Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29

By Sophie Beauvais | 24 Jun, 2012

Dear All,

Please join us for a week-long virtual panel discussion starting tomorrow, Monday June 25, on the future of malaria vector control and insecticides. Led by community moderator Mike Reddy, Ph.D., we are delighted to have the following guest panelists:
- Prof. Janet Hemingway, Director of the Liverpool School of Tropical Medicine and Head of the Innovative Vector Control Consortium;
- Anthony Kiszewski, Associate Professor at Bentley University and visiting scientist at Harvard School of Public Health
- Manuel F. Lluberas, Public Health Entomologist and Executive Director for Public Health at H. D. Hudson Manufacturing Company

In various countries, resistance to DDT, pyrethroid, but also carbamates and organophosphates, has been discovered and is now threatening the sustainability of vector control programmes. Globally, resistance to insecticides is hard to assess as there is no international database for malaria vector surveillance.

Please join panelists and share your perspective and/or answer the following questions:
- How are insecticides used in your area, country?
- What role should insecticides play in anti-malaria efforts going forward?
- What alternative approaches should be considered?
- How can resistance to insecticides be mitigated? Mosaic spraying? Switching insecticides?
- Is there enough political-will and economic support for developing comprehensive, safe, and sustainable approaches?
- What do you think of the WHO Global Plan for Insecticide Resistance Management in Malaria Vectors?

Panelists will start posting tomorrow, Monday June 25, but feel free to post now. We look forward to a fruitful discussion.

Sincerely, Sophie

Replies

 

Seraphine Adibaku Replied at 8:24 AM, 25 Jun 2012

In Uganda there has been growing resistance to Pyrethroids as revealed by studies carried out in 2009 and repeated in 2011. Other classes of insecticides have not been spared by this trend. While Carbamates (Bendiocard) had no resistance at all in 2009, the 2011 study showed probable resistance in in some sites. On the other hand DDT (Organochlorine) that ahd high levels of resistance in 2009 has showed remarkable recovery in 2011 in areas where Bendiocarb has been used for IRS since 2009. As the country ia set to attain universal coverage with LLINs, the strategy to protect LLINs (Pyrethroids) from further resistance is to use non-pyrethroid insecticides for IRS and adopt a mix of rotational and mosaic approaches to IRS. While there is a strong political will towards malaria control and elimination, the national budget is inadequate to meet the costs of significant scale up of IRS in the country given the high costs involved especially with use of Bendiocarb

Seraphine

Tony Kiszewski Replied at 10:04 AM, 25 Jun 2012

I have been involved in interventions against vector-borne infections since the early 1980s, when in Liberia, as a Cornell research assistant, I helped conduct some of the early trials of ivermectin against onchocerciasis (river blindness). This work led to the discovery of ivermectin’s sterilizing effect on adult worms, interrupting transmission of microfiliariae to Simuliid (black fly) vectors.
However, my first dabblings in insecticidal interventions came at an operational level for the US Navy. I trained pesticide applicators, performed shipboard pest control, monitored the vectors of Japanese Encephalitis on Okinawan military facilities and suppressed malaria vectors in support of US Marine training exercises in Thailand via ultra low volume (ULV) spraying and larviciding.
It was on Okinawa, conducting bioassays of insecticides against local pests and vectors, that I first encountered the power of resistance firsthand. Resistance here ran the gamut from the uncanny refractoriness of the German cockroaches infesting a temporary lodging facility to Culex tritaeniorhynchus larvae completely oblivious to the dosage of malathion that the local pest control facility had been applying for years without realizing the futility of their efforts (much like the recent experience involving DDT and Anopheles arabiensis in Ethiopia).

Tony Kiszewski Replied at 10:06 AM, 25 Jun 2012

Any vector-borne disease intervention based solely on biocides is by nature, temporary. In most cases the duration of efficacy is inversely proportional to the intensity and coverage. Ironically, the more successfully an insecticide-based intervention is distributed and complied with, the shorter its useful lifespan.

Tony Kiszewski Replied at 10:17 AM, 25 Jun 2012

Seraphine's experience in Uganda seems very typical, although I find the rebound of DDT efficacy in only 2 years quite surprising. I wouldn't place too much hopes on rotations and mosaics, though. Agricultural studies and theoretical models (Loy, Tabashnik) indicate that such strategies are only helpful under very unique combinations of circumstances unlikely to be encountered in the field, including substantial fitness deficits, dispersal rates, negatively correlated insecticide effects, and the use of two insecticides for which there is no prior resistance. Over the long term, rotations do not prevent the inevitable, they simply force resistance to be incremented in steps as each insecticide takes it turn as a selective force.

Michael Reddy Moderator Emeritus Replied at 12:16 PM, 25 Jun 2012

Thank you Tony and Seraphine for your insightful first posts in Global Health Delivery's expert panel discussion on "The Future of Malaria Vector Control and Insecticides, June 25-29. I am pleased to see firsthand accounts and operational and experience featured in the opening of this online forum. As the moderator of this discussion, I hope to serve as a guide and facilitator of discusion. Where needed I am pleased to provide specific references (as availability allows) to participants and will comment where warranted. Please follow the examples of Tony and Seraphine, in observing mutual respectfulness and appropriate decorum when responding or posting comments. I look forward to participating in this important discussion and learning from everyone's operational and research experience. I believe a critical discourse is needed now more than ever for informing our understanding and appreciation of the scope of issues currently facing public health decision-makers with respect to the role of insecticides in anti-malaria interventions. Thank you for your participation.

-Mike Reddy

__________________________________
Michael Reddy PhD MPH
Yale University
Depts of Epidemiology and Public Health &
Ecology and Evolutionary Biology
New Haven CT 06511-8034 USA

Michael Reddy Moderator Emeritus Replied at 2:12 PM, 25 Jun 2012

I'd like to include some recent publications for consideration by the expert panel and participating members. The first is a general review of the pyrethroid insecticide resistance and resistance management strategies by Ranson et al 2011. I think the paper does a superb job of providing readers an updated understanding of the biology and natural history of pyrethroid resistance and relevant issues facing the malaria community with respect to the role of pyrethroids (one of the few WHOPES=approved insecticides for public health uses), going forward.

A couple of questions for the community to consider as they read (or re-read) this paper is: given the widespread nature of target site resistance against pyrethroids in particular and resistance mechanisms of all types in general (metabolic, behavioral...etc), how do implementers scale-up efforts most effectively address this issue in planning and carrying out anti-vector operations? Is continuing to "do more of the same, but better (if possible)"whether it be IRS, ITNs or other strategies, appropriate or even ethical given what is currently known about resistance in the major malaria vectors? Can we do better and if so, how? I look forward to your responses. -MR

Attached resource:

Tony Kiszewski Replied at 9:12 AM, 26 Jun 2012

The presence of any one mechanism of resistance does not necessarily render an insecticide useless. A compromised insecticide can remain partially efficacious and operationally useful for some time. Increasing application rates or switching to less compromised members of an insecticide family (e.g. permethrin to deltamethrin) can temporarily compensate for loss of efficacy. Simple aging can even restore some of the vulnerability of resistant vectors. Switching to another class of insecticide (e.g. pyrethroids to carbamates) will bypass class-specific resistance mechanisms, as long as resistance to the new class is absent.
But, once resistance emerges, if insecticidal pressure is maintained or increased, selection will proceed and resistance will inevitably worsen. Only when resistance harms the reproductive competitiveness (fitness) of unexposed vectors does resistance ever fade in the absence of insecticidal pressure. But these fitness deficits are often negligible, the genes associated with resistance traits often recessive, in which case, resistance alleles persist in the vector population indefinitely long after insecticidal pressure is relaxed.
Under selection, multiple resistance mechanisms can accrue and combine their effects. Independent metabolic detoxification mechanisms may arise and accumulate. Supplementary mutations can occur in sodium channel genes, amplifying the effects of target site insensitivity-based mechanisms such as knock down resistance (kdr). Complex, polygenic traits, such as outdoor feeding tendencies, may also become more prevalent.

Manuel Lluberas Replied at 9:47 AM, 26 Jun 2012

Insecticide resistance is an indicator of the pressure exerted on the vector population and should be a warning shot across the bow of malaria control programs. We need to modify our position related to malaria vector control from the single-minded approach of focusing on ITNs with sporadic IRS with essentially the same insecticides to a more generic mosquito control program that addresses all mosquitoes and their developmental stages. However, if the consensus remains that we should continue this single-minded approach to malaria control, the least we can do is attack the vector’s developmental cycle on as many fronts as possible. We need to incorporate larviciding methods and environmental manipulation as possible and feasible. This is not a popular position and some don't agree on that it would work, but it has been proven in many countries. The current system works, but we have been focusing our attention far too long on a single method (ITNs) though IRS has gained some traction in the past few years. We are also pushing the vectors outdoors in some areas and there are no plans to address this. Once the vectors become mostly exophagic, our approach, which relies heavily on mosquito nets will become useless. Moreover, when the time comes that donors ask countries to fund part or all of their own programs, there will be no mosquito control expertise other than that related to ITNs and IRS. Contrary to popular belief, these are components of a comprehensive and integrated mosquito control programs and should not be perceived as the program itself.

Manuel F. Lluberas MS IDHA
Public Health Entomologist

-----Original Message-----
From: GHDonline (Tony Kiszewski) [mailto:]
Sent: Tuesday, June 26, 2012 09:13
To: Manuel Lluberas
Subject: Re: [Malaria Treatment & Prevention] Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29

Tony Kiszewski replied to the discussion "Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29" in the Malaria Treatment & Prevention community.

Reply contents:
"The presence of any one mechanism of resistance does not necessarily render an insecticide useless. A compromised insecticide can remain partially efficacious and operationally useful for some time. Increasing application rates or switching to less compromised members of an insecticide family (e.g. permethrin to deltamethrin) can temporarily compensate for loss of efficacy. Simple aging can even restore some of the vulnerability of resistant vectors. Switching to another class of insecticide (e.g. pyrethroids to carbamates) will bypass class-specific resistance mechanisms, as long as resistance to the new class is absent.
But, once resistance emerges, if insecticidal pressure is maintained or increased, selection will proceed and resistance will inevitably worsen. Only when resistance harms the reproductive competitiveness (fitness) of unexposed vectors does resistance ever fade in the absence of insecticidal pressure. But these fitness deficits are often negligible, the genes associated with resistance traits often recessive, in which case, resistance alleles persist in the vector population indefinitely long after insecticidal pressure is relaxed.
Under selection, multiple resistance mechanisms can accrue and combine their effects. Independent metabolic detoxification mechanisms may arise and accumulate. Supplementary mutations can occur in sodium channel genes, amplifying the effects of target site insensitivity-based mechanisms such as knock down resistance (kdr). Complex, polygenic traits, such as outdoor feeding tendencies, may also become more prevalent."

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Gil Germain Padonou Replied at 11:00 AM, 26 Jun 2012

Dear Manuel,

I agree with this view and hopes that the future programs take into account the behavior exophagic mosquitoes so mosquito control programs is more efficient.
Gil Germain Padonou
Medical Entomologist

----- Mail original -----
> De : GHDonline (Manuel Lluberas) <>
> À : Gil Germain Padonou <>
> Cc :
> Envoyé le : Mardi 26 juin 2012 15h47
> Objet : Re: [Malaria Treatment & Prevention] Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29
>
> Manuel Lluberas replied to the discussion "Expert Panel: The Future of
> Malaria Vector Control and Insecticides, June 25-29" in the Malaria
> Treatment & Prevention community.
>
> Reply contents:
> "Insecticide resistance is an indicator of the pressure exerted on the
> vector population and should be a warning shot across the bow of malaria control
> programs. We need to modify our position related to malaria vector control from
> the single-minded approach of focusing on ITNs with sporadic IRS with
> essentially the same insecticides to a more generic mosquito control program
> that addresses all mosquitoes and their developmental stages. However, if the
> consensus remains that we should continue this single-minded approach to malaria
> control, the least we can do is attack the vector’s developmental cycle on as
> many fronts as possible. We need to incorporate larviciding methods and
> environmental manipulation as possible and feasible. This is not a popular
> position and some don't agree on that it would work, but it has been proven
> in many countries. The current system works, but we have been focusing our
> attention far too long on a single method (ITNs) though IRS has gained some
> traction in the past few years. We are also pushing the vectors outdoors in some
> areas and there are no plans to address this. Once the vectors become mostly
> exophagic, our approach, which relies heavily on mosquito nets will become
> useless. Moreover, when the time comes that donors ask countries to fund part or
> all of their own programs, there will be no mosquito control expertise other
> than that related to ITNs and IRS. Contrary to popular belief, these are
> components of a comprehensive and integrated mosquito control programs and
> should not be perceived as the program itself.
>
> Manuel F. Lluberas MS IDHA
> Public Health Entomologist
>
> -----Original Message-----
> From: GHDonline (Tony Kiszewski) [mailto:]
> Sent: Tuesday, June 26, 2012 09:13
> To: Manuel Lluberas
> Subject: Re: [Malaria Treatment & Prevention] Expert Panel: The Future of
> Malaria Vector Control and Insecticides, June 25-29
>
> Tony Kiszewski replied to the discussion "Expert Panel: The Future of
> Malaria Vector Control and Insecticides, June 25-29" in the Malaria
> Treatment & Prevention community.
>
> Reply contents:
> "The presence of any one mechanism of resistance does not necessarily
> render an insecticide useless. A compromised insecticide can remain partially
> efficacious and operationally useful for some time. Increasing application rates
> or switching to less compromised members of an insecticide family (e.g.
> permethrin to deltamethrin) can temporarily compensate for loss of efficacy.
> Simple aging can even restore some of the vulnerability of resistant vectors.
> Switching to another class of insecticide (e.g. pyrethroids to carbamates) will
> bypass class-specific resistance mechanisms, as long as resistance to the new
> class is absent.
> But, once resistance emerges, if insecticidal pressure is maintained or
> increased, selection will proceed and resistance will inevitably worsen. Only
> when resistance harms the reproductive competitiveness (fitness) of unexposed
> vectors does resistance ever fade in the absence of insecticidal pressure. But
> these fitness deficits are often negligible, the genes associated with
> resistance traits often recessive, in which case, resistance alleles persist in
> the vector population indefinitely long after insecticidal pressure is relaxed.
> Under selection, multiple resistance mechanisms can accrue and combine their
> effects. Independent metabolic detoxification mechanisms may arise and
> accumulate. Supplementary mutations can occur in sodium channel genes,
> amplifying the effects of target site insensitivity-based mechanisms such as
> knock down resistance (kdr). Complex, polygenic traits, such as outdoor feeding
> tendencies, may also become more prevalent."
>
> --
> View this post online:
> <http://www.ghdonline.org/malaria/discussion/expert-panel-the-future-of-malari...>
>
> Unsubscribe or change your email notification settings:
> <http://www.ghdonline.org/users/manuel-lluberas/edit/>
>
> Contact the GHDonline team:
> <http://www.ghdonline.org/contact/>
>
> You can reply to this discussion by responding directly to this e-mail; it will
> be shared with all community members and posted as is. Files cannot be added via
> email attachment and must be uploaded directly to GHDonline."
>
> --
> View this post online:
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>
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> You can reply to this discussion by responding directly to this e-mail; it will
> be shared with all community members and posted as is. Files cannot be added via
> email attachment and must be uploaded directly to GHDonline.
>

Manuel Lluberas Replied at 11:31 AM, 26 Jun 2012

Gil:

Thanks for your comment. I need to impress upon program managers and donor agencies a sense of urgency when it comes to changing our mosquito control tactics before we find ourselves on an emergency mode trying to figure out what to do next when the current methods cease to provide the desired results. We don't have a lot of choices when it comes to insecticides and these are slowly showing signs of not being as effective in many regions. Yet, we continue to do the same things. We need to insist that when we say we operate an integrated vector control program we really are doing so and use as many of the mosquito control tools as possible against all life stages. To paraphrase Einstein, if you want different results, try something different.

Manuel

-----Original Message-----
From: GHDonline (Gil Germain Padonou) [mailto:]
Sent: Tuesday, June 26, 2012 11:03
To: Manuel Lluberas
Subject: Re: [Malaria Treatment & Prevention] Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29

Gil Germain Padonou replied to the discussion "Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29" in the Malaria Treatment & Prevention community.

Reply contents:
"Dear Manuel,

I agree with this view and hopes that the future programs take into account the behavior exophagic mosquitoes so mosquito control programs is more efficient.
Gil Germain Padonou
Medical Entomologist

----- Mail original -----
> De : GHDonline (Manuel Lluberas) <> À : Gil
> Germain Padonou <> Cc :
> Envoyé le : Mardi 26 juin 2012 15h47
> Objet : Re: [Malaria Treatment & Prevention] Expert Panel: The Future
> of Malaria Vector Control and Insecticides, June 25-29
>
> Manuel Lluberas replied to the discussion "Expert Panel: The Future of
> Malaria Vector Control and Insecticides, June 25-29" in the Malaria
> Treatment & Prevention community.
>
> Reply contents:
> "Insecticide resistance is an indicator of the pressure exerted on the
> vector population and should be a warning shot across the bow of
> malaria control programs. We need to modify our position related to
> malaria vector control from the single-minded approach of focusing on
> ITNs with sporadic IRS with essentially the same insecticides to a
> more generic mosquito control program that addresses all mosquitoes
> and their developmental stages. However, if the consensus remains that
> we should continue this single-minded approach to malaria control, the
> least we can do is attack the vector’s developmental cycle on as many
> fronts as possible. We need to incorporate larviciding methods and
> environmental manipulation as possible and feasible. This is not a
> popular position and some don't agree on that it would work, but it
> has been proven in many countries. The current system works, but we
> have been focusing our attention far too long on a single method
> (ITNs) though IRS has gained some traction in the past few years. We
> are also pushing the vectors outdoors in some areas and there are no
> plans to address this. Once the vectors become mostly exophagic, our
> approach, which relies heavily on mosquito nets will become useless.
> Moreover, when the time comes that donors ask countries to fund part
> or all of their own programs, there will be no mosquito control
> expertise other than that related to ITNs and IRS. Contrary to popular belief, these are components of a comprehensive and integrated mosquito control programs and should not be perceived as the program itself.
>
> Manuel F. Lluberas MS IDHA
> Public Health Entomologist
>
> -----Original Message-----
> From: GHDonline (Tony Kiszewski) [mailto:]
> Sent: Tuesday, June 26, 2012 09:13
> To: Manuel Lluberas
> Subject: Re: [Malaria Treatment & Prevention] Expert Panel: The Future
> of Malaria Vector Control and Insecticides, June 25-29
>
> Tony Kiszewski replied to the discussion "Expert Panel: The Future of
> Malaria Vector Control and Insecticides, June 25-29" in the Malaria
> Treatment & Prevention community.
>
> Reply contents:
> "The presence of any one mechanism of resistance does not necessarily
> render an insecticide useless. A compromised insecticide can remain
> partially efficacious and operationally useful for some time.
> Increasing application rates or switching to less compromised members of an insecticide family (e.g.
> permethrin to deltamethrin) can temporarily compensate for loss of efficacy.
> Simple aging can even restore some of the vulnerability of resistant vectors.
> Switching to another class of insecticide (e.g. pyrethroids to
> carbamates) will bypass class-specific resistance mechanisms, as long
> as resistance to the new class is absent.
> But, once resistance emerges, if insecticidal pressure is maintained
> or increased, selection will proceed and resistance will inevitably
> worsen. Only when resistance harms the reproductive competitiveness
> (fitness) of unexposed vectors does resistance ever fade in the
> absence of insecticidal pressure. But these fitness deficits are often
> negligible, the genes associated with resistance traits often
> recessive, in which case, resistance alleles persist in the vector population indefinitely long after insecticidal pressure is relaxed.
> Under selection, multiple resistance mechanisms can accrue and combine
> their effects. Independent metabolic detoxification mechanisms may
> arise and accumulate. Supplementary mutations can occur in sodium
> channel genes, amplifying the effects of target site
> insensitivity-based mechanisms such as knock down resistance (kdr).
> Complex, polygenic traits, such as outdoor feeding tendencies, may also become more prevalent."
>
> --
> View this post online:
> <http://www.ghdonline.org/malaria/discussion/expert-panel-the-future-o
> f-malaria-vector-control-/#reply-4991-3?id=17794970&format=text&type=i
> nstant>
>
> Unsubscribe or change your email notification settings:
> <http://www.ghdonline.org/users/manuel-lluberas/edit/>
>
> Contact the GHDonline team:
> <http://www.ghdonline.org/contact/>
>
> You can reply to this discussion by responding directly to this
> e-mail; it will be shared with all community members and posted as is.
> Files cannot be added via email attachment and must be uploaded directly to GHDonline."
>
> --
> View this post online:
> <http://www.ghdonline.org/malaria/discussion/expert-panel-the-future-o
> f-malaria-vector-control-/#reply-4993-2?id=13584547&format=text&type=i
> nstant>
>
> Unsubscribe or change your email notification settings:
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>
> Contact the GHDonline team:
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>
> You can reply to this discussion by responding directly to this
>e-mail; it will be shared with all community members and posted as is.
>Files cannot be added via email attachment and must be uploaded directly to GHDonline.
>"

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Michael Reddy Moderator Emeritus Replied at 12:03 AM, 27 Jun 2012

I think Tony and Manuel raise really important and relevant points regarding the time-limited nature of interventions reliant on biocides. Further, both suggest that vector suppression efforts need to anticipate the failure of a particular insecticide-class where its used solely and intensely as selection for resistance mechanisms are soon to follow. It isn't IF vectors develop resistance, but rather WHEN and what are decision-makers prepared to do in response. We also need to be thinking beyond simply IRS and ITNs interventions. They remain important in the prevention of malaria transmission, but are subject to operational failure by virtue of the fact they rely on the efficacy of the insecticide used in each. Where appropriate, they should be used with vigilant monitoring and evaluation efforts to ensure their continued success or to justify the use of alternative interventions. Policy makers and implementers would be well advise to consider interventions other those reliant solely on biocides. These include but are not limited to improved environmental approaches to source reduction (draining or improved drainage of permanent breeding sites, improved housing/construction methods to reduce human-mosquito interactions, repellents (both personal protection and spatial)...etc. As public health professionals we have a responsibility to consider all the options available and proven effective. This is not to suggest that what works in one locale is appropriate for all locations. Quite the contrary, in fact, we need to tailor interventions designed to protect a defined population or community so as to maximize the efficacy of anti-vector "tools" currently available whether that includes insecticides or not. Fortunately, we currently find ourselves in a time where political and economic will favors anti-malaria interventions in support of goal of elimination of this disease. This will not last forever and must plan as such. The recent uncertainty regarding the Global Fund's funding for future rounds of support, should serve as a warning that financial support for global health initiatives is tenuous at best. Limited resources necessitate creative AND cost-effective solutions in the fight against malaria. The question in my mind is do decision-makers recognize this and are they prepared to take the necessary steps to use resources like insecticidal interventions judiciously?

Michael Reddy Moderator Emeritus Replied at 12:14 AM, 27 Jun 2012

Attached is a review by M.A. Hoy (1998) entitled "Myths, models and mitigation of resistance to pesticides" previously cited by Tony in his post regarding the agricultural community's experience with resistance management strategies.

Attached resource:

Tony Kiszewski Replied at 6:20 AM, 27 Jun 2012

I also see a need for more sustainable solutions that complement insecticides without exacerbating resistance. But the situation is urgent. We can’t afford to wait for new technologies. We need to deploy underutilized existing technologies that are culturally appropriate and responsive to the diverse ecology and behavior of local vectors. These include such measures as:
1) Housing modification. Over the years, many researchers have identified a wide array of customizable and inexpensive alterations to dwellings that substantially reduce the flow of vectors, thus reducing biting and transmission rates. 2) Habitat modification. Malaria vectors are ecologically diverse, but in every locale, simple measures can be undertaken at the community level that can reduce the availability of larval habitat near households, forcing vectors to utilize more crowded or marginal breeding sites, increasing intraspecific competition and reducing not only abundance but more powerful influences of vectorial capacity,such as competence and longevity. 3) Personal repellents inhibit biting in every venue, indoors and out, providing the perfect complement to insecticidal measures that depend on vectors entering homes to feed, particularly as evidence mounts of increasing exophagy in malaria vectors, perhaps in response to insecticidal pressure. New, low cost, highly efficacious repellents (e.g. No Mas) make this approach more practical than ever.

Manuel Lluberas Replied at 8:29 AM, 27 Jun 2012

To be able to implement a comprehensive mosquito control program that deploys the methods listed by Tony and as many of the other tools as possible depending on local vector and environmental conditions, we need to train more field entomologists and provide them with a career path. At the moment, the vast majority of the vector control programs are in the hands of physicians. While they may be good at diagnosing and treating malaria and other vector-borne diseases, the entomological aspect of malaria programs are very different. As a public health entomologist with at least three decades in the malaria control field I consider myself pretty knowledgeable about malaria diagnosis and treatment, but I don’t think anyone would consider me for a position directing a malaria control hospital or ward; and it should be that way. Unfortunately, the reverse has been the case for decades. We need to start placing public health entomologists in charge of vector control and train field technicians so we have boots on the ground. We need to start by providing growth potential for entomologists and technicians wanting to go this route and start building and strengthening this capacity. To use the medical analogy, we have physicians who diagnose and treat diseases, but the nurses in the wards are the ones who watch over the patients, carry out the medical orders and consult with the physicians when something does not look or feel right. We have no equivalent in the vector control field. We need to start changing that.

I would be remiss if I did not mention that I think we have not been serious about malaria control. In addition to my points above, I believe we are addressing a full time problem on a part time basis. If you look at malaria control programs around the world, you'll notice that they operate between 6 to 8 or nine months a year with little or no activity during the "off season". Not only do they operate on a part time basis, entire programs are frequently dissolved or disbanded at the end of a season. As long as we continue addressing malaria in this fashion we will continue to have malaria. We need to get serious and start engaging vector control the way it should be: with qualified public health entomologists and field technicians who can look at their areas and determine what vector control methods and approaches would be best suited. Anything short of this will almost certainly lead to continued malaria deaths for decades to come. Is this the way we want to keep it?

Manuel

-----Original Message-----
From: GHDonline (Tony Kiszewski) [mailto:]
Sent: Wednesday, June 27, 2012 06:24
To: Manuel Lluberas
Subject: Re: [Malaria Treatment & Prevention] Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29

Tony Kiszewski replied to the discussion "Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29" in the Malaria Treatment & Prevention community.

Reply contents:
"I also see a need for more sustainable solutions that complement insecticides without exacerbating resistance. But the situation is urgent. We can’t afford to wait for new technologies. We need to deploy underutilized existing technologies that are culturally appropriate and responsive to the diverse ecology and behavior of local vectors. These include such measures as:
1) Housing modification. Over the years, many researchers have identified a wide array of customizable and inexpensive alterations to dwellings that substantially reduce the flow of vectors, thus reducing biting and transmission rates. 2) Habitat modification. Malaria vectors are ecologically diverse, but in every locale, simple measures can be undertaken at the community level that can reduce the availability of larval habitat near households, forcing vectors to utilize more crowded or marginal breeding sites, increasing intraspecific competition and reducing not only abundance but more powerful influences of vectorial capacity,such as competence and longevity. 3) Personal repellents inhibit biting in every venue, indoors and out, providing the perfect complement to insecticidal measures that depend on vectors entering homes to feed, particularly as evidence mounts of increasing exophagy in malaria vectors, perhaps in response to insecticidal pressure. New, low cost, highly efficacious repellents (e.g. No Mas) make this approach more practical than ever."

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Mary Nnankya Replied at 8:49 AM, 27 Jun 2012

A very valuable, updated and more practical approach to malaria (vector) control****************IMPORTANT--PLEASE READ*******************
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> Subject: Re: [Malaria Treatment & Prevention] Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29
> From:
> To:
> Date: Wed, 27 Jun 2012 08:29:37 -0400
>
> Manuel Lluberas replied to the discussion "Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29" in the Malaria Treatment & Prevention community.
>
> Reply contents:
> "To be able to implement a comprehensive mosquito control program that deploys the methods listed by Tony and as many of the other tools as possible depending on local vector and environmental conditions, we need to train more field entomologists and provide them with a career path. At the moment, the vast majority of the vector control programs are in the hands of physicians. While they may be good at diagnosing and treating malaria and other vector-borne diseases, the entomological aspect of malaria programs are very different. As a public health entomologist with at least three decades in the malaria control field I consider myself pretty knowledgeable about malaria diagnosis and treatment, but I don’t think anyone would consider me for a position directing a malaria control hospital or ward; and it should be that way. Unfortunately, the reverse has been the case for decades. We need to start placing public health entomologists in charge of vector control and train field technicians so we have boots on the ground. We need to start by providing growth potential for entomologists and technicians wanting to go this route and start building and strengthening this capacity. To use the medical analogy, we have physicians who diagnose and treat diseases, but the nurses in the wards are the ones who watch over the patients, carry out the medical orders and consult with the physicians when something does not look or feel right. We have no equivalent in the vector control field. We need to start changing that.
>
> I would be remiss if I did not mention that I think we have not been serious about malaria control. In addition to my points above, I believe we are addressing a full time problem on a part time basis. If you look at malaria control programs around the world, you'll notice that they operate between 6 to 8 or nine months a year with little or no activity during the "off season". Not only do they operate on a part time basis, entire programs are frequently dissolved or disbanded at the end of a season. As long as we continue addressing malaria in this fashion we will continue to have malaria. We need to get serious and start engaging vector control the way it should be: with qualified public health entomologists and field technicians who can look at their areas and determine what vector control methods and approaches would be best suited. Anything short of this will almost certainly lead to continued malaria deaths for decades to come. Is this the way we want to keep it?
>
> Manuel
>
> -----Original Message-----
> From: GHDonline (Tony Kiszewski) [mailto:]
> Sent: Wednesday, June 27, 2012 06:24
> To: Manuel Lluberas
> Subject: Re: [Malaria Treatment & Prevention] Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29
>
> Tony Kiszewski replied to the discussion "Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29" in the Malaria Treatment & Prevention community.
>
> Reply contents:
> "I also see a need for more sustainable solutions that complement insecticides without exacerbating resistance. But the situation is urgent. We can’t afford to wait for new technologies. We need to deploy underutilized existing technologies that are culturally appropriate and responsive to the diverse ecology and behavior of local vectors. These include such measures as:
> 1) Housing modification. Over the years, many researchers have identified a wide array of customizable and inexpensive alterations to dwellings that substantially reduce the flow of vectors, thus reducing biting and transmission rates. 2) Habitat modification. Malaria vectors are ecologically diverse, but in every locale, simple measures can be undertaken at the community level that can reduce the availability of larval habitat near households, forcing vectors to utilize more crowded or marginal breeding sites, increasing intraspecific competition and reducing not only abundance but more powerful influences of vectorial capacity,such as competence and longevity. 3) Personal repellents inhibit biting in every venue, indoors and out, providing the perfect complement to insecticidal measures that depend on vectors entering homes to feed, particularly as evidence mounts of increasing exophagy in malaria vectors, perhaps in response to insecticidal pressure. New, low cost, highly efficacious repellents (e.g. No Mas) make this approach more practical than ever."
>
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Asnakew Yeshiwondim Replied at 9:05 AM, 27 Jun 2012

Tony and others mentioned important points. important breeding sites are clustered around homesteads, where communities can modify the habitats. But, identification of these habitats are crucial. Here is where Manuel's point become valuable. in practice, habitat modification thru community participation has resulted negative results. This can be improved through linking GIS/Remote Sensing and vector control to maximize the benefits.

Richard Pollack Replied at 9:31 AM, 27 Jun 2012

Manuel, I anticipate you're preaching to a chorus composed mainly of the converted. The current strategy of relying mainly upon nets distributed directly to the consumer was based on several false assumptions, irrational hopes for success, and an unhealthy dose of voodoo economics. Yes, we need experienced public health entomologists overseeing campaigns staffed by full-time field technicians. But, with what funds will these armies be supported? Pursuing efforts aimed at source reduction and larviciding will require sustainable fiscal resources and political support. Even in some of the wealthier areas of the U.S., the mosquito control districts have been under attack because they're perceived to be 'doing nothing' during the cooler months. As a result, some legislators and officials have suggested they be disbanded and relaunched each summer with temporary workers. All this to save dollars. It is a short-sighted and impractical approach. To counter these misguided efforts, we've ensured that the MCD personnel are active throughout the year. Many source reduction efforts are more readily conducted during the seasons when MCD personnel need not monitor mosquito populations or apply insecticides. We do our best to try to demonstrate to officials that our intervention teams are not idle here, even when the ground is frozen. Field personnel in malarious areas need also to demonstrate convincingly that they're active throughout the year, and that retaining a full time highly trained crew is, in the long-term, more economical and practical than trying to re-create and train a new crew each year. Finally, I fully support and encourage each of the strategies suggested by Tony. While we await the next 'magic bullet' to arrive from the biotech world, we should pursue those lower tech and locally-appropriate methods to intervene.

Lester Hartman Replied at 10:14 AM, 27 Jun 2012

Perhaps I missed this but are benders still part of a solution given that exophagic mosquitoes are not purely exophagic? Haiti's mosquito breed is such an example
________________________________________
From: GHDonline (Richard Pollack) []
Sent: Wednesday, June 27, 2012 9:32 AM
To: Hartman, Lester
Subject: Re: [Malaria Treatment & Prevention] Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29

Richard Pollack replied to the discussion "Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29" in the Malaria Treatment & Prevention community.

Reply contents:
"Manuel, I anticipate you're preaching to a chorus composed mainly of the converted. The current strategy of relying mainly upon nets distributed directly to the consumer was based on several false assumptions, irrational hopes for success, and an unhealthy dose of voodoo economics. Yes, we need experienced public health entomologists overseeing campaigns staffed by full-time field technicians. But, with what funds will these armies be supported? Pursuing efforts aimed at source reduction and larviciding will require sustainable fiscal resources and political support. Even in some of the wealthier areas of the U.S., the mosquito control districts have been under attack because they're perceived to be 'doing nothing' during the cooler months. As a result, some legislators and officials have suggested they be disbanded and relaunched each summer with temporary workers. All this to save dollars. It is a short-sighted and impractical approach. To counter these misguided efforts, we've ensured that the MCD personnel are active throughout the year. Many source reduction efforts are more readily conducted during the seasons when MCD personnel need not monitor mosquito populations or apply insecticides. We do our best to try to demonstrate to officials that our intervention teams are not idle here, even when the ground is frozen. Field personnel in malarious areas need also to demonstrate convincingly that they're active throughout the year, and that retaining a full time highly trained crew is, in the long-term, more economical and practical than trying to re-create and train a new crew each year. Finally, I fully support and encourage each of the strategies suggested by Tony. While we await the next 'magic bullet' to arrive from the biotech world, we should pursue those lower tech and locally-appropriate methods to intervene."

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Lester Hartman Replied at 10:19 AM, 27 Jun 2012

"bednets ILN. " I meant my apologies!
Lester
________________________________________
From: GHDonline (Lester Hartman) []
Sent: Wednesday, June 27, 2012 10:15 AM
To: Hartman, Lester
Subject: Re: [Malaria Treatment & Prevention] Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29

Lester Hartman replied to the discussion "Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29" in the Malaria Treatment & Prevention community.

Reply contents:
"Perhaps I missed this but are benders still part of a solution given that exophagic mosquitoes are not purely exophagic? Haiti's mosquito breed is such an example
________________________________________
From: GHDonline (Richard Pollack) []
Sent: Wednesday, June 27, 2012 9:32 AM
To: Hartman, Lester
Subject: Re: [Malaria Treatment & Prevention] Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29

Richard Pollack replied to the discussion "Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29" in the Malaria Treatment & Prevention community.

Reply contents:
"Manuel, I anticipate you're preaching to a chorus composed mainly of the converted. The current strategy of relying mainly upon nets distributed directly to the consumer was based on several false assumptions, irrational hopes for success, and an unhealthy dose of voodoo economics. Yes, we need experienced public health entomologists overseeing campaigns staffed by full-time field technicians. But, with what funds will these armies be supported? Pursuing efforts aimed at source reduction and larviciding will require sustainable fiscal resources and political support. Even in some of the wealthier areas of the U.S., the mosquito control districts have been under attack because they're perceived to be 'doing nothing' during the cooler months. As a result, some legislators and officials have suggested they be disbanded and relaunched each summer with temporary workers. All this to save dollars. It is a short-sighted and impractical approach. To counter these misguided efforts, we've ensured that the MCD personnel are active throughout the year. Many source reduction efforts are more readily conducted during the seasons when MCD personnel need not monitor mosquito populations or apply insecticides. We do our best to try to demonstrate to officials that our intervention teams are not idle here, even when the ground is frozen. Field personnel in malarious areas need also to demonstrate convincingly that they're active throughout the year, and that retaining a full time highly trained crew is, in the long-term, more economical and practical than trying to re-create and train a new crew each year. Finally, I fully support and encourage each of the strategies suggested by Tony. While we await the next 'magic bullet' to arrive from the biotech world, we should pursue those lower tech and locally-appropriate methods to intervene."

--
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Manuel Lluberas Replied at 10:29 AM, 27 Jun 2012

Richard, thanks for your comments. I suspect we are all preaching to the converted, but maybe we need to start talking to our communities and influential people, ministers, the US Congress and others after we leave the temple, mosque, synagogue, shade tree or wherever it is we meet with the choir. Forgive me for saying this like this, but what do you mean there's no money? The malaria control programs in Africa and other parts of the World have spent several tens of billions (1X109) of US dollars in the last decade or so on malaria control. And what do we have to show for? A malaria death toll equivalent to six or seven 747 Jumbo jetliners crashing every day.

During the last Vector Control Working Group meeting at WHO Geneva, it was reported that 1 billion US Dollars had been spent by the Global Fund alone on nets while USD100 Million (1X106) were budgeted for IRS and only 80% was spent. In addition, Global Fund has about 10% of the budget for capacity building and training that is seldom used. At the rate money has been spent in since the Roll Back Malaria Campaign, the Global Fund, the PMI, Clinton Initiative, Gates Foundation, the World Bank Malaria Booster program (just to name the largest ones) were instituted, we should have wiped put malaria already. There is money; and lots of it! All we need to do is get serious about malaria control. How was it that mosquito nets were equated to vector control? There are many examples of countries where malaria has been wiped out and has stayed out. I don't want to bore you details you already know. What happened? How did we get to where we are now? In my opinion, we are here because those making decisions about malaria control know little about mosquito control. Some even consider insecticides as dangerous chemicals that should be banned altogether. And this from people who have no problem prescribing restricted chemicals like drugs, antibiotics and chemotherapeutic agents. Insecticides are just that: antibiotics for the environment. As such, they need to be used when needed and by people trained to prescribe them.

With regards to "down time", the problem here in my humble opinion is lack of foresight and detailed knowledge of mosquito biology and ecology. I believe the general opinion about vector control is something akin to "How difficult it can be? Just go out and spray something." The down time should be used for community education, surveillance, training, maintenance, calibration, larval surveillance and control and evaluating alternatives. Mosquitoes don't take a vacation. Unfortunately, there is no job security or path for vector control professionals in Africa and other countries where they are most needed. We also need to take this time to engage the press, the members of parliament, ministers and other influential people mentioned in the first few lines of my note.

Mosquito control is not cheap, but how much value do we put on the few plane loads of children under five and pregnant women who perish annually?

Manuel

-----Original Message-----
From: GHDonline (Richard Pollack) [mailto:]
Sent: Wednesday, June 27, 2012 09:32
To: Manuel Lluberas
Subject: Re: [Malaria Treatment & Prevention] Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29

Richard Pollack replied to the discussion "Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29" in the Malaria Treatment & Prevention community.

Reply contents:
"Manuel, I anticipate you're preaching to a chorus composed mainly of the converted. The current strategy of relying mainly upon nets distributed directly to the consumer was based on several false assumptions, irrational hopes for success, and an unhealthy dose of voodoo economics. Yes, we need experienced public health entomologists overseeing campaigns staffed by full-time field technicians. But, with what funds will these armies be supported? Pursuing efforts aimed at source reduction and larviciding will require sustainable fiscal resources and political support. Even in some of the wealthier areas of the U.S., the mosquito control districts have been under attack because they're perceived to be 'doing nothing' during the cooler months. As a result, some legislators and officials have suggested they be disbanded and relaunched each summer with temporary workers. All this to save dollars. It is a short-sighted and impractical approach. To counter these misguided efforts, we've ensured that the MCD personnel are active throughout the year. Many source reduction efforts are more readily conducted during the seasons when MCD personnel need not monitor mosquito populations or apply insecticides. We do our best to try to demonstrate to officials that our intervention teams are not idle here, even when the ground is frozen. Field personnel in malarious areas need also to demonstrate convincingly that they're active throughout the year, and that retaining a full time highly trained crew is, in the long-term, more economical and practical than trying to re-create and train a new crew each year. Finally, I fully support and encourage each of the strategies suggested by Tony. While we await the next 'magic bullet' to arrive from the biotech world, we should pursue those lower tech and locally-appropriate methods to intervene."

--
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<http://www.ghdonline.org/malaria/discussion/expert-panel-the-future-of-malari...>

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Manuel Lluberas Replied at 10:42 AM, 27 Jun 2012

Lester:

Haiti is an interesting case. For reasons that escape me, mosquito nets and IRS were recommended as an option, which led me to write the attached article. Mosquito nets may help a person get a good night sleep in parts of Haiti, but I don't think they are a viable option with exophagic vectors like the Anopheles mosquitoes you have on the island or Aedes aegypti and Ae. albopictus. In Haiti's case, I think a good surveillance program that includes breeding source location, larval control and adulticiding might help. Unfortunately, this will require specific training and equipment and is also an unpopular position. Anything you decide to implement must be combined with active community participation and involvement of the hundreds of NGOs currently operating in the country. I am sure a handful of us can provide you with a specific plan of action if you want to go that route.

All the best,

Manuel

-----Original Message-----
From: GHDonline (Lester Hartman) [mailto:]
Sent: Wednesday, June 27, 2012 10:21
To: Manuel Lluberas
Subject: Re: [Malaria Treatment & Prevention] Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29

Lester Hartman replied to the discussion "Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29" in the Malaria Treatment & Prevention community.

Reply contents:
""bednets ILN. " I meant my apologies!
Lester
________________________________________
From: GHDonline (Lester Hartman) []
Sent: Wednesday, June 27, 2012 10:15 AM
To: Hartman, Lester
Subject: Re: [Malaria Treatment & Prevention] Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29

Lester Hartman replied to the discussion "Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29" in the Malaria Treatment & Prevention community.

Reply contents:
"Perhaps I missed this but are benders still part of a solution given that exophagic mosquitoes are not purely exophagic? Haiti's mosquito breed is such an example ________________________________________
From: GHDonline (Richard Pollack) []
Sent: Wednesday, June 27, 2012 9:32 AM
To: Hartman, Lester
Subject: Re: [Malaria Treatment & Prevention] Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29

Richard Pollack replied to the discussion "Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29" in the Malaria Treatment & Prevention community.

Reply contents:
"Manuel, I anticipate you're preaching to a chorus composed mainly of the converted. The current strategy of relying mainly upon nets distributed directly to the consumer was based on several false assumptions, irrational hopes for success, and an unhealthy dose of voodoo economics. Yes, we need experienced public health entomologists overseeing campaigns staffed by full-time field technicians. But, with what funds will these armies be supported? Pursuing efforts aimed at source reduction and larviciding will require sustainable fiscal resources and political support. Even in some of the wealthier areas of the U.S., the mosquito control districts have been under attack because they're perceived to be 'doing nothing' during the cooler months. As a result, some legislators and officials have suggested they be disbanded and relaunched each summer with temporary workers. All this to save dollars. It is a short-sighted and impractical approach. To counter these misguided efforts, we've ensured that the MCD personnel are active throughout the year. Many source reduction efforts are more readily conducted during the seasons when MCD personnel need not monitor mosquito populations or apply insecticides. We do our best to try to demonstrate to officials that our intervention teams are not idle here, even when the ground is frozen. Field personnel in malarious areas need also to demonstrate convincingly that they're active throughout the year, and that retaining a full time highly trained crew is, in the long-term, more economical and practical than trying to re-create and train a new crew each year. Finally, I fully support and encourage each of the strategies suggested by Tony. While we await the next 'magic bullet' to arrive from the biotech world, we should pursue those lower tech and locally-appropriate methods to intervene."

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Tony Kiszewski Replied at 11:54 AM, 27 Jun 2012

I agree that bednets remain useful, even in places where exophagy is highly prevalent (but not exclusive) but they should never have been relied on as the sole means of intervention against vectors, and now as vectors adapt, that is even more the case. One major flaw of the overall malaria intervention strategy has been the reluctance of decision makers to craft locale-specific policies instead of attempting a one-size-fits-all approach. In part, this requires listening and responding to local expertise instead of trying to impose top down solutions that are not always appropriate or effective for a particular locale.

Blessed Goje Replied at 1:37 PM, 27 Jun 2012

On Vector Control and Insecticides,
I feel not enough is being put to educate the public on breeding habits of mosquitoes. Unless people understand this and seek to eliminate potential breeding places we are not addressing the problem at its root.

Here is an observation: Sometimes I notice that mosquitoes swarm around people with a type of body cream or hair cream. I wonder if there has been any study done in creating an odour house that attaracts mosquitoes to a certain corner of the house or even outside the house. In the Hausa language the name for mosquito net is 'gidan sauro' which literally means 'home of mosquitoes'. How about building a 'house' for mosquitoes where they can be herded, so to speak, to their own destruction?

Blessed
Kaduna, Nigeria

Manuel Lluberas Replied at 2:12 PM, 27 Jun 2012

Kaduna:

You are correct, we need to do a better job of recruiting and training the communities regarding mosquito control. This is a very simplistic approach, but anything that will hold water from 5 to 9 days in a row is a potential breeding site. Some mosquitoes will breed in different types of breeding sites and water quality, but the bottom line is that some mosquito will find it attractive. The subject is too broad to go into the specifics for each species, but anything holding water for a week or so will eventually produce mosquitoes. This is the kind of activity that can be carried out by mosquito control staff during the "off season".

With regards to your comment on attractiveness, you are correct: some people are more attractive than others. For example, pregnant women are known to be more attractive to mosquitoes than those who are not pregnant. Again, this is a very broad subject into which I can't go much deeper for now, but you are correct.

The idea of a "death cage" has been tried in parts of the tropics. Here's what I've seen. Prepare a 1 meter cube wooden box. Painted it flat black on the outside and red/black checker of about 10 cm on the inside. The brighter the red -a color known commonly as buoy red works well. Place a clear funnel-shaped "entrance" on one side and place it with the entrance facing away from the sun in a shaded area. Mosquitoes will use this to shelter themselves from the sun during the day. I must say that I am not sure what mosquito you'll trap, but I am sure you'll trap some. This seemed to work best against Aedes spp. in Central America. You must be able to locate this cube as it could become a great refuge for mosquitoes if you abandon it.

Give this a try, but try to identify the mosquitoes collected and let us all know how it worked out. It may turn out to be a good operational research paper.

Manuel

-----Original Message-----
From: GHDonline (Blessed Goje) [mailto:]
Sent: Wednesday, June 27, 2012 13:39
To: Manuel Lluberas
Subject: Re: [Malaria Treatment & Prevention] Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29

Blessed Goje replied to the discussion "Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29" in the Malaria Treatment & Prevention community.

Reply contents:
"On Vector Control and Insecticides,
I feel not enough is being put to educate the public on breeding habits of mosquitoes. Unless people understand this and seek to eliminate potential breeding places we are not addressing the problem at its root.

Here is an observation: Sometimes I notice that mosquitoes swarm around people with a type of body cream or hair cream. I wonder if there has been any study done in creating an odour house that attaracts mosquitoes to a certain corner of the house or even outside the house. In the Hausa language the name for mosquito net is 'gidan sauro' which literally means 'home of mosquitoes'. How about building a 'house' for mosquitoes where they can be herded, so to speak, to their own destruction?

Blessed
Kaduna, Nigeria"

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Michael Reddy Moderator Emeritus Replied at 5:00 PM, 27 Jun 2012

I'd like to share a recent report by Jones et al in PNAS (2012) pertinent to this discussion regarding evidence for positive selection for a secondary target-site mutation (N1575Y) detected in mosquitoes already possessing the kdr- "west" (L1014F) mutation. The authors find "Haplotypic tests of association suggest the latter: The 1014F-1575Y haplotype confers a significant additive benefit above 1014F-1575N for survival to DDT (M form P = 0.03) and permethrin (S form P = 0.003" This to my knowledge represents the first molecular evidence of selection for a "super-kdr" type of resistance to pyrethroids and DDT in an important malaria vector (Anopheles gambiae) and indeed represents a troubling development with regard to the continued intense application of pyrethroids for anti-vector interventions. Thanks to Tony for sharing this literature with the community.

Insecticide resistance is an ideal model to study the emergence and
spread of adaptative variants. In the African malaria mosquito,
Anopheles gambiae, this is complemented by a strong public
health rationale. In this insect, resistance to pyrethroid and DDT
insecticides is strongly associated with the mutations L1014F and
L1014S within the para voltage-gated sodium channel (VGSC).
Across much of West Africa, 1014F frequency approaches fixation.
Here, we document the emergence of a mutation, N1575Y, within
the linker between domains III-IV of the VGSC. In data extending
over 40 kbp of the VGSC 1575Y occurs on only a single long-range
haplotype, also bearing 1014F. The 1014F-1575Y haplotype was
found in both M and S molecular forms of An. gambiae in West/
Central African sample sites separated by up to 2,000 km. In Burkina
Faso M form, 1575Y allele frequency rose significantly from
0.053 to 0.172 between 2008 and 2010. Extended haplotype homozygosity
analysis of the wild-type 1575N allele showed rapid
decay of linkage disequilibrium (LD), in sharp contrast to the extended
LD exhibited by 1575Y. A haplotype with long-range LD
and high/increasing frequency is a classical sign of strong positive
selection acting on a recent mutant. 1575Y occurs ubiquitously on
a 1014F haplotypic background, suggesting that the N1575Y mutation
compensates for deleterious fitness effects of 1014F and/or
confers additional resistance to insecticides. Haplotypic tests of
association suggest the latter: The 1014F-1575Y haplotype confers
a significant additive benefit above 1014F-1575N for survival to
DDT (M form P = 0.03) and permethrin (S form P = 0.003).

Attached resource:

Michael Reddy Moderator Emeritus Replied at 10:27 PM, 27 Jun 2012

I'd also like to solicit any comments or observations from personnel affiliated with PMI, Roll Back Malaria...etc and/or other large-scale, multi-national operational programs currently grappling with the issue of insecticide resistance. Specifically I would appreciate comments that describe what strategies they intend to pursue in order to mitigate resistance where it has already been observed or is likely to in order to preserve the efficacy of insecticides currently in use. Thanks in advance to those willing to share their views and observations with the rest of the community. -MR

Seraphine Adibaku Replied at 3:11 AM, 28 Jun 2012

Manuel is spot on. The paucity of Entomologists and the low priority
accorded to their training and deployment needs urgent redress as a
critical component of the required package to achieve better control and
elimination of malaria. In my country which has one of the highest burdens
of malaria, there is high transmission all year round so we do not take
holidays from malaria work. However the revised health staffing structure
adopted in 2002 eliminated the position of an Entomologist at the district
level, retaining only one at sub-district level for a population of close
to 100,000. This has resulted into the kind of practice illustrated by
Manuel where technical roles of entomologists are attempted by other
professions that are ill prepared for the tasks. The related cadre often
used where available is a Vector Control Officer.

Just to ask "Would a Vector Control Officer ably perform the roles of an
Entomologist?"

Seraphine

On Wed, Jun 27, 2012 at 3:29 PM, GHDonline (Manuel Lluberas) <
> wrote:

> [image: Boxbe] <https://www.boxbe.com/overview> Malaria Treatment &
> Prevention () is not on your Guest List<https://www.boxbe.com/approved-list>| Approve
> sender <https://www.boxbe.com/anno?tc=11693835569_937854173> | Approve
> domain <https://www.boxbe.com/anno?tc=11693835569_937854173&dom>
>
> Manuel Lluberas replied to the discussion "Expert Panel: The Future of
> Malaria Vector Control and Insecticides, June 25-29" in the Malaria
> Treatment & Prevention community.
>
> Reply contents:
> "To be able to implement a comprehensive mosquito control program that
> deploys the methods listed by Tony and as many of the other tools as
> possible depending on local vector and environmental conditions, we need
> to train more field entomologists and provide them with a career path. At
> the moment, the vast majority of the vector control programs are in the
> hands of physicians. While they may be good at diagnosing and treating
> malaria and other vector-borne diseases, the entomological aspect of
> malaria programs are very different. As a public health entomologist with
> at least three decades in the malaria control field I consider myself
> pretty knowledgeable about malaria diagnosis and treatment, but I don’t
> think anyone would consider me for a position directing a malaria control
> hospital or ward; and it should be that way. Unfortunately, the reverse has
> been the case for decades. We need to start placing public health
> entomologists in charge of vector control and train field technicians so we
> have boots on the ground. We need to start by providing growth potential
> for entomologists and technicians wanting to go this route and start
> building and strengthening this capacity. To use the medical analogy, we
> have physicians who diagnose and treat diseases, but the nurses in the
> wards are the ones who watch over the patients, carry out the medical
> orders and consult with the physicians when something does not look or feel
> right. We have no equivalent in the vector control field. We need to start
> changing that.
>
> I would be remiss if I did not mention that I think we have not been
> serious about malaria control. In addition to my points above, I believe we
> are addressing a full time problem on a part time basis. If you look at
> malaria control programs around the world, you'll notice that they operate
> between 6 to 8 or nine months a year with little or no activity during the
> "off season". Not only do they operate on a part time basis, entire
> programs are frequently dissolved or disbanded at the end of a season. As
> long as we continue addressing malaria in this fashion we will continue to
> have malaria. We need to get serious and start engaging vector control the
> way it should be: with qualified public health entomologists and field
> technicians who can look at their areas and determine what vector control
> methods and approaches would be best suited. Anything short of this will
> almost certainly lead to continued malaria deaths for decades to come. Is
> this the way we want to keep it?
>
> Manuel
>
> -----Original Message-----
> From: GHDonline (Tony Kiszewski) [mailto:]
> Sent: Wednesday, June 27, 2012 06:24
> To: Manuel Lluberas
> Subject: Re: [Malaria Treatment & Prevention] Expert Panel: The Future of
> Malaria Vector Control and Insecticides, June 25-29
>
> Tony Kiszewski replied to the discussion "Expert Panel: The Future of
> Malaria Vector Control and Insecticides, June 25-29" in the Malaria
> Treatment & Prevention community.
>
> Reply contents:
> "I also see a need for more sustainable solutions that complement
> insecticides without exacerbating resistance. But the situation is urgent.
> We can’t afford to wait for new technologies. We need to deploy
> underutilized existing technologies that are culturally appropriate and
> responsive to the diverse ecology and behavior of local vectors. These
> include such measures as:
> 1) Housing modification. Over the years, many researchers have identified
> a wide array of customizable and inexpensive alterations to dwellings that
> substantially reduce the flow of vectors, thus reducing biting and
> transmission rates. 2) Habitat modification. Malaria vectors are
> ecologically diverse, but in every locale, simple measures can be
> undertaken at the community level that can reduce the availability of
> larval habitat near households, forcing vectors to utilize more crowded or
> marginal breeding sites, increasing intraspecific competition and reducing
> not only abundance but more powerful influences of vectorial capacity,such
> as competence and longevity. 3) Personal repellents inhibit biting in every
> venue, indoors and out, providing the perfect complement to insecticidal
> measures that depend on vectors entering homes to feed, particularly as
> evidence mounts of increasing exophagy in malaria vectors, perhaps in
> response to insecticidal pressure. New, low cost, highly efficacious
> repellents (e.g. No Mas) make this approach more practical than ever."
>
> --
> View this post online:
> <
> http://www.ghdonline.org/malaria/discussion/expert-panel-the-future-of-malari...
> >
>
> Unsubscribe or change your email notification settings:
> <http://www.ghdonline.org/users/manuel-lluberas/edit/>
>
> Contact the GHDonline team:
> <http://www.ghdonline.org/contact/>
>
> You can reply to this discussion by responding directly to this e-mail; it
> will be shared with all community members and posted as is. Files cannot be
> added via email attachment and must be uploaded directly to GHDonline."
>
> --
> View this post online:
> <
> http://www.ghdonline.org/malaria/discussion/expert-panel-the-future-of-malari...
> >
>
> Unsubscribe or change your email notification settings:
> <http://www.ghdonline.org/users/seraphine-adibaku/edit/>
>
> Contact the GHDonline team:
> <http://www.ghdonline.org/contact/>
>
> You can reply to this discussion by responding directly to this e-mail; it
> will be shared with all community members and posted as is. Files cannot be
> added via email attachment and must be uploaded directly to GHDonline.
>
>


--
Dr. Seraphine Adibaku
MB.ChB (Makerere) MPH (Tulane, USA)
Tel Cell: +256-772507245/ 712607245
Email:

Manuel Lluberas Replied at 10:03 AM, 28 Jun 2012

Seraphine:

Thanks for your note. Sharing some of my concerns on the subject during the course of this week made me wonder if it would be possible to get together those of us who share this frustration -electronically or in person- and present these issues to the WHO, WHOPES, Global Fund, PMI and the other organizations that are in a position to affect some change. As a group, I believe we are in a good position to direct and affect changes in malaria control the way we think will have a bigger impact rather than accept what is mandated by others. Your thoughts on this are welcomed.

Manuel

-----Original Message-----
From: GHDonline (Seraphine Adibaku) [mailto:]
Sent: Thursday, June 28, 2012 03:12
To: Manuel Lluberas
Subject: Re: [Malaria Treatment & Prevention] Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29

Seraphine Adibaku replied to the discussion "Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29" in the Malaria Treatment & Prevention community.

Reply contents:
"Manuel is spot on. The paucity of Entomologists and the low priority accorded to their training and deployment needs urgent redress as a critical component of the required package to achieve better control and elimination of malaria. In my country which has one of the highest burdens of malaria, there is high transmission all year round so we do not take holidays from malaria work. However the revised health staffing structure adopted in 2002 eliminated the position of an Entomologist at the district level, retaining only one at sub-district level for a population of close to 100,000. This has resulted into the kind of practice illustrated by Manuel where technical roles of entomologists are attempted by other professions that are ill prepared for the tasks. The related cadre often used where available is a Vector Control Officer.

Just to ask "Would a Vector Control Officer ably perform the roles of an Entomologist?"

Seraphine

On Wed, Jun 27, 2012 at 3:29 PM, GHDonline (Manuel Lluberas) < > wrote:

> [image: Boxbe] <https://www.boxbe.com/overview> Malaria Treatment &
> Prevention () is not on your Guest
> List<https://www.boxbe.com/approved-list>| Approve sender
> <https://www.boxbe.com/anno?tc=11693835569_937854173> | Approve domain
> <https://www.boxbe.com/anno?tc=11693835569_937854173&dom>
>
> Manuel Lluberas replied to the discussion "Expert Panel: The Future of
> Malaria Vector Control and Insecticides, June 25-29" in the Malaria
> Treatment & Prevention community.
>
> Reply contents:
> "To be able to implement a comprehensive mosquito control program that
> deploys the methods listed by Tony and as many of the other tools as
> possible depending on local vector and environmental conditions, we
> need to train more field entomologists and provide them with a career
> path. At the moment, the vast majority of the vector control programs
> are in the hands of physicians. While they may be good at diagnosing
> and treating malaria and other vector-borne diseases, the
> entomological aspect of malaria programs are very different. As a
> public health entomologist with at least three decades in the malaria
> control field I consider myself pretty knowledgeable about malaria
> diagnosis and treatment, but I don’t think anyone would consider me
> for a position directing a malaria control hospital or ward; and it
> should be that way. Unfortunately, the reverse has been the case for
> decades. We need to start placing public health entomologists in
> charge of vector control and train field technicians so we have boots
> on the ground. We need to start by providing growth potential for
> entomologists and technicians wanting to go this route and start
> building and strengthening this capacity. To use the medical analogy,
> we have physicians who diagnose and treat diseases, but the nurses in
> the wards are the ones who watch over the patients, carry out the
> medical orders and consult with the physicians when something does not
> look or feel right. We have no equivalent in the vector control field. We need to start changing that.
>
> I would be remiss if I did not mention that I think we have not been
> serious about malaria control. In addition to my points above, I
> believe we are addressing a full time problem on a part time basis. If
> you look at malaria control programs around the world, you'll notice
> that they operate between 6 to 8 or nine months a year with little or
> no activity during the "off season". Not only do they operate on a
> part time basis, entire programs are frequently dissolved or disbanded
> at the end of a season. As long as we continue addressing malaria in
> this fashion we will continue to have malaria. We need to get serious
> and start engaging vector control the way it should be: with qualified
> public health entomologists and field technicians who can look at
> their areas and determine what vector control methods and approaches
> would be best suited. Anything short of this will almost certainly
> lead to continued malaria deaths for decades to come. Is this the way we want to keep it?
>
> Manuel
>
> -----Original Message-----
> From: GHDonline (Tony Kiszewski) [mailto:]
> Sent: Wednesday, June 27, 2012 06:24
> To: Manuel Lluberas
> Subject: Re: [Malaria Treatment & Prevention] Expert Panel: The Future
> of Malaria Vector Control and Insecticides, June 25-29
>
> Tony Kiszewski replied to the discussion "Expert Panel: The Future of
> Malaria Vector Control and Insecticides, June 25-29" in the Malaria
> Treatment & Prevention community.
>
> Reply contents:
> "I also see a need for more sustainable solutions that complement
> insecticides without exacerbating resistance. But the situation is urgent.
> We can’t afford to wait for new technologies. We need to deploy
> underutilized existing technologies that are culturally appropriate
> and responsive to the diverse ecology and behavior of local vectors.
> These include such measures as:
> 1) Housing modification. Over the years, many researchers have
> identified a wide array of customizable and inexpensive alterations to
> dwellings that substantially reduce the flow of vectors, thus reducing
> biting and transmission rates. 2) Habitat modification. Malaria
> vectors are ecologically diverse, but in every locale, simple measures
> can be undertaken at the community level that can reduce the
> availability of larval habitat near households, forcing vectors to
> utilize more crowded or marginal breeding sites, increasing
> intraspecific competition and reducing not only abundance but more
> powerful influences of vectorial capacity,such as competence and
> longevity. 3) Personal repellents inhibit biting in every venue,
> indoors and out, providing the perfect complement to insecticidal
> measures that depend on vectors entering homes to feed, particularly
> as evidence mounts of increasing exophagy in malaria vectors, perhaps
> in response to insecticidal pressure. New, low cost, highly efficacious repellents (e.g. No Mas) make this approach more practical than ever."
>
> --
> View this post online:
> <
> http://www.ghdonline.org/malaria/discussion/expert-panel-the-future-of
> -malaria-vector-control-/#reply-5012-2?id=17794970&format=text&type=in
> stant
> >
>
> Unsubscribe or change your email notification settings:
> <http://www.ghdonline.org/users/manuel-lluberas/edit/>
>
> Contact the GHDonline team:
> <http://www.ghdonline.org/contact/>
>
> You can reply to this discussion by responding directly to this
> e-mail; it will be shared with all community members and posted as is.
> Files cannot be added via email attachment and must be uploaded directly to GHDonline."
>
> --
> View this post online:
> <
> http://www.ghdonline.org/malaria/discussion/expert-panel-the-future-of
> -malaria-vector-control-/#reply-5014-2?id=17795837&format=text&type=in
> stant
> >
>
> Unsubscribe or change your email notification settings:
> <http://www.ghdonline.org/users/seraphine-adibaku/edit/>
>
> Contact the GHDonline team:
> <http://www.ghdonline.org/contact/>
>
> You can reply to this discussion by responding directly to this
> e-mail; it will be shared with all community members and posted as is.
> Files cannot be added via email attachment and must be uploaded directly to GHDonline.
>
>


--
Dr. Seraphine Adibaku
MB.ChB (Makerere) MPH (Tulane, USA)
Tel Cell: +256-772507245/ 712607245
Email:
"

--
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<http://www.ghdonline.org/malaria/discussion/expert-panel-the-future-of-malari...>

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Janet Hemingway Replied at 11:49 AM, 28 Jun 2012

I am pleased we have opened up the discussion on what type of resistance is operationally significant and how we should respond when resistance is selected.

While using larvicides or other integrated vector tools may be an attractive proposition in some settings many high transmission settings operate using very constrained resources and the benefit and impact of alternative methods needs to be carefully considered in line with the increases in cost.

Janet

Tony Kiszewski Replied at 1:25 PM, 28 Jun 2012

True. Cost is always an issue in these settings. However, as resistance proceeds, the currently favorable cost/benefit ratio of insecticide-only methods will worsen. And cost-benefits analyses don't always capture the true long-term cost of an intervention window if too short a time window is analyzed. LLINs or IRS alone may seem inexpensive when looked at over a 5 year span, but more sustainable methods such as habitat alteration (though initial investments may be higher) may average out much better over the long-term, once resistance, sooner-than-expected replacement cycles, non-compliance and other factors are accurately captured.

I'm not sure about larvicides as a complementary intervention tool, not only because of the expense but because they are also prone to strong selective forces that render them unsustainable. Not to mention, incomplete kills of larval population might lead to the unintended consequence of enhancing vectorial capacity by reducing competition among survivors.

Awash Teklehaimanot Replied at 1:52 PM, 28 Jun 2012

Janet has suggested that use of larvicides in many high transmission areas may not be cost effective and that alternative methods need to be considered. Larviciding is an operation that require repeated applications and thus a challenge to sustain it. I agree with Janet's suggestion that larviciding may not be cost effective , particularly in those resource constrained situations.However, it wwould be interesting to program mangers and others if Janet was to share what the alternative methods she is referring.

Awash


___________________________________
From: GHDonline (Janet Hemingway) []
Sent: Thursday, June 28, 2012 11:49 AM
To: Awash Teklehaimanot
Subject: Re: [Malaria Treatment & Prevention] Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29

Janet Hemingway replied to the discussion "Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29" in the Malaria Treatment & Prevention community.

Reply contents:
"I am pleased we have opened up the discussion on what type of resistance is operationally significant and how we should respond when resistance is selected.

While using larvicides or other integrated vector tools may be an attractive proposition in some settings many high transmission settings operate using very constrained resources and the benefit and impact of alternative methods needs to be carefully considered in line with the increases in cost.

Janet"

--
View this post online:
<http://www.ghdonline.org/malaria/discussion/expert-panel-the-future-of-malari...>

Unsubscribe or change your email notification settings:
<http://www.ghdonline.org/users/awash-teklehaimanot/edit/>

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Manuel Lluberas Replied at 1:58 PM, 28 Jun 2012

Larviciding may not be a popular concept, but it would be very useful in the off season -presumably the dry period- when breeding sites can be easily identified and categorized and larval suppression methods deployed. This way, the mosquito population has a smaller pool of individuals from which it can recover. This would certainly help the overall malaria program. Moreover, hormones, bacteria and many other non-chemical methods are available and can (should) be employed, thus reducing the pressure on the insecticide component of the program.

Manuel


-----Original Message-----
From: GHDonline (Tony Kiszewski) [mailto:]
Sent: Thursday, June 28, 2012 13:27
To: Manuel Lluberas
Subject: Re: [Malaria Treatment & Prevention] Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29

Tony Kiszewski replied to the discussion "Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29" in the Malaria Treatment & Prevention community.

Reply contents:
"True. Cost is always an issue in these settings. However, as resistance proceeds, the currently favorable cost/benefit ratio of insecticide-only methods will worsen. And cost-benefits analyses don't always capture the true long-term cost of an intervention window if too short a time window is analyzed. LLINs or IRS alone may seem inexpensive when looked at over a 5 year span, but more sustainable methods such as habitat alteration (though initial investments may be higher) may average out much better over the long-term, once resistance, sooner-than-expected replacement cycles, non-compliance and other factors are accurately captured.

I'm not sure about larvicides as a complementary intervention tool, not only because of the expense but because they are also prone to strong selective forces that render them unsustainable. Not to mention, incomplete kills of larval population might lead to the unintended consequence of enhancing vectorial capacity by reducing competition among survivors."

--
View this post online:
<http://www.ghdonline.org/malaria/discussion/expert-panel-the-future-of-malari...>

Unsubscribe or change your email notification settings:
<http://www.ghdonline.org/users/manuel-lluberas/edit/>

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<http://www.ghdonline.org/contact/>

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Richard Pollack Replied at 2:35 PM, 28 Jun 2012

Manuel suggests that larvicides can, perhaps, have a more profound effect when larval habitats are few and far between. I agree. Even when such habitats are far more numerous and productive, priority can be focused on those sites nearest human dwellings. This may a locally practical, appropriate and feasible option - in some places. As Tony mentioned, there are downsides to reliance on larviciding, even as a supplemental intervention. Source reduction is considered amongst other options discussed. Let's be mindful that source reduction tends to be labor intensive and efforts must be sustained to manage many such habitats, or they may degrade to support Anopheles development once again. I've lost count of the number of times I've heard health officials (and even some vector ecologists) suggest that source reduction is a one-time effort.

William Jobin Replied at 3:50 PM, 28 Jun 2012

Dear Manuel,

Thanks for all your insight about controlling these nasty little beasts. And I share your concern about the way we can reach the folks at WHO, PMI, etc, to get them to broaden their strategy. Clive Shiff brought up this same concern at the inaugural meeting of our African Malaria Coalition two weeks ago in Manhattan. He sees a positive opening in the recent re-establishment of periodic Malaria Expert Committee meetings in Geneva, which used to be the forum for everybody to contribute to planning the attack on malaria.

I am going to be in Geneva next week and will try to sound out those folks on how often and large these Expert Committees will be, a critical issue because of budget restrictions at WHO.

In the case of the US PMI, the people in Washington do not seem to pay much attention to alternative approaches, but perhaps we can influence them by giving them positive support for their budget requests to Congress and the Senate, and in the process try to get a broader approach adopted.

Incidentally our African Malaria Coalition will meet in Manhattan again in early October, and I will keep you posted.

Bill
William Jobin, Blue Nile Associates, Colorado


-----Original Message-----
>From: "GHDonline (Manuel Lluberas)" <>
>Sent: Jun 28, 2012 10:04 AM
>To: william jobin <>
>Subject: Re: [Malaria Treatment & Prevention] Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29
>
>Manuel Lluberas replied to the discussion "Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29" in the Malaria Treatment & Prevention community.
>
>Reply contents:
>"Seraphine:
>
>Thanks for your note. Sharing some of my concerns on the subject during the course of this week made me wonder if it would be possible to get together those of us who share this frustration -electronically or in person- and present these issues to the WHO, WHOPES, Global Fund, PMI and the other organizations that are in a position to affect some change. As a group, I believe we are in a good position to direct and affect changes in malaria control the way we think will have a bigger impact rather than accept what is mandated by others. Your thoughts on this are welcomed.
>
>Manuel
>
>-----Original Message-----
>From: GHDonline (Seraphine Adibaku) [mailto:]
>Sent: Thursday, June 28, 2012 03:12
>To: Manuel Lluberas
>Subject: Re: [Malaria Treatment & Prevention] Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29
>
>Seraphine Adibaku replied to the discussion "Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29" in the Malaria Treatment & Prevention community.
>
>Reply contents:
>"Manuel is spot on. The paucity of Entomologists and the low priority accorded to their training and deployment needs urgent redress as a critical component of the required package to achieve better control and elimination of malaria. In my country which has one of the highest burdens of malaria, there is high transmission all year round so we do not take holidays from malaria work. However the revised health staffing structure adopted in 2002 eliminated the position of an Entomologist at the district level, retaining only one at sub-district level for a population of close to 100,000. This has resulted into the kind of practice illustrated by Manuel where technical roles of entomologists are attempted by other professions that are ill prepared for the tasks. The related cadre often used where available is a Vector Control Officer.
>
>Just to ask "Would a Vector Control Officer ably perform the roles of an Entomologist?"
>
>Seraphine
>
>On Wed, Jun 27, 2012 at 3:29 PM, GHDonline (Manuel Lluberas) < > wrote:
>
>> [image: Boxbe] <https://www.boxbe.com/overview> Malaria Treatment &
>> Prevention () is not on your Guest
>> List<https://www.boxbe.com/approved-list>| Approve sender
>> <https://www.boxbe.com/anno?tc=11693835569_937854173> | Approve domain
>> <https://www.boxbe.com/anno?tc=11693835569_937854173&dom>
>>
>> Manuel Lluberas replied to the discussion "Expert Panel: The Future of
>> Malaria Vector Control and Insecticides, June 25-29" in the Malaria
>> Treatment & Prevention community.
>>
>> Reply contents:
>> "To be able to implement a comprehensive mosquito control program that
>> deploys the methods listed by Tony and as many of the other tools as
>> possible depending on local vector and environmental conditions, we
>> need to train more field entomologists and provide them with a career
>> path. At the moment, the vast majority of the vector control programs
>> are in the hands of physicians. While they may be good at diagnosing
>> and treating malaria and other vector-borne diseases, the
>> entomological aspect of malaria programs are very different. As a
>> public health entomologist with at least three decades in the malaria
>> control field I consider myself pretty knowledgeable about malaria
>> diagnosis and treatment, but I don’t think anyone would consider me
>> for a position directing a malaria control hospital or ward; and it
>> should be that way. Unfortunately, the reverse has been the case for
>> decades. We need to start placing public health entomologists in
>> charge of vector control and train field technicians so we have boots
>> on the ground. We need to start by providing growth potential for
>> entomologists and technicians wanting to go this route and start
>> building and strengthening this capacity. To use the medical analogy,
>> we have physicians who diagnose and treat diseases, but the nurses in
>> the wards are the ones who watch over the patients, carry out the
>> medical orders and consult with the physicians when something does not
>> look or feel right. We have no equivalent in the vector control field. We need to start changing that.
>>
>> I would be remiss if I did not mention that I think we have not been
>> serious about malaria control. In addition to my points above, I
>> believe we are addressing a full time problem on a part time basis. If
>> you look at malaria control programs around the world, you'll notice
>> that they operate between 6 to 8 or nine months a year with little or
>> no activity during the "off season". Not only do they operate on a
>> part time basis, entire programs are frequently dissolved or disbanded
>> at the end of a season. As long as we continue addressing malaria in
>> this fashion we will continue to have malaria. We need to get serious
>> and start engaging vector control the way it should be: with qualified
>> public health entomologists and field technicians who can look at
>> their areas and determine what vector control methods and approaches
>> would be best suited. Anything short of this will almost certainly
>> lead to continued malaria deaths for decades to come. Is this the way we want to keep it?
>>
>> Manuel
>>
>> -----Original Message-----
>> From: GHDonline (Tony Kiszewski) [mailto:]
>> Sent: Wednesday, June 27, 2012 06:24
>> To: Manuel Lluberas
>> Subject: Re: [Malaria Treatment & Prevention] Expert Panel: The Future
>> of Malaria Vector Control and Insecticides, June 25-29
>>
>> Tony Kiszewski replied to the discussion "Expert Panel: The Future of
>> Malaria Vector Control and Insecticides, June 25-29" in the Malaria
>> Treatment & Prevention community.
>>
>> Reply contents:
>> "I also see a need for more sustainable solutions that complement
>> insecticides without exacerbating resistance. But the situation is urgent.
>> We can’t afford to wait for new technologies. We need to deploy
>> underutilized existing technologies that are culturally appropriate
>> and responsive to the diverse ecology and behavior of local vectors.
>> These include such measures as:
>> 1) Housing modification. Over the years, many researchers have
>> identified a wide array of customizable and inexpensive alterations to
>> dwellings that substantially reduce the flow of vectors, thus reducing
>> biting and transmission rates. 2) Habitat modification. Malaria
>> vectors are ecologically diverse, but in every locale, simple measures
>> can be undertaken at the community level that can reduce the
>> availability of larval habitat near households, forcing vectors to
>> utilize more crowded or marginal breeding sites, increasing
>> intraspecific competition and reducing not only abundance but more
>> powerful influences of vectorial capacity,such as competence and
>> longevity. 3) Personal repellents inhibit biting in every venue,
>> indoors and out, providing the perfect complement to insecticidal
>> measures that depend on vectors entering homes to feed, particularly
>> as evidence mounts of increasing exophagy in malaria vectors, perhaps
>> in response to insecticidal pressure. New, low cost, highly efficacious repellents (e.g. No Mas) make this approach more practical than ever."
>>
>> --
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>> -malaria-vector-control-/#reply-5012-2?id=17794970&format=text&type=in
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>
>
>--
>Dr. Seraphine Adibaku
>MB.ChB (Makerere) MPH (Tulane, USA)
>Tel Cell: +256-772507245/ 712607245
>Email:
> "
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William Jobin, Sc.D.
Director of Blue Nile Associates
President of Boston Harbor Publishers*
25558 Road N.6, Cortez, Colorado 81321
cell 1 970 560 1182

*See our monograph "A realistic strategy for fighting malaria in Africa" on Amazon.com

Michael Reddy Moderator Emeritus Replied at 2:23 PM, 29 Jun 2012

Thanks Bill, Rich and Manuel for your comments RE; the need for better technical assistance and communication between and within large multi-lateral interventions. It is encouraging to learn that a Malaria Expert Committee has been convened to provide technical assistance to the agencies that are responsible for implementation of scale up activities. These sorts of panels are critical to bridge the gaps in expertise that are often lacking in malaria control programs. I agree with Manuel and Seraphine that having staff trained in basic aspects of medical entomology, if not a professional medical entomologist on staff is critical in developing effective strategies against all stages of vectors present in a particular locality. More importantly, having a entomologist on staff is of particular utility when devising studies regarding the efficaciousness of different intervention types and establishing effective monitoring and evaluation programs. In-house expertise, has proven crucial in developing a better understanding of the ecological and biological challenges vector control operations face. (i.e. developing strategies to address insecticide resistance in response to intervention activities). Supporting anti-malaria interventions through technical assistance is extraordinarily important as scale-up of interventions continue. Bill's initiative to create the African Malaria Coalition is an excellent step in the right direction, as are increased efforts to bring medical entomologists into the fold of current and planned anti-vector operations.

As today is the last day this panel will be convened, I encourage participants to post any additional comments or questions to the panel members as soon as possible so as to receive a reply. I would like to thank our panel members, Dr. Janet Hemingway, Dr. Tony Kisewski and Mr. Manuel Lluberas for their participation on the panel and the highly informative posts they shared with the community. I would also like to thank all the community members of their participation in this important panel discussion. I look forward to continuing this discussion and others related to anti-vector interventions in the Malaria Treatment and Prevention online community.

Sincerely,
Mike Reddy (moderator)

Michael Reddy Moderator Emeritus Replied at 2:24 PM, 29 Jun 2012

I meant to write "Dr. Tony Kiszewski" (sorry Tony!)

Manuel Lluberas Replied at 2:41 PM, 29 Jun 2012

Michael:

It was a privilege and a pleasure to share some of my thoughts on this subject. I look forward helping malaria vector control program managers take steps, however small they might be, towards alleviating the burden of malaria wherever I may be of help. Thanks for the opportunity.

All the best to all,

Manuel

Manuel F. Lluberas MS IDHA
Public Health Entomologist
Executive Director for Public Health
H. D. Hudson Manufacturing Company

www.hdhudson.com
Skype: lluberas

Home Office:
4863 Ashley Manor way W.
Jacksonville, FL 32225-4040

Tel/Fax: 1.904.998.8124
E-voice/Skype: 1.904.425.1689




-----Original Message-----
From: GHDonline (Michael Reddy) [mailto:]
Sent: Friday, June 29, 2012 14:25
To: Manuel Lluberas
Subject: Re: [Malaria Treatment & Prevention] Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29

Michael Reddy replied to the discussion "Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29" in the Malaria Treatment & Prevention community.

Reply contents:
"Thanks Bill, Rich and Manuel for your comments RE; the need for better technical assistance and communication between and within large multi-lateral interventions. It is encouraging to learn that a Malaria Expert Committee has been convened to provide technical assistance to the agencies that are responsible for implementation of scale up activities. These sorts of panels are critical to bridge the gaps in expertise that are often lacking in malaria control programs. I agree with Manuel and Seraphine that having staff trained in basic aspects of medical entomology, if not a professional medical entomologist on staff is critical in developing effective strategies against all stages of vectors present in a particular locality. More importantly, having a entomologist on staff is of particular utility when devising studies regarding the efficaciousness of different intervention types and establishing effective monitoring and evaluation programs. In-house expertise, has proven crucial in developing a better understanding of the ecological and biological challenges vector control operations face. (i.e. developing strategies to address insecticide resistance in response to intervention activities). Supporting anti-malaria interventions through technical assistance is extraordinarily important as scale-up of interventions continue. Bill's initiative to create the African Malaria Coalition is an excellent step in the right direction, as are increased efforts to bring medical entomologists into the fold of current and planned anti-vector operations.

As today is the last day this panel will be convened, I encourage participants to post any additional comments or questions to the panel members as soon as possible so as to receive a reply. I would like to thank our panel members, Dr. Janet Hemingway, Dr. Tony Kisewski and Mr. Manuel Lluberas for their participation on the panel and the highly informative posts they shared with the community. I would also like to thank all the community members of their participation in this important panel discussion. I look forward to continuing this discussion and others related to anti-vector interventions in the Malaria Treatment and Prevention online community.

Sincerely,
Mike Reddy (moderator)"

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Violet Chaka Moderator Emeritus Replied at 4:15 PM, 29 Jun 2012

What an important and interesting discussion. I think for any vector control program to be a resounding success, the involvement of the community is critical. If you take for instance a country like Namibia where the malaria endemic areas are peri-urban or rural, you have to consider the level of education in mapping out strategies of vector control. This determines how receptive communities will be to these strategies.
Malaria incidence has been going down here due to community involvement. National level tools like radio spots and talk programs in vernacular languages, community level tools like primary school events (children will take the message home), incorporation of malaria in life skills curricula, training of IRS sprayers and LLIN distributors (some folks need to be convinced why their houses should be sprayed or why and how they should use nets all the time).
This has been a great discussion...

Michael Reddy Moderator Emeritus Replied at 2:51 PM, 2 Jul 2012

I'd like to leave the panel discussion with what I believe is a timely and instructive paper written by Prof. Andrew Spielman and colleagues, Uriel Kitron and Richard Pollack. Andy and colleagues touched on many of the topics and points of discussion raised in this online forum including insecticidal resistance and interventions based on biocides being time- limited.. Keep in mind this piece was written in 1993- nearly 20 years ago, before many of the resources currently deployed (PMI, RBM, other gov orgs (USAID...etc) and NGO's became engaged in the global fight against malaria. I would urge policy-makers, researchers, physicians and vector control implementers to read this piece with an open mind and a willingness to confront the challenges raised in this commentary . Thanks to Rich Pollack for making this pdf available. If a cleaner version becomes available, I will be sure to upload it. Thanks for participating. Sincerely, -Michael Reddy, moderator.

Attached resource:

Roly Gosling Replied at 3:03 PM, 2 Jul 2012

Thank you Jaime

This is very useful.
--
Dr Roly Gosling MD, PhD

Associate Professor
Lead, Malaria Elimination Initiative
Global Health Group,
University of California, San Francisco

Michael Reddy Moderator Emeritus Replied at 1:05 PM, 30 Jul 2012

Thank you once again to our panelists and everyone who contributed to the recent Panel Discussion entitled "The Future of Malaria Vector Control and Insecticides". I'd like to call to the community's attention a discussion "brief" that summarizes many of the key points made by our contributing experts and members. The brief can be found below or by clicking on the link at the top of this page. Please feel free to add to the existing discussion by posting replies to this discussion or to the Malaria Treatment and Prevention community in general. Many thanks for your continued interest and insightful comments. -MR

Attached resource:

Clive Shiff Replied at 8:41 AM, 2 Aug 2012

Yes Mike, I have just seen the "leaky vaccine" paper. Very thought provoking...
We still need to stick with mosquitoes.
Clive

-----Original Message-----
From: GHDonline (Michael Reddy) [mailto:]
Sent: Wednesday, August 01, 2012 2:25 PM
To: Shiff, Clive
Subject: Re: [Malaria Treatment & Prevention] Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29

Michael Reddy replied to the discussion "Expert Panel: The Future of Malaria Vector Control and Insecticides, June 25-29" in the Malaria Treatment & Prevention community.

Reply contents:
"For an excellent synopsis of how evolutionary forces such as natural selection and adaptation "shape" infectious diseases in humans esp. with regard to malaria treatment (parasite chemotherapeutic resistance) and transmission (insecticide resistance), I'd like to point the community to Andrew Read's recent TEDMED talk at the 2012 conference in Washington DC. I would also like to share an excellent blog post in PLoS Biology's Biologue on how "leaky" vaccines can lead to selection of higher virulence in rodent malaria models. See below for links. -MR"

Attached resources:
* <http://www.ghdonline.org/malaria/discussion/expert-panel-the-future-of-malari... Read @ TEDMED 2012

* <http://www.ghdonline.org/malaria/discussion/expert-panel-the-future-of-malari... Vaccines Breed Super-Virulent Malaria? by Liza Gross


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