US Department of Defense Support of Civilian Vector Control Operations Following Natural Disasters.

The United States Department of Defense (DoD) employs advanced-degreed entomologists as Preventive Medicine and Public Health Officers in the Army, Navy, and Air Force. While the primary objective of military entomologists is service member health and readiness ("force health protection"), military entomology resources can provide support to civil authorities as directed by the President or Secretary of Defense through Department of Defense Directive 3025.18, Defense Support of Civil Authorities (DSCA). The employment of DSCA is complex and involves the consideration of such factors as the proper request process, funding, legality, risk, appropriateness, and readiness. Once approved and mobilized, however, military preventive medicine assets can be of significant help to civil authorities when dealing with emergency vector control. This paper will address some of the policy issues surrounding the use of DSCA, outline the resources available from the individual military services, and provide examples of DoD contingency vector control support to civil authorities.

Estimating the impact of city-wide Aedes aegypti population control: An observational study in Iquitos, Peru.

During the last 50 years, the geographic range of the mosquito Aedes aegypti has increased dramatically, in parallel with a sharp increase in the disease burden from the viruses it transmits, including Zika, chikungunya, and dengue. There is a growing consensus that vector control is essential to prevent Aedes-borne diseases, even as effective vaccines become available. What remains unclear is how effective vector control is across broad operational scales because the data and the analytical tools necessary to isolate the effect of vector-oriented interventions have not been available. We developed a statistical framework to model Ae. aegypti abundance over space and time and applied it to explore the impact of citywide vector control conducted by the Ministry of Health (MoH) in Iquitos, Peru, over a 12-year period. Citywide interventions involved multiple rounds of intradomicile insecticide space spray over large portions of urban Iquitos (up to 40% of all residences) in response to dengue outbreaks. Our model captured significant levels of spatial, temporal, and spatio-temporal variation in Ae. aegypti abundance within and between years and across the city. We estimated the shape of the relationship between the coverage of neighborhood-level vector control and reductions in female Ae. aegypti abundance; i.e., the dose-response curve. The dose-response curve, with its associated uncertainties, can be used to gauge the necessary spraying effort required to achieve a desired effect and is a critical tool currently absent from vector control programs. We found that with complete neighborhood coverage MoH intra-domicile space spray would decrease Ae. aegypti abundance on average by 67% in the treated neighborhood. Our framework can be directly translated to other interventions in other locations with geolocated mosquito abundance data. Results from our analysis can be used to inform future vector-control applications in Ae. aegypti endemic areas globally.

Honey Bee Swarms Aboard the USNS Comfort: Recommendations for Sting Prevention, Swarm Removal, and Medical Readiness on Military Ships.

The article provides observations of multiple honey bee (Apis mellifera) swarms aboard the USNS Comfort (TAH-20) during the Continuing Promise 2015 mission. A brief overview of swarming biology is given along with control/removal recommendations to reduce sting exposures. The observations suggest that preventive medicine personnel should provide adequate risk communications about the potential occurrence of bee swarms aboard military ships, and medical department personnel should be prepared for the possibility of treating of multiple sting exposures, especially in the Southern Command Area of Operations where the Africanized genotype of A mellifera is common.

Using adult mosquitoes to transfer insecticides to Aedes aegypti larval habitats.

Vector control is a key means of combating mosquito-borne diseases and the only tool available for tackling the transmission of dengue, a disease for which no vaccine, prophylaxis, or therapeutant currently exists. The most effective mosquito control methods include a variety of insecticidal tools that target adults or juveniles. Their successful implementation depends on impacting the largest proportion of the vector population possible. We demonstrate a control strategy that dramatically improves the efficiency with which high coverage of aquatic mosquito habitats can be achieved. The method exploits adult mosquitoes as vehicles of insecticide transfer by harnessing their fundamental behaviors to disseminate a juvenile hormone analogue (JHA) between resting and oviposition sites. A series of field trials undertaken in an Amazon city (Iquitos, Peru) showed that the placement of JHA dissemination stations in just 3-5% of the available resting area resulted in almost complete coverage of sentinel aquatic habitats. More than control mortality occurred in 95-100% of the larval cohorts of Aedes aegypti developing at those sites. Overall reductions in adult emergence of 42-98% were achieved during the trials. A deterministic simulation model predicts amplifications in coverage consistent with our observations and highlights the importance of the residual activity of the insecticide for this technique.

Comparison of two active surveillance programs for the detection of clinical dengue cases in Iquitos, Peru.

Endemic dengue transmission has been documented in the Amazonian city of Iquitos, Peru, since the early 1990s. To better understand the epidemiology of dengue transmission in Iquitos, we established multiple active surveillance systems to detect symptomatic infections. Here we compare the efficacy of distinct community-based (door to door) and school absenteeism-based febrile surveillance strategies in detecting active cases of dengue. Febrile episodes were detected by both systems with equal rapidity after disease onset. However, during the period that both programs were running simultaneously in 2004, a higher number of febrile cases in general (4.52/100 versus 1.64/100 person-years) and dengue cases specifically (2.35/100 versus 1.29/100 person-years) were detected in school-aged children through the community-based surveillance program. Similar results were obtained by direct comparison of 435 participants concurrently enrolled in both programs (P < 0.005). We conclude that, in Iquitos, community-based door-to-door surveillance is a more efficient and sensitive design for detecting active dengue cases than programs based on school absenteeism.

Potential use of pyriproxyfen for control of Aedes aegypti (Diptera: Culicidae) in Iquitos, Perú.

The effects of pyriproxyfen were tested against a local population of Aedes aegypti (L.) in Iquitos, Perú. Bioassays showed that, when applied to late instars, pyriproxyfen prevented adult emergence at extremely low concentrations (LC50 = 0.012 ppb). There was no adult emergence from water sampled from storage tanks that had been seeded with the equivalent of 50-83 ppb (AI) pyriproxyfen. Five months after treatment, despite constant dilution of these tanks, water sampled from these sources continued to be lethal to larvae and pupae. Additional studies, carried out in the laboratory, showed that groups of five or 20 female blood-fed mosquitoes, exposed to residues of approximately 0.003 g (AI) pyriproxyfen/m2, could transfer enough chemical to new oviposition sites to prevent approximately 80% of adult emergence from larvae developing in that previously uncontaminated water. Moreover, although the fecundity of the adult females used as the transfer vehicles in these tests was unaffected, the subsequent eclosion of the eggs that these mosquitoes laid was decreased by 70-90%. It also was shown that, at very high concentrations (>30,000 ppb), pyriproxyfen-treated water sources were as likely to be used as oviposition sites as untreated sources. These data suggest that treated sites might act as sinks for mosquito reproduction and moreover that such sites might act as dissemination sources for the horizontal transfer of larvicides to new environments by mature females. We review the literature on the environmental and human health effects of this compound and discuss its potential for use as a mosquito control agent in the field.

Temporal and geographic patterns of Aedes aegypti (Diptera: Culicidae) production in Iquitos, Peru.

Large-scale longitudinal cohort studies are necessary to characterize temporal and geographic variation in Aedes aegypti (L.) (Diptera: Culicidae) production patterns and to develop targeted dengue control strategies that will reduce disease. We carried out pupal/demographic surveys in a circuit of approximately 6,000 houses, 10 separate times, between January 1999 and August 2002 in the Amazonian city of Iquitos, Peru. We quantified the number of containers positive for Ae. aegypti larvae and/or pupae, containers holding pupae, and the absolute number of pupae by 4-mo sampling circuits and spatially by geographic area by using a geographic information system developed for the city. A total of 289,941 water-holding containers were characterized, of which 7.3% were positive for Ae. aegypti. Temporal and geographic variations were detected for all variables examined, and the relative importance of different container types for production of Ae. aegypti was calculated. Ae. aegypti larvae and pupae were detected in 64 types of containers. Consistent production patterns were observed for the lid status (lids: 32% wet containers, 2% pupal production), container location (outdoor: 43% wet containers, 85% pupal production), and method by which the container was filled with water (rain filled: 15% wet containers, 88.3% pupal production); these patterns were consistent temporally and geographically. We describe a new container category (nontraditional) that includes transient puddles, which were rare but capable of producing large numbers of pupae. Because of high variable pupal counts, four container categories (large tank, medium storage, miscellaneous, and nontraditional) should be targeted in addition to outdoor rain-filled containers that are not covered by a lid. The utility of targeted Ae. aegypti control is discussed, as well as the ability to achieve control objectives based on published but untested threshold values.