ArmedForcesPestManagementBoardTechnicalGuideNo.47

January27,2012

DengueandChikungunya

VectorControlPocketGuide

PublishedandDistributedbytheArmedForcesPestManagementBoard

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Acknowledgements

This Armed Forces Pest Management Board (AFPMB)TechnicalGuide(TG)waswrittenbyLCDRCraigStoopsandLT Anthony Hanley of the U.S. Navy Entomology Center ofExcellence, Dr. Gary Clark, USDA‐ARS Center for Medical,Agricultural and Veterinary Entomology, and Dr. GrahamWhite,AFPMB.

DisclaimerAnymention of specific proprietary products, trade names,ormanufacturersdoesnot constitutea recommendationoranofficialendorsementoftheseproductsbytheDepartmentof Defense but is intended for illustration and informationpurposes only. Neither should the absence of an itemnecessarilybeinterpretedasDoDdisapproval. Informationor inquiries concerning any equipment or items should besent through Command Pest Management Professionals orApplied Biologists to the Armed Forces Pest ManagementBoardMedicalEntomologyCommitteeforevaluation.

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Foreword

This technical guide (TG)waswritten to consolidateinformation and procedures for surveillance andcontrol of mosquitoes that transmit dengue andchikungunyaviruses. ThisTGfocusesonmosquitoesthat transmit dengue but also makes reference tochikungunyaandyellowfeverbecausethepathogensthat cause these diseasesmay be transmitted by thesame mosquito species. Thus, control of denguevectorswillalsocontrolthespreadofthesediseases.ThisTG is not a regulationbut provides guidance tothose individuals responsible for conducting pestcontrolandsurveillanceduringmilitarydeployments.This TG will receive periodic review and will beupdatedtoensurethatinformationpresentedreflectscurrent technology and guidance. Individuals usingthis TG are encouraged to submit comments andsuggestions for improvement to theDirector, ArmedForces Pest Management Board, US ArmyGarrison―ForestGlen,2460LindenLane,Bldg#172,Silver Spring,MD 20910‐1230: (301) 295‐7476; Fax(301)295‐7473.

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TableofContents

1.Introduction.………………………………………….42.Identification/Biology.………...…………………73.Surveillance…………….....…..…………………….104.Control…………………………………………………205.PersonalProtection………………………………296.AdditionalGuidance..……………………………..317.References……………………………………………328.PointsofContact……………………………………33

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1.Introduction

This guide is designed to serve as a quickreferencefortheidentification,surveillance,andcontrol of mosquito species that transmitdengue and chikungunya viruses. The threemain components of the guide arebiology/identification, surveillance, andcontrol.These components are necessary in theplanning, conduct and evaluation of a denguevectorcontrolprogram.Thisguide isnotacomprehensive treatmentofthe subject.Please see theAdditionalGuidance,References,andPointsofContactsectionsforin‐depth information on specific subjectsintroducedinthisguide.

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Dengue is considered a significant risk todeployed troops by the National Center forMedical Intelligence. The approximateworldwide distribution of dengue viruses isshownbelow.

Estimatedworldwidedenguedistribution.Denguerangeminimum10oCisotherm,northandsouthofthetropics.Orange‐shadedcountriesareareaswheredengueriskiswellknown.

Aedesaegypti,Ae.albopictusandAe.polynesiensisare three mosquito species that are vectors ofdengue.Aedesaegypti accounts for >95%of allcasesworldwide.Duringdeployments,allthreespecies must be considered important vectors,andcontrolmeasuresmustbeput intoplace toprotecttroophealth.

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Chikungunya is another arboviral diseasetransmitted to humans by the bite of infectivemosquitoes. Chikungunya virus has causedhuman epidemics in many areas of Africa andAsia, and most recently in a limited area ofEurope (CDC 2008). Both Ae. aegypti and Ae.albopictus are vectors of chikungunya, and thisvirus is of special concern due to the recentresurgence and spread of these mosquitospecies.

Estimateddistributionofchikungunyavirus.

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2.Identification/Biology

Aedesaegypti

‐Smallblackandwhitemosquitowithmarkingsthatlooklikeaguitaronthethorax.‐Daytimebiter.‐Vectorofdengueandchikungunyaviruses.

CDCmapshowingdengueoutbreaksinred(foryear2000) and wider distribution of the vector Aedesaegypti inyellow.Distribution:pantropical,OldandNewWorldtropics,Pacificislands.

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Aedesalbopictus

‐Smallblackandwhitemosquitowithsinglewhitestripeonthorax.‐Daytimebiter.‐Vectorofdengueandchikungunyaviruses.

GlobaldistributionofAedesalbopictus:pantropical,OldandNewWorldtropics,Pacificislands.

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Mosquitoes are flying insects that develop from aquaticimmature stages, fromwhich adults emerge. Adult femalemosquitoestakebloodmealstonourishtheireggs.

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3.Surveillance Immature Stages: Anymaterial, manmade ornatural, thatholdswater formore than severalhours could contain mosquito eggs, larvae orpupae.Examplesofsuchitemsaretarps,plasticsheeting,andothermaterialsusedascovers.Inareaswherethereisnoindoorplumbingandpeoplemuststorewater,eithercollectedfromapump or during rains, the risk of vectormosquitoes being present increasesdramatically. Such water storage containersprovide suitable, stablehabitats formosquitoesto exploit. Water storage basins used bydomesticated animals may also serve asmosquitobreedingsites.In areaswhere there is regular rainfall, naturaland man‐made containers that hold water willbe of critical importance, exponentiallyincreasing the number of mosquito habitatsavailable.

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Indoorwaterstorage(Bakmandi)inJakarta,Indonesia.

Outdoorpilas(sinks)inPeru.

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Some examples of outdoor breeding places of Aedesspp.Breedingoccursin(1)discardedcansandplasticcontainers,(2)bottles,(3)coconuthusks,(4)oldtires,(5) drums and barrels, (6) water storage tanks, (7)bromeliads and axils of banana trees, (8) obstructedroofgutters,(9)plantpotsaucers,(10)brokenbottlesfixed onwalls as a precaution against burglars, (11)holes in unused construction blocks, and (12) theupperedgeofblockwalls.FromRozendaal,1997.

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Conduct surveys to identify main breedinglocations and to develop a control program.Survey containers both inside and outsidehomes.Surveillanceoflarvaeandpupaecanbedonebyvisually inspectingcontainersforthesestagesandcollectingthem.

Equipment necessary includes a flashlight,syringe or other suction device, and watersample bags or another type of storage

LarvalandpupalsurveyINSIDEandOUTSIDEhomes

Artificialcontainers:Cans,barrels(leftphoto),tires,raingutters,animaltroughs,stormdrains(rightphoto)Naturalcontainers:water‐filledaxilsofbromeliadplants,cutsectionsofbamboo,treeholes

Sampleaminimumof10‐20%ofhabitatsidentified

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container if larvaeorpupaearebeingreturnedtothelaboratory.

Larvae: The table below summarizes thecommon indices used in larval surveillance.These indices can signal when to control orwhencontrolhasbeenachieved.

HouseIndex

#ofPositiveHouses

HI=‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐Total#ofHouses

Surveyed

AftereffectivecontroloperationstheHI=0.

BreteauIndex

#ofPositiveContainersBI=‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐100HousesSurveyed

RiskofdenguetransmissionwhenBI>5.EmergencyvectorcontrolwhenBI>100.

ContainerIndex

#ofPositiveContainersCI=‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐Total#ofContainers

Surveyed

AftereffectivecontroloperationstheCI=0.

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Collectingeggsusingovitraps isaneffectiveway tomonitorpopulationsofAedesspp.Ovitraps,whichserveasegg‐layingsites,allowpresenceorabsenceofspeciestobedetermined.Eggs can also be returned to the laboratory and hatched solarvaecanberearedforidentification.

Ovitrap

Usedforgeneralsurveillanceofeggs.GoodforbothAe.aegyptiandAe.albopictus.

NoNSN.

Ovitrapsareeasilyconstructedfromblackcupsorjars.Tonguedepressorsorfilterpaperwillcollecteggs.

Placeinareasinfullorpartialshadenearwalls,fences,hedges,junkortirepiles.Inspectatleastweeklyandreplacewater.

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Adult Stages: Surveillance of adult Ae. aegyptiandAe.albopictusismostreliablyaccomplishedbycollectingliveadultsusingeitherabackpackaspirator or a mouth aspirator. The BG‐SentinelTM and CDC light trap are effective aswell, although catches will be lower with theCDCtrap.The table below outlines the equipmentavailabletoconductadultsurveillance.

Equipment NSNAspirator,1.5v(2D‐Cellbattery)powered,MechanicalAspirator

6640‐01‐210‐2368

CollectionBottleAssembly/Tube,MechanicalAspirator

6640‐01‐210‐2371

Aspirator,InsectBackpack,CDCModel1412,Gel‐cellbattery

6640‐01‐503‐5339

Aspirator,Oral,EntomologySpecimenCollection,Model412

6649‐01‐474‐7402

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PoweredaspiratorsareveryusefultoolsforcollectingadultAe. aegypti and Ae. albopictus. For Ae. aegypti, use theminside homes and focus on clothing hanging inside andoutside closets, dark corners, and covered areas. For Ae.albopictus, focus on vegetation surrounding houses orforestedpartsofknownbreedinghabitats.

CDCbackpackaspirator.NSN6640‐01‐503‐5339

Prokopackaspirator(http://www.futurity.org/health‐medicine/mosquito‐surveillance‐on‐the‐cheap/).NoNSNavailable.

Use extension pole to accessceilingsandotherhard‐to‐reachareas.

Aspiratorsforcollectingadultmosquitoes.

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TheBG‐SentinelTMtrap(http://www.mueckenfallen.de/)hasbeenfoundtocollectAe.aegyptiandAe.albopictusmoreeffectivelythanthestandardCDClighttrap.

BG‐SentinelTMTrapUsedforgeneralsurveillanceofadults.GoodforbothAe.aegyptiandAe.albopictus.

NoNSN.RequiresD‐cellbatteries.UseofBGlureisstronglyrecommended.

Placeinareasinsideoroutsidewhereyoususpectadultstooccur.

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The CDC Light Trap hasbeen found to collect Ae.aegypti and Ae. albopictus,butinlownumbers.

CDCTrapUsedforgeneralsurveillanceofadults.WillcollectbothAe.aegyptiandAe.albopictus.

NSN:3740‐00‐134‐9229RequiresD‐cellbatteries.Useofalure(chemicalordryice)isstronglyrecommended.

Placeinareasinsideoroutsidewhereyoususpectadultstooccur.

Product manuals detail specific setupprocedures and instructions for use of eachpieceofsurveillanceequipment.

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4.Control

An importantway to bothprevent and controldengue transmission is to eliminate thebreeding sites ofAe.aegypti andAe.albopictusand/or kill larvae and adult mosquitoes.Environmental control or eliminating breedingsiteswillinvolvemobilizationofmilitaryassetsand the direct support of your chain ofcommand.ThenecessaryequipmenttokilladultandlarvalAedes can be found in AFPMB Technical Guide24:ContingencyPestManagementGuide.Ifyoudo not have a copy of this document, visitwww.afpmb.org or contact the AFPMBdirectlytoobtainone.SURVEILLANCE is ESSENTIAL in monitoringthe success or failure of any control program.Alwaystrytosamplelarvaeand/oradultspriorto and after control efforts, thereby revealinganyreductioninmosquitonumbers.

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Environmental Control: The best way toreduce populations of bothAe. aegypti andAe.albopictus is through environmental control,alsoknownassourcereduction,removinganddisposingofcontainersthatholdwaterallowingimmaturestagestodevelop.Usingthismethod,dengue has been successfully prevented incommunities and over large geographic areas.Checking for the presence of mosquito larvaeand pupae will tell you which containers arebreedingmosquitoes.The idea isverysimplebutdifficult toput intopractice and sustain over long periods of timewithout thenecessarysupport. Youmusthavetheabsolutesupportofyourchainofcommandto develop and conduct a source reductionprogram.During humanitarian missions, if you plan ondesigning and carrying out a source reductionprogram as part of Integrated VectorManagement (WHO 2011), efforts must becoordinated with local, regional and nationalhealthauthoritiestoensurelocalcompliance.

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Larvicides: Insecticides listed in theContingency Pest Management Guide forcontrollingmosquito larvae appear in the tablebelow.Theseinsecticidesareeffectiveatkillinglarvae but are very time consuming and laborintensivebecauseindividuallarvalhabitatsmustbelocated.Strictlyadheretoalldirectionsontheinsecticidelabel.NOMENCLATURE NSNInsecticide,Bacillusthuringiensis,10%,BactimosBriquets,DONOTUSEINDRINKINGWATER

6840‐01‐377‐7049

Insecticide,Bacillusthuringiensis,VectobacWettableDG,DONOTUSEINDRINKINGWATER

6840‐01‐565‐8241

Insecticide,Temephos,Abate4E,2.5‐gal,DONOTUSEINDRINKINGWATER

6840‐01‐424‐3132

Insecticide,Methoprene,AltosidXRBriquettes,DONOTUSEINDRINKINGWATER

6840‐01‐424‐2495

Insecticide,Methoprene,AltosidSR20LiquidLarvicide,DONOTUSEINDRINKINGWATER

6840‐01‐424‐2493

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Adulticides: The WHO recommendsadulticidingfordenguecontrolduringepidemics(WHO 2009), although there is little evidencethat adulticiding is an effective long‐termdenguecontrolstrategy(Esuetal.2010).Controlmeasuresshouldbecarriedoutevery7to10daystoensurethatthebreedingcyclesofbothAe.aegyptiandAe.albopictusaredisrupted(WHO2009).Control measures should be carried out bothinside and outside of structures. It is alsoimportanttotreatpossiblebreedingareas,suchastires,withresidual insecticides(Ritchieetal.2001).The list of insecticides available in theContingencyPestManagementGuideisfoundonpage24ofthisguide.

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NOMENCLATURE NSN

Insecticide,d‐Phenothrin‐PiperonylButoxide(10%‐10%),Anvil10+10ULV,(2)2.5‐galco/BX

6840‐01‐474‐7751

Insecticide,d‐Phenothrin‐PiperonylButoxide,(10%‐10%),Anvil10+10ULV,250galmini‐bulkcontainer

6840‐01‐474‐7706

InsecticidePyrethrins,3%pyrethrinswithsynergists,liquid,ULVFogConcentrate,1‐galcan

6840‐01‐104‐0780

Insecticide,Resmethrin4%+12%PiperonylButoxide,Scourge,5‐galcan,RESTRICTEDUSEINSECTICIDE

6840‐01‐359‐8533

Insecticide,Malathion,96.5%,liquid,FyfanonULV,5GLcan

6840‐01‐169‐1842

Insecticide,Lambda‐cyhalothrin,SurrenderPestabs®,40tablets/bottle

6840‐01‐431‐3357

Insecticide,d‐Phenothrin,2%Aerosol,12ozcan

6840‐01‐412‐4634

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IndoorResidualSpray: Aedesaegypti readilybites people indoors and will rest on wallsurfaces after taking a blood meal. IndoorResidual Spray (IRS) is an application methodwhere an insecticide is directly applied towallsurfaces. Mosquitoescontactingthe insecticidearekilled.In addition to directly killing adultAe.aegypti,theinsecticideappliedtothewallsurfacesmayactasarepellentandpreventadultmosquitoesfromenteringhouses.IntheContingencyPestManagementGuide,theonly insecticide recommended for IRS islambda‐cyhalothrin. Strictly follow allguidelinesontheinsecticidelabel.Nomenclature NSNInsecticide,lambda‐cyhalothrin,SurrenderPestabs®

6840‐01‐431‐3357

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Twotypesofequipmentinthestocksystemcanbe used to apply IRS: 1) hand compressedsprayers and 2) backpack sprayers. The tablebelow lists all available hand compressed andbackpacksprayersinthestocksystem.Nomenclature NSNSprayer,Pesticide,ManuallyCarried,1‐gallonstainlesstank,withpressuregauge.CIDA‐A‐55748.Flowrate‐0.8l/min

3740‐00‐191‐3677

Sprayer,Pesticide,ManuallyCarried,2‐gallonstainlesstankwithpressuregauge.CIDA‐A‐55748.Flowrate‐0.8l/min

3740‐00‐641‐4719

Sprayer‐Duster,Pesticide,Backpack,STIHLModelSR420,gasolineenginedriven.Tanksize–3.5gal.,24.6”highX18.9”wideX11”deep,24lbsemptywt

3740‐01‐463‐0147

Sprayer,Pesticide,ManuallyCarriedHydraulicBackpacksprayer

3740‐01‐496‐9306

Sprayer,Pesticide,ManuallyCarriedHydraulicBackpacksprayer.Birchmeier,ModelIris

3740‐01‐543‐0676

Sprayer,Pesticide,ManuallyCarriedCompressedAirBackpackSprayer.DorendorfP/NAQSZ‐12

3740‐01‐561‐9663

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Thermal Fogging: Indoor and outdoor spacespraying using thermal fogs is a component ofmany dengue control programs around theworld. If possible, spray inside and within a400m to 500m radius of structures (WHO2009).For control of sylvatic populations of Ae.albopictus, spraying in and around vegetationthatservesasharboragewillbecritical.Due to the amount of smoke generated, becertain to coordinate your efforts with allsecurity personnel prior to conducting spraymissions.TheGoldenEagleiscurrentlytheonlyhandheldthermalfoggeravailableinthestocksystem.Seethe insecticide list onpage24of this guide forinsecticidesusedforthermalfogging.NOMENCLATURE NSNFogGenerator,ManuallyCarried,gasolineenginedriven,thermalfog,CurtisDynaModel2610GoldenEagle.

3740‐00‐818‐6648

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Ultra Low Volume: The WHO recommendsconducting spraying in areas where denguecases have been identified (WHO 2009). Aswith thermal fogging, ULV (COLD FOGGING)spraying should be conducted within a 400 ‐500m radius of structures (WHO2009).Belowis a list of ULV sprayers available in the stocksystem.Seetheinsecticidelistonpage24ofthisguideforULVinsecticides.NOMENCLATURE NSNFogger,HandHeld,gasolineenginedriven,ULV,LondonAireColt.PN#8675

3740‐01‐456‐2622

Fogger,HandHeld,gasolineenginedriven,ULV,ClarkeP‐1

3740‐01‐456‐2623

FogGenerator,SkidMounted,gasolineenginedriven,GrizzlyPDS

3740‐01‐463‐0147

Sprayer,Pesticide,SkidMounted,LondonFogULVXKEGasSprayer

3740‐01‐496‐9306

Sprayer,Pesticide,SkidMounted,ModelProMist,ULV

3740‐01‐543‐0676

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5.PersonalProtectionDiseases such as dengue and chikungunya, andinjury caused by insect bites can be preventedby employing personal protective measures.ThemilitaryrecommendsuseoftheDoDInsectRepellentSystem,athreefoldsystemcomprisingapermethrin‐treateduniform, applicationofaninsect repellent on exposed skin, and properwearingoftheuniform.Thetreatmentoffielduniformswithpermethrincan be accomplished individually using eitherthe Aerosol Spray Can (NSN: 6840‐01‐278‐1336) or an IDAKit (NSN: 6840‐01‐345‐0237).Service members can also have a certifiedapplicatortreatuniformsusing40%permethrin(NSN: 6840‐01‐334‐2666) applied with an aircompressionsprayer.

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Several DEET‐based repellents for use onexposed skin are currently available. Theyinclude 3M Ultrathon 33% DEET lotion (NSN:6840‐01‐284‐3982); Cutter Backwoods 23%DEET spray (NSN: 6840‐01‐584‐8598);Ultra30/LipoDEET 30% lotion (NSN: 6840‐01‐584‐8393), a controlled release formulation;DEET/SPF15 sunscreen 20% DEET [NSNs:6840‐01‐288‐2188 (tube) and 6840‐01‐452‐9582(packets)];andcamouflagefacepaint30%DEET(NSN:6840‐01‐493‐7334).Proper wearing of the uniform provides anexcellent physical barrier against insect bites.This is accomplished by ensuring that theundershirt is tucked into the pants, and blousesleevesarerolleddownandbuttoned.Pantscanbe secured using blousing straps or can betucked into the boots. The uniform should bewornlooselysothatinsectscannotbitethroughfabricthatistightagainsttheskin.Treatedpop‐upstylebednetsarealsoavailableto protect service members while they sleep[NSNs: 3740‐01‐516‐4415 (green camo) and3740‐01‐518‐7310(coyotebrown)].

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6.AdditionalGuidanceThe World Health Organization recentlypublished an extensive set of guidelines fordenguecontrol. Comprehensive informationonsurveillance and control of dengue vectors canbefoundinthefollowingreferences:WHO.2009.Dengue,GuidelinesforDiagnosis,TreatmentandControl.WorldHealthOrganization,Geneva.147pp.ContingencyPestManagementGuide.AFPMBTechnicalGuide24.GuidetoPestSurveillanceduringContingencyOperations.AFPMBTechnicalGuide43.PersonalProtectiveMeasuresagainstInsectsandotherArthropods.AFPMBTechnicalGuide36.UltraLowVolumeDispersalofInsecticidesusingGroundEquipment.AFPMBTechnicalGuide13.

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7.References CDC.2008.ChikungunyaFactSheet.CentersforDiseaseControlandPrevention,UnitedStates.

Esu,E.,A.Lenhart,L.SmithandO.Horstick.2010.Effectivenessofperidomesticspacesprayingwithinsecticideondenguetransmission;systematicreview.TropicalMedicine&InternationalHealth15(5):619‐631.

Ritchie,S.A.,B.L.Montgomery,I.D.Walsh,S.A.LongandA.J.Hart.2001.Efficacyofanaerosolsurfacesprayagainstcontainer‐breedingAedes.JournaloftheAmericanMosquitoControlAssociation17:147‐149.

Rozendaal,J.A.1997.VectorControl:MethodsforUsebyIndividualsandCommunities.WorldHealthOrganization,Geneva.412pp.

WHO.2009.Dengue,GuidelinesforDiagnosis,TreatmentandControl.WorldHealthOrganization,Geneva.147pp.

WHO.2011.HandbookonIntegratedVectorManagement.WorldHealthOrganization,Geneva.(inpress).

8.PointsofContactContingencyLiaisonOfficerArmedForcesPestManagementBoardEmail:afpmb‐webmaster@osd.milCOM:301‐295‐7476DSN:(312)295‐7476USNavyEntomologyCenterofExcellenceCOM:904‐542‐2424DSN:(312)942‐2424USArmyPublicHealthCommandPHCR‐NorthEntomologicalSciencesDivisionE‐mail:PHCR‐NorthESD@amedd.army.milCOM:301‐677‐3466DSN:(312)622‐3466USAFSchoolofAerospaceMedicine/PHRWright‐PattersonAFB,OHE‐mail:Will.Reeves@wpafb.af.milCOM:937‐938‐4129DSN:(312)798‐4129MosquitoandFlyResearchUnitCenterforMedical,Agricultural&VeterinaryEntomologyE‐mail:Dan.Kline@ars.usda.govVoice:(352)374‐5933Fax:(352)374‐5922

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