title: The interactive roles of Aedes aegypti super-production and human density in dengue transmission.
abstract: BACKGROUND
  A. aegypti production and human density may vary considerably in dengue endemic areas. Understanding how interactions between these factors influence the risk of transmission could improve the effectiveness of the allocation of vector control resources. To evaluate the combined impacts of variation in A. aegypti production and human density we integrated field data with simulation modeling.
  
  
  RESULTS
  Using data from seven censuses of A. aegypti pupae (2007-2009) and from demographic surveys, we developed an agent-based transmission model of the dengue transmission cycle across houses in 16 dengue-endemic urban 'patches' (1-3 city blocks each) of Armenia, Colombia. Our field data showed that 92% of pupae concentrated in only 5% of houses, defined as super-producers. Average secondary infections (R(0)) depended on infrequent, but highly explosive transmission events. These super-spreading events occurred almost exclusively when the introduced infectious person infected mosquitoes that were produced in super-productive containers. Increased human density favored R(0), and when the likelihood of human introduction of virus was incorporated into risk, a strong interaction arose between vector production and human density. Simulated intervention of super-productive containers was substantially more effective in reducing dengue risk at higher human densities.
  
  
  CONCLUSIONS
  These results show significant interactions between human population density and the natural regulatory pattern of A. aegypti in the dynamics of dengue transmission. The large epidemiological significance of super-productive containers suggests that they have the potential to influence dengue viral adaptation to mosquitoes. Human population density plays a major role in dengue transmission, due to its potential impact on human-A. aegypti contact, both within a person's home and when visiting others. The large variation in population density within typical dengue endemic cities suggests that it should be a major consideration in dengue control policy.
authors.affiliation: Yale School of Public Health, New Haven, Connecticut, United States of America. harish.padmanabha@yale.edu
authors.forename: Harish
authors.initials: H
authors.lastname: Padmanabha
authors.forename: David
authors.initials: D
authors.lastname: Durham
authors.forename: Fabio
authors.initials: F
authors.lastname: Correa
authors.forename: Maria
authors.initials: M
authors.lastname: Diuk-Wasser
authors.forename: Alison
authors.initials: A
authors.lastname: Galvani
mesh_terms: D000330:Aedes / Q000254:growth & development*; D000818:Animals; D050936:Basic Reproduction Number; D002947:Cities; D003105:Colombia; D003715:Dengue / Q000453:epidemiology* / Q000635:transmission*; D004199:Disease Vectors; D005260:Female; D006801:Humans; D015233:Models, Statistical; D011156:Population Density; D014505:Urban Population