Dave D. Chadee

Climate change and health: on the latest IPCC report

www.thelancet.com Vol 383 April 5, 2014 1185 The Intergovernmental Panel on Climate Change (IPCC) released its latest report on March 31, 2014. This report was the second instalment of the Fifth Assessment Report, prepared by Working Group 2, on impacts, vulnerability, and adaptation to climate change. In this Comment, we, as contributors to the chapter on human health, explain how the IPCC report was prepared and highlight important fi ndings. The IPCC reviews and assesses the scientifi c published work on climate change. As an intergovernmental body composed of members of the UN, the IPCC does not undertake research itself; instead it appoints Working Groups who assess the work. This assessment means more than simply to summarise the state of knowledge: Working Groups are asked to weigh what has been written (in both peer-reviewed publications and grey literature), to make judgments about likelihood and uncertainty, and to fl ag important emerging issues. The focus for Working Group 2 was mainly, but not exclusively, on what had been written since the previous assessment in 2007; papers were eligible for inclusion if they were published, or accepted for publication, before Aug 31, 2013. The Working Groups were required to highlight what might be relevant to policy, but did not recommend policies. The Fifth Assessment Report Working Group 1 reported on the physical science of climate change in September, 2013 (appendix). Working Group 3, concerned with mitigation (ie, reduction of greenhouse gas emissions), will release its report in April, 2014. The scale of the enterprise is remarkable—indeed, reports by the IPCC together probably represent the largest scientifi c assessment exercise in history. There are 310 authors and review editors in Working Group 2, and an even greater number of contributing authors who have added to the report from their areas of special expertise. In addition to health, Working Group 2 examined natural and managed resources (eg, fresh water, coastal systems, and food production), human settlements, and other aspects of wellbeing such as security and livelihoods. The report (30 chapters) will be published in two volumes, and includes integrated assessments of impacts and adaptation in nine geographic regions and an overarching summary for policy makers. Work on the Fifth Assessment Report began 5 years ago (appendix) and aspects of the IPCC process distinguish its assessments from other reviews and scientifi c publications. One diff erence is the substantial role of member states in determination of, in the initial stages, the scope of the reports and the membership of writing groups. At the beginning of each round of assessment, meetings organised by the IPCC decide on the structure of the reports, including the number of chapters and the topics to be covered, and then member states nominate potential authors. The fi nal decision about authors is made by a subgroup from the IPCC, the Bureau, on the basis of scientifi c merit and the necessary institutional and disciplinary perspectives for each chapter, seeking, at the same time, to achieve a balance of representation by gender and region. Once appointed, the IPCC authors work independently; government input occurs as part of the peer review process. However, the member states must approve and sign off on the fi nal report. Thus, the IPCC assessments are the outputs of many iterative interactions between scientists and policy makers. Another feature of the IPCC process is the intensity of peer review. There were four rounds of review for the Fifth Assessment Report, two of which involved hundreds of self-nominated experts and scientists appointed by member-state governments. Each round generated an enormous number of comments, questions, and requests for change. For instance, the IPCC received 1009 reviewer comments just on the second-order draft of chapter 11 (human health). Two dedicated review editors per chapter are charged with ensuring that the authors consider each comment seriously and, if they reject it, that they do so with good reasons. Both the comments and the chapter authors’ responses will be published on the IPCC website. The IPCC does not prescribe how chapter groups should gather and interpret the scientifi c work, partly because conventions and practice diff er among disciplines. Contributors to the health chapter used many strategies to identify relevant published work. Due to the breadth of the topic, including the range of health outcomes and exposure pathways, the chapter team decided that one systematic review would not be possible. Climate change and health: on the latest IPCC report

Effects of different temperature regimens on the development of Aedes aegypti (L.) (Diptera: Culicidae) mosquitoes

This study was conducted to determine the effects of increased water temperatures on the development of Aedes aegypti immatures under laboratory conditions in Trinidad, West Indies using temperature regulated water baths to cover a range of temperatures from 24-25°C to 34-35°C at a relative humidity of 80%. Two experiments were designed: (1) at constant temperature regimens and (2) under diurnal temperature regimens ranging from 24-25°C to 34-35°C. At 24-25°C egg hatching success was 98% at 48 h, however at 34-35°C egg hatching rates declined to 1.6% after 48 h. Ae. aegypti larvae reared under constant temperature regimens showed pupation on day 4 with highest pupation occurring at 30°C (78.4%) However, under diurnal temperature regimens, pupation began on day 4 but only at the higher temperatures of 30-35°C. Under diurnal temperature regimens ranging from 24°C to 35°C significantly more females emerged at higher temperatures, than males. In contrast, at constant temperatures of 24-35°C no significant difference in M/F ratios were observed. The body size of Ae. aegypti reared at constant temperature regimens was significantly larger than males and females larvae reared under diurnal temperature regimens of 25-30°C. The results of this study are discussed in the context of changing or increasing water temperatures, seasonal changes in vector populations and vector competence. Using these key factors control strategies are recommended to manage vector populations as expected increases in temperatures impact the Caribbean region.

Climate, mosquito indices and the epidemiology of dengue fever in Trinidad (2002–2004)

Abstract Between January 2002 and December 2004, a population-based study on the effects of climate and mosquito indices on the incidences of dengue fever (DF) and dengue haemorrhagic fever (DHF) was conducted in Trinidad, West Indies. The incidence of DF was 5.05 cases/1000 population in 2002, largely as the result of a major outbreak, but declined to 0.49 case/1000 in 2004. The monthly Aedes aegypti (L.) Breteau indices (BI) did not decline over the 3-year study period, however, but increased from a mean of 29 in 2002 to one of 36 in 2004, with seasonal variations (BI of 30–46 and 20–34 were recorded in the wet and dry seasons, respectively). No significant correlations were observed between temperature and DF or DHF incidence but rainfall was found to be significantly correlated with DF incidence, with a clearly defined dengue season, between June and November, in two of the study years. The apparent decline in dengue transmission since 2002 appears to be largely attributable to the development of herd immunity in the general population and not to the attempts at vector control. Since the introduction of new serotypes or the fading of the herd immunity could lead to an explosive epidemic of dengue in Trinidad, there is clearly a need for continued surveillance.

Characterization of insecticide resistance in Trinidadian strains of Aedes aegypti mosquitoes.

Bioassays and biochemical assays were conducted on eight Trinidadian strains of Aedes aegypti larvae to determine the involvement of biochemical mechanisms in resistance to insecticides. Larval strains were assayed to dichlorodiphenyltrichloroethane (DDT), bendiocarb, temephos and permethrin, using the Centers for Disease Control and Prevention (CDC) time-mortality bioassay method. A Resistance Threshold (RT) was calculated for each insecticide in relation to the CAREC reference susceptible Ae. aegypti strain and larval strains with <80% mortality were considered to be resistant. Biochemical assays were performed to determine the activities of nonspecific esterases (α- and β-), PNPA-esterases, mixed function oxidases (MFO), glutathione-S-transferases (GST) and acetylcholinesterase (AChE) enzymes which are involved in insecticide resistance in mosquitoes. Enzyme profiles of each strain were compared with those of the CAREC reference susceptible strain by Kruskal-Wallis and Dunns multiple comparison tests (p<0.05). The CAREC 99th percentile was calculated for each enzyme and the percentage of individuals with enzyme activities above that of the CAREC 99th percentile was calculated. Activities were classified as unaltered (<50%), incipiently altered (15-50%) or altered (>50%) for each strain. The established RTs for permethrin and bendiocarb were 30 and 75 min, respectively; and 120 min for DDT and temephos. All strains were resistant to DDT (1.00-40.25% mortality) and temephos (11.50-74.50% mortality) while six strains were resistant to bendiocarb (51.50-78.50% mortality) and five to permethrin (6.50-42.50% mortality). Biochemical assays revealed that the median activity levels for all enzymes varied significantly (p<0.05). The Curepe strain had incipiently altered levels of α-esterase while the other seven strains had altered activity with five of them registering 100%. The St Clair strain showed altered activity levels of β-esterase while three strains had incipiently altered levels. The majority of strains had altered activity of MFO enzymes but only the St Clair strain showed altered activity of GST. PNPA-esterases activity was unaltered in all strains and only the Haleland Park strain showed altered remaining AChE activity in the presence of propoxur. Elevated levels of enzymes (incipiently altered or altered), except in the case of PNPA-esterases, show that biochemical resistance may play an important role in the manifestation of insecticide resistance in Trinidadian populations of Ae. aegypti. It is therefore important for insecticide resistance surveillance to be ongoing as the detection of resistance before it spreads throughout an entire population makes it possible for early intervention.

Impact of vector control on a dengue fever outbreak in Trinidad, West Indies, in 1998.

In 1998, Trinidad experienced its first major outbreak of dengue haemorrhagic fever. Data from the Trinidad Public Health Laboratory, the National Surveillance Unit and Insect Vector Control Division, Ministry of Health, Trinidad and Tobago were analysed to determine the impact of vector control measures on the dengue outbreak. Geographical Information Systems (GIS)/Global Positioning Systems (GPS) were used to map cases and to distinguish epidemiological clusters. The Aedes aegypti population densities were higher than the 5% transmission threshold in all counties. The spatial distribution of dengue fever cases was significantly correlated with the heavily populated east–west corridor in the north and several distinctly separate clusters in the western part of the island. The temporal distribution patterns showed significantly more dengue fever cases occurring during the rainy season than during the dry season. This study documents the importance of vector control in the prevention of dengue transmission since no vaccine is currently available, and emphasizes the urgent need to understand better the environmental factors which contribute to the proliferation of this disease vector Ae. aegypti.

Influence of urban landscapes on population dynamics in a short-distance migrant mosquito: evidence for the dengue vector Aedes aegypti.

Background Dengue viruses are endemic across most tropical and subtropical regions. Because no proven vaccines are available, dengue prevention is primarily accomplished through controlling the mosquito vector Aedes aegypti. While dispersal distance is generally believed to be ∼100 m, patterns of dispersion may vary in urban areas due to landscape features acting as barriers or corridors to dispersal. Anthropogenic features ultimately affect the flow of genes affecting vector competence and insecticide resistance. Therefore, a thorough understanding of what parameters impact dispersal is essential for efficient implementation of any mosquito population suppression program. Population replacement and genetic control strategies currently under consideration are also dependent upon a thorough understanding of mosquito dispersal in urban settings. Methodology and Principal Findings We examined the effect of a major highway on dispersal patterns over a 2 year period. A. aegypti larvae were collected on the east and west sides of Uriah Butler Highway (UBH) to examine any effect UBH may have on the observed population structure in the Charlieville neighborhood in Trinidad, West Indies. A panel of nine microsatellites, two SNPs and a 710 bp sequence of mtDNA cytochrome oxidase subunit 1 (CO1) were used for the molecular analyses of the samples. Three CO1 haplotypes were identified, one of which was only found on the east side of the road in 2006 and 2007. AMOVA using mtCO1 and nuclear markers revealed significant differentiation between the east- and west-side collections. Conclusion and Significance Our results indicate that anthropogenic barriers to A. aegypti dispersal exist in urban environments and should be considered when implementing control programs during dengue outbreaks and population suppression or replacement programs.

Review : Improving our knowledge of male mosquito biology in relation to genetic control programmes

The enormous burden placed on populations worldwide by mosquito-borne diseases, most notably malaria and dengue, is currently being tackled by the use of insecticides sprayed in residences or applied to bednets, and in the case of dengue vectors through reduction of larval breeding sites or larviciding with insecticides thereof. However, these methods are under threat from, amongst other issues, the development of insecticide resistance and the practical difficulty of maintaining long-term community-wide efforts. The sterile insect technique (SIT), whose success hinges on having a good understanding of the biology and behaviour of the male mosquito, is an additional weapon in the limited arsenal against mosquito vectors. The successful production and release of sterile males, which is the mechanism of population suppression by SIT, relies on the release of mass-reared sterile males able to confer sterility in the target population by mating with wild females. A five year Joint FAO/IAEA Coordinated Research Project brought together researchers from around the world to investigate the pre-mating conditions of male mosquitoes (physiology and behaviour, resource acquisition and allocation, and dispersal), the mosquito mating systems and the contribution of molecular or chemical approaches to the understanding of male mosquito mating behaviour. A summary of the existing knowledge and the main novel findings of this group is reviewed here, and further presented in the reviews and research articles that form this Acta Tropica special issue.

Efficacy of sticky and standard ovitraps for Aedes aegypti in Trinidad, West Indies.

ABSTRACT: The double sticky trap (DST) is described for the first time and is evaluated along with standard ovitraps and sticky traps (STs) to determine population densities of Ae. aegypti in the urban township of St. Augustine and the rural community of Tamana, Trinidad, West Indies. Ten houses were selected at each study site. At each of the ten houses, one ovitrap, one ST, and one DST were placed using the criteria established for placement of ovitraps. The results showed the three trapping methods successfully collected Ae. aegypti mosquitoes. All three traps collected significantly more adults or eggs in St. Augustine than in Tamana. DSTs collected 2,286 adults from St. Augustine vs 316 adults from Tamana (p<0.002), STs collected 1,480 and 220 adults, respectively (p<0.01), and the ovitraps collected 2,735 and 517 eggs, respectively from St. Augustine and Tamana (p<0.002). Based on these results, the DSTs collected significantly (P<0.02) more adults than the STs. The DSTs and STs collected both adult and immature stages which can be used for toxicology, virology, and PCR studies and are suitable alternative Ae. aegypti surveillance tools for the Caribbean and Latin American region.

Investigations of dengue-2 susceptibility and body size among Aedes aegypti populations.

Abstract The mosquito Aedes aegypti (L.) (Diptera: Culicidae) is the primary global vector for dengue virus (DENV), yet considerable genetic variation exists among populations in terms of its competence to vector DENV. Variability in adult body size has also been observed among various mosquito populations and several studies have reported a relationship between body size and arbovirus dissemination, although most of these relied on artificially derived variation in body size. Here we examine the relationship between body size and disseminated DENV infection among 10 Ae. aegypti populations reared under optimum laboratory conditions. Body size variability was inferred from wing length measurements and DENV competence was evaluated as the proportion of individuals with disseminated infections following exposure to the dengue‐2 JAM1409 strain. There were significant differences in mean wing lengths among populations (anova, F9,22= 7.10, P < 0.0001), ranging from 2.16 mm (Bangkok population) to 2.79 mm (MOYO‐S [susceptible] population). We also observed significant differences among some populations in mean DENV infection rates (Waller−Duncan K‐ratio t‐test), ranging from 19.54% (MOYO‐R [refractory] population) to 56.60% (MOYO‐S population). However, we did not observe evidence for significant interactions between body size and DENV dissemination. We suggest that either the two traits are genetically independent or that our ability to detect interactions between them was limited by their respective inheritances as quantitative traits.

Seasonal profiles of Aedes aegypti (Diptera: Culicidae) larval habitats in an urban area of Costa Rica with a history of mosquito control

ABSTRACT Dengue is the most important arboviral disease worldwide and the principal vector-borne disease in Costa Rica. Control of Aedes aegypti populations through source reduction is still considered the most effective way of prevention and control, although it has proven ineffective or unsustainable in many areas with a history of mosquito control. In this study, seasonal profiles and productivity of Aedes aegypti were analyzed in the city of Puntarenas, Costa Rica, where vector control has been practiced for more than ten years. Households contained more than 80% of larval habitats identified, although presence of habitats was more likely in other locations like lots and streets. In the wet season, habitats in the “other” category, like appliances, small manholes, and miscellaneous containers, were the most frequent habitats observed as well as the most common and productive habitats for Ae. aegypti. In the dry season, domestic animal drinking containers were very common, although concrete washtubs contained 79% of Ae. aegypti pupae collected. Individually, non-disposable habitats were as likely or more likely to contain mosquito larvae, and large containers were more likely to harbor mosquito larvae than the small ones only in the dry season. Considering various variables in the logistic regressions, predictors for Ae. aegypti in a habitat were habitat type (p<0.001), setting (p=0.043), and disposability (p=0.022) in the wet season and habitat capacity in the dry season (p=0.025). Overall, traditional Ae. aegypti larval indices and pupal indices in Puntarenas were high enough to allow viral transmission during the wet season. In spite of continued vector control, it has not been possible to reduce vector densities below threshold levels in Puntarenas, and the habitat profiles show that non-household locations, as well as non-disposable containers, should be targeted in addition to the standard control activities.