmission. Information on the adult distribution and density are important for assessing transmission risk as well as for developing effective control strategies. This study introduces a new entomological index, Gravitrap aegypti index (GAI), which estimates the adult female Aedes aegypti population in the community and presents its association with dengue cases. Gravitraps were deployed across 34 treatment sites in Singapore from September 2013 to September 2016. The GAI, derived from the Gravitrap surveillance data, was analysed to investigate the spatio-temporal patterns of the Ae. aegypti population in Singapore. The index was further categorised into low, moderate, and high-risk groups and its association with dengue cases were examined. A Before-After Control Impact analysis was performed to evaluate the epidemiology impact of Gravitrap system on dengue transmission. The Ae. aegypti population exhibits a seasonal pattern, and spatial heterogeneity in Ae. aegypti abundance was observed among treatment sites. The Ae. aegypti population was also found to be unevenly distributed among floors of an apartment block, with low floors (floors 1-4) having a higher abundance of mosquitoes trapped than mid (floors 5-8) and high (floors ≥9) floors. Areas with high GAI were shown to have higher dengue case count. Gravitrap has also demonstrated to be a good dengue control tool. The contribution of cases by treatment sites to the national numbers was lower after Gravitraps deployment. The GAI, which is of better relevance to dengue transmission risk, could be recommended as an indicator for decision making in vector control efforts, and to monitor the spatio-temporal variability of the adult Aedes population in the country. In addition, findings from this study indicate that Gravitraps can be used as a dengue control tool to reduce dengue transmission.
Subject(s)
Aedes/physiology , Disease Outbreaks/prevention & control , Mosquito Control/instrumentation , Mosquito Control/methods , Aedes/virology , Animals , Dengue/epidemiology , Dengue Virus , Environment , Female , Insect Vectors , Population Density , SingaporeABSTRACT
Mosquito-borne flaviviruses are emerging pathogens of an increasing global public health concern because of their rapid increase in geographical range and the impact of climate change. Japanese encephalitis virus (JEV) and West Nile virus (WNV) are of concern because of the risk of reemergence and introduction by migratory birds. In Singapore, human WNV infection has never been reported and human JEV infection is rare. Four sentinel vector surveillance sites were established in Singapore to understand the potential risk posed by these viruses. Surveillance was carried out from August 2011 to December 2012 at Pulau Ubin, from March 2011 to March 2013 at an Avian Sanctuary (AS), from December 2010 from October 2012 at Murai Farmway, and from December 2010 to December 2013 at a nature reserve. The present study revealed active JEV transmission in Singapore through the detection of JEV genotype II in Culex tritaeniorhynchus collected from an Avian Sanctuary. Culex flavivirus (CxFV), similar to the Quang Binh virus isolated from Cx. tritaeniorhynchus in Vietnam and CxFV-LSFlaviV-A20-09 virus isolated in China, was also detected in Culex spp. (vishnui subgroup). No WNV was detected. This study demonstrates the important role that surveillance plays in public health and strongly suggests the circulation of JEV among wildlife in Singapore, despite the absence of reported human cases. A One Health approach involving surveillance, the collaboration between public health and wildlife managers, and control of mosquito populations remains the key measures in risk mitigation of JEV transmission in the enzootic cycle between birds and mosquitoes.
Subject(s)
Culex/virology , Encephalitis Virus, Japanese/isolation & purification , Encephalitis, Japanese/epidemiology , Mosquito Vectors/virology , Animals , Encephalitis Virus, Japanese/genetics , Encephalitis, Japanese/virology , Epidemiological Monitoring , Female , Genotype , Geography , Humans , Singapore/epidemiologyABSTRACT
Accurate identification of mosquitoes is crucial for the management and control of vector species. Although Singapore is a tropical country with high mosquito diversity, there are no identification keys specific to its mosquito fauna. An illustrated identification key to the genera of the adult female mosquitoes of Singapore is presented. Twenty genera are characterized and two genera found in Malaysia, Culiseta and Topomyia, are also included. The key will aid non-taxonomically trained operational officers in adult mosquito identification. The key to the genera provides the first crucial step in the process to species identification.
Subject(s)
Culicidae , Animals , Disease Vectors , Female , Malaysia , Mosquito Vectors , SingaporeABSTRACT
Singapore experienced its first Zika virus (ZIKV) cluster in August 2016. To understand the implication of human movement on disease spread, a retrospective study was conducted using aggregated and anonymized mobile phone data to examine movement from the cluster to identify areas of possible transmission. An originâ»destination model was developed based on the movement of three groups of individuals: (i) construction workers, (ii) residents and (iii) visitors out of the cluster locality to other parts of the island. The odds ratio of ZIKV cases in a hexagon visited by an individual from the cluster, independent of the group of individuals, is 3.20 (95% CI: 2.65â»3.87, p-value < 0.05), reflecting a higher count of ZIKV cases when there is a movement into a hexagon from the cluster locality. A comparison of independent ROC curves tested the statistical significance of the difference between the areas under the curves of the three groups of individuals. Visitors (difference in AUC = 0.119) and residents (difference in AUC = 0.124) have a significantly larger difference in area under the curve compared to the construction workers (p-value < 0.05). This study supports the proof of concept of using mobile phone data to approximate population movement, thus identifying areas at risk of disease transmission.
Subject(s)
Zika Virus Infection/transmission , Cell Phone , Humans , Movement , Odds Ratio , Retrospective Studies , Singapore/epidemiology , Zika Virus , Zika Virus Infection/epidemiologyABSTRACT
Prior to 1965, Singapore was part of the Malaya (now Malaysia) and was usually not mentioned when mosquito records were reported for Malaya. Consequently, many species that occurred in Singapore were not listed in the world mosquito catalog, and the available checklist for Singapore since 1986 is incomplete, with some imprecise species information. In updating this checklist, we examined and verified mosquito specimens collected from Singapore in various depositories, including a thorough review of past taxonomic literature. Here, we report a checklist of 182 mosquito species, 33 new distribution records, and a consolidated status list of vectors for Singapore. As Singapore is a travel hub and hosts one of the busiest container ports in the world, there is a risk of introducing mosquito species and their associated pathogens of human disease to the country. Hence, the distribution records are important to increase our knowledge on mosquito ecology as well as to understand the risk of newly introduced vectors and their associated pathogens.
Subject(s)
Biodiversity , Culicidae , Animals , Checklist , Female , Male , Mosquito Vectors , SingaporeABSTRACT
BACKGROUND: In 2013 and 2014, Singapore experienced its worst dengue outbreak known-to-date. Mosquito breeding in construction sites stood out as a probable risk factor due to its association with major dengue clusters in both years. We, therefore, investigated the contribution of construction sites to dengue transmission in Singapore, highlighting three case studies of large construction site-associated dengue clusters recorded during 2013-16. METHODS: The study included two components; a statistical analysis of cluster records from 2013 to 2016, and case studies of three biggest construction site-associated clusters. We explored the odds of construction site-associated clusters growing into major clusters and determined whether clusters seeded in construction sites demonstrated a higher tendency to expand into major clusters. DENV strains obtained from dengue patients residing in three major clusters were genotyped to determine whether the same strains expanded into the surroundings of construction sites. RESULTS: Despite less than 5% of total recorded clusters being construction site-associated, the odds of such clusters expanding into major clusters were 17.4 (2013), 9.2 (2014), 3.3 (2015) and 4.3 (2016) times higher than non-construction site clusters. Aedes premise index and average larvae count per habitat were also higher in construction sites than residential premises during the study period. The majority of cases in clusters associated with construction sites were residents living in the surroundings. Virus genotype data from three case study sites revealed a transmission link between the construction sites and the surrounding residential areas. CONCLUSIONS: Significantly high case burden and the probability of cluster expansion due to virus spill-over into surrounding areas suggested that construction sites play an important role as a driver of sustained dengue transmission. Our results emphasise that the management of construction-site associated dengue clusters should not be limited to the implicated construction sites, but be extended to the surrounding premises to prevent further transmission.
Subject(s)
Aedes/virology , Construction Industry , Construction Materials/virology , Dengue Virus , Dengue/transmission , Animals , Humans , SingaporeABSTRACT
Singapore has experienced periodic dengue epidemics despite maintaining a low Aedes house index. Each epidemic was associated with a switch in the predominant serotype. We investigated the temporal dynamics of dengue fever and dengue virus (DENV) and analyzed the epidemiological and entomological patterns of dengue in Singapore from 2004 to 2016. The case surveillance is based on a mandatory notification system that requires all medical practitioners to report clinically suspected and laboratory-confirmed cases. Circulating (DENV) serotypes are monitored through a virus surveillance program. Entomological surveillance involves inspections for larval breeding and monitoring of adults using gravitraps. Singapore experienced a similar epidemic pattern during 2004-2007 and 2013-2016. The pattern involved a 2-year DENV-1 epidemic occurring after a switch in the predominant serotype from DENV-2 to DENV-1, followed by a "lull" year. Thereafter, the predominant serotype switched back to DENV-2, tailed by a small-scale epidemic. Across the years, the highest incidence group was in the 25-44 years age group. The incidence rate of those aged ≥ 55 years was about half of that of the 15-24 years age group during DENV-1 predominant years. However, it was almost equal to the younger age group in DENV-2 predominant years. Types of Aedes aegypti breeding habitats remained similar. Dengue incidence was significantly higher in areas with high breeding percentage (BP) than areas with low BP (P < 0.05). In conclusion, the oscillation of DENV-1 and DENV-2, throughout the 13-year period, led to a cyclical epidemic pattern and older adults were more affected by DENV-2 than DENV-1.
Subject(s)
Aedes/virology , Dengue Virus/genetics , Dengue/epidemiology , Epidemics , Mosquito Vectors/virology , Adolescent , Adult , Animals , Dengue/diagnosis , Dengue/transmission , Dengue/virology , Dengue Virus/classification , Dengue Virus/isolation & purification , Disease Notification/statistics & numerical data , Epidemiological Monitoring , Female , Humans , Incidence , Larva/virology , Male , Middle Aged , Mosquito Control/methods , Public Health , Pupa/virology , Serogroup , Singapore/epidemiologyABSTRACT
Dengue is the most important human arboviral disease in Singapore. We classified residential areas into low-rise and high-rise housing and investigated the influence of urban drainage on the distribution of dengue incidence and outdoor breeding at neighborhood and country scales. In Geylang area (August 2014 to August 2015), dengue incidence was higher in a subarea of low-rise housing compared to high-rise one, averaging 26.7 (standard error, SE = 4.83) versus 2.43 (SE = 0.67) per 1,000 people. Outdoor breeding drains of Aedes aegypti have clustered in the low-rise housing subarea. The pupal density per population was higher in the low-rise blocks versus high-rise ones, 246 (SE = 69.08) and 35.4 (SE = 25.49) per 1,000 people, respectively. The density of urban drainage network in the low-rise blocks is double that in the high-rise ones, averaging 0.05 (SE = 0.0032) versus 0.025 (SE = 0.00245) per meter. Further, a holistic analysis at a country-scale has confirmed the role of urban hydrology in shaping dengue distribution in Singapore. Dengue incidence (2013-2015) is proportional to the fractions of the area (or population) of low-rise housing. The drainage density in low-rise housing is 4 times that corresponding estimate in high-rise areas, 2.59 and 0.68 per meter, respectively. Public housing in agglomerations of high-rise buildings could have a positive impact on dengue if this urban planning comes at the expense of low-rise housing. City planners in endemic regions should consider the density of drainage networks for both the prevention of flooding and the breeding of mosquitoes.
ABSTRACT
BACKGROUND: Singapore has been certified malaria-free by the World Health Organization since November 1982. However, sporadic autochthonous malaria outbreaks do occur. In one of the most recent outbreaks of vivax malaria, an entomological investigation identified Anopheles sinensis as the most probable vector. As metaphase karyotype studies divided An. sinensis into two forms, A and B, with different vector competence: the investigation of vector competence of An. sinensis found in Singapore was thus pursued using Plasmodium vivax field isolates from the Thailand-Myanmar border. METHODS: Adults and larvae An. sinensis were collected from Singapore from 14 different locations, using various trapping and collection methods between September 2013 and January 2016. Molecular identification of An. sinensis species were conducted by amplifying the ITS2 and CO1 region using PCR. Experimental infections of An. sinensis using blood from seven patients infected with P. vivax from the Thailand-Myanmar border were conducted with Anopheles cracens (An. dirus B) as control. RESULTS: Phylogenetic analysis showed that An. sinensis (F22, F2 and collected from outbreak areas) found in Singapore was entirely Form A, and closely related to An. sinensis Form A from Thailand. Artificial infection of these Singapore strain An. sinensis Form A resulted in the development of oocysts in four experiments, with the number of sporozoites produced by one An. sinensis ranging from 4301 to 14,538. CONCLUSIONS: Infection experiments showed that An. sinensis Form A from Singapore was susceptible to Thai-Myanmar P. vivax strain, suggesting a potential role as a malaria vector in Singapore.