title: Evaluation of ICON Maxx, a long-lasting treatment kit for mosquito nets: experimental hut trials against anopheline mosquitoes in Tanzania.
abstract: BACKGROUND
  Insecticide-treated nets are the primary method of preventing malaria. To remain effective, the pyrethroid insecticide must withstand multiple washes over the lifetime of the net. ICON(®) Maxx is a 'dip-it-yourself' kit for long-lasting treatment of polyester nets. The twin-sachet kit contains a slow-release capsule suspension of lambda-cyhalothrin plus binding agent. To determine whether ICON Maxx meets the standards required by the World Health Organization Pesticide Evaluation Scheme (WHOPES), the efficacy and wash fastness of ICON Maxx was evaluated against wild, free-flying anopheline mosquitoes.
  
  
  METHODS
  ICON Maxx was subjected to bioassay evaluation and experimental hut trial against pyrethroid-susceptible Anopheles gambiae, Anopheles arabiensis and Anopheles funestus. Mosquito mortality, blood feeding inhibition and personal protection were compared between untreated nets, conventional lambda-cyhalothrin treated nets (CTN) washed either four times (cut-off threshold) or 20 times, and ICON Maxx-treated nets either unwashed or washed 20 times.
  
  
  RESULTS
  In bioassay, ICON Maxx demonstrated superior wash resistance to the CTN. In the experimental hut trial, ICON Maxx killed 75 % of An. funestus, 71 % of An. gambiae and 47 % of An. arabiensis when unwashed and 58, 66 and 42 %, respectively, when 20 times washed. The CTN killed 52 % of An. funestus, 33 % of An. gambiae and 30 % of An. arabiensis when washed to the cut-off threshold of four washes and 40, 40 and 36 %, respectively, when 20 times washed. Percentage mortality with ICON Maxx 20 times washed was similar (An. funestus) or significantly higher (An. gambiae, An. arabiensis) than with CTN washed to the WHOPES cut-off threshold. Blood-feeding inhibition with ICON Maxx 20 times washed was similar to the CTN washed to cut-off for all three species. Personal protection was significantly higher with ICON Maxx 20 times washed (66-79 %) than with CTN washed to cut-off (48-60 %).
  
  
  CONCLUSIONS
  Nets treated with ICON Maxx and washed 20 times met the approval criteria set by WHOPES for Phase II trials in terms of mortality and blood-feeding inhibition. This finding raises the prospect of conventional polyester nets and other materials being made long-lastingly insecticidal through simple dipping in community or home, and thus represents a major advance over conventional pyrethroid treatments.
authors.affiliation: National Institute for Medical Research, Amani Medical Research Centre, Muheza, Tanzania. patrickkijatungu@hotmail.com.|Pan-African Malaria Vector Research Consortium (PAMVERC), P.O.Box 81, Muheza, Tanga, Tanzania. patrickkijatungu@hotmail.com.
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Tungu
authors.affiliation: National Institute for Medical Research, Amani Medical Research Centre, Muheza, Tanzania. rmalima@nimr.or.tz.|Pan-African Malaria Vector Research Consortium (PAMVERC), P.O.Box 81, Muheza, Tanga, Tanzania. rmalima@nimr.or.tz.
authors.forename: Robert
authors.initials: R
authors.lastname: Malima
authors.affiliation: Pan-African Malaria Vector Research Consortium (PAMVERC), P.O.Box 81, Muheza, Tanga, Tanzania. fwmosha@gmail.com.|Kilimanjaro Christian Medical Centre, Moshi, Tanzania. fwmosha@gmail.com.
authors.forename: Frank W
authors.initials: FW
authors.lastname: Mosha
authors.affiliation: Kilimanjaro Christian Medical Centre, Moshi, Tanzania. ilyimo@ihi.or.tz.
authors.forename: Issa
authors.initials: I
authors.lastname: Lyimo
authors.affiliation: National Institute for Medical Research, Amani Medical Research Centre, Muheza, Tanzania. caroline.maxi@gmail.com.|London School of Hygiene and Tropical Medicine, London, UK. caroline.maxi@gmail.com.
authors.forename: Caroline
authors.initials: C
authors.lastname: Maxwell
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK. harparkash.kaur@lshtm.ac.uk.
authors.forename: Harparkash
authors.initials: H
authors.lastname: Kaur
authors.affiliation: National Institute for Medical Research, Amani Medical Research Centre, Muheza, Tanzania. wnkisinza@gmail.com.|Pan-African Malaria Vector Research Consortium (PAMVERC), P.O.Box 81, Muheza, Tanga, Tanzania. wnkisinza@gmail.com.
authors.forename: William N
authors.initials: WN
authors.lastname: Kisinza
authors.affiliation: National Institute for Medical Research, Amani Medical Research Centre, Muheza, Tanzania. smagesa@hotmail.com.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Magesa
authors.affiliation: Pan-African Malaria Vector Research Consortium (PAMVERC), P.O.Box 81, Muheza, Tanga, Tanzania. matthew.kirby@lshtm.ac.uk.|London School of Hygiene and Tropical Medicine, London, UK. matthew.kirby@lshtm.ac.uk.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Kirby
authors.affiliation: Pan-African Malaria Vector Research Consortium (PAMVERC), P.O.Box 81, Muheza, Tanga, Tanzania. mark.rowland@lshtm.ac.uk.|London School of Hygiene and Tropical Medicine, London, UK. mark.rowland@lshtm.ac.uk.
authors.forename: Mark
authors.initials: M
authors.lastname: Rowland
mesh_terms: D000818:Animals; D000852:Anopheles; D005260:Female; D057148:Insecticide-Treated Bednets; D007306:Insecticides; D008288:Malaria / Q000517:prevention & control*; D009032:Mosquito Control / Q000379:methods*; D009570:Nitriles; D011722:Pyrethrins; D013636:Tanzania
chemical_list: D007306:Insecticides; D009570:Nitriles; D011722:Pyrethrins; C037304:cyhalothrin