Grant: Project Grant

Dengue is increasing in its global presence with an estimated 4 billion people at-risk of infection in at least 128 countries. In a context of sustainable healthy cities promoted the sustainable development goals, environmentally friendly approaches to Aedes control are needed to attain permanent reductions in mosquito populations which are increasingly supported by Ministries of Health in endemic countries. The principal research question is to determine if an EcoHealth intervention based upon community mobilization reduces the risk of dengue virus infection among 3 to 9 years olds compared to usual dengue control practice in Fortaleza, Brazil. The present study will follow a pragmatic cluster RCT design with randomization at the census tract level with equal allocation to the two arms. There will be 34 clusters in each arm of 80 children aged between 3 to 9 years old for a total of 5,440 children enrolled in the study. Household visits will occur every six months for a total of six visits over a 3-year period to cover both dry and rainy seasons. At allocation, adaptable locally-made covers for water containers will be installed in all households from the intervention clusters. Following water cover installation, community mobilization activities will begin and locally customized activities will be implemented. Primary outcomes are rates of anti-dengue Immunoglobin G (IgG) seroconversion to evaluate the incidence of primary infections, levels of salivary biomarkers of Aedes exposure to evaluate the exposure to Aedes bites, and the number of pupae per 100 households examined to evaluate Aedes presence and density. The results will help develop evidence-based vector control programs in Brazil, and also in other countries struggling with Aedes-transmitted diseases. Importantly, this study will also provide estimates on dengue burden based upon a representative population sample, which is currently lacking in Brazil as they rely on passive surveillance.