title: Assessing Interventions to Manage West Nile Virus Using Multi-Criteria Decision Analysis with Risk Scenarios.
abstract: The recent emergence of West Nile virus (WNV) in North America highlights vulnerability to climate sensitive diseases and stresses the importance of preventive efforts to reduce their public health impact. Effective prevention involves reducing environmental risk of exposure and increasing adoption of preventive behaviours, both of which depend on knowledge and acceptance of such measures. When making operational decisions about disease prevention and control, public health must take into account a wide range of operational, environmental, social and economic considerations in addition to intervention effectiveness. The current study aimed to identify, assess and rank possible risk reduction measures taking into account a broad set of criteria and perspectives applicable to the management of WNV in Quebec under increasing transmission risk scenarios, some of which may be related to ongoing warming in higher-latitude regions. A participatory approach was used to collect information on categories of concern to relevant stakeholders with respect to WNV prevention and control. Multi-criteria decision analysis was applied to examine stakeholder perspectives and their effect on strategy rankings under increasing transmission risk scenarios. Twenty-three preventive interventions were retained for evaluation using eighteen criteria identified by stakeholders. Combined evaluations revealed that, at an individual-level, inspecting window screen integrity, wearing light colored, long clothing, eliminating peridomestic larval sites and reducing outdoor activities at peak times were top interventions under six WNV transmission scenarios. At a regional-level, the use of larvicides was a preferred strategy in five out of six scenarios, while use of adulticides and dissemination of sterile male mosquitoes were found to be among the least favoured interventions in almost all scenarios. Our findings suggest that continued public health efforts aimed at reinforcing individual-level preventive behaviours combined with the application of larvicides to manage the risk of WNV infection are the interventions most acceptable and effective at reaching current management objectives now and under future theoretical transmission risk.
authors: Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, Canada.|Département de pathologie et microbiologie, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, Canada.
authors: Valerie
authors: V
authors: Hongoh
authors: Institut national de santé publique du Québec, Québec, Canada.|Département de médecine sociale et préventive, Université Laval, Québec, Canada.
authors: Céline
authors: C
authors: Campagna
authors: Institut national de santé publique du Québec, Québec, Canada.|Canadian Field Epidemiology Program, Public Health Agency of Canada, Ottawa, Ontario, Canada.
authors: Mirna
authors: M
authors: Panic
authors: Institut national de santé publique du Québec, Québec, Canada.
authors: Onil
authors: O
authors: Samuel
authors: Institut national de santé publique du Québec, Québec, Canada.|Ouranos, Consortium on regional climatology and adaptation to climate change, Montreal, Quebec, Canada.
authors: Pierre
authors: P
authors: Gosselin
authors: Group for Research in Decision Analysis, Montréal, Québec, Canada.
authors: Jean-Philippe
authors: JP
authors: Waaub
authors: Département de pathologie et microbiologie, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, Canada.
authors: André
authors: A
authors: Ravel
authors: Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, Canada.|Université Aube Nouvelle, Ouagadougou, Burkina Faso.
authors: Karim
authors: K
authors: Samoura
authors: Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, Canada.|National Microbiology Laboratory at Saint-Hyacinthe, Public Health Agency of Canada, Saint-Hyacinthe, Québec, Canada.
authors: Pascal
authors: P
authors: Michel
mesh_terms: D000818:Animals; D002980:Climate; D009033:Culicidae / Q000254:growth & development / Q000821:virology*; D003661:Decision Support Techniques; D019468:Disease Management; D004196:Disease Outbreaks / Q000517:prevention & control; D006801:Humans; D007303:Insect Vectors / Q000254:growth & development / Q000821:virology*; D008297:Male; D011634:Public Health; D011792:Quebec / Q000453:epidemiology; D040242:Risk Reduction Behavior; D014901:West Nile Fever / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D014902:West Nile virus / Q000472:pathogenicity*