| Penulis/Author |
dr. Citra Indriani, MPH. (1) ; Stephanie k. Tanamas (2); Katherine L. Anders (3); Suzanne M. Dufault (4); RUbangi (5); dr. Riris Andono Ahmad, MPH, Ph.D (6); Prof. dr. Adi Utarini, M.Sc., MPH.,Ph.D. (7); Cameron P. Simmons (8) |
| Abstrak/Abstract |
We conducted a cluster randomised trial of deployments of wMel-infected Ae. aegypti for dengue
control in Yogyakarta City, Indonesia (Applying Wolbachia to Eliminate Dengue (AWED) trial). A
predefined secondary endpoint was to determine the impact of wMel deployment on dengue cases
notified to the surveillance system, which requires hospitals to report cases diagnosed clinically as
Dengue Hemorrhagic Fever (DHF). Mixed-effect negative binomial regression was used to model
monthly DHF case count (Jan 2006 - Apr 2020) comparing wMel-treated kelurahans (urban villages)
with both the pre-intervention period and untreated kelurahans. The boundaries of the 35 kelurahans
in the trial site do not all align with those of the 24 AWED clusters and rules were defined to apply a
binary wMel intervention status to each kelurahan. Nineteen kelurahans were classified as ‘treated’
(wMel frequency >50% AND >50% trap positivity for 2 monthly monitoring events in a 6-month
rolling window), 10 as ‘untreated’, and six were excluded from the analysis using binary wMel exposure
classification due to highly variable %wMel. A secondary model used quintiles of monthly kelurahanlevel wMel prevalence as the predictor of dengue incidence. DHF incidence was 54% lower in wMeltreated vs untreated kelurahans (IRR 0.46 [95% CI 0.34, 0.62]), and 61% lower in kelurahan-months with 80-100% wMel prevalence compared to kelurahan-months with 0-20% wMel (0.39 [0.25, 0.60]).
An effect was also seen with 60-80% (0.61 [0.37, 1.00]) and 40-60% wMel (0.56 [0.38, 0.82]). The impact
of wMel deployment on insecticide fogging activities, undertaken by vector control teams around the
homes of notified DHF cases, was also analysed using negative binomial regression. Pre-intervention,
fogging occurred at similar frequencies in areas later randomised to wMel-treated and untreated arms
of the trial. After wMel deployment, fogging occurred significantly less frequently in treated areas (0.13
[0.07, 0.27]). These findings show that wMel deployments reduced the application of perifocal
insecticide spraying by 87%, consistent with lower dengue case notifications in wMel-treated areas |
