title: Effective control of dengue vectors with curtains and water container covers treated with insecticide in Mexico and Venezuela: cluster randomised trials.
abstract: OBJECTIVE
  To measure the impact on the dengue vector population (Aedes aegypti) and disease transmission of window curtains and water container covers treated with insecticide.
  
  
  METHODS
  Cluster randomised controlled trial based on entomological surveys and, for Trujillo only, serological survey. In addition, each site had a non-randomised external control.
  
  
  METHODS
  18 urban sectors in Veracruz (Mexico) and 18 in Trujillo (Venezuela).
  
  
  METHODS
  4743 inhabitants (1095 houses) in Veracruz and 5306 inhabitants (1122 houses) in Trujillo.
  
  
  METHODS
  Sectors were paired according to entomological indices, and one sector in each pair was randomly allocated to receive treatment. In Veracruz, the intervention comprised curtains treated with lambdacyhalothrin and water treatment with pyriproxyfen chips (an insect growth regulator). In Trujillo, the intervention comprised curtains treated with longlasting deltamethrin (PermaNet) plus water jar covers of the same material. Follow-up surveys were conducted at intervals, with the final survey after 12 months in Veracruz and nine months in Trujillo.
  
  
  METHODS
  Reduction in entomological indices, specifically the Breteau and house indices.
  
  
  RESULTS
  In both study sites, indices at the end of the trial were significantly lower than those at baseline, though with no significant differences between control and intervention arms. The mean Breteau index dropped from 60% (intervention clusters) and 113% (control) to 7% (intervention) and 12% (control) in Veracruz and from 38% to 11% (intervention) and from 34% to 17% (control) in Trujillo. The pupae per person and container indices showed similar patterns. In contrast, in nearby communities not in the trial the entomological indices followed the rainfall pattern. The intervention reduced mosquito populations in neighbouring control clusters (spill-over effect); and houses closer to treated houses were less likely to have infestations than those further away. This created a community effect whereby mosquito numbers were reduced throughout the study site. The observed effects were probably associated with the use of materials treated with insecticide at both sites because in Veracruz, people did not accept and use the pyriproxyfen chips.
  
  
  CONCLUSIONS
  Window curtains and domestic water container covers treated with insecticide can reduce densities of dengue vectors to low levels and potentially affect dengue transmission.
authors.affiliation: Special Programme for Research and Training in Tropical Medicine (TDR/WHO), World Health Organization, Geneva, Switzerland. kroegera@who.int
authors.forename: Axel
authors.initials: A
authors.lastname: Kroeger
authors.forename: Audrey
authors.initials: A
authors.lastname: Lenhart
authors.forename: Manuel
authors.initials: M
authors.lastname: Ochoa
authors.forename: Elci
authors.initials: E
authors.lastname: Villegas
authors.forename: Michael
authors.initials: M
authors.lastname: Levy
authors.forename: Neal
authors.initials: N
authors.lastname: Alexander
authors.forename: P J
authors.initials: PJ
authors.lastname: McCall
mesh_terms: D000330:Aedes; D000818:Animals; D001512:Bedding and Linens; D003715:Dengue / Q000517:prevention & control*; D006801:Humans; D007303:Insect Vectors; D007306:Insecticides; D008800:Mexico; D009032:Mosquito Control / Q000379:methods*; D009570:Nitriles; D010342:Patient Acceptance of Health Care; D011722:Pyrethrins; D011725:Pyridines; D014504:Urban Health; D014687:Venezuela; D014867:Water / Q000469:parasitology; D014881:Water Supply
chemical_list: D007306:Insecticides; D009570:Nitriles; D011722:Pyrethrins; D011725:Pyridines; D014867:Water; C055613:pyriproxyfen; C037304:cyhalothrin