Geographic expansion of the introduced Aedes albopictus and other native Aedes species in the Democratic Republic of the Congo.

BACKGROUND: Aedes albopictus has been reported in several Central African countries, including the Democratic Republic of the Congo (DRC). The establishment of this mosquito species poses a serious threat as a vector of various infectious diseases. Although Ae. albopictus has been reported in the western region of the DRC, information about its distribution is still scarce in the country. The aim of this study was to investigate the current nationwide distribution of the invasive Ae. albopictus, as well as other native Aedes mosquitoes, in the DRC and to identify suitable areas for its future expansion. METHODS: Two entomological surveys were conducted in 2017-2019 and 2022. Based on the occurrence sites of Ae. albopictus, important environmental variables were identified. Then, geographical areas suitable for Ae. albopictus establishment were determined using the maximum entropy model. The distribution and abundance of Ae. albopictus were also compared with those of the major native Aedes species. RESULTS: Aedes albopictus was found in the western, northern, central, and eastern regions of the DRC, but it was not found in the southeastern region. The maximum entropy model predicted that most parts of the DRC are suitable for the establishment of this mosquito. The unsuitable areas encompassed the eastern highlands, known for their low temperatures, and the southeastern highlands, which experience both low temperatures and a long dry season. The native Aedes species found were Aedes aegypti, Aedes simpsoni, Aedes africanus, and Aedes vittatus. Aedes albopictus dominated in the western and northern regions, while Ae. aegypti was more prevalent in other regions. CONCLUSIONS: Aedes albopictus has been well established in the western and northern regions of the DRC. This mosquito is expanding its distribution while replacing the native Aedes species. Most of the country is suitable for the establishment of this mosquito species, except the highlands of the eastern and the southeastern regions.

Searching for a sign of exotic Aedes albopictus (Culicidae) introduction in major international seaports on Kyushu Island, Japan.

BACKGROUND: The Asian tiger mosquito, Aedes albopictus, has spread around the world. The migration was mainly mediated by maritime transportations. This species is known as an efficient vector for arboviruses, and it was responsible for the recent dengue outbreak in Tokyo, Japan. As the vector competence varies among geographical populations, and insecticide resistant populations have emerged, it is important to reveal their movements. The present study uses molecular techniques to search for a sign of introduction of an exotic population in three major international seaports on Kyushu Island. METHODOLOGY/PRINCIPAL FINDINGS: Adults of Ae. albopictus were sampled around the international seaports of Fukuoka, Kitakyushu, and Nagasaki. Pairwise fixation indexes were estimated between the sampled populations based on 13 microsatellite markers. There was no clear genetic differentiation between distant and port populations in Kitakyushu and Nagasaki. However, the analysis found one distinct group near the container terminal in Fukuoka, which handles international freight containers mainly from adjacent countries. DNA samples were also obtained from Goto, Tsushima, Honshu, Ryukyu, Thailand, and the Philippines; and a cluster analysis and discriminant analysis revealed that the distinct group in Fukuoka did not belong to these groups. Combined with the results of phylogenetic analysis based on CO1, these results implied that this group originated from one Asian temperate region outside of Japan. Neutrality test and mismatch distribution analysis suggested that the establishment of this group was not recent. CONCLUSIONS/SIGNIFICANCE: The present study found a sign of Ae. albopictus introduction from a temperate region of Asia through maritime freight container transportation. The genetically distinct group found in Fukuoka likely originated from a temperate region outside of Japan. Maritime container transportation may introduce to Japan mosquitoes with greater vector competence/insecticide resistance. This is the first study to describe the spatial population structure of Ae. albopictus in Japan using molecular techniques.

What does soil-transmitted helminth elimination look like? Results from a targeted molecular detection survey in Japan.

BACKGROUND: Japan is one of the few countries believed to have eliminated soil-transmitted helminths (STHs). In 1949, the national prevalence of Ascaris lumbricoides was 62.9%, which decreased to 0.6% in 1973 due to improvements in infrastructure, socioeconomic status, and the implementation of national STH control measures. The Parasitosis Prevention Law ended in 1994 and population-level screening ceased in Japan; therefore, current transmission status of STH in Japan is not well characterized. Sporadic cases of STH infections continue to be reported, raising the possibility of a larger-scale recrudescence of STH infections. Given that traditional microscopic detection methods are not sensitive to low-intensity STH infections, we conducted targeted prevalence surveys using sensitive PCR-based assays to evaluate the current STH-transmission status and to describe epidemiological characteristics of areas of Japan believed to have achieved historical elimination of STHs. METHODS: Stool samples were collected from 682 preschool- and school-aged children from six localities of Japan with previously high prevalence of STH. Caregivers of participants completed a questionnaire to ascertain access to water, sanitation and hygiene (WASH), and potential exposures to environmental contamination. For fecal testing, multi-parallel real-time PCR assays were used to detect infections of Ascaris lumbricoides, Necator americanus, Ancylostoma duodenale and Trichuris trichiura. RESULTS: Among the 682 children, no positive samples were identified, and participants reported high standards of WASH. CONCLUSIONS: To our knowledge, this is the first STH-surveillance study in Japan to use sensitive molecular techniques for STH detection. The results suggest that recrudescence of STH infections has not occurred, and that declines in prevalence have been sustained in the sampled areas. These findings suggest that reductions in prevalence below the elimination thresholds, suggestive of transmission interruption, are possible. Additionally, this study provides circumstantial evidence that multi-parallel real-time PCR methods are applicable for evaluating elimination status in areas where STH prevalence is extremely low.

Extremely High Biting Densities of Aedes albopictus (Skuse) (Diptera: Culicidae) at a University Campus in Nagasaki, Japan.

Aedes albopictus (Skuse) transmits several arboviral diseases. This mosquito was the vector responsible for both the past and recent dengue outbreaks in Japan. Sites with a high density of A. albopictus are at risk of outbreaks of arboviral diseases. This study describes extremely high biting densities of A. albopictus at a campus of Nagasaki University, southwestern Japan. In August of 2015 and 2016, an 8 min human-bait-sweep collection obtained on average 33.4 and 38.9 females, respectively. In both 2015 and 2016, the highest and the second highest biting densities were observed at sites densely shaded by trees and covered with a large number of understory plants. In addition, major A. albopictus breeding sites were identified near these locations in 2016. A predaceous larval mosquito, Lutzia vorax Edwards, appeared to strongly suppress the breeding of A. albopictus in catch basins near the site with the highest adult density, although its effect was insufficient to maintain A. albopictus density at a low level. After the catch basins had been cleaned, A. albopictus immatures became more abundant, especially in shallow catch basins in shaded sites.

A high-intensity cluster of Schistosoma mansoni infection around Mbita causeway, western Kenya: a confirmatory cross-sectional survey.

In Kenya, communities residing along the shores and islands of Lake Victoria bear a substantial burden of schistosomiasis. Although there is a school-based deworming program in place, the transmission of Schistosoma mansoni varies even at a fine scale. Given the focal nature of schistosomes' transmission, we aim to identify areas with high intensity of S. mansoni infection in Mbita, Homabay County, western Kenya, for prioritized integrated control measures. Our findings confirm a high intensity of S. mansoni infection cluster around Mbita causeway. While the current efforts to curtail morbidity due to schistosomiasis through preventive chemotherapy in schools are crucial, fine-scale mapping of risk areas is necessary for specific integrated control measures.

Identification of Three Distinct Groups of Anopheles lindesayi in Japan by Morphological and Genetic Analyses.

Anopheles (Anopheles) lindesayi Giles consists of 5 subspecies. In Japan, only one subspecies, An. l. japonicus Yamada, has been reported. Its geographical populations are morphologically diverse; however, they are regarded as a single subspecies. In this study, we re-evaluated the taxonomic status of An. l. japonicus in Japan, and that of another subspecies, An. l. pleccau, distributed in Taiwan, by comparative morphological and molecular analyses based on the gene sequences of mitochondrial DNA cytochrome c oxidase I (COI) and ribosomal DNA internal transcribed spacer 2 (ITS2). Nucleotide sequence divergence was calculated using the Kimura-two-parameter (K2P) distance model. Phylogenetic trees based on COI and ITS2 sequences showed 3 distinct clades: Eastern Japan, Western Japan, and the Ryukyus. The sequences of the Ryukyu specimens were located within the same clade as that of the sequences of the Taiwanese specimens. Regarding the COI sequences, the 3 geographical groups in Japan were genetically distinct. The following morphological characteristics distinguished the groups: larval seta 1-S, pupal setae 5 through segments IV-VII, and pupal setae 6 on segments IV-VII. Based on these results, it was revealed that An. l. japonicus included 3 genetically and morphologically distinct groups: 2 groups of An. l. japonicus and a group in the Ryukyus, which was a synonym of An. l. pleccau.

Simulation Study of the Effects of Host Availability on Bite Rate of Aedes albopictus (Skuse) (Diptera: Culicidae) and Risk of Dengue Outbreaks in Non-Endemic Areas.

Aedes albopictus is an important vector of dengue fever and tends to live in specific area, where it may ambush blood host that it encounters. Thus, host contact frequency may affect the bite rate and risk of disease outbreak, although no studies have examined these parameters. The present study used a simple model to clarify the fundamental relationship between host availability, bite rate, and risk of dengue outbreaks in non-endemic areas. A hypothetical isolated mosquito population was divided into "ambush" and "resting" subpopulations, and human hosts were modeled as visiting the mosquito population at constant intervals. A single infectious human who visited the mosquito population only on a single occasion was responsible for mosquito infections and consequently, secondary infections among humans who subsequently visit the area after the incubation period. The results confirmed that the bite rate per host increased with decreasing host availability. The number of secondary infections among hosts exhibited a unimodal relationship with the frequency of host visits, with a maximum value at host visits every 24 h. Furthermore, when host availability was not very low, the bite rate was a good indicator of the potential risk of dengue outbreaks. Therefore, human-bait-sweep collection data may be useful for monitoring the risk of dengue outbreaks.

Spatial distribution and risk factors of Schistosoma haematobium and hookworm infections among schoolchildren in Kwale, Kenya.

BACKGROUND: Large-scale schistosomiasis control programs are implemented in regions with diverse social and economic environments. A key epidemiological feature of schistosomiasis is its small-scale heterogeneity. Locally profiling disease dynamics including risk factors associated with its transmission is essential for designing appropriate control programs. To determine spatial distribution of schistosomiasis and its drivers, we examined schoolchildren in Kwale, Kenya. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a cross-sectional study of 368 schoolchildren from six primary schools. Soil-transmitted helminths and Schistosoma mansoni eggs in stool were evaluated by the Kato-Katz method. We measured the intensity of Schistosoma haematobium infection by urine filtration. The geometrical mean intensity of S. haematobium was 3.1 eggs/10 ml urine (school range, 1.4-9.2). The hookworm geometric mean intensity was 3.2 eggs/g feces (school range, 0-17.4). Heterogeneity in the intensity of S. haematobium and hookworm infections was evident in the study area. To identify factors associated with the intensity of helminth infections, we utilized negative binomial generalized linear mixed models. The intensity of S. haematobium infection was associated with religion and socioeconomic status (SES), while that of hookworm infection was related to SES, sex, distance to river and history of anthelmintic treatment. CONCLUSIONS/SIGNIFICANCE: Both S. haematobium and hookworm infections showed micro-geographical heterogeneities in this Kwale community. To confirm and explain our observation of high S. haematobium risk among Muslims, further extensive investigations are necessary. The observed small scale clustering of the S. haematobium and hookworm infections might imply less uniform strategies even at finer scale for efficient utilization of limited resources.

Complete Genome Sequencing and Phylogenetic Analysis of a Getah Virus Strain (Genus Alphavirus, Family Togaviridae) Isolated from Culex tritaeniorhynchus Mosquitoes in Nagasaki, Japan in 2012.

Getah virus (GETV; genus Alphavirus, family Togaviridae) is a mosquito-borne virus known to cause disease in horses and pigs. In 2014, for the first time in ∼30 years, a sudden GETV outbreak occurred among racehorses in Ibaraki, Japan. Two years before this outbreak, we obtained multiple GETV isolates from Culex tritaeniorhynchus mosquitoes collected in Nagasaki, Japan and determined the whole genome sequence of GETV isolate 12IH26. Our phylogenetic analysis of GETV strains revealed that the isolate 12IH26 forms a robust clade with the epidemic strains 14-I-605-C1 and 14-I-605-C2 isolated from horses in the 2014 outbreak in Ibaraki. Furthermore, the complete genomic sequence of the isolate 12IH26 was 99.9% identical to those of the 2014 epidemic strains in Ibaraki. Phylogenetic analysis also showed that the recent Japanese GETV strains, including the isolate 12IH26, are closely related to the Chinese and South Korean strains rather than the previous Japanese strains, suggesting that GETV strains may be transported from overseas into Japan through long-distance migration of the infected mosquitoes or migratory birds.

Risk factors and spatial distribution of Schistosoma mansoni infection among primary school children in Mbita District, Western Kenya.

BACKGROUND: An increasing risk of Schistosoma mansoni infection has been observed around Lake Victoria, western Kenya since the 1970s. Understanding local transmission dynamics of schistosomiasis is crucial in curtailing increased risk of infection. METHODOLOGY/PRINCIPAL FINDINGS: We carried out a cross sectional study on a population of 310 children from eight primary schools. Overall, a total of 238 (76.8%) children were infected with S. mansoni, while seven (2.3%) had S. haematobium. The prevalence of hookworm, Trichuris trichiura and Ascaris lumbricoides were 6.1%, 5.2% and 2.3%, respectively. Plasmodium falciparum was the only malaria parasite detected (12.0%). High local population density within a 1 km radius around houses was identified as a major independent risk factor of S. mansoni infection. A spatial cluster of high infection risk was detected around the Mbita causeway following adjustment for population density and other potential risk factors. CONCLUSIONS/SIGNIFICANCE: Population density was shown to be a major factor fuelling schistosome infection while individual socio-economic factors appeared not to affect the infection risk. The high-risk cluster around the Mbita causeway may be explained by the construction of an artificial pathway that may cause increased numbers of S. mansoni host snails through obstruction of the waterway. This construction may have, therefore, a significant negative impact on the health of the local population, especially school-aged children who frequently come in contact with lake water.

Tanay virus, a new species of virus isolated from mosquitoes in the Philippines.

In 2005, we isolated a new species of virus from mosquitoes in the Philippines. The virion was elliptical in shape and had a short single projection. The virus was named Tanay virus (TANAV) after the locality in which it was found. TANAV genomic RNA was a 9562 nt+poly-A positive strand, and polycistronic. The longest ORF contained putative RNA-dependent RNA polymerase (RdRP); however, conserved short motifs in the RdRP were permuted. TANAV was phylogenetically close to Negevirus, a recently proposed taxon of viruses isolated from haemophagic insects, and to some plant viruses, such as citrus leprosis virus C, hibiscus green spot virus and blueberry necrotic ring blotch virus. In this paper, we describe TANAV and the permuted structure of its RdRP, and discuss its phylogeny together with those of plant viruses and negevirus.

Push by a net, pull by a cow: can zooprophylaxis enhance the impact of insecticide treated bed nets on malaria control?

BACKGROUND: Mass insecticide treated bed net (ITN) deployment, and its associated coverage of populations at risk, had "pushed" a decline in malaria transmission. However, it is unknown whether malaria control is being enhanced by zooprophylaxis, i.e., mosquitoes diverted to feed on hosts different from humans, a phenomenon that could further reduce malaria entomological transmission risk in areas where livestock herding is common. METHODS: Between May and July 2009, we collected mosquitoes in 104 houses from three neighboring villages with high ITN coverage (over 80%), along Lake Victoria. We also performed a census of livestock in the area and georeferenced tethering points for all herds, as well as, mosquito larval habitats. Bloodmeal contents from sampled mosquitoes were analyzed, and each mosquito was individually tested for malaria sporozoite infections. We then evaluated the association of human density, ITN use, livestock abundance and larval habitats with mosquito abundance, bloodfeeding on humans and malaria sporozoite rate using generalized linear mixed effects models. RESULTS: We collected a total of 8123 mosquitoes, of which 1664 were Anopheles spp. malaria vectors over 295 household spray catches. We found that vector household abundance was mainly driven by the number of householders (P < 0.05), goats/sheep tethered around the house (P < 0.05) and ITNs, which halved mosquito abundance (P < 0.05). In general, similar patterns were observed for Anopheles arabiensis, but not An. gambiae s.s. and An. funestus s.s., whose density did not increase with the presence of livestock animals. Feeding on humans significantly increased in all species with the number of householders (P < 0.05), and only significantly decreased for An. arabiensis in the presence of cattle (P < 0.05). Only 26 Anopheles spp. vectors had malaria sporozoites with the sporozoite rate significantly decreasing as the proportion of cattle feeding mosquitoes increased (P < 0.05). CONCLUSION: Our data suggest that cattle, in settings with large ITN coverage, have the potential to drive an unexpected "push-pull" malaria control system, where An. arabiensis mosquitoes "pushed" out of human contact by ITNs are likely being further "pulled" by cattle.

Rapid assessment procedures to detect hidden endemic foci in areas not subjected to mass drug administration in Sri Lanka.

For the declaration of elimination of lymphatic filariasis, reliable epidemiological data in all parts of a country are required. In Sri Lanka, due to social disturbance, there are 3 provinces whose endemicity has been declared unknown. Further, a recent report revealed an endemic pocket, which is on the border with the district that was not covered by the national elimination program. These facts indicate the necessity of more extensive studies to discover hidden endemic foci. To facilitate such studies, we evaluated 2 methods of Rapid Assessment Procedure (RAP) in Hambantota district, where the filariasis endemicity was low: (1) indirect questioning by mailing a questionnaire to each local leader (IndQ), asking about the presence of clinical cases, and (2) focus group discussion (FGD) by villagers. The information given by people was validated with clinical examination by doctors (CE) and IgG4 ELISA using urine samples. In the results: there was a strong positive correlation between CE and ELISA rates. The hydrocele rates obtained by FGD or IndQ were associated significantly with CE rates. The rates by FGD or Cluster-IndQ ('modified' IndQ) were also associated significantly with ELISA rates. The IndQ was most cost-effective. Based on these findings, we have concluded that screening by IndQ and confirmation by the ELISA would be an effective and practical way in Sri Lanka to locate endemic foci in hitherto unsurveyed districts.

Possible association between recent migration and hospitalisation for dengue in an urban population: a prospective case-control study in northern Vietnam.

A prospective case-control study was conducted in urban districts in Hanoi, northern Vietnam to evaluate the effect of migration on the risk of hospitalisation for dengue in a Vietnamese urban population. We enrolled laboratory-confirmed dengue patients aged ≥ 18 years who were hospitalised in local hospitals in November and December 2010. Four neighbourhood-matched controls for each case were recruited within a week of hospitalisation. Sociodemographic data were collected by interviews, and the number of immature and adult mosquitoes within household premises was counted by entomological survey. Matched-pair analyses were conducted using conditional logistic regression models. Among 43 cases and 168 controls, 84% and 83% were migrants from rural areas, respectively. Although statistical significance was marginal, recent migration (residing in study area for ≤ 5 years) independently increased the risk of hospitalisation for dengue compared with inhabitants after controlling for potential confounders (adjusted odds ratio [aOR] = 3.78; 95% confidence interval [CI] = 0.99-14.27), whereas longer-term migration (residing in study area for ≥ 6 years) did not change the risk (aOR = 1.1; 95% CI = 0.30-4.05). Younger age (18-34 years) (aOR = 7.26; 95% CI = 2.39-22.06) and higher adult Aedes aegypti infestation level within household premises (aOR = 9.25; 95% CI = 1.68-51.09) were also independently associated with hospitalisation for dengue. Recent migration from rural areas seems to increase the risk of hospitalisation for dengue in urban populations in endemic areas. Further research including cohort study should be done to confirm the impact of migration on the risk of dengue in urban areas.

Topographic models for predicting malaria vector breeding habitats: potential tools for vector control managers.

BACKGROUND: Identification of malaria vector breeding sites can enhance control activities. Although associations between malaria vector breeding sites and topography are well recognized, practical models that predict breeding sites from topographic information are lacking. We used topographic variables derived from remotely sensed Digital Elevation Models (DEMs) to model the breeding sites of malaria vectors. We further compared the predictive strength of two different DEMs and evaluated the predictability of various habitat types inhabited by Anopheles larvae. METHODS: Using GIS techniques, topographic variables were extracted from two DEMs: 1) Shuttle Radar Topography Mission 3 (SRTM3, 90-m resolution) and 2) the Advanced Spaceborne Thermal Emission Reflection Radiometer Global DEM (ASTER, 30-m resolution). We used data on breeding sites from an extensive field survey conducted on an island in western Kenya in 2006. Topographic variables were extracted for 826 breeding sites and for 4520 negative points that were randomly assigned. Logistic regression modelling was applied to characterize topographic features of the malaria vector breeding sites and predict their locations. Model accuracy was evaluated using the area under the receiver operating characteristics curve (AUC). RESULTS: All topographic variables derived from both DEMs were significantly correlated with breeding habitats except for the aspect of SRTM. The magnitude and direction of correlation for each variable were similar in the two DEMs. Multivariate models for SRTM and ASTER showed similar levels of fit indicated by Akaike information criterion (3959.3 and 3972.7, respectively), though the former was slightly better than the latter. The accuracy of prediction indicated by AUC was also similar in SRTM (0.758) and ASTER (0.755) in the training site. In the testing site, both SRTM and ASTER models showed higher AUC in the testing sites than in the training site (0.829 and 0.799, respectively). The predictability of habitat types varied. Drains, foot-prints, puddles and swamp habitat types were most predictable. CONCLUSIONS: Both SRTM and ASTER models had similar predictive potentials, which were sufficiently accurate to predict vector habitats. The free availability of these DEMs suggests that topographic predictive models could be widely used by vector control managers in Africa to complement malaria control strategies.

Beyond buzzing: mosquito watching stimulates malaria bednet use-a household-based cluster-randomized controlled assessor blind educational trial.

Malaria remains a severe health problem in Sub-Saharan Africa, with approximately one million deaths and 365 million cases each year. In terms of malaria control, insecticide-treated bednets are an effective tool, and many organizations have distributed free or highly subsidized bednets in malaria endemic areas. Nevertheless, some recipients do not use bednets because of social, environmental or cultural factors. Making vulnerable populations aware of the presence of mosquitoes may improve bednet use among people owning but not using a bednet. We hypothesized that showing freshly collected mosquitoes from the vicinity could improve bednet use in households owning but not using bednets. To test this hypothesis, we applied a household-based cluster-randomized controlled assessor blind educational trial. Indirect observation of mosquitoes, via educational leaflets, produced no change in bednet use, while showing freshly captured mosquitoes led to a 13-fold increase in bednet use. Our results suggest that direct observation of freshly captured mosquitoes can encourage bednet use and may potentially improve effective bednet coverage for malaria control and elimination.

Effect of housing factors on infestation by Aedes aegypti (L.) and Aedes albopictus Skuse in urban Hanoi City, Vietnam.

To determine the effect of housing factors on infestation with Aedes aegypti (L.) and Aedes albopictus Skuse we conducted an entomological survey and inspection of 267 urban houses in Hanoi City, Vietnam. Two hundred ten pupae and 194 adult Ae. aegypti were collected from 19 and 88 houses, respectively. One hundred eighty-one pupae and 24 adult Ae. albopictus were collected from 21 and 14 houses, respectively. The presence of a private well was associated with increasing infestation with Ae. aegypti adults (p = 0.01) and increased the risk of Ae. aegypti and Ae. albopictus pupal presence (p = 0.04 for Ae. aegypti, p = 0.03 for Ae. albopictus). The presence of an outdoor space in the household premises was associated with a higher risk of Ae. albopictus pupal presence (p = 0.004) and a higher risk of high levels of Ae. albopictus adults (p = 0.01); however, it had no association with infestation with Ae. aegypti. The presence of an air-conditioning unit (p = 0.03) and four or more rooms in the residence (p = 0.02) were negatively and positively associated with the risk for Ae. albopictus presence, respectively.

Hydroclimatological variability and dengue transmission in Dhaka, Bangladesh: a time-series study.

BACKGROUND: While floods can potentially increase the transmission of dengue, only few studies have reported the association of dengue epidemics with flooding. We estimated the effects of river levels and rainfall on the hospital admissions for dengue fever at 11 major hospitals in Dhaka, Bangladesh. METHODS: We examined time-series of the number of hospital admissions of dengue fever in relation to river levels from 2005 to 2009 using generalized linear Poisson regression models adjusting for seasonal, between-year variation, public holidays and temperature. RESULTS: There was strong evidence for an increase in dengue fever at high river levels. Hospitalisations increased by 6.9% (95% CI: 3.2, 10.7) for each 0.1 metre increase above a threshold (3.9 metres) for the average river level over lags of 0-5 weeks. Conversely, the number of hospitalisations increased by 29.6% (95% CI: 19.8, 40.2) for a 0.1 metre decrease below the same threshold of the average river level over lags of 0-19 weeks. CONCLUSIONS: Our findings provide evidence that factors associated with both high and low river levels increase the hospitalisations of dengue fever cases in Dhaka.

Optimal timing of insecticide fogging to minimize dengue cases: modeling dengue transmission among various seasonalities and transmission intensities.

BACKGROUND: Dengue infection is endemic in many regions throughout the world. While insecticide fogging targeting the vector mosquito Aedes aegypti is a major control measure against dengue epidemics, the impact of this method remains controversial. A previous mathematical simulation study indicated that insecticide fogging minimized cases when conducted soon after peak disease prevalence, although the impact was minimal, possibly because seasonality and population immunity were not considered. Periodic outbreak patterns are also highly influenced by seasonal climatic conditions. Thus, these factors are important considerations when assessing the effect of vector control against dengue. We used mathematical simulations to identify the appropriate timing of insecticide fogging, considering seasonal change of vector populations, and to evaluate its impact on reducing dengue cases with various levels of transmission intensity. METHODOLOGY/PRINCIPAL FINDINGS: We created the Susceptible-Exposed-Infectious-Recovered (SEIR) model of dengue virus transmission. Mosquito lifespan was assumed to change seasonally and the optimal timing of insecticide fogging to minimize dengue incidence under various lengths of the wet season was investigated. We also assessed whether insecticide fogging was equally effective at higher and lower endemic levels by running simulations over a 500-year period with various transmission intensities to produce an endemic state. In contrast to the previous study, the optimal application of insecticide fogging was between the onset of the wet season and the prevalence peak. Although it has less impact in areas that have higher endemicity and longer wet seasons, insecticide fogging can prevent a considerable number of dengue cases if applied at the optimal time. CONCLUSIONS/SIGNIFICANCE: The optimal timing of insecticide fogging and its impact on reducing dengue cases were greatly influenced by seasonality and the level of transmission intensity. We suggest that these factors should be considered when planning a control strategy against dengue vectors.

Effect of daily versus weekly home fortification with multiple micronutrient powder on haemoglobin concentration of young children in a rural area, Lao People's Democratic Republic: a randomised trial.

BACKGROUND: Multiple micronutrient deficiencies, in particular iron deficiency anaemia (IDA) is a severe public health problem in Lao People's Democratic Republic (Lao PDR). Because of the practical difficulties encountered in improving the nutritional adequacy of traditional complementary foods and the limitations associated with the use of liquid iron supplementation for the treatment and prevention of IDA in infants and young children, recently, home-fortification with multivitamins and minerals sprinkles was recommended. This study aims to compare the effect of twice weekly versus daily supplementation with multivitamins and minerals powder (MMP) on anaemia prevalence, haemoglobin concentration, and growth in infants and young children in a rural community in Lao PDR. METHODS: A randomized trial was conducted in six rural communities. Children aged 6 to 52 months (n = 336) were randomly assigned to a control group (n = 110) or to one of two intervention groups receiving either two sachets per week (n = 115) or a daily sachet (n = 111) of MMP for 24 weeks; 331 children completed the study. A finger prick of blood was taken at baseline, at week 12, and again at week 24 to determine haemoglobin concentration. Anthropometric measurements were taken every 4 weeks. The McNemar test was used to assess within group differences at three time points in the study subjects with anaemia and one-way ANOVA was used to assess changes in mean haemoglobin concentration in the treatment groups. RESULTS: MMP supplementation resulted in significant improvements in haemoglobin concentration and in the reduction of anaemia prevalence in the two treatment groups compared with the control group (p <0.001). The severely to moderately anaemic children (Hb <100 g/L) on daily supplementation recovered faster than those on twice weekly supplementation. MMP was well accepted and compliance was high in both treatment groups. Overall, the improvement in the weight for age Z-score was very small and not statistically significant across the three study groups. CONCLUSIONS: MMP supplementation had positive effects in reduction of anaemia prevalence and in improving haemoglobin concentration. For severely to moderately anaemic children, daily MMP supplementation was more effective in improving haemoglobin concentration and reducing anaemia prevalence. A longer intervention period is probably needed to have a positive effect on growth.