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. 2024 Apr 10;4(4):CD015636.
doi: 10.1002/14651858.CD015636.pub2.

Wolbachia-carrying Aedes mosquitoes for preventing dengue infection

Affiliations

Wolbachia-carrying Aedes mosquitoes for preventing dengue infection

Tilly Fox et al. Cochrane Database Syst Rev. .

Abstract

Background: Dengue is a global health problem of high significance, with 3.9 billion people at risk of infection. The geographic expansion of dengue virus (DENV) infection has resulted in increased frequency and severity of the disease, and the number of deaths has increased in recent years. Wolbachia,an intracellular bacterial endosymbiont, has been under investigation for several years as a novel dengue-control strategy. Some dengue vectors (Aedes mosquitoes) can be transinfected with specific strains of Wolbachia, which decreases their fitness (ability to survive and mate) and their ability to reproduce, inhibiting the replication of dengue. Both laboratory and field studies have demonstrated the potential effect of Wolbachia deployments on reducing dengue transmission, and modelling studies have suggested that this may be a self-sustaining strategy for dengue prevention, although long-term effects are yet to be elucidated.

Objectives: To assess the efficacy of Wolbachia-carrying Aedes speciesdeployments (specifically wMel-, wMelPop-, and wAlbB- strains of Wolbachia) for preventing dengue virus infection.

Search methods: We searched CENTRAL, MEDLINE, Embase, four other databases, and two trial registries up to 24 January 2024.

Selection criteria: Randomized controlled trials (RCTs), including cluster-randomized controlled trials (cRCTs), conducted in dengue endemic or epidemic-prone settings were eligible. We sought studies that investigated the impact of Wolbachia-carrying Aedes deployments on epidemiological or entomological dengue-related outcomes, utilizing either the population replacement or population suppression strategy.

Data collection and analysis: Two review authors independently selected eligible studies, extracted data, and assessed the risk of bias using the Cochrane RoB 2 tool. We used odds ratios (OR) with the corresponding 95% confidence intervals (CI) as the effect measure for dichotomous outcomes. For count/rate outcomes, we planned to use the rate ratio with 95% CI as the effect measure. We used adjusted measures of effect for cRCTs. We assessed the certainty of evidence using GRADE.

Main results: One completed cRCT met our inclusion criteria, and we identified two further ongoing cRCTs. The included trial was conducted in an urban setting in Yogyakarta, Indonesia. It utilized a nested test-negative study design, whereby all participants aged three to 45 years who presented at healthcare centres with a fever were enrolled in the study provided they had resided in the study area for the previous 10 nights. The trial showed that wMel-Wolbachia infected Ae aegypti deployments probably reduce the odds of contracting virologically confirmed dengue by 77% (OR 0.23, 95% CI 0.15 to 0.35; 1 trial, 6306 participants; moderate-certainty evidence). The cluster-level prevalence of wMel Wolbachia-carrying mosquitoes remained high over two years in the intervention arm of the trial, reported as 95.8% (interquartile range 91.5 to 97.8) across 27 months in clusters receiving wMel-Wolbachia Ae aegypti deployments, but there were no reliable comparative data for this outcome. Other primary outcomes were the incidence of virologically confirmed dengue, the prevalence of dengue ribonucleic acid in the mosquito population, and mosquito density, but there were no data for these outcomes. Additionally, there were no data on adverse events.

Authors' conclusions: The included trial demonstrates the potential significant impact of wMel-Wolbachia-carrying Ae aegypti mosquitoes on preventing dengue infection in an endemic setting, and supports evidence reported in non-randomized and uncontrolled studies. Further trials across a greater diversity of settings are required to confirm whether these findings apply to other locations and country settings, and greater reporting of acceptability and cost are important.

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Conflict of interest statement

TF is a Cochrane Infectious Diseases Group (CIDG) Research Associate, and was not involved in the editorial process. She has no known conflicts of interest to declare.

YS works as a systematic reviewer for Cochrane Response, an evidence services unit operated by Cochrane, and was not involved in the editorial process. She has no known conflicts of interest to declare.

IAR has been an employee of the Cochrane Central Executive Team (Cochrane Response/Evidence, Production & Methods Directorate) since 2021, and was not involved in the editorial process. She has no known conflicts of interest to declare.

WR has no known conflicts of interest to declare.

MC is a CIDG Editor, and was not involved in the editorial process. She has no known conflicts of interest to declare.

DD has no known conflicts of interest to declare.

GV works as senior systematic reviewer for Cochrane Response, an evidence services unit operated by Cochrane, and was not involved in the editorial process. She has no known conflicts of interest to declare.

YS, IAR, and GV were contracted by the World Health Organization (WHO) to conduct a systematic review on wMel‐Wolbachia‐carrying mosquitoes for the biocontrol of dengue virus infection in 2023 via Cochrane Response. The WHO report was conducted independently of this review, which is not associated with the WHO.

Figures

1
1
PRISMA diagram.
1.1
1.1. Analysis
Comparison 1: Prevalence of dengue virus infection, Outcome 1: All serotypes
2.1
2.1. Analysis
Comparison 2: Prevalence of dengue virus infection – subgroup analysis, Outcome 1: Subgroup investigations – dengue virus (DENV) serotype
3.1
3.1. Analysis
Comparison 3: Hospitalizations due to dengue fever (DF) or dengue haemorrhagic fever (DHF), Outcome 1: Hospitalizations due to DF or DHF

Update of

References

References to studies included in this review

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References to other published versions of this review

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