Researchers
Background
Rural communities across the Peruvian Amazon are experiencing a rapid invasion of Aedes aegypti, the primary vector of dengue virus. This spread is likely exacerbated by human actions involving household water storage and solid waste management. This project integrates human behavior and health communication perspectives into an ongoing stepped wedge study evaluating a combined solid waste management system and community health worker program aimed at reducing Ae. aegypti infestation and solid waste pollution.
Problem
Aedes aegypti mosquitoes transmit numerous viruses impacting human health, including dengue virus, across the global tropics and subtropics. Dengue virus causes about 400 million infections per year, resulting in over 40,000 deaths. The disease can manifest a significant range of morbidity, including the need for advanced hospital care in the ICU, leading to a cumulative cost of about US$8.9 billion.
The first detection of Ae. aegypti in rural communities outside of Iquitos (the city where dengue was first identified in Peru) was in 2008, through an epidemiological study on arboviruses conducted by the U.S. Naval Medical Research Unit SOUTH (then known as the Navy Medical Research Center Detachment, NMRCD) and independent routine surveillance activities conducted by the Peruvian Ministry of Health. In 2011–2012, a more comprehensive Ae. aegypti survey was conducted across 34 sites along the Amazon River and the 95 km stretch of road between Iquitos and Nauta (a small nearby city). These collections showed heterogeneous mosquito distributions in riverine communities and spatially explicit patterns along the roads. Half of surveyed riverine communities were infested. Communities with a larger human population size and closer distance to Iquitos were more likely to be infested with Ae. aegypti. Rural Ae. aegypti populations will likely expand further with increasing levels of transport connectivity, increasing use of plastics and other waste that can serve as larval habitat in rural areas, and persistent lack of access to running water, necessitating water collection. This trend has received limited attention despite mirrored increases in rural dengue transmission, with evidence of high seroprevalence and the circulation of multiple serotypes in rural communities, particularly in Colombia and Ecuador. Importantly, records of this rural expansion of the mosquito and virus is likely a substantial underestimate of their true rural distribution due to limited vector and disease surveillance in rural areas.
Goals
The research team will use knowledge, attitudes, and practices surveys and focus groups to assess behavior change and identify key facilitators and barriers to intervention uptake. Findings will inform improvements to intervention strategies in future years and, if successful, provide a scalable framework to address the growing rural threats of both dengue transmission and plastic pollution.
Progress
An update on progress towards these goals will be presented at the upcoming symposium From Households to Habitats on September 11.