NEW PARADIGMS FOR MALARIA VECTOR

CONTROL AND ELIMINATION

Gerry Killeen

Draper & Smith 1960 TRSTMH 54: 342

β = -0.0013, se = 4.19 10-5

p <0.0001

Pro

port

ion A

n. gam

bia

e s

.s.

DISTINGUISHING VECTOR CONTROL

LIMITATIONS FROM FAILURES

0 1 2 3-1 4

YEARS SINCE INTRODUCTION OF AN INTERVENTION

Sustained Impact

Impact Limitation

MA

LAR

IA T

RA

NSM

ISSI

ON

INTE

NSI

TY

Persisting residual transmission

LIMITATION OF VECTOR CONTROL IMPACT DUE TO PRE-EXISTING BEHAVIOURAL RESILIENCETO THE

INTERVENTION WITHIN THE MOSQUITO POPULATION

0 1 2 3-1 4

YEARS SINCE INTRODUCTION OF AN INTERVENTION

UnsustainedImpact

Impact Limitation

MA

LAR

IA T

RA

NS

MIS

SIO

N IN

TE

NS

ITY

Rebounding residual transmission

FAILUREOF VECTOR CONTROL IMPACT DUE TO EITHER 1) WEAKENING OF CONTROL IMPLEMENTATION OR

2) EMERGENCE OF SELECTED BEHAVIOURAL OR PHYSIOLOGICAL RESISTANCETO THE INTERVENTION

WITHIN THE MOSQUITO POPULATION

Govella et al 2013 Malar J 12: 124

Best practice for holoendemic sub-

Saharan Africa over

the last half century

Adapted from Smith et al. 2007 PLoS Biol 5: e42

Killeen 2013 AJTMH 88:809

Kabula et al 2013 Med Vet Entomol ePub ahead of print

Kabula et al 2012 Trop Med Int Health 17: 742

4/26/2014 7

Oxborough et al 2010 TRSTMH 104: 639

Malima et al 2009 Med Vet Entomol 23: 317

NEW ACTIVE INGREDIENTS FOR

NETS AND SPRAYS

4/26/2014 8 Tungu et al 2010 Malar J 9: 21

THE FIRST COMBINATION NETS

WITH TWO COMPLEMENTARY

ACTIVE INGREDIENTS

4/26/2014

Lwetoijera et al 2014 AJTMH ePub ahead of print

JUVENILE HORMONE ANALOGUES FOR

STERILIZING BLOOD FED MOSQUITOES

4/26/2014 10

NEW GENERATION COMBINATION NETS THAT SUPPLEMENT

PYRETHROIDS WITH JUVENILE HORMONE ANALOGUES TO

KILL MORE MOSQUITOES AND STERILIZE ALL SURVIVORS

Draper & Smith 1960 TRSTMH 54: 342

EMERGE

GESTATE

FEED ON UNPROTECTED HUMANS OR ANIMALS OUTDOORS

FEED ON UNPROTECTED HUMANS INDOORS

NIG

HT

TIM

ED

USK

AN

D D

AW

ND

AY

TIM

E

NOCTURNAL HOST-SEEKING

CREPUSCULAR HOST-SEEKINGOVIPOSIT

AVOID CONTACT WITH INSECTICIDE-TREATED SURFACES AND EXIT HOUSE IN

SEARCH OF UNPROTECTED HOSTS

SUGAR FEEDING

CAUSES OF PERSISTING RESIDUAL TRANSMISSION

EMERGE

GESTATE

FEED ON UNPROTECTED HUMANS OR ANIMALS OUTDOORS

FEED ON UNPROTECTED HUMANS INDOORSN

IGH

T T

IME

DU

SK A

ND

DA

WN

DA

Y T

IME

NOCTURNAL HOST-SEEKING

CREPUSCULAR HOST-SEEKINGOVIPOSIT

AVOID CONTACT WITH INSECTICIDE-TREATED SURFACES AND EXIT HOUSE IN

SEARCH OF UNPROTECTED HOSTS

SUGAR FEEDING

Protecting humans outdoors with vapour phase repellents

Classical formats Contemporary formats

Ogoma et al (In preparation)

EMERGE

GESTATE

FEED ON UNPROTECTED HUMANS OR ANIMALS OUTDOORS

FEED ON UNPROTECTED HUMANS INDOORSN

IGH

T T

IME

DU

SK A

ND

DA

WN

DA

Y T

IME

NOCTURNAL HOST-SEEKING

CREPUSCULAR HOST-SEEKINGOVIPOSIT

AVOID CONTACT WITH INSECTICIDE-TREATED SURFACES AND EXIT HOUSE IN

SEARCH OF UNPROTECTED HOSTS

SUGAR FEEDING

4/26/2014 17

Lyimo et al 2012 J Parasit Res 2012: 280853

LIVESTOCK AS A TARGET FOR VECTOR CONTROL

4/26/2014 18

Lwetoijera et al 2014 AJTMH ePub ahead of print

EMERGE

GESTATE

FEED ON UNPROTECTED HUMANS OR ANIMALS OUTDOORS

FEED ON UNPROTECTED HUMANS INDOORSN

IGH

T T

IME

DU

SK A

ND

DA

WN

DA

Y T

IME

NOCTURNAL HOST-SEEKING

CREPUSCULAR HOST-SEEKINGOVIPOSIT

AVOID CONTACT WITH INSECTICIDE-TREATED SURFACES AND EXIT HOUSE IN

SEARCH OF UNPROTECTED HOSTS

SUGAR FEEDING

Muller et al. Malar J 9: 262

TOXIC SUGAR BAITS

Stewart et al 2014 PLoS One 8: e81468 ZAC STEWART

A

C

E

F

G

I

B

D

H

J

18

.00

-19.

001

9.0

0-2

0.00

20

.00

-21.

002

1.0

0-2

2.00

22

.00

-23.

002

3.0

0-2

4.00

24

.00

-1.0

01

.00

-2.0

02

.00

-3.0

03

.00

.4.0

04

.00

-5.0

05

.00

-6.0

06

.00

-7.0

0

An. gambiae s.l. An. funestus s.l.

Indoors Outdoors

Not present

Ase

mb

oLu

angw

aR

ufi

jiU

lan

gaO

ub

rite

nga

Ko

urw

eo

go

BIT

ING

RA

TE (

bit

es

· p

ers

on

-1·

ho

ur

-1)

BIT

ING

RA

TE (

bit

es

· p

ers

on

-1·

ho

ur

-1)

BIT

ING

RA

TE (

bit

es

· p

ers

on

-1·

ho

ur

-1)

Time

Not present

0.0

0.2

0.4

0.0

0.2

0.4

0.6

0.8

1.0

0.0

0.2

0.4

0.6

0.8

1.0

1.2

0.0

0.2

0.4

0.6

0.8

1.0

0.0

0.2

0.4

0.6

0.8

1.0

0.0

10.0

20.0

30.0

0.0

0.2

0.4

0.0

0.2

0.4

0.6

0.8

1.0

0.0

0.2

0.4

0.0

0.2

0.4

0.6

0.8

1.0

πi = 0.97

πi = 0.95

πi = 0.95

πi = 0.87

πi = 0.89

πi = 0.95

πi = 0.62

πi = 0.77

πi = 0.92

πi = 0.97

18

.00

-19.

001

9.0

0-2

0.00

20

.00

-21.

002

1.0

0-2

2.00

22

.00

-23.

002

3.0

0-2

4.00

24

.00

-1.0

01

.00

-2.0

02

.00

-3.0

03

.00

.4.0

04

.00

-5.0

05

.00

-6.0

06

.00

-7.0

0

Time

A

C

E

F

G

I

Rar

ied

aLu

angw

aR

ufi

jiU

lan

gaO

ub

rite

nga

Ko

urw

eo

go

PR

OP

OR

TION

IND

OO

RS O

R A

SLEEPPB

ITIN

G R

ATE

(b

ite

s ·

pe

rso

n-1

· h

ou

r -1

)

B

D

J

H

BIT

ING

RA

TE (

bit

es

· p

ers

on

-1·

ho

ur

-1) P

RO

PO

RTIO

N IN

DO

OR

S OR

ASLEEP

P

An. gambiae s.l. An. funestus s.l.

BIT

ING

RA

TE (

bit

es

· p

ers

on

-1·

ho

ur

-1) P

RO

PO

RTIO

N IN

DO

OR

S OR

ASLEEP

P

Mosquito biting rate Proportion of humans

Outdoors

Indoors Indoors

Outdoors

18

.00

-19.

001

9.0

0-2

0.00

20

.00

-21.

002

1.0

0-2

2.00

22

.00

-23.

002

3.0

0-2

4.00

24

.00

-1.0

01

.00

-2.0

02

.00

-3.0

03

.00

.4.0

04

.00

-5.0

05

.00

-6.0

06

.00

-7.0

0

Time

18

.00

-19.

001

9.0

0-2

0.00

20

.00

-21.

002

1.0

0-2

2.00

22

.00

-23.

002

3.0

0-2

4.00

24

.00

-1.0

01

.00

-2.0

02

.00

-3.0

03

.00

.4.0

04

.00

-5.0

05

.00

-6.0

06

.00

-7.0

0

Time

Not present

Not present

0.0

0.2

0.4

0.6

0.8

1.0

0.0

0.2

0.4

0.6

0.8

1.0

0.0

0.2

0.4

0.6

0.8

1.0

0.0

0.2

0.4

0.6

0.8

1.0

0.0

0.2

0.4

0.6

0.8

1.0

0.0

10.0

20.0

30.0

40.0

0.0

0.2

0.4

0.6

0.8

1.0

0.0

0.2

0.4

0.6

0.8

1.0

0.0

0.2

0.4

0.6

0.8

1.0

0.0

0.2

0.4

0.6

0.8

1.0

0.0

0.2

0.4

0.6

0.8

1.0

0.0

0.2

0.4

0.6

0.8

1.0

0.0

0.2

0.4

0.6

0.8

1.0

0.0

0.2

0.4

0.6

0.8

1.0

0.0

0.2

0.4

0.6

0.8

1.0

0.0

0.2

0.4

0.6

0.8

1.0

1.2

0.0

0.2

0.4

0.6

0.8

1.0

0.0

0.1

0.2

0.3

0.0

0.2

0.4

0.6

0.8

1.0

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

Huho et al 2013 Int J Epidemiol 42: 235

Kitau et al 2012 PLoS One 7: e31481

Okumu et al 2013 Parasit vector 6: 46

EMERGE

GESTATE

FEED ON UNPROTECTED HUMANS OR ANIMALS OUTDOORS

FEED ON UNPROTECTED HUMANS INDOORSN

IGH

T T

IME

DU

SK A

ND

DA

WN

DA

Y T

IME

NOCTURNAL HOST-SEEKING

CREPUSCULAR HOST-SEEKINGOVIPOSIT

AVOID CONTACT WITH INSECTICIDE-TREATED SURFACES AND EXIT HOUSE IN

SEARCH OF UNPROTECTED HOSTS

SUGAR FEEDING

Oxborough et al. 2014

Malar J 13: 37

Mnyone et al 2012 Malar J 11: 87

FORCING MOSQUITOES INTO FATAL CONTACT WITH

CONTAMINATED EAVE BAFFLES WHEN THEY EXIT HOUSES

4/26/2014 27

Eave tube Eave brick

Smar

t p

atch

Eave screen

LOW COST MOSQUITO CONTAMINATION DEVICES

Oviposition/resting device

OPCBOCPYOPCBOCPYOPCBOCPYOPCBOCPYO

PC

BO

CP

YO

PC

BO

CP

YO

PC

BO

CPYO

PC

BO

CP

Y

Combination therapy of insecticides

Outdoor host seeking mosquito device

4/26/2014 29

EMERGE

GESTATE

FEED ON UNPROTECTED HUMANS OR ANIMALS OUTDOORS

FEED ON UNPROTECTED HUMANS INDOORSN

IGH

T T

IME

DU

SK A

ND

DA

WN

DA

Y T

IME

NOCTURNAL HOST-SEEKING

CREPUSCULAR HOST-SEEKINGOVIPOSIT

AVOID CONTACT WITH INSECTICIDE-TREATED SURFACES AND EXIT HOUSE IN

SEARCH OF UNPROTECTED HOSTS

SUGAR FEEDING

Chaki 2009 MalarJ 8: 311

Chaki 2011 Human Res Health 9: 21

Chaki 2012 Malar J 11: 172

Chaki 2014 Malar J In Press

Devine et al 2009 PNAS 106: 11530

Uchawi kidogo!!!!

Auto-dissemination of Pyriproxyfen (JHA)

in breeding sites by adult mosquitoes

(mothers killing their own babies!!!)

resting exposure to JHA

dust

transfer of dust

on body

contamination of

sentinel site

containing

juvenile stages

JHA AUTODISSEMINATION BY ANOPHELES

ARABIENSIS IN LARGE CAGES

Lwetoijera et al 2014 Malar J (In press)

Asanteni sana Thanks very much