Field efficacy of guppies and pyriproxyfen (Sumilarv® 2MR) combined with community engagement on dengue vectors in Cambodia: a randomized controlled trial

Evidence on the effectiveness of low-cost, sustainable biological vector control tools for Aedes mosquitoes is limited. Therefore, the purpose of this trial is to estimate the impact of guppy fish, in combination with the use of the larvicide Pyriproxyfen (Sumilarv ® 2MR), and Communication for Behavioral Impact (COMBI) activities to reduce entomological indices in Cambodia. In this cluster randomized, controlled superiority trial, 30 clusters comprising of one or more villages each (with approximately 170 households) will be allocated, in a 1:1:1 ratio, to receive either a) three interventions (guppies, Sumilarv ® 2MR, and COMBI activities), b) two interventions (guppies and COMBI activities), or c) control (standard vector control). Households were invited to participate, and entomology surveys among 40 randomly selected households per cluster were carried out quarterly. The primary outcome was the population density of adult female Aedes mosquitoes (i.e. number per house) trapped using adult resting collections. Secondary outcome measures include the House index, Container index, Breteau index, Pupae Per House, Pupae Per Person, mosquito infection rate, guppy fish coverage, Sumilarv ® 2MR coverage, and percentage of respondents with knowledge about Aedes mosquitoes causing dengue. In the primary analysis, adult female Aedes density and mosquito infection rates was aggregated over follow-up time points to give a single rate per cluster. This was analyzed by negative binomial regression, yielding density ratios. The number of Aedes females was reduced by roughly half compared to the control in both the guppy and PPF arm (Density Ratio (DR)=0.54 [95% CI 0.34-0.85], p=0.0073), and guppy arm (DR=0.49 [95% CI 0.31-0.77], p=0.0021). The extremely low cost of including guppy rearing in community-based health structures along with the effectiveness demonstrated suggest guppies should be considered as a vector control tool as long as the benefits outweigh any potential environmental concerns. PPF was also highly accepted and preferred over current vector control tools used in Cambodia, however product costs and availability are still unknown. Author Summary Dengue is one of the most rapidly spreading mosquito-borne viral diseases in the world, is caused by bites of infected Aedes mosquitoes, and can sometimes lead to death. Cambodia has one of the highest per-capita incidence rates in Asia. Without a cure or routinely available efficacious vaccine, dengue control relies largely on reduction and avoidance of mosquitoes. In Cambodia, dengue mosquito control activities are focused on larviciding with temephos and pyrethroid based adulticide sprays to which Aedes have been shown to be increasingly resistant. This study was designed to evaluate novel biological vector control tools (guppy fish and a controlled release larvicidal matrix) utilizing an integrated vector management approach with community-based methods tailored to the local context. The results indicate that the tools resulted in a statistically significant reduction in immature and adult Aedes mosquito density. The interventions were accepted by and communities were willing to pay for them. The results suggest guppies are an ideal vector control tool as long as the benefits outweigh any potential environmental concerns. PPF was also highly accepted and preferred over current vector control tools used in Cambodia, however product costs and availability are still unknown.