| Abstrak/Abstract |
Dengue is the most rapidly spreading mosquito-borne disease worldwide, with global incidence increasing 30- fold during the past 50 years. In 2019, the World Health Organization declared dengue as one of the top ten global health threats1. Clinically, dengue is a systemic viral illness of 3-7 days duration. Headache, fever, myalgia, anorexia and rash are common features. With a population of ~250 million, Indonesia is one of the largest dengue endemic countries in Asia. Correspondingly, the economic burden of dengue is estimated to be amongst the highest of countries in the region2. Between 2016-2020, the five provinces with highest incidence of DHF were Bali (205.1/100,000 population), East Kalimantan (138.0/100,000), North Kalimantan (105.4/100,000), Yogyakarta Special Region (80.8/100,000) and DKI Jakarta (76.8/100,000).
Dengue has been endemic in Yogyakarta for decades3. Between 2006 and 2020 the local public health surveillance system in Yogyakarta City received notification of 6,772 dengue haemorrhagic fever cases, including two large outbreaks in 2010 and 2016 (Figure 2). The administrative area of Yogyakarta City, with a population in 2015 of 408,000 in an area of 32 km2 4, has generally had a higher dengue incidence than surrounding districts.
The AWED trial was a cluster randomised controlled trial undertaken in a 26 km2 area that included 35 kelurahans in Yogyakarta City and 2 kelurahans in Bantul District. The trial reported a 77?ficacy (95% confidence interval 65% to 85%) of the wMel intervention against VCD, with a similar protective efficacy against all four serotypes, and an efficacy of 86% (95%CI 66% to 94%) against dengue hospitalisation. Following the success of the AWED trial, wMel deployments were undertaken in the previously untreated areas of Yogyakarta City, including the control areas of the quasi-experimental study and the untreated clusters of the AWED trial. Releases commenced in October 2020 and concluded in January 2021. 2021 saw a historically low year for dengue in Yogyakarta City (Figure 4). These are promising early signs towards elimination of dengue as a public health problem, consistent with results from previous city-wide wMel releases in the non-endemic setting of northern Australia (Cairns and Townsville) where wMel prevalence remains high 4-10 years after wMel was deployed in the area and the public health authorities have seen the effective elimination of locally-acquired dengue cases22–24.
As dengue data routinely reported to the surveillance system in Yogyakarta include only hospitalised cases that are classified as dengue haemorrhagic fever, these do not include the large ambulatory dengue patient population. Complementary surveillance and reporting from outpatient settings is required to better understand whether locally-acquired dengue is still occurring in the population.
Aim of the study: To measure the long-term public health and economic outcomes of city-wide implementation of Wolbachia-infected Aedes aegypti mosquitoes in Yogyakarta, Indonesia, to support the scale up of this method for the sustained and cost-effective control of dengue and other Aedes-borne diseases in Indonesia and globally.
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