Produced and Published by the Caribbean Public Health Agency P.O. Box 164, 16-18 Jamaica Boulevard Port of Spain Trinidad and Tobago

Email: [email protected] Website: http://www.carpha.org

CARPHA (2017). A Toolkit on Integrated Vector Management for the Caribbean, pgs. 128. ISBN: 978-976-8114-32-7 © Caribbean Public Health Agency, 2017.

ACKNOWLEDGEMENTS

The Caribbean Public Health Agency (CARPHA) is grateful to Dr Samuel Rawlins for producing this toolkit on Integrated Vector Management (IVM) for its Member States. CARPHA expresses its appreciation to all the organisations and individuals. Among these are:-

• All the Vector Management practitioners in the CMS countries. • Those who helped with the production of the earlier manual: “Manual on the Integrated Vector Management in Eastern Caribbean Countries”. • The Insect Vector Control Division of Trinidad and Tobago, in collaboration with the PAHO for their “Training Manual for Insect Vector Control Operators”. • The numerous artists of vectors and VBDs (sources) whose works have been reproduced in various ways in an attempt to make this manual more easily understandable. • The WHO for their resource materials on “Integrated Vector Management, which were very helpful to this present production. • Rawlins, SC, Tikasingh, ES & Martinez, R. for use of information on “Catalogue of haematophagous arthropods in the Caribbean region.” CAREC. • Ms Nicole Joseph, for her work as a graphic designer/desktop publisher, who was of great assistance. This toolkit was produced through a consultancy funded by the US-Centers for Disease Control (US-CDC) Global Health Security Cooperative Agreement (CDC-RFA-GH15-1627). CONTENTS

Chapter 1. Introduction 1 Chapter 2. A Review of the Common Mosquito Vectors of Disease in the Caribbean 7 2.1. The Range of Diversity and Number of Vector Species 8 2.2. What is a Mosquito? 8 2.3. Identification (ID) of Three common Mosquito Types 10 2.4. Mosquitoes of the Caribbean 10 2.5. Possible Change of Name of Mosquitoes of the Aedes genus 32 2.6. Surveillance Methods for Mosquito Vectors 32 Chapter 3. The Common Mosquito Vector-Borne Diseases in the Caribbean Region 40 3.0. Mosquito-Borne Diseases of the Caribbean Countries 41 3.1. How Mosquitoes and other Vectors are essential in the role of Disease Transmission 41 3.2. Arbovirus Transmission Cycle 42 3.3. Dengue Fever in Caribbean Countries 43 3.4. Climate Factors Affecting VBDs 45 3.5. Chikungunya Virus Disease 46 3.6. Zika Virus Disease 47 3.7. Malaria 49 3.8 Lymphatic Filariasis 51 3.9. West Nile Virus Infection 53 3.10. Yellow Fever 54 Chapter 4. Integrated Vector Management: Theory and Practice 56 4.1. Module 1: Introduction to IVM 57 4.2. Module 2. Basic Introduction to Vectors of Disease and IVM 61 4.3. Module 3. Planning and Implementation 63 4.4. Module 4. Organisation and Management 68 4.5. Module 5. Policy and Institutional Framework 70 4.6. Module 6. Advocacy and Communication 72 4.7. Module 7. Monitoring and Evaluation 74 Chapter 5. Tools for Vector Management in the IVM Programme 77 5.1. Introduction 78 5.2. Chemical Control Methods for Common Vectors of Disease 78 5.3. Biological Control Methods 83 5.4. Environmental Control Methods 85 5.5. Environmental Sanitation for Zika, Chik V and DF control 87 5.6. Solid Waste Management 87 5.7. Personal Protection. 89 5.8. Integrated Vector Management in VBD Emergency Situations. 89 Chapter 6. Work of the Vector Control Operator or Officer (VCO) and their Involvement in IVM 91 6.1. Introduction 92 6.2. Expectations of the role of the VCO 92 6.3. Work Schedule/Work Plan 93 6.4. Organisation of Work 94 6.5. Refusal to Permit Inspection 95 6.6. Inspection Procedures 95 6.6. Daily Worksheets 95 6.7. Mosquito Breeding Places 97 6.8. Inspecting Water Containers 98 6.9. Appropriate Technology for Vector Surveillance 99 6.10. Elimination of Mosquito Breeding Places and Conversations for Health Education with the Householder 99 6.11. Dealing with Closed and Vacant Premises/Houses 99 6.12. Collection of Samples 100 6.13. Some Calculations 103 Chapter 7. Other Selected Arthropods and Reservoirs of Public Health Importance which may be subjected to IVM 105 7.1. Biting Midges (Sand flies) (Ceratopogonidae) 106 7.2. Sand flies (Phlebotomines) 108 7.3. Black Flies (Simulium spp.) 109 7.4. Fleas 110 7.5. Lice 112 7.6. House Flies 113 7.7. Ticks and Mites 114 7.8. Cockroaches 117 7.9. Rodents 119 Conclusions 123 Glossary 124 References 127 FIGURES

Figure 1. Map of CARPHA Member States 2 Figure 2. Aedes aegypti adult female 4 Figure 3. A tyre habitat for the immature of Ae aegypti and possibly another vector Culex quinquefasciatus 5 Figure 4. A Generalised Adult Ae aegypti female mosquito 9 Figure 5. A Generalised Mosquito Life Cycle 9 Figure 6. Identification of generalised Anopheles, Aedes or Culex mosquito types based on Eggs, Larval, Pupal and Adult features 11 Figure 7. Diagram of an ovitrap 35

Figure 8. Diagram of a Stratified Random Sampling Method System 38 Figure 9. Diagram of a Cluster Sampling Method System 38 Figure 10. The Three Essential Requirements of Hosts for Disease Transmission by a Vector 41 Figure 11. Arbovirus Transmission Cycle 42 Figure 12. Dengue Fever Transmission Cycle 43 Figure 13. Climate Indicators and Dengue Fever 45 Figure 14. Extrinsic and Intrinsic Incubation Periods for Chikungunya Virus 46 Figure 15. Zika Virus Fever Transmission 49 Figure 16. Malaria Transmission Cycle 50 Figure 17. Lymphatic Filariasis Transmission Cycle 52 Figure 18. West Nile Virus Transmission Cycle 53 Figure 19. Diagram of the Life Cycle of Sylvatic (Jungle) and Urban Yellow Fever 54 Figure 20. Decision Making in IVM 64 Figure 21. Processes & Outcomes in Planning for M&E in IVM 75 Figure 22. Schematic Representation of M&E for IVM 75 Figure 23. Larvivorous fish – the Guppy Mosquito Fish (Poecilia. Spp.) and Gambusia affinis 83 Figure 24. Toxorhynchites spp. 84 Figure 26. Bacillus thuringiensis 85 Figure 27. Diagram of a Water Tank protected with Polystyrene beads to prevent mosquito access to water 86 Figure 28a. Scrap metal pile (potential vector habitats) before being compacted (Anguilla) 88 Figure 28b. Compacting machinery at work 88 Figure 28c. Body of a motor car after compaction 89 Figure 29. Daily Worksheet 96 Figure 30. An example of the House Card for Vector Management Home Record 97 Figure 31. The Variety of breeding places of the Dengue, Chik V or Zika mosquito in your surroundings 98 Figure 32. Twenty pictures of potential Ae aegypti breeding habitats 102 Figure 33. Adult “Sand Fly” (Culicoides) 106 Figure 34. The biting midge (sand fly) life cycle 107 Figure 35. Plebotomine Sand fly (Lutzomia sp) 108 Figure 37. The Black Fly (Simulium spp.) 109 Figure 38. The Life Cycle of the Black Fly 110 Figure 39. The Cat Flea (Ctenocephalides felis) Adult 111 Figure 40. The Life Cycle of the Cat Flea 111 Figure 41. Human Lice spp – Body and Pubic Lice 112 Figure 42. The Life Cycle of Human Lice spp – Body and Pubic Lice 113 Figure 43. The Adult House Fly (Musca domestica) 113 Figure 44. The Life Cycle of the House Fly 114 Figure 45. Biting mites (Trombicula spp.), Scabies mites (Sarcoptes scabiei) and House dust mite (Dermatophagoides complex) 115 Figure 46. The Life Cycle of the Biting Mite 115 Figure 47. Features of Hard and soft ticks 116 Figure 48. The Life Cycle of Hard and Soft Ticks 117 Figure 49. Three Common Cockroach Species – American cockroach (Periplaneta americana), German cockroach (Blatella germanica), Oriental cockroach (Blatta orientalis) 118 Figure 50. Roof Rat (Rattus rattus), Norway Rat (Rattus norvegicus) and House Mouse (Mus musculus) 120 Figure 51. Distinguishing features of the two main rat species 120 Figure 52. Field identification of a young rat and a house mouse 121 TABLES

Mosquitoes of the Caribbean

Table 1. Anguilla 12 Table 2. Antigua & Barbuda 12 Table 3. Bahamas 12 Table 4. Barbados 13 Table 5. Belize 13 Table 6. Bermuda 15 Table 7. Cayman Islands 15

Table 8. Dominica 16 Table 9. Grenada 17 Table 10. Guyana 17 Table 11. Hispaniola (Haiti and The Dominican Republic) 19 Table 12. Jamaica 20 Table 13. Montserrat 22 Table 14a. Nevis 23 Table 14b. St. Kitts 23 Table 15. St. Lucia 23 Table 16. St. Vincent & The Grenadines 24 Table 17. Suriname 24 Table 18a. Tobago 26 Table 18b. Trinidad 27 Table 19. Turks and Caicos Islands 31 Table 20. Virgin Islands (US & British) 31 Table 21. Aedes aegypti Surveillance Methods 33 Table 22. Fold Resistance to Temephos (Abate) in Selected Eastern Caribbean Countries 36 Table 23. Laboratory Confirmed Cases of Dengue Fever reported to CARPHA by CMSs for 2015 and 2016 44 Table 24. Laboratory Confirmed Cases of Chikungunya Virus Infection reported to CARPHA for 2015 and 2016 47 Table 25. Laboratory Confirmed Cases of Zika Virus Infection reported to CARPHA for 2015 and 2016 48 Table 26. Cases of Imported Malaria reported to CARPHA by CMSs for 2015 and 2016 51 Table 27. Cases of Autochthonous Malaria (native) reported to CARPHA for 2015 and 2016 51 Table 28. Characteristics of breeding sites for three types of common mosquito genera 62 Table 29. Recommended dilution rates for Abate (Temephos 1% sand granules) 79 Table 31. Information required on Daily Worksheets 96 Table 32. List of possible breeding places 103 Chapter 1: Introduction

CHAPTER 1 INTRODUCTION

AFTER COMPLETING THIS CHAPTER, THE CARIBBEAN COMMUNITY INCLUDING THE GENERAL POPULATION, PH MANAGERS, INSECT VECTOR CONTROL OPERATORS (IVCOS) SHOULD:

• Be aware of the significance of the challenges Insect- and other Vector-borne diseases (VBDs) present to Public Health in Caribbean member states (CMSs) • Be aware of their respective roles in preventing and controlling VBDs in our environment. • Be aware of how Public health officials and communities can work together in Integrated Vector Management (IVM) to prevent VBDs

1 A Toolkit on Integrated Mosquito Vector Management for the Caribbean

The Health Significance of the Major Mosquitoes and other Blood-Sucking Arthropods of the Caribbean Countries

INTRODUCTION We are living in “interesting times” in terms of the emergence of vector-borne diseases (VBDs) in the Caribbean Region and the Americas. In 2011 when we prepared a manual similar to this one for the Eastern Caribbean countries, entitled “Manual on Integrated Vector Management (IVM) in the Eastern Caribbean, there was no mention of the words “Chikungunya (Chik V), or of Zika virus. Since then, we’ve seen the outbreak of epidemics of Chik V and of Zika virus infections that have since caused havoc in public health in virtually every country in our region. And with this have come major health challenges to and disruption of the significant economic activities such as the travel industry and tourism in our communities. Who knows what VBD challenges may be threatening us later in 2017 and beyond? Because there are no effective vaccines or appropriate medications available for a range of vector-borne diseases (VBDs), vector control (VC) is an important component of prevention of VBDs. Even better, is the use of the rational decision-making process to optimise the use of resources for vector control in Integrated Vector Management (IVM). This will be the subject of a large portion of this manual. All mosquitoes and other haematophagous (blood-feeding) arthropods preying on humans and other animal hosts are potentially vectors (transmitters) of various diseases. In addition to this, these micro-predators are of nuisance value, terrorising our population and our guests in trying to get a blood meal from man and his animals. In this unit, we will focus our attention on the introduction to mosquitoes which are known to be responsible for the transmission of major vector-borne diseases (VBDs) in our part of the world such as: Dengue Fever (DF), Chikungunya Virus (Chik V), Zika Virus, Malaria, and any other parasites and viruses.

Figure 1. Map of CARPHA Member States

2 Chapter 1: Introduction

CARPHA Member States. The CARPHA Member States for whom this toolkit is being prepared (Figure 1.), consists of that chain of island countries stretching from Trinidad and Tobago in the Southern Caribbean, up to the Bahamas in the Northern Caribbean and Bermuda in the Atlantic. CMSs exclude the French-speaking countries the Dominican Republic and Cuba, but include the mainland countries of Suriname and Guyana in South America and Belize in Central America. They are by and large, the English-speaking, French-speaking Haiti and Dutch- speaking parts of the Caribbean. These CMSs were to a large extent former members of the CAREC Member Countries (CMCs), which benefitted from the ownership and expertise of the former Caribbean Epidemiology Centre (CAREC). Like other countries in the Americas, these countries have in common, the fact that they lie in the tropics and have the omnipresence of the vector, Aedes aegypti, of which we will discuss much in this toolkit because its association with Dengue Fever, Chikungunya virus infection and Zika virus infection. But there are other vector-borne diseases (VBDs) which too, will engage our discussion in this toolkit, take for example the issue of malaria in the tropics. The malaria situation in the tropics is an issue which public health authorities must always take seriously. If any one disease could be said to be characteristic of tropical diseases worldwide, it is malaria! Despite the fact that there have been just a few locally-transmitted cases in most of the islands of the Caribbean in recent times, this remains an on-going threat bearing in mind that in some malaria-endemic countries, hundreds of thousands of persons – especially children – die from this disease each year. In addition, malaria has the potential to cause severe economic losses in terms of reduction in our productivity due to illness, expenses in trying to control this disease and the negative impact on our hospitality industry. In 1962, the island countries of the English-speaking Caribbean were declared to be free of the dangerous Anopheles mosquito-transmitted disease, and this was indeed a great achievement. However, the vectors of malaria were never eliminated from our areas and potential vectors of malaria such as Anopheles albimanus and An aquasalis are still present in most Caribbean countries (Rawlins et al. 2008). However, the presence of several Anopheles species in our Caribbean countries (Chapter 2) means that we are at risk of resumption of malaria transmission, with the attendant risk to lives, tremendous cost of disease control and the negative impact on our tourism industry on which most of the economies of our islands depend. Dengue Fever. Another scourge of Vector-borne disease (VBD) that our Caribbean region has been exposed to over the last 30-40 years or more is that of Dengue Fever (DF), which remains endemic in the Caribbean, is the most important viral VBD in the world. Here in the Caribbean, all of the four DF viruses have been in circulation, being transmitted by the omnipresent Aedes aegypti. The management of this VBD is a significant challenge, because of three features:– • There is not any efficient treatment for the DF virus in man or in the vector. • There is not as yet any vaccine to protect man against infection by the virus. • The vector is so well adapted to human habitation and culture, that though control of the mosquito is the only way of protecting against disease transmission, this is not an easy undertaking. Chikungunya and Zika virus infections as mentioned above, are the most recent VBDs which have been in circulation in our region in the last few years. Like DF, they are transmitted by the almost omnipresent Ae. aegypti (Figure 2) and can be a major threat to our way of life and our vital tourist industry. Chikungunya Virus (Chik V) infection was introduced into the Caribbean region in 2013 and immediately proved itself to be capable of visiting epidemics in virtually every Caribbean country. It is characterised by symptoms such as fever, nausea, headache, muscle, back and joint pain – often crippling as told by some of its local victims. By its painful manifestation to us in the Caribbean, we have found Chik V to be true to its Makonde origin in its painful characteristic: “that which bends you up”! We had hardly gotten used to the pronouncement of the word Chikungunya virus and the adverse consequences of the circulation of the “new” virus, when another struck.

3 A Toolkit on Integrated Mosquito Vector Management for the Caribbean

Figure 2. Aedes aegypti adult female

Source: USDA

Zika Virus infection, first described (1947) from mammalian hosts from the Zika region of Uganda, East Africa, and more recently, in 2015 found to be endemic in parts of Brazil became localised in 2015 in the Caribbean and immediately spread like wildfire. By August, 2016, virtually all CMSs reported confirmed cases of Zika virus infection. Like Chik V, Zika virus infection is characterised by fever, skin rash, muscle and joint pain, headaches, malaise, in addition to conjunctivitis (red eye). Also, the possible presence of Guillain-Barre Syndrome (GBS) and congenital anomalies in the unborn baby make Zika infection even more to be feared than some of the other VBDs that we have experienced in the Caribbean. The threat of DF, Chik V and Zika virus transmission in our communities is aggravated by several factors e.g.:– • The issue of climate variability (CV), one aspect of climate change (CC), where there has emerged a pattern of greater production of mosquitoes in the years after the warmer and drier El Nino (EN) Years – EN+1, when it is wetter and more conducive to mosquito production in natural and artificial containers. • The growing human population. • Continued and frequently unplanned urbanisation. • Inadequate municipal services such as water supply (unreliable) and solid waste disposal. • Increased regional and inter-continental travel. • The circulation of Chik V, Zika and DF in the region simultaneously. • The unrestrained production and use of non-biodegradable food and drink packaging (disposable) and non-disposable containers such as drums and other water storage vessels, which may become larval habitats. • Absence of programmes for disposal of habitats such as used tyres (Figure 3) which could eventually become mosquito production habitats. All or some of these features may combine to make the occurrence and the management of Zika, Chik V and DF virus to be a challenging prospect.

4 Chapter 1: Introduction

Figure 3. A tyre habitat for the immature of Ae aegypti and possibly another vector Culex quinquefasciatus

Source: M. Minchington Israel

It is important to note however that because DF, Chik V and Zika are transmitted by a peridomestic vector, that is, one that lives in and around human habitation, a significant part of its control could result from human populations working effectively to prevent vector production. Thus, human behaviour change could be a key tool in the Integrated Vector Management (IVM). An important component of this the utilisation of “Communications for Behavioural Impact, (COMBI)”, according to Parks and Lloyd (2004) which has the following essential components for involvement of the community in participation to prevent vector production and disease control:– • Public Relations/Advocacy – news coverage, media coverage for getting every one’s attention to the anti-mosquito/VBD message. • Community mobilisation, including use of participatory research, group meetings, using all the media. • Sustained appropriate advertising. • Personal selling/interpersonal communication/counseling, involving volunteers, school children etc. • The involvement of the whole community as stakeholders for collaboration. • Point-of-service promotion: emphasising easily accessible and readily available vector control measures, diagnosis and fever treatment. This then is the work of all stakeholders in the Caribbean – the community, the public health authorities – to join in the fight to prevent Aedes aegypti production, using all the tools at our disposal. This is what this manual – aimed at the community, including the man in the street, public health managers and Vector Control Operators – is about. In the following Chapter 2, details of the diversity of mosquito species in the various countries of the region is presented, showing a very rich range of mosquito species populations. This demonstrates that the range of mosquitoes available for transmission of the diversity of viruses and other organisms is very significant.

5 A Toolkit on Integrated Mosquito Vector Management for the Caribbean

It also suggests that other VBD pathogens which have not reached us as yet have a range of potential vectors to transmit them. A good example is the current (2017) yellow fever (YF) outbreak in Brazil; it demonstrates the need for knowledge of the diversity of our vector populations and the capacity of vector control staff to recognise these. YF poses a threat to Caribbean countries – especially those like Trinidad and Tobago where proven YF vectors such as urban YF (Ae aegypti) and jungle YF (Sabethes sp. and Haemagogus spp.) occur. In Chapter 3, we are reviewing in greater detail, the variety of VBDs which are currently challenging us in the Caribbean and other areas of the Americas. The foundations of the requirements for VBD transmission are explored, with the intention of identifying the weakest link in the cycle in order to arrest disease transmission. In Chapter 4, the concept and details of Integrated Pest Management (IPM) are expanded and the various roles of the partners who will be required to become involved in the response to VBDs are emphasised. There is a role for everyone who lives and works in our communities; there is a combination of activities for all of us to implement, rather than leave the vector management to the officers of the Vector Control (VC) unit of the Ministry of Health, since they cannot do it alone. The whole community of our region in the last three years when we experienced the epidemics of Chik V and Zika infections and of DF in the years before – expressed the frustration of why the designated authorities could not solve the simple task of managing these mosquito-borne diseases: “surely, this is not rocket science”! Well it isn’t but we are now showing that IVM by all of us is the way forward for VBD prevention and control. In Chapter 5, we are reviewing the range of vector control tools presently available for the management of our most common vectors, and how they may most properly be integrated into our IVM programmes that we are launching in all communities in every CMS country. Thus we may decide which are the most appropriate tools which are available for incorporation into our combination strategies for our IVM. In Chapter 6, we are reviewing in detail, the work of the Vector Control Operator (VCO), since it is these professionals who will be interfacing with us the rest of the community – more than any one else of our IVM partners or participants – in promoting the IVM strategy. Thus, these VCOs will need to be “experts” in vector and disease natural history, in surveillance and vector management. They will also be versed in the arts of advocacy and communication to make the IVM programme acceptable to the community, and in order to measure the process and impact of the IVM strategy, they will be key partners in the Monitoring and Evaluation (M & E) aspect of the programme. Chapter 7 on “Other selected arthropods and reservoirs of public health importance” has been included since all partners and participants in our IVM programmes will need to be knowledgeable on at least some of the non- mosquito (non – Culicid) vectors of pest and disease in our region. Since there will be a teaching role for most of us in IVM, this unit will help in the “Train the Trainer” programme. Our recent history shows us that we may not be aware now which new VBD may emerge and which of the potential non- culicid vector or reservoirs – which now seem quite harmless – may visit us with terror. May we continue to live in “interesting times”, but let us work and pray that we will be in a position of preparation so that whatever challenges in the realm of VBDs will confront us now and in the future, we will be prepared to use our skills in Integrated Vector Management (IVM), to prevent major disruptions as has happened in the recent past.

6 Chapter 2: A Review of the Common Mosquito Vectors of Disease in The Caribbean

CHAPTER 2 A REVIEW OF THE COMMON MOSQUITO VECTORS OF DISEASE IN THE CARIBBEAN

AFTER COMPLETION OF THIS CHAPTER, THE INSECT VECTOR CONTROL OPERATOR SHOULD:

• Know the various common mosquitoes and other potential arthropod vectors of disease in the country. • Know the identification and characteristics of the more common mosquitoes. • Know the risk factors for disease transmission associated with genera of mosquitoes such as Aedes, Anopheles, Culex. • Have a good understanding of control of the vector and the disease through integrated vector control strategies. • Have a good understanding of surveillance methods for mosquitoes and other vectors. • Be able and willing to incorporate other non-traditional sampling systems for inspection which could provide useful information and at the same time, maximise the efficient use of staff time.

THE MANAGERS AND PARTICIPANTS OF THE IVM PROGRAMMES SHOUD HAVE AN UNDERSTANDING OF:

• Some of the diversity of interactions and partnering for mosquito control. • The need for skilled technologists and VCO who have been trained in the techniques of identifying mosquito vector species. • The need to provide basic laboratory resources to backup mosquito surveillance exercises.

HOUSEHOLDERS WILL UNDERSTAND:

• Mosquito biology and the householder’s role in roles in habitat reduction.

7 A Toolkit on Integrated Mosquito Vector Management for the Caribbean

The recorded list of mosquitoes of the various CARPHA Member States (CMSs) countries are included below; (although when the document is modified for each country, only that country’s recorded mosquito data need be listed or according to local wishes.)

2.1. The Range of Diversity and Number of Vector Species The Tables (1-20) showing the numbers and diversity of mosquito vector species are worth a comment. Depending on the geographical local of the various countries and size, the numbers of species may vary. Thus, the island of Trinidad, located so close to the continent of South America, with its rich diversity and abundance of fauna, is significantly richer in the mosquito abundance and types than there are in some other islands which are smaller and situated away from the South, Central or North American coasts, as is say, the island of Bermuda. Thus, there are some 140 species of mosquitoes recorded to be present in Trinidad, while only about three or four in the smaller, Atlantic island of Bermuda. Also, as mentioned in Chap 3, vector species such as Sabethes and spp which may potentially be vectors of certain viruses such as Yellow Fever (YF), may be present on Trinidad, though not transmitting the virus, while some islands just do not have these potential vectors at all. In all Caribbean countries, there are several species of mosquitoes, most of which take a blood meal from human beings and are therefore of nuisance value to us. (Some mosquitoes also get their blood meal exclusively from various other animals as well). Several mosquitoes however are known to be important vectors (transmitters) of disease to man, such as the vector of dengue fever (DF), Zika and Chik V, (Aedes aegypti) and the vector of malaria, (Anopheles sp). In addition, there are some Culex species which could be responsible for the spread of other diseases such as Lymphatic filariasis and West Nile virus disease (Culex quinquefasciatus). There are several other mosquitoes which could potentially be vectors of other diseases, and only because the source for infection of the mosquito (the infected human or other vertebrate host with the organism) is not currently available locally, they do not present an immediate risk for the transmission of that disease; but this could change promptly. Aedes aegypti, the common peridomestic (breeding around human habitations) mosquito, is the common denominator of all our Caribbean countries. The travel industry has facilitated the movement of infected human hosts to the extent that the infected person could have become infected in exotic sounding countries such as Brazil, Indonesia, Kenya etc., where transmission may be taking place, and tomorrow be here in the Caribbean, and soon become the source of an infectious blood meal for one of our many species of mosquito vectors! Below, are listed for each CMS, the mosquitoes that have been identified in each country, but one must bear in mind that new species of mosquitoes could be imported into these counties, and could thus become resident and a disease transmitter locally. An example of a potential imported vector of disease could be the other vector of DF, Aedes albopictus, (Figure 4) which has been known to spread and colonise parts of the US and some other Caribbean countries, while it was known not to be present some years before. Thus, the work of the Vector Control Operator (VCO) can prove to be more exciting in that native mosquitoes must be recognised and further surveillance work must be done to detect any imported vector species. Certainly, mosquitoes present a major Public Health (PH) challenge, to confront which, we need to be prepared and committed.

2.2. What is a Mosquito? Mosquitoes are essentially insects, part of a group of the arthropods. These arthropods are invertebrate animals with hard exoskeletons with joints; these are characteristics which place them along with other groups such as the crabs, spiders, mites and shrimps etc., as members of the arthropod group. The mosquito’s main characteristic is that they need a blood meal for egg development (vitellogenesis) for reproduction (with the exception of a few species such as Toxorhynchites sp); thus female mosquitoes have piercing and sucking mouthparts, which they use to puncture the unbroken skin of its host in order to draw blood – which we refer to as “biting”.

8 Chapter 2: A Review of the Common Mosquito Vectors of Disease in The Caribbean

Mosquitoes like all other mature insects have their bodies divided in three main sections – the head (with eyes and antennae), thorax (with wings and legs) and abdomen – see diagram in Figure 4.

Figure 4. A Generalised Adult Ae aegypti female mosquito

Source: Centers for Disease Control and Prevention (CDC)

Figure 5. A Generalised Mosquito Life Cycle

Source: Centers for Disease Control and Prevention (CDC)

9 A Toolkit on Integrated Mosquito Vector Management for the Caribbean

The ADULT female mosquito takes a blood-meal and after digestion of the blood and absorbing the protein, it flies to an appropriate location, lays EGGS in close proximity to water – depending on the species, directly on the water surface, on the sides of a container, or on plants growing in the water. Depending on the species, the eggs may hatch in 1-3 days, producing LARVAE. These larvae may grow in 4 instars (stages) when they cast off their old skins and increase in size. This whole larval stage may take up to 7 days or more, depending on the nutrition and species – it is a phase of feeding and growth for the mosquito. (Figure 5). Larval mosquitoes feed on debris of organic matter and are the identification stage that most people can recognise as the wriggling immature stage of the mosquito This is followed by the PUPA, a comma-shaped phase of the insect. This pupal stage is a resting phase when the adult features of the adult mosquito are developed, and only lasts 1-2 days. Because it only lasts 1-2 days, and thus mortality in this stage is relatively low, detecting and counting the pupae present in any container, is a good indication of the productivity of a container, rather than depend on the counts of the larvae which can last just 7 days to several weeks, depending on the nutrition and species. The ADULT then emerges from the pupa, takes to the wing and flies off to mate and feed; for its food, it takes a blood meal (females), or plant juices (males).

2.3. Identification (ID) of Three common Mosquito Types Because different mosquito types (species) behave and live in a variety of habitats, it is important to identify at least three common mosquito genera types, to understand their biology and thus, formulate strategies for their control. In the discipline of medical (public health) entomology, a system of “keys” has been developed to identify mosquitoes at the species and at the generic levels. These keys are based on anatomical features such as the appearance of:– • The head (the eyes, the antennae, the mouth parts); • The thorax (the wings and venation, the scales on the wings and thorax, the legs and details); • The abdomen – (the shape, the terminal segment, the hairs and scales etc.). However, for identification of general common mosquito types, in the egg, larval, pupal and adult stages of an Anopheles, Aedes or Culex types, the characteristics shown in the attached diagram (Figure 6) will help to identify the mosquito. In addition, pictorial keys for the assistance in identifying specific mosquitoes or other vectors will be referred to. This matter of mosquito identification of the species is in itself a science which requires a fair knowledge of the anatomy of the various species: this with the diversity of mosquito species in some countries makes mosquito identification to be a challenging exercise. The unit 2.4 below on Mosquitoes of the Caribbean demonstrates the diversity of mosquitoes identified from the CMS countries; this indicates that the art of mosquito ID is more detailed and complicated than this simple Figure 6 will permit. However, this is a start.

2.4. Mosquitoes of the Caribbean The great diversity of species of mosquito vectors and potential vectors of disease in CMSs is shown below, so that we may all know how significant is the mosquito potential vector of our region. Most of us only know of three genera – Anopheles, Culex and Aedes, and their potential to transmit diseases that we already know about. In the future, we are likely to hear of exotic sounding new diseases, transmitted by vectors we would not have heard of, if it were not for some of the names in the lists below. And yet, these may well be the potential vectors already in our midst, but unknown to us, which are capable of transmitting these newly imported viruses or other organisms. The skills for actually identifying the “new” species of vectors may not be present in our limited staffs, but we may learn of the identity of the species which is transmitting the organism elsewhere from the international scientific literature. Thus, we may be one jump ahead in identifying the risk for local transmission and its control.

10 Chapter 2: A Review of the Common Mosquito Vectors of Disease in The Caribbean

Figure 6. Identification of generalised Anopheles, Aedes or Culex mosquito types based on Eggs, Larval, Pupal and Adult features

Source: Vector Control – Methods for Use by Individuals and Communities (WHO).

11 A Toolkit on Integrated Mosquito Vector Management for the Caribbean

Table 1. Anguilla

Genus Species Reference Aedes aegypti (Linnaeus) 4 Aedes taeniorhynchus (Wiedemann) 4 Culex bahemensis (Dyar & Knab) 4 Culex quinquefasciatus Say 4 Deinocerites magnus Theobald 4

Table 2. Antigua & Barbuda

Genus Species Reference Aedes aegypti (Linnaeus) 4 Aedes taeniorhynchus (Wiedemann) 4 Aedes tortilis (Theobald) 4 Anopheles albimanus (Wiedemann) 4 Anopheles aquasalis Curry 4 Anopheles argyritarsis Robineau-Desvoidy 4 Culex bahamensis (Dyar & Knab) 4 Culex declarator Dyar & Knab 4 Culex habilitator (Dyar & Knab) 4 Culex nigripalpus (Theobald) 4 Culex quinquefasciatus Say 4 Culex bisulcatus (Coquillett) 4 Deinocerites magnus (Theobald) 4 Psorophora sp near cingulata (Fabricus) 4 Uranotaenia apicalis Theobald 4 Culex atratus (Theobald)

Table 3. Bahamas

Genus Species Reference Aedes aegypti (Linnaeus) 3,6 Aedes albonotatus (Coquillett) 3,6 Aedes bahamensis Berlin 3,6 Aedes condolescens Dyar & Knab 3,6 Aedes obturator Dyar & Knab 3,6 Aedes pertinax Grabham 3,6 Aedes sollicitans (Walker) 3,6 Aedes taeniorhynchus Wiedemann 3,6 Aedes tortilis (Theobald) 3,6 Anopheles albimanus Wiedemann 3,6 Anopheles crucians Wiedemann 3,6 Culex antillummagnorum Dyar 3,6 Culex atratus Theobald 3,6 Culex bahamensis mulrennani Basham 3,6

12 Chapter 2: A Review of the Common Mosquito Vectors of Disease in The Caribbean

Table 3. Bahamas

Genus Species Reference Culex nigripalpus Theobald 3,6 Culex opisthopus Komp 3,6 Culex pilosus (Dyar & Knab) 3,6 Culex quinquefasciatus Say 3,6 Culex scimitar Branch & Seabrook 3,6 Culex sphinx Howard, Dyar & Knab 3,6 Deinocerites cancer Theobald 3,6 Psorophora columbiae Dyar & Knab 3,6 Psorophora johnstonni (Grabham) 3,6 Psorophora ferox (Humboldt) 3,6 Psorophora pygmaea (Theobald) 3,6 Wyeomyia autocratica Dyar & Knab 3,6 Wyeomyia bahama Dyar & Knab 3,6 Uranotaenia lowii Theobald 3,6

Table 4. Barbados

Genus Species Reference Aedes aegypti (Linnaeus) 5 Aedes taeniorhynchus (Wiedemann) 5 Anopheles aquasalis Curry** 5 Culex atratus Theobald 5 Culex inflictus Theobald 5 Culex nigripalpus Theobald 5 Culex quinquefasciatus Say 5 Deinocerites magnus (Theobald) 5 Wyeomyia pertinans (Williston) 5 Anopheles albimanus (Wiedemann) 5** **AB Knudsen (1986); Unpub.

Table 5. Belize

Genus Species Reference Aedeomyia squamipennis (Lyn. & Arr.) 9 Aedes angustivittatus Dyar & Knab 9 Ae bertrami Schick 9 Ae cozumelensis Diaz Najera 9 Ae fulvus (Wiedmann) 9 Ae podographicus Dyar & Knab 9 Ae scapularis (Rondani) 9 Ae serratus (Theobaldi) 9 Ae taeniorhynchus (Wiedmann) 9 Ae terrens (Walker) 9

13 A Toolkit on Integrated Mosquito Vector Management for the Caribbean

Table 5. Belize

Genus Species Reference Ae vexans (Meigen) 9 Anopheles apimacula Dyar & Knab 9 Anopheles argyritarsis Rob. & Des. 9 Anopheles albimanus Wiedmann 9 Anopheles cruicans Wiedmann 9 Anopheles eiseni Coquillett 9 Anopheles neomaculipalpus Curry 9 Anopheles pseudopunctipennis Theobald 9 Anopheles punctimacula Dyar & Knab 9 Anopheles vestipennis Dyar & Knab 9 Chagasia bathana (Dyar) 9 Coquillettidia fasciolator group 9 Coquillettidia nigricans (Coquillett) * Culex aikenii Dyar & Knab 6 Culex chrysonotus Dyar & Knab 9 Culex corniger Theobald 9 Culex coronator Dyar & Knab 9 Culex conservator Dyar & Knab 9 Culex dunni Dyar 9 Culex educator Dyar & Knab 9 Culex erraticus (Dyar & Knab) 9 Culex interrogator Dyar & Knab 9 Culex nigripalpus Theobald 9 Culex opisthopus Komp 9 Culex panocossa Dyar 9 Culex pilosus Dyar & Knab 9 Culex quinquefasciatus Say * Culex sp. Near paracrybda 9 Culex taeniopus group 9 Culex theobaldi (Lutz) * Culex zeteki Dyar 9 Deinocerites cancer Theobald 9 Haemagogus equinus Theobald 9 Haemagogus mesodendatus Komp & Kumm * Limatus asulleptus (Theobald) 9 Limatus durhamii Theobald 9 Mansonia dyari Belk., Hein, & Page 9 Mansonia titillans Walker 9 Mansonia venezuelensis (Theobald) * Psorophora albipes (Theobald) 9 Psorophora champerico (Dyar & Knab) 9

14 Chapter 2: A Review of the Common Mosquito Vectors of Disease in The Caribbean

Table 5. Belize

Genus Species Reference Psorophora ciliata (Fabricius) 9 Psorophora cilipes (Fabricius) 9 Psorophora cingulata (Fabricius) 9 Psorophora cinfinnis (Arribalzaga) 9 Psorophora ferox (Humboldt) 9 Psorophora sp.3 pisces 9 Sabethes chloropterus (Humboldt) 9 Sabethes tarsopus Dyar & Knab 9 Trichoprosopon digitatum (Rondani) * Trichoprosopon magnum (Theobald) * Uranotaenia geometrica (Theobaldi) 9 Uranotaenia lowii Theobald 9 Uranotaenia pulcherrima Lyn. & Arr. 9 Uranotaenia socialis Theobald 9 Wyeomyia ablabes Dyar & Knab 9 Wyeomyia aparonoma Dyar & Knab 9 Wyeomyia arthrostigma (Lutz) 9 Wyeomyia celaenocephala Dyar & Knab 9 Wyeomyia pertinans (Williston) 9 *Beretram, DS (1971)

Table 6. Bermuda

Genus Species Reference Aedes aegypti Linnaeus Tikasingh, ES (1982); Unpub. Aedes albopictus (Skuse) Rawlins, SC (1995); Unpub. Culex salinarius Coq. Bram, R (1967); Unpub.

Table 7. Cayman Islands

Genus Species Reference Aedes aegypti (Linnaeus) 6 Aedes calumnior Belkin, Heinem & Page 2,6 Aedes condolescens Dyar & Knab 2,6 Aedes mediovittatus (Coquillett) 2,6 Aedes sollicitans (Walker) 2,6 Aedes taeniorhynchus (Wiedemann) 2,6 Aedes tortilis (Theobald) 2,6 Anopheles albimanus Wiedemann 2,6 Anopheles atropos Dyar & Knab 2,6 Anopheles grabhamii Theobald 2,6 Culex atratus Theobald 2,6 Culex bahamensis Dyar & Knab 2,6

15 A Toolkit on Integrated Mosquito Vector Management for the Caribbean

Table 7. Cayman Islands

Genus Species Reference Culex chidesteri Dyar 2,6 Culex iolambdis Dyar 2,6 Culex janitor Theobald 2,6 Culex mulrennani Basham 2,6 Culex nigripalpus Theobald 2,6 Culex opisthopus Komp 2,6 Culex quinquefasciatus Say 2,6 Culex sphinx Howard, Dyar & Knab 2,6 Deinocerites cancer Theobald 2,6 Psorophora ciliata (Fabricius) 2,6 Psorophora columbiae (Theobald) 2,6 Psorophora johnstonni (Grabham) 2,6 Psorophora pygmaea (Theobald) 2,6 Uranotaenia lowii Theobald 2,6 Wyeomyia mitchelli (Theobald) 2,6 Wyeomyia vanduzeei Dyar & Knab 2,6

Table 8. Dominica

Genus Species Reference Aedes aegypti (Linnaeus) 5 Aedes buskii (Coquillett) 5 Anopheles argyritarsis Robinson-Desvoidy 5 Anopheles aquasalis (Curry) 5 Culex atratus Theobald 5 Culex bisculatus (Coquillett) 5 Culex declarator (Dyar & Knab) 5 Culex idottus Dyar 5 Culex inflictus Theobald 5 Culex madininensis Senevet 5 Culex nigripalpus Theobald 5 Culex quinquefasciatus Say 5 Culex sp. Near secutor Theobald 5 Deinocerites magnus (Theobald) 5 Limatus durhamii (Theobald) 5 Psorophora ferox (Humboldt) 5 Trichoprospon perturbans (Williston) 5 Wyeomyia grayii Theobald 5 Wyeomyia medioalbipes Lutz 5

16 Chapter 2: A Review of the Common Mosquito Vectors of Disease in The Caribbean

Table 9. Grenada

Genus Species Reference Aedes aegypti (Linnaeus) 5,6 Aedes buskii (Coquillett) 5,6 Aedes phaeonotus Arnell * Aedes taeniorhynchus (Wiedemann) * Anopheles aquasalis Curry * Anopheles argyritarsis Robineau-Desvoidy * Anopheles pseudopunctpennis Theobald * Culex idottus Dyar * Culex immitabilis Dyar & Knab * Culex inflictus Theobald * Culex jocasta Komp & Rozeboom * Culex nigripalpus Theobald * Culex quinquefasciatus Say * Deinocerites magnus (Theobald) 5,6 Haemagogus splendens Williston 5,6 Psorophora sp. Near cingulata (Fabricius) 5,6 Uranotaenia lowii Theobald 5,6 Wyeomyia clasoleuca Dyar & Knab 5,6 Wyeomyia melanocephala Dyar & Knab 5,6 Wyeomyia pertinans Williston 5,6 *Arnell (1976)

Table 10. Guyana

Genus Species Reference Aedeomyia squamipennis Arribalzaga 10 Aedes aegypti (Linnaeus) 10 Aedes arborealis Bonne-Wepster & Bonne 10 Aedes serratus (Theobald) 10 Aedes scapularis (Rondani) ** Aedes taeniorhynchus (Wiedmann) 10 Anopheles aquasalis Curry 10 Anopheles albimanus Wiedmann 10 Anopheles albitarsis Arribalzaga 10 Anopheles apimacula Dyar & Knab 10 Anopheles argyritarsis Robineau-Desvoidy 10 Anopheles bellator Dyar & Knab 10 Anopheles braziliensis (Chagas) 10 Anopheles darlingi Root *** Anopheles evansae Brethes 10 Anopheles intermedius (Peryassu) 10 Anopheles ediopunctatus (Theobald) 10

17 A Toolkit on Integrated Mosquito Vector Management for the Caribbean

Table 10. Guyana

Genus Species Reference Anopheles nimbus (Theobald) 10 Anopheles oswoldoi (Peryassu) 10 Anopheles peryassui Dyar & Knab 10 Anopheles shannoni Davis 10 Anopheles triannulatus (Neiva & Pinto) 10 Chagasia faiardi (Lutz) **** Culex aikenni (Aiken & Row.) 10 Culex accelerans How, Dyar & Knab 10 Culex allostigma How, Dyar & Knab 10 Culex bigoti Bellardi 10 Culex bonneae Dyar & Knab 10 Culex caudelli Dyar & Knab 10 Culex coronator group 10 Culex corniger Theobald ** Culex chryselatus Dyar & Knab 10 Culex declarator group 10 Culex dunni group 10 Culex epirus Aiken 10 Culex erraticus (Dyar & Knab) 10 Culex imitator Theobald 10 Culex mollis (Dyar & Knab) 10 Culex nigripalpus Theobald 10 Culex ocossa Dyar & Knab 10 Culex pilosus (Dyar & Knab) 10 Culex pleuristriatus Theobald ** Culex quinquefasciatus Say 10 Culex stonei Lane & Whitman 10 Culex urichii (Coquillett) 10 Deinocerites magnus (Theobald) 10 Haemagogus albomaculatus Theobald 10 Haemagogus equinus Theobald 10 Limatus asulleptus (Theobald) 10 Limatus durhamii Theobald 10 Mansonia humeralis Dyar & Knab 10 Mansonia titillans (Walker) 10 Orthopodomyia fascipes (Coquillett) 10 Phoniomyia splendida Bonne Wep & Bonne 10 Psorophora ciliata (Fabricius) 10 Psorophora cilipes (Fabricius) 10 Psorophora confinnis (Arribalzaga) 10 Psorophora cyanescens (Coquillett) 10

18 Chapter 2: A Review of the Common Mosquito Vectors of Disease in The Caribbean

Table 10. Guyana

Genus Species Reference Psorophora infinis (Dyar & Knab) 10 Psorophora lutzii (Theobald) 10 Sabethes albiprivus Theobald 10 Sabethes belisarioi Neiva 10 Sabethes bipartes Dyar & Knab 10 Sabethes chloropterus (Humboldt) 10 Sabethes undosus (Coquellett) 10 Trichprosopon frontosum (Theobald) 10 Trichprosopon fluviatilis (Theobald) 10 Trichprosopon longipes (Fabricius) 10 Trichprosopon ulopus (Dyar & Knab) 10 Uranotaenia apicalis Theobald 10 Uranotaenia geometrica Theobald 10 Uranotaenia leucoptera (Theobald) 10 Uranotaenia lowii Theobald 10 Uranotaenia nataliae Arribalzaga 10 Uranotaenia pulcherrima Arribalzaga 10 Uranotaenia socialis Theobald 10 Wyeomyia aphobema Dyar 10 Wyeomyia complosa (Dyar) 10 Wyeomyia flavidacies Edwards 10 Wyeomyia melanocephala Dyar & Knab 10 Wyeomyia moerbista (Dyar & Knab) 10 Wyeomyia occulata Bonne-Wepster & Bonne 10 Wyeomyia pseudopecten group 10 ** Knight and Stone (1977); *** Zavortink (1973); **** Rambajan (1987)

Table 11. Hispaniola (Haiti and The Dominican Republic)

Genus Species Reference Aedes aegypti (Linnaeus) 3 Aedes albonatus (Coquillett) 3 Aedes calumnior Belkin et al. 6 Aedes hemisurus Dyar & Knab 3 Aedes mediovittatus (Coquillett) 3 Aedes pertinax Grabham 3 Aedes sollicitans (Walker) 3 Aedes taeniorhynchus (Wiedemann) 3 Aedes tortilis (Theobald) 3 Anopheles albimanus (Wiedemann) 3 Anopheles crucians Wiedemann) 3 Anopheles grabhamii Theobald 3

19 A Toolkit on Integrated Mosquito Vector Management for the Caribbean

Table 11. Hispaniola (Haiti and The Dominican Republic)

Genus Species Reference Anopheles vestitipennis Dyar & Knab 3 Culex antillummagnorum Dyar 3 Culex atratus Theobald 3 Culex bahamensis Dyar & Knab 3 Culex carcinophilus (Dyar & Knab) 3 Culex corniger Theobald 3 Culex duplicator Dyar & Knab 3 Culex erraticus (Dyar & Knab) 3 Culex habilitator Dyar & Knab 3 Culex iolambdis Dyar 3 Culex janitor Theobald 3 Culex nigripalpus Theobald 3 Culex opisthopus Komp 3 Culex pilosus (Dyar & Knab) 3 Culex secutor Theobald 3 Culex quinquefasciatus Say 3 Deinocerites cancer Theobald 3 Limatus hoffmani Root 6 Mansonia dyari (Belkin, Heinemann & Page) 6 Mansonia flaveola (Coquillett) 6 Mansonia titillans (Walker) 3 Orthopodomyia signifera (Coquillett) 3 Psorophora ferox (Humboldt) 3 Psorophora jamaicensis (Theobald) 3 Psorophora johnstonii (Grabham) 3 Psorophora infinis (Dyar & Knab) 3 Psorophora insularia (Dyar & Knab) 3 Psorophora pygmaea (Theobald) 3 Sabethes bipartes Dyar & Knab 6 Uranotaenia cooki (Root) 6 Uranotaenia lowii Theobald 6 Wyeomyia mitchellii 6 Wyeomyia nigritubus Gal. Carp. & Trap. 6 Wyeomyia sororcula Dyar & Knab 3 Wyeomyia ulocoma (Theobald) 3

Table 12. Jamaica

Genus Species Reference Aedes aegypti (Linnaeus) 6 Aedes auratus Grabham 6 Aedes aurites Theobald 6

20 Chapter 2: A Review of the Common Mosquito Vectors of Disease in The Caribbean

Table 12. Jamaica

Genus Species Reference Aedes calumnior Belkin et al 6 Aedes grabhami Berlin 6 Aedes hemisurus Dyar & Knab 6 Aedes inequalis (Grabham) 6 Aedes mediovittatus (Coquillett) 6 Aedes obturator Dyar & Knab 6 Aedes pertinax Grabham 6 Aedes sollicitans (Walker) 6 Aedes stenei Thompson 6 Aedes taeniorhynchus (Wiedmann) 6 Aedes tortilis (Theobald) 6 Aedes walkeri (Theobald) 6 Anopheles albimanus Wiedmann 6 Anopheles atropos Dyar & Knab 6 Anopheles crucians Wiedmann) 6 Anopheles grabhamii Berlin 6 Anopheles vestitipennis Dyar & Knab 6 Culex arawak Berlin 6 Culex atratus Theobald 6 Culex bahamensis Dyar & Knab 6 Culex chidesteri Dyar 6 Culex corniger Theobald 6 Culex erraticus (Dyar & Knab) 6 Culex inhibitator Dyar & Knab 6 Culex iolambdis Dyar 6 Culex janitor Theobald 6 Culex nigripalpus Theobald 6 Culex opisthopus Komp 6 Culex panocossa Dyar 6 Culex pilosus (Dyar & Knab) 6 Culex quinquefasciatus Say 6 Culex secutor Theobald 6 Coquillettidia nigricans (Coquillett) 6 Deinocerites cancer (Theobald) 6 Limatus hofmani Root 6 Mansonia dyari = indubitans n. Sp. 6 Mansonia titillans (Walker) 6 Psorophora ciliata (Fabricius) 6 Psorophora ferox (Humboldt) 6 Psorophora infinis (Dyar & Knab) 6

21 A Toolkit on Integrated Mosquito Vector Management for the Caribbean

Table 12. Jamaica

Genus Species Reference Psorophora insularia (Dyar & Knab) 6 Psorophora jamaicensis Theobald 6 Psorophora jamaican form 6 Psorophora johnstonii (Grabham) 6 Psorophora pygmaea (Theobald) 6 Wyeomyia atrata Belk., Heine & Page 6 Wyeomyia corona Belk., Heine., & Page 6 Wyeomyia jamaican form A 6 Wyeomyia jamaican form B 6 Wyeomyia juxtahirsuta 6 Wyeomyia hirsuta (Hill & Hill) 6 Wyeomyia luna Belk., Heine, & Page 6 Wyeomyia mitchelli (Theobald) 6 Wyeomyia nigritubus Gal., Carp. & Trap. 6 Wyeomyia stellata Belk., Heine. Page 6 Wyeomyia vanduzeei Dyar & Knab 6 Uranotaenia lowii Theobald 6 Uranotaenia socialis Theobald 6

Table 13. Montserrat

Genus Species Reference Aedes aegypti (Linnaeus) 4 Aedes buskii (Coquillet) 4 Aedes taeniorhynchus (Wiedemann) 4 Aedes tortilis (Theobald) 4 Anopheles albimanus Wiedemann 4 Anopheles argyritarsis Robineau-Desvoidy 4 Anopheles aquasalis Curry 4 Culex atratus Theobald 4 Culex bahamensis Dyar & Knab 4 Culex bisulcatus (Coquillett) 4 Culex declarator Dyar & Knab 4 Culex habilitator Dyar & Knab 4 Culex madininensis Senevet 4 Culex nigripalpus Theobald 4 Culex quinquefasciatus Say 4 Deinocerites magnus (Theobald) 4 Psorophora sp. near cingulata (Fabricius) 4 Wyeomyia gravii Theobald 4

22 Chapter 2: A Review of the Common Mosquito Vectors of Disease in The Caribbean

Table 14a. Nevis

Genus Species Reference Aedes aegypti (Linnaeus) 4,6 Aedes taeniorhynchus (Wiedemann) 4,6 Aedes tortilis (Theobald) 4,6 Anopheles albimanus Wiedemann 4,6 Anopheles aquasalis Curry 4,6 Culex bisulcatus (Coquillett) 4,6 Culex habilitator Dyar & Knab 4,6 Culex madininensis Senevet 4,6 Culex quinquefasciatus Say 4,6 Deinocerites magnus (Theobald) 4,6 Psorophora pygmaea (Theobald) 4,6

Table 14b. St. Kitts

Genus Species Reference Aedes aegypti (Linnaeus) 4,6 Aedes buskii (Coquillett) 4,6 Aedes tarniorhynchus (Wiedemann) 4,6 Aedes tortilis (Theobald) 4,6 Anopheles albimanus Wiedemann ** Culex bahamansis Dyar & Knab 4,6 Culex bisulcatus Coquillett 4,6 Culex declarator Dyar & Knab 4,6 Culex habilitator Dyar & Knab 4,6 Culex madininensis Senevet 4,6 Culex quinquefasciatus Say 4,6 Deinocerites magnus (Theobald) 4,6 Psorophora pygmaea (Theobald) 4,6 **Mohammed, H (2014)

Table 15. St. Lucia

Genus Species Reference Aedes aegypti (Linnaeus) 5,6 Aedes buskii (Coquillett) 5,6 Aedes tarniorhynchus (Wiedemann) 5,6 Aedes tortilis (Theobald) 5,6 Anopheles albimanus Wiedemann * Anopheles aquasalis Curry 5,6 Anopheles argyritarsis Robineau-Desvoidy 5,6 Culex busulcatus (Coquillett) 5,6 Culex conservator Dyar & Knab *

23 A Toolkit on Integrated Mosquito Vector Management for the Caribbean

Table 15. St. Lucia

Genus Species Reference Culex coronator Dyar & Knab 5,6 Culex declarator Dyar & Knab 5,6 Culex idottus Dyar 5,6 Culex inflictus Theobald 5,6 Culex madininensis Senevet 5,6 Culex nigripalpus Theobald 5,6 Culex quinquefasciatus Say 5,6 Deinocerites cancer Theobald * Mansonia titillans (Walker) 5,6 Psorophora sp. Near cingulata (Fabricius) 5,6 Psorophora ferox (Humboldt) 5,6 *Davies, J (1967); Unpub.

Table 16. St. Vincent & The Grenadines

Genus Species Reference Aedes aegypti (Linnaeus) 5,6 Aedes taeniorhynchus (Wiedemann) 5,6 Anopheles argyritarsis Robineau-Desvoidy 5,6 Culex inflictus Theobald 5,6 Culex iocasta Komp & Rozeboom 5,6 Culex nigripalpus Theobald 5,6 Culex quinquefasciatus Say 5,6 Deinocerites magnus (Theobald) 5,6 Haemagogus splendens Williston 5,6 Trichoprosopon pertubans (Williston) 5,6 Wyeomyia aporonoma Dyar & Knab 5,6 Wyeomyia pertinans (Williston) 5,6

Table 17. Suriname

Genus Species Reference Aedomyia squamipennis (Lynch & Arribalzaga) 10 Aedes fulvithorax gp. 10 Aedes scapularis (Rondani) 10 Aedes serratus gp 10 Aedes taeniorhynchus (Wiedemann) 10 Aedes aegypti (Linnaeus) 10 Aedes hortator Dyar & Knab 10 Anopheles mediopunctatus (Theobald) 10 Anopheles aquasalis Curry 10 Anopheles triannulatus (Nieva & Pinto) 10 Anopheles nimbus (Theobald) 10

24 Chapter 2: A Review of the Common Mosquito Vectors of Disease in The Caribbean

Table 17. Suriname

Genus Species Reference Coquillettidia sp. Undetermined 10 Corethrella sp. Undetermined 10 Culex amazonensis (Lutz) 10 Culex urichii (Coquillett) 10 Culex coronator gp 10 Culex mollis Dyar & Knab 10 Culex nigripalpus Theobald 10 Culex quinquefasciatus Say 10 Culex bastagarius Dyar & Knab 10 Culex chrysonotium Dyar & Knab 10 Culex dunni gp. 10 Culex erraticus (Dyar & Knab) 10 Culex ocossa Dyar & Knab 10 Culex pilossus (Dyar & Knab) 10 Culex portesi Senevet & Abonnenc 10 Culex spissipes (Theobald) 10 Culex zeteki gp. 10 Culex chryseletus Dyar & Knab 10 Culex imitator sub. G. 10 Culex pleuristriatus gp. 10 Culex stonei Lane & Whitman 10 Culex sp. 19 near inimitabilis 10 Deinocerites magnus (Theobald) 10 Haemagogus albomaculatus Theobald 10 Haemagogus janthinomys Dyar 10 Limatus asuleptus (Theobald) 10 Limatus durhamii Theobald 10 Mansonia humeralis Dyar & Knab 10 Mansonia indubitans Dyar & Shannon 10 Mansonia pseudotitillans Theobald 10 Mansonia titillans (Walker) 10 Orthopodomyia fascipes (Coquillett) 10 Phoniomyia splendida (B, Wepster & Bonne) 10 Psorophora cingulata gp 10 Psorophora albipes (Theobald) 10 Psorophora ferox (Humboldt) 10 Psorophora sp. 6 near albipes 10 Psorophora cilipes (Fabricius) 10 Sabethes cyaneus gp 10 Toxorhynchites haemorrhoidalis (Fabricius) 10

25 A Toolkit on Integrated Mosquito Vector Management for the Caribbean

Table 17. Suriname

Genus Species Reference Toxorhynchites near superbus 10 Toxorhynchites near moengoensis 10 Trichprosopon longipes (Fabricius) 10 Trichprosopon ulopus (Dyar & Knab) 10 Uranotaenia apicalis Theobald 10 Uranotaenia geometrica Theobald 10 Uranotaenia leucoptera (Theobald) 10 Uranotaenia lowii Theobald 10 Uranotaenia nataliae Theobald 10 Uranotaenia pallidoventer Theobald 10 Uranotaenia pulcherrima Lynch Arribalzaga 10 Wyeomyia melanocephala Dyar & Knab 10 Wyeomyia occulata B. Wepster & Bonne 10 Wyeomyia rorotai gp. 10 Wyeomyia aphobema gp. 10 Wyeomyia complosa (Dyar) 10 Wyeomyia pertinans gp. 10

Table 18a. Tobago

Genus Species Reference Aedes aegypti (Linnaeus) * Aedes berlini Schick 11 Aedes scapularis (Rondani) 11 Aedes serrarus group 11 Aedes taeniorhynchus (Wiedmann) 11 Anopheles apimacula Dyar & Knab 11 Anopheles neomaculipalpus Curry 11 Anopheles aquasalis Curry 11 Corethrella appendiculata Grabham** 11 Corethrella downsi Lane** 11 Culex conservator Dyar & Knab 11 Culex corniger Theobald 11 Culex coronator group 11 Culex declarator group 11 Culex inflictus group 11 Culex mollis Dyar & Knab 11 Culex nigripalpus Dyar & Knab 11 Culex quinquefasciatus Say 11 Culex conspirator Dyar & Knab 11 Culex idottus group 11 Culex lucifugus Komp 11

26 Chapter 2: A Review of the Common Mosquito Vectors of Disease in The Caribbean

Table 18a. Tobago

Genus Species Reference Culex imitator subgroup 11 Culex inimitabilis Dyar & Knab 11 Culex pleuristriatus group 11 Deinocerites magnus (Theobald) 11 Haemagogus celeste Dyar & Knab 11 Haemagogus equinus Theobald 11 Johnbelkinia ulopus (Dyar & Knab) 11 Limatus asulleptus (Theobald) 11 Limatus durhamii Theobald 11 Mansonia titillans (Walker) 11 Phoniomyia trinidadensis (Theobald) 11 Psorophora cingulata group 11 Psorophora ferox (Humboldt) 11 Toxorhynchites montezuma (Dyar & Knab) 11 Toxorhynchites superbus (Dyar & Knab) 11 Trichoprosopron digitatum (Rondini) 11 Uranotaenia lowii Theobald 11 Wyeomyia melanocephala Dyar & Knab 11 Wyeomyia felicia group 11 Wyeomyia pseudopecten group 11 Wyeomyia ulocoma group 11 Wyeomyia sp. Near bourrouli 11 Wyeomyia arthrostigma (Lutz) 11 Wyeomyia ypsipola Dyar 11 Wyeomyia pertinans group 11 **Non-haematophagous. Corethrella sp now recognised by some authors as Fam, Chaoboridae. * Rawlins, S . Unpub

Table 18b. Trinidad

Genus Species Reference Aedeomyia squamipennis Arribalzaga 11 Aedes aegypti (Linnaeus) * Aedes fulvithorax (Lutz) 11 Aedes fulvus (Wiedemann) 11 Aedes hortator Dyar & Knab 11 Aedes insolitus (Coquillett) 11 Aedes ioliota Dyar & Knab 11 Aedes oligopistus Dyar 11 Aedes serratus (Theobald) 11 Aedes sexlineatus (Theobald) 11 Aedes scapularis (Rondani) 11

27 A Toolkit on Integrated Mosquito Vector Management for the Caribbean

Table 18b. Trinidad

Genus Species Reference Anopheles alopha (Peryassu) 11 Anopheles apimacula Dyar & Knab 11 Anopheles aquasalis Curry 11 Anopheles bellator Dyar & Knab 11 Anopheles eiseni Coquillett 11 Anopheles fluminensis Root 11 Anopheles homunculus Komp 11 Anopheles mediopunctatus (Theobald) 11 Anopheles neomaculipalpus Curry 11 Anopheles nimbus (Theobald) 11 Anopheles oswaldoi (Peryassu) 11 Coquillettidia fasciolata (Arribalzaga) 11 Culex accelerans Root 11 Culex amazonensis (Lutz) 11 Culex airosai Lane & Cergueira 11 Culex bastagarius Dyar & Knab 11 Culex brevispinosus Bonn-Wep. & Bonne 11 Culex caudelli (Dyar & Knab) 11 Culex sp. Near chrysonotum 11 Culex comminutor Dyar 11 Culex conservator Dyar & Knab 11 Culex consolator Dyar & Knab 11 Culex conspiritor Dyar & Knab 11 Culex Contei Duret 11 Culex corniger Theobald 11 Culex coronator group 11 Culex crybda Dyar 11 Culex declarator group 11 Culex distinguendus Dyar *** Culex dunni group 11 Culex eastor Dyar 11 Culex elevator Dyar & Knab *** Culex erraticus (Dyar & Knab) 11 Culex evansae Root **** Culex flabellifer Komp *** Culex quadeator Dyar & Knab *** Culex idottus Dyar 11 Culex imitator Theobald **** Culex sp. Near inhibitator 11 Culex inimitabilis Dyar & Knab 11 Culex inflictus group 11

28 Chapter 2: A Review of the Common Mosquito Vectors of Disease in The Caribbean

Table 18b. Trinidad

Genus Species Reference Culex lucifugus Komp 11 Culex maracayensis Evans 11 Culex mollis Dyar & Knab 11 Culex mistura group 11 Culex nicceriensis Bonne-Wep Bonne 11 Culex nigripalpalpus Evans 11 Culex originator Gordon & Evans 11 Culex paganus Evans *** Culex phlogistus Dyar 11 Culex pilosus (Dyar & Knab) 11 Culex pleuristriatus 11 Culex portesi Senevet & Abonnenc 11 Culex puntumayensis Matheson 11 Culex near pulidoi 11 Culex quinquefasciatus Say 11 Culex rabanicola Floch & Abonnenc 11 Culex serratumarge Root 11 Culex simulator Dyar & Knab **** Culex spissipes (Theobald) 11 Culex stonei Lane & Whitman 11 Culex urichii (Coquillett) 11 Culex virgultus Theobald 11 Culex vormerifer Komp *** Culex near xenophobus 11 Culex ybarmis Dyar 11 Culex zeteki Dyar 11 Denocerites magnus Theobald *** Haemaggogus leucocelaenus (Dyar & Shann) 11 Haemaggogus celeste Dyar & nunez Tovar 11 Haemaggogus equinus Theobald 11 Haemaggogus janthinomys Dyar 11 Johnbelkinia ulopus (Dyar & Knab) 11 Limatus asulleptus (Theobald) 11 Limatus durhamii Theobald 11 Limatus flavisetosus De Oliveira Castro *** Lutzomiops sp.1 near davisi 11 Lutzomiops sp. 4 juguiana Lane & Aitken 11 Lutzomiops sp. 5 amazonica Lane & Aitken 11 Lutzomiops sp. 6. 11 Mansonia indubitans Dyar & Shannon 11 Mansonia pseudotitillans (Theobald) 11

29 A Toolkit on Integrated Mosquito Vector Management for the Caribbean

Table 18b. Trinidad

Genus Species Reference Mansonia titillans (Walker) 11 Mansonia sp. D 11 Orthopodomyia fascipes (Coquillett) 11 Phoniomyia incaudata (Root) 11 Phoniomyia splendida Bonne-Wep & Bonne 11 Phoniomyia theobaldi Lane & Cerqueira 11 Phoniomyia trinidadensis (Theobald) 11 Psorophora cingulata group 11 Psorophora albipes (Theobald) 11 Psorophora ferox (Humboldt) 11 Psorophora lutzi (Theobald) 11 Psorophora lineata Humboldt 11 Runchomyia frontosa Theobald 11 Sabethes belisarioi Neiva 11 Sabethes cyaneus (Fabricius) 11 Sabethes imperfectus Bonne-Wepster *** Sabethes undosus (Coquillett) 11 Sabethes chloropterus (Humboldt) 11 Sabethes brasiliensis Lane & Aitken 11 Toxorhynchites iris (Knab)* 11 Toxorhynchites montezuma (Dyar & Knab)* 11 Toxorhynchites superbus (Dyar & Knab)* 11 Trichoprosopon digitatum (Rondani) 11 Trichoprosopon theobaldi Lane & Cerqueira *** Uranotaenia apicalis Theobald 11 Uranotaenia berti Garcia & Rausseo 11 Uranotaenia briseis Dyer 11 Uranotaenia calosomata group *** Uranotaenia coatzocoalcos Dyer & Knab 11 Uranotaenia geometrica Theobald 11 Uranotaenia sp. Near incognita Gal. Blan & Peyton 11 Uranotaenia leucoptera (Theobald) 11 Uranotaenia lowii Theobald 11 Uranotaenia nataliae Lynch 11 Uranotaenia pallidiventer Theobald 11 Uranotaenia pulcherrima Arribalzaga 11 Uranotaenia socialis Theobald 11 Wyeomyia melanocephala Dyer & Knab 11 Wyeomyia inincola Fauran & Pajot 11 Wyeomyia felicia group 11 Wyeomyia kerri Del Ponte & Cerqueira ***

30 Chapter 2: A Review of the Common Mosquito Vectors of Disease in The Caribbean

Table 18b. Trinidad

Genus Species Reference Wyeomyia pseudopecten Dyar & Knab *** Wyeomyia rorotai group 11 Wyeomyia serrata Lutz *** Wyeomyia scotinomous Dyar & Knab **** Wyeomyia ulocoma Theobald **** Wyeomyia near howardi Lane & Cerqueira 11 Wyeomyia near bourrouli Lane & cerqueira 11 Wyeomyia autocratica Dyar & Knab 11 Wyeomyia codiocampa Dyer & Knab 11 Wyeomyia arthrostigma (Lutz) 11 Wyeomyia gausapata Dyar & Knab 11 Wyeomyia pertinans Williston 11 Anopheles triannulatus Neiva & Pinto **** *Non-haematophagous. * Chadee DD (1990) Unpub.; *** Aitken (1984) Unpub.; **** Knight & Stone (1970).

Table 19. Turks and Caicos Islands

Genus Species Reference Aedes aegypti (Linnaeus) (Unpublished) Aedes sollicitans (Walker) (Unpublished) Aedes taeniorhynchus Wiedmann (Unpublished) Culex bahamensis Berlin (Unpublished) Culex quinquefasciatus Say (Unpublished) Deinocerites cancer Theobald (Unpublished) Psorophora pygmaea (Theobald) (Unpublished) Psorophora ciliata (Fabricius) (Unpublished) Psorophora confinnis (Lynch Arribalzaga) (Unpublished) Gosborn (unpub. 1981)

Table 20. Virgin Islands (US & British)

Genus Species Reference Aedes aegypti (Linnaeus) 2,6 Aedes mediovittatus (Coquillett) 2,6 Aedes sollicitans (Walker) * Aedes taeniorhynchus (Wiedemann) 2,6 Aedes tortillis (Theobald) 2,6 Anopheles albimanus Wiedemann 2,6 Anopheles grabhamii Theobald 2,6 Culex antillummagnoum Dyar 2,6 Culex atratus Theobald 2,6 Culex bahamensis Dyar & Knab 2,6

31 A Toolkit on Integrated Mosquito Vector Management for the Caribbean

Table 20. Virgin Islands (US & British)

Genus Species Reference Culex bisulcatus Coquillett 2,6 Culex duplicator Dyar & Knab * Culex erraticus (Dyar & Knab) * Culex habilitator Dyar & Knab 2,6 Culex quinuefasciatus Say 2,6 Deinocerites cancer Theobald 2,6 Deinocerites magnus Theobald 2,6 Mansonia flaveola (Coquillett) 2,6 Psorophora confinnis (Arribalzaga) 2,6 Psorophora jamaicensis Theobald 2,6 Psorophora johnstonni (Grab.) 2,6 Uranotaenia cooki Root 2,6 Uranotaenia lowii Theobald * Uranotaenia sapphirina (Osten-sack) * * Porter (1967)

2.5. Possible Change of Name of Mosquitoes of the Aedes genus In 2004, a publication of Reinert et al. suggested that the Aedini sub genera of the Aedes genus should be upgraded to the generic level. As such Aedes aegypti could then assume the new generic name of its sub-genus and become Stegomyia aegypti, while other previously Aedes spp such as Ae taeniorhynchus could become part of another genus and be Ochlorotatus taeniorhynchus. This new classification had the risk of causing some considerable confusion, in the realm of medical entomology and public health. Fortunately, The Journal of Medical Entomology (ESA, 8th May, 2006) indicated that until further evidence becomes available, it would be appropriate to continue using the traditional terminology to refer to these mosquitoes of public health importance. No additional information has come to the attention of this reviewer.

2.6. Surveillance Methods for Mosquito Vectors The most important vector mosquito in the CMS countries is the DF, Chik V, Zika vector, Aedes aegypti. Consequently most of our discussion on surveillance will centre around this species, though reference to other species surveillance will be alluded to as the need arises. The following is largely an excerpt from the section on “Surveillance” from PAHO’s Publication #548 “Dengue and DHF in the Americas: Guidelines for Prevention and Control”. Mosquito surveillance is used to determine changes in the geographic distribution of the vector, to obtain relative measurements of the vector population over time, and to facilitate appropriate and timely decisions regarding control interventions. It may serve to identify areas of high density infestation or periods of population increases. In areas where the vector is no longer present, entomological surveillance is critical in order to rapidly detect new introductions before they become widespread and difficult to eliminate. Monitoring of insecticide susceptibility of the vector population also should be an integral part of surveillance of any programme that uses insecticides. There are available methods for detecting or monitoring larval and adult populations. The selection of appropriate sampling methods depends on the surveillance objectives, on the levels of infestation, and on the skills available for their implementation (See Table 21).

32 Chapter 2: A Review of the Common Mosquito Vectors of Disease in The Caribbean

Table 21. Aedes aegypti Surveillance Methods

Objectives Methods Larval Human bait Resting Ovitraps Tyre Adult/larval Suscepti- surveys collections collections larvitraps bioassay bility tests

Baseline infestation surveys X

Control programme monitoring: levels >5% X Low infestation levels <5% X X X Surveillance against reinfestation X X X Verification of eradication X X X X Evaluation of control methods* X X X X X X X * Choice depending on intervention used

Source: Dengue and Dengue Hemorrhagic Fever in the Americas: Guidelines for Prevention and Control (PAHO) 1994

2.6.1. Sampling the Larval and Pupal Populations For reasons of practicality and reproducibility, the most common survey methodologies employ larval sampling procedures rather than egg, pupal or adult collections. The basic sampling unit is the house or premises which is systematically searched for water-holding containers. This is the one survey tool that is used in virtually all CMSs in vector control. The containers are examined for the presence of mosquito larvae, pupae, and larval and pupal skins. Depending on the objectives of the survey, the search may be terminated as soon as aedine larvae are found, or may be continued until all containers have been examined. Laboratory examination is usually necessary to confirm the species. The following three indices are commonly used to record Ae aegypti infestation levels:– House (premises) Index (HI): This is the percentage of houses infested with larvae and/or pupae

HI = Number of Infested houses x 100 Total number of Houses inspected

The Container Index (CI): This is the percentage of water-holding containers infested with larvae and/or pupae

CI = Number of Containers positive x 100 Total number of wet containers inspected

The Breteau Index (BI): This is the number of positive containers per 100 houses inspected

BI = The number of positive containers x 100 Total number of houses inspected

The House Index has been used most widely for measuring population levels, but it does not take into account the number of positive containers nor the productivity of those containers. Similarly, the Container index only provides information on the proportion of water-holding containers that are positive.

33 A Toolkit on Integrated Mosquito Vector Management for the Caribbean

The Breteau Index establishes a relationship between positive containers and houses, and is considered to be the most informative, but again, there is no accounting for container productivity. Nevertheless, in the course of gathering the basic information for calculating the Breteau index, it is possible and highly desirable to obtain a profile of the larval habitat characteristics by simultaneously recording the relative abundance of the various container types either as potential or actual sites of mosquito production (e.g. number of positive drums per 100 houses etc.). These data are particularly relevant for focusing larval control efforts on the management or elimination of the most common habitats and for the orientation of educational messages for community-based initiatives. For the selection of appropriate interventions for targeted container management or elimination, it is important to understand from the household resident’s perspective, the significance of the container type. If a population considers a man-made habitat to be “useful” or “essential” (e.g. a rainwater drum or a house plant) the strategy employed will most likely be one of management or modification rather than destruction or removal. For a “useless” or “non-essential” category (e.g. a discarded tyre or abandoned domestic appliance), the option of removal is open. Natural habitats (e.g. rock holes, tree holes or plant axils) constitute a third category that may be subject to either elimination or management.

It should be noted that larval indices are a poor indication of adult production. For example, adult emergence rates from rainwater drums are likely to differ markedly from those for discarded cans or houseplants, yet the larval survey registers them only as positive or negative. The implication is that for localities with similar larval indices but different container profiles, adult densities, hence disease transmission potentials, may be quite different. The rates of recruitment of newly-emerged adults to the adult population from different container types can vary widely. Estimates of relative adult production may be based on pupal counts (i.e. the counting of all Ae aegypti pupae found in each container). The corresponding index is:– Pupal Index (PI): the number of pupae per 100 houses

PI = The total number of pupae x 100 The total number of houses

To compare the relative importance of the immature mosquito habitats, the pupal index in “useful” containers may be compared with the pupal index in “non-essential” containers and “natural” containers. If desired, this may be broken down further by container type, such as pupal index in tyres, flower vases etc. Given the practical difficulties and effort entailed in obtaining accurate pupal counts, especially from large containers, this method need not be used in every survey, but may be reserved for special studies or used once in each locality during the wet season and once during the dry season. Needless to say that identification of the species of mosquito immatures collected in various habitats is extremely important. Even if the observer is convinced that the larva/pupa is one of Ae aegypti, it is advised that samples be collected and taken to the VC centre to be accurately identified for the species. Some habitats such as tyres may be colonised by more than one species such as Culex quinquefasciatus, the vector of lymphatic filariasis, as well as Aedes spp. The inspector thus needs to recognise these, and report appropriately. Surveillance of Other Mosquito larval types: Immature stages of mosquitoes thrive in a diversity of habitats. Thus, understanding and identifying the preferred breeding sites of the various vectors is important. Sampling the various types of water bodies may determine which vectors may be identified.

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This may determine whether an Anopheles type versus a Culex type or an Aedes type of mosquito would be more likely to be found. For example, whether the habitat is sunlit or shady, flowing or stagnant, temporary or permanent may determine the type of mosquito immature that one may detect. Thus, depending on which mosquito is the suspected vector, would determine the habitat (ecology), the frequency and type of sampling to be examined. Better still, by examining a range of mosquito habitat types, one may be more successful in incriminating a potential vector or vectors which may be responsible for VBD transmission. The constraints on resources of time and man-power etc., could be a limitation of habitats that one may be inclined to sample.

2.6.2. Sampling the Adult Population Adult vector sampling procedures can provide valuable data for specific studies such as seasonal population trends, transmission dynamics or evaluation of adulticiding interventions. These adult sampling methods may include:– • Landing/Biting Collections: Both males and females may be collected, using a hand net or aspirator. Rates may be expressed in landing/biting counts per hour. • Resting Collections: Mosquitoes may be collected during resting periods, using a hand net or an aspirator.

2.6.3. Measurement of Oviposition Rates Oviposition traps (or ovitraps) are devices that constitute a sensitive and economical method for detecting the presence of Ae aegypti and Ae albopictus in situations where infestations are light and larval surveys are generally unproductive (e.g. when the Breteau Index is <5). They have proven especially useful for the early detection of new infestations in areas from which the mosquito has been eliminated. They are used extensively for surveillance at international ports of entry which, according to international sanitary codes, should be maintained free of vector breeding. The standard ovitrap is a wide-mouthed pint-sized glass or plastic jar, painted black on the outside, and equipped with a cardboard or wooden paddle clipped vertically to the inside with its rough side facing inwards (the centre of the cup). (See Figure 7) We have found that the use of seed germination (a rough) paper placed on the inside of the cup is even more convenient for use in the ovitrap. The jar is partially filled with water and is appropriately placed in the field.

Figure 7. Diagram of an ovitrap

Source: Timothy D. Deschamps Sr., Central Massachusetts Mosquito Control Project

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Ovitraps are usually serviced on a weekly basis, or even more frequently e.g. 48h interval. After the eggs on the paddle have been counted, the paddles may be cleaned or discarded. Field data for each ovitrap should be recorded, giving the mean number of eggs per trap etc. The “enhanced CDC ovitrap” has yielded significantly more eggs than the ordinary or original version. This has the addition of a “Hay infusion” of about 7 days old. Sometimes an ovitrap with the infusion is paired with one with only 10% of the infusion. This combination seems to be more powerful in attracting female mosquitoes to oviposit. The enhanced ovitrap has been used successfully for monitoring the impact of adulticidal space spraying on adult female populations. We used and found it very useful in evaluating the impact of aerial insecticide spray treatment in the Kingston, Jamaica DF epidemic of 1995.

2.6.4. Tyre Section Larvitraps Tyre sections of various designs have been used for monitoring oviposition activity. However, it is the larvae that emerge from these eggs in the water-filled tyre sections that are counted and monitored over specific units of time, e.g. weekly intervals. They may be useful alternatives to the ovitraps.

2.6.5. Insecticide Susceptibility Testing The initial and continued susceptibility of the vector to insecticides is of fundamental importance for the success of larviciding or adulticiding operations – as part of the Integrated Vector Management (IVM) programme. The development of resistance may lead to control failure unless it is carefully monitored and a timely decision is made to use alternative insecticide or other control strategies. Standard WHO bioassay procedures and kits are available for determining the susceptibility or resistance of mosquito larvae and adults to insecticides. In the past, CAREC/ CARPHA entomology labs routinely performed tests for all CMSs, if eggs from specific regions were supplied. Comparative data showing insecticide sensitivity or resistance for most countries were available. Vector Control units of CMSs may request that CARPHA or PAHO perform such surveillance if they are unable to perform these tests in country. Insecticide resistance to the commonly used larvicide, temephos (Abate) has been demonstrated in virtually all EC countries since 1987, but because Abate is one of the few insecticides recommended for use in potable water, it is still being utilised for treatment of container breeding Ae aegypti. However, as a sample of the surveillance of resistance to temephos, populations of selected EC countries showed the following resistance to this insecticide as reported by Rawlins, (1998):–

Table 22. Fold Resistance to Temephos (Abate) in Selected Eastern Caribbean Countries

Fold Resistance to Temephos Fold Resistance to Temephos Country (in comparison to the reference Country (in comparison to the reference susceptible – CAREC-strain) susceptible – CAREC-strain)

Anguilla 2 – 8.3 St Kitts/Nevis 1.5 – 4.6 Antigua 7.6 – 10.3 St Lucia 5.3 – 17.7 Barbados 2.0 – 2.4 St Vincent 4.1 – 19.4 Dominica 6.8 – 9.6 Tortola 6.3 – 14.8 Grenada 2.0 – 13.6

Resistance to the organophosphate adulticide, malathion, which has been used in Caribbean countries for the last 40 years, in times of emergency such as dengue fever epidemics, was of a much lower order.

36 Chapter 2: A Review of the Common Mosquito Vectors of Disease in The Caribbean

The most recent Caribbean surveillance data on insecticide resistance in mosquito vectors was that of Polson et al. (2010). These findings came from data from laboratory studies on Ae aegypti larvae originating from eight diverse sites in Trinidad and one from Tobago. The mosquito strains were subjected to challenges to organophosphate insecticides:– temephos, fenthion and malathion, using a Centres for Disease Control and Prevention time/ mortality based bioassay method. The results showed that while some of the mosquito strains were still susceptible to malathion and fenthion, resistance to temephos was more widespread and intense in four of the strains, and indeed, all strains were resistant to this long-utilised insecticide, and some were resistant to malathion and fenthion. The data suggested that further selection pressure is taking place risking that this class of insecticides (organophosphates) may be losing their usefulness for this omnipresent mosquito vector. Other insecticide types such as pyrethroids – though not as commonly used as OPs – in the Caribbean were also assayed and showed some level of resistance in some strains of Ae aegypti. This just shows that there is the importance of insecticide resistance surveillance to guide and advise on the usefulness of insecticide usage in IVM.

2.6.6. Sampling Strategies Traditionally, throughout the CMS countries, the practice of sampling for Ae aegypti mosquito infestations is to examine every household and to search for the presence of breeding mosquito places and to eliminate these. But the objective which justifies such intense surveillance is one in which the objective is one of eradication and there is a need to locate every larval focus after infestation levels have been reduced to very low levels (HI=<1.0%); or to verify that eradication has indeed been achieved or to ensure that re-infestation has not occurred. Otherwise, the number of houses to be inspected should be based on consideration of:– • Available resources, • The desired levels of the precision of the results, and • The total number of houses in the locality. As long as surveillance is not necessarily linked to the VC authorities being responsible for the actual treatment of each and every home in the community, several sampling procedures that eliminate the tedious house-to -house inspection can be applied equally well to the selection of premises for larval, adult, ovitrap surveillance or a knowledge, attitude and practices (KAP) survey:– • Systematic sampling: This can be used to sample every “n”th home (house) throughout a community a community or along linear transects through the community. For example, if a sample of 5% of the houses is to be inspected, every 20th house (=100/5) would be inspected. This is a practical option for rapid assessment of infestation levels, especially in areas where there is no house numbering system. It would be important to ensure that all areas of the locality would be well represented. • Simple random sampling. This technique can be utilised when premises (houses) to be selected are obtained from a list of random numbers (either from tables of random numbers in a statistical text book or from a calculator or computer-generated) list. This is a more laborious process, as detailed house maps or lists of street addresses are a prerequisite for identifying the selected houses. Many statistical tests require random sampling. Unfortunately, although every house has an equal chance of being selected, usually some areas of the locality are under-represented and others are over-represented. • Stratified random sampling. This minimises the problem of under- and over-representation by subdividing the localities into sectors or “strata”, usually based on identified risk factors, such as areas with homes without piped water supply, areas not served by sanitation services, and densely-populated areas. A simple random sample is taken from each stratum, the number of houses inspected being in proportion to the number of houses in each stratum (Figure 8).

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• Cluster sampling. This may be conducted in large cities or geographic areas where it may be difficult or impossible to use random or systematic samplings because of limitations of time, money and personnel etc. Here, the sample may be selected in two stages in order to minimise the resources needed for the survey. The first stage is obtained by simple or stratified random sampling of population groups or clusters (e.g. city blocks, villages, administrative districts). • Having identified these clusters, simple or stratified random sampling procedures are again applied to identify the specific houses within each cluster for inclusion in the survey (Figure 9). • Geographical Information Systems (GIS). This involves the use of geographical mapping devices which are already down-loaded and stored on the local VC computers. Mosquito surveillance data previously collected may then be superposed onto these maps, so that high risk areas for vector production may be high-lighted and selected for more frequent sampling and intervention. This is valuable so that a visual presentation of infestation patterns may help in focusing on interventions

Figure 8. Diagram of a Stratified Random Sampling Method System

Figure 9. Diagram of a Cluster Sampling Method System

38 Chapter 2: A Review of the Common Mosquito Vectors of Disease in The Caribbean

2.6.7. Frequency of Sampling The frequency of mosquito sampling in most CMS countries depends on the resources available – that is manpower. For routine surveillance, most VC districts only manage 2-3 cycle of surveillance per year. At best this means a sampling of any locality of just once in about 17 weeks. This also means that several generations of Ae aegypti could have been produced since the last inspection. PAHO recommends that for time-limited, insecticide eradication campaigns with cyclical rounds of treatment every 6-12 weeks, larval evaluation traditionally precedes each application. However, where integrated control programmes are in use, the frequency may be less than this, since biocontrol tools, may be in use and these may last longer periods. If rapid feedback of intervention is required then, more frequent intervals would be necessary. It is for this reason, given the constraints of the limitations of manpower, that statistical sampling procedures which do not involve the visit of every premises, mentioned above, be considered for vector surveillance.

39 A Toolkit on Integrated Mosquito Vector Management for the Caribbean

CHAPTER 3 THE COMMON MOSQUITO VECTOR-BORNE DISEASES IN THE CARIBBEAN REGION

AFTER COMPLETION OF THIS CHAPTER, THE INSECT VECTOR CONTROL OPERATOR SHOULD:

• Have a comprehensive understanding of the diversity of the vector-borne diseases (VBDs) prevalent in the region, and • Appreciate the importance of his/her role in VBD prevention and control through the IVM strategy and practice.

PUBLIC HEALTH ADMINISTRATORS SHOULD:

• Be aware of the dynamics of VBD transmission and control and • Be sensitive to the needs of the various resources that will be required for IVM.

THE LAYMAN (COMMUNITY) WILL BETTER UNDERSTAND THE NEED:

• To collaborate with the public health authorities in the IVM strategy in limiting the range of VBDs that may be transmitted in the peridomestic areas.

40 Chapter 3: The Common Mosquito Vector-Borne Diseases in the Caribbean Region

3.0. Mosquito-Borne Diseases of the Caribbean Countries Because of the large diversity of mosquito vectors in the Caribbean countries, the easy and frequent human access by travel from any one region of the world to another, one may expect to encounter any of the VBDs prevalent in the tropical regions of the world. However, to be realistic, the following are the major more common vector-borne diseases (VBDs) that one may expect to find locally:– • Dengue Fever (DF) transmitted by Aedes aegypti in virtually all countries. • Chikungunya (Chik. V) infection introduced into the Caribbean Region in 2014, and transmitted region-wide in 2015 by Ae aegypti. • Zika virus infection, introduced into the Caribbean in 2015, and also transmitted extensively by the omni- present Ae aegypti. • Malaria transmitted by Anopheles spp. mosquitoes in mainland CARPHA-Member Countries (CMSs) such as Guyana, Suriname, Belize, as well as Haiti and Jamaica (briefly, 2008/9) in addition to Non-CMS country the Dominican Republic (DR). • Yellow Fever (YF), listed by WHO as being endemic in Trinidad, and the South American mainland and transmitted by Haemagogus and Sabethes mosquitoes. (It is noteworthy that there have not been any human cases of YF in Trinidad in the last 30 years. • Lymphatic filariasis, transmitted by Culex and Mansonia titillans mosquitoes, but only confirmed in recent times in mainland CMCs of Guyana and Suriname and the island of Haiti. • West Nile virus infection, transmitted by Culex spp. mosquitoes, may be present in migratory birds. In 2002, there were confirmed infections in birds in Jamaica, DR and Puerto Rico. There were human cases in 2002 in Cayman and the Bahamas, and caged bird and horse infection in Trinidad in 2004.

3.1. How Mosquitoes and other Vectors are essential in the role of Disease Transmission Organisms that cause disease in man have three essential requirements:– • An infectious host (the reservoir) – usually a human being • A vector (transmitter) e.g. a mosquito host • A susceptible (sensitive) host – a human being.

Figure 10. The Three Essential Requirements of Hosts for Disease Transmission by a Vector

41 A Toolkit on Integrated Mosquito Vector Management for the Caribbean

The role of the vector is shown in the diagram above (Figure 10). The mosquito or other vector (usually an invertebrate host) may be a biological or non-biological one. That is, the mosquito usually is infected by the organism, which replicates in the body of the vector, e. g. in the case of dengue fever in Aedes aegypti or malaria in an Anopheles sp. mosquito. Some vectors are potentially transmitters of organisms through mechanical contamination, and are therefore playing the role of a biological syringe, in which the vector itself is not adversely affected by the organism.

Figure 11. Arbovirus Transmission Cycle

Source: Centers for Disease Control and Prevention (CDC)

3.2. Arbovirus Transmission Cycle Organisms such as viruses (arboviruses) may be transmitted from one vertebrate host to another via the infection of an invertebrate host, the mosquito. Transmission may be affected by environmental factors such as weather/ climate, food space and breeding sites availability (Figure 11). This extrinsic cycle may be impacted by weather/climate conditions, which may vary the rate of virus replication (multiplication) in the mosquito host. For example, DF virus may take about 12 day period for replication after an infectious blood meal to the time of an infective bite. But warm environmental conditions – brought on by warming of climate change/variability – may cause the replication process to be completed in a shorter period. Thus, infection – transmitting the virus to a new host may take place in a shorter period of time, increasing the probability of a new infection. Warming may also affect the speed of development of the immature mosquito stages, and affect the transmission rate of viruses in a different way. Thus, the period of oviposition of eggs to emergence of an adult may take less time, but may also produce smaller mosquito adults. These smaller adults may require more frequent blood meals. This may have an epidemiological impact: the more frequent blood meals may thus cause increased risks of transmission of the virus to a new host. Incidental hosts such as livestock and other animals (Figure 11), may sometimes be infected by an infectious mosquito, transmitting a virus from an infected human host. Conversely, viruses adapted to certain animals may be transmitted to man, a zoononosis, once the vector is common to man and the animal (non-human) host.

42 Chapter 3: The Common Mosquito Vector-Borne Diseases in the Caribbean Region

3.3. Dengue Fever in Caribbean Countries Since Dengue Fever (DF) is one of our major VBDs in the Caribbean, it is probably worthy of detailed discussion. DF is a viral disease that is transmitted from an infected to a non-infected person, by the bite of an Aedes aegypti mosquito. The Asian Tiger mosquito Ae albopictus is also a potential vector of this virus, but it is not commonly endemic in the Caribbean. DF is characterised by:– • The sudden onset of Fever with • Headache with • Retro-Orbital Pains • Backache • Loss of Appetite • Muscle and Joint Pain. The incubation period is 3-15 days, usually 3-5 days. By and large, the infection is self-limiting, and the patient infected with one of the 4 Dengue serotypes recovers after being unwell for 10-15 days. (See Figure 12 showing DF Transmission Cycle).

Figure 12. Dengue Fever Transmission Cycle

43 A Toolkit on Integrated Mosquito Vector Management for the Caribbean

Table 23. Laboratory Confirmed Cases of Dengue Fever reported to CARPHA by CMSs for 2015 and 2016

Country Cases reported in 2015 2016 Anguilla – 2 Antigua & Barbuda 14 3 Aruba 131 104 Bahamas 2 1 Barbados 113 429 Belize 245 – BVI 114 – Cayman Is 2 2 Dominica 5 6 Grenada 24 91 Guyana 363 303 Jamaica 12 169 St Lucia 25 80 St Kitts/Nevis 1 – St Martin 9 10 St Vincent/Grenadines 13 7 Turks/Caicos Is. 331 484 a. Countries not reporting:– Haiti; Montserrat; N. Antilles; Suriname; Trinidad/Tobago; Curacao; Bonaire/Saba/St. Eustatius. b. – Indicates no data reported. c. Latest data provided by CARPHA, May 2017.

Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS) are the severe forms of DF that are characterised by bleeding under the skin and internally, which may lead to death as a result of circulatory failure. DHF and DSS may be fatal if not properly monitored and treated under Intensive Care Unit settings. The most recent data reported to CARPHA for DF in CMSs, are shown in Table 23. They show that even with the outbreak of the other Ae aegypti-transmitted disease – Chikungunya Virus Infection (Chik V) in 2015, and of Zika Virus Infection in 2015-2016 – DF was still highly prevalent in most CMSs. All countries in the Caribbean region have in the past suffered from the outbreak of DF, and this has varied from year to year based on the number of factors including:– • The presence of an effective vector mosquito – Aedes aegypti (in all countries). • The presence of an infectious (DF virus infected) host. • The presence of a DF susceptible host to whom the virus could be transmitted. This is usually the case, since while DF virus confers an immunity on its victim, this immunity is only effective for that particular serotype. Since there are 4 different DF serotypes, a person would have had to have been exposed to all DF types to benefit from the total immune protection caused from DF exposure. In addition, travellers from a non-DF environment and babies born since the last outbreak would be susceptible to infection.

44 Chapter 3: The Common Mosquito Vector-Borne Diseases in the Caribbean Region

3.4. Climate Factors Affecting VBDs In some years there are more episodes of DF transmission than other years, and this may be affected by climatic conditions. Dry hot periods such as occur in an El Nino period – as happened in late 2009 and early 2010 in the Caribbean – are not very conducive for mosquito production. However, research has shown that the year after (El Nino +1), when it is wet and warm could be good for mosquito production and virus multiplication in the mosquito and transmission to new susceptible hosts.

Figure 13. Climate Indicators and Dengue Fever

Figure 13 shows the correlation of rainfall, temperatures impacting on mosquito production in the form of the Breteau Index and the resulting DF cases for 2002 to 2004, the last period such data were presented for Trinidad and Tobago (Chen, Chadee and Rawlins, 2005). The pattern which emerged was that there was no significant variation in the monthly temperature data, however, the rainfall pattern showed seasonal variation. Related to this was the variation in the Breteau indices, indicating Ae aegypti changes in abundance with rainfall; this was followed by changes in the numbers of DF cases. Unfortunately, we are not aware of more recent data on Climate variation/change (CV/CC) impacting on mosquito production and DF cases in any Caribbean country. It is important for regional researchers to capture the data on CC/CV impacting on the transmission of arboviral infections in our region. There is much talk about CC and disease, but not much research being executed to confirm these conclusions.

45 A Toolkit on Integrated Mosquito Vector Management for the Caribbean

The IPCC considers that to confirm the cause and effect of CC and health issues, there needs to be a history of about 30 years of data collected to confirm our speculations! The role of the IVM partners is thus very important in DF prevention, since:– • There are no effective treatment for DF virus infection • There are no effective vaccines for prevention of DF virus to a susceptible host, readily available • But the Aedes aegypti vector could be controlled/eliminated at the immature and mature stages of the mosquito!

3.5. Chikungunya Virus Disease The aetiological (infectious) agent for Chik V is an RNA virus that belongs to the Alphavirus genus in the Togaviridae family. The CDC and PAHO (2011) inform us that the attack rate in communities that have been affected in recent epidemics of this virus ranged from 38-63%. While the two major vectors for Chik V are Ae aegypti and Ae albopictus, it is Ae aegypti which is most likely to be the vector in our region, since it is virtually present everywhere in the Caribbean region. As we have mentioned before, the main symptoms of the disease are:– • Fever • Headache • Muscle/Back/Joint pain • Rash • Nausea The Extrinisic cycle involves the mosquito taking an infectious blood meal and acquiring the virus. Following the average extrinsic incubation period of about ten days, the mosquito is then able to transmit the virus to a naïve (susceptible) human host when she takes a new blood meal. In humans, bitten by the infected mosquito, disease symptoms occur after an average Intrinsic incubation period of three to seven days (range 1-12 days).

Figure 14. Extrinsic and Intrinsic Incubation Periods for Chikungunya Virus

Source: Lark L. Coffey, Anna-Bella Failloux, Scott C. Weaver

46 Chapter 3: The Common Mosquito Vector-Borne Diseases in the Caribbean Region

Mosquito feeds/ Mosquito refeeds/ acquires virus transmits virus

Extrinsic Intrinsic incubation incubation period period

ViremiaViremia

0581216202428 DAYS IllnessIllness Human #1 Human #2

Viremia is a blood-borne viral infection Source: CDC, PAHO 2011

Table 24. Laboratory Confirmed Cases of Chikungunya Virus Infection reported to CARPHA for 2015 and 2016

Country Cases Reported in 2015 2016 Anguilla 3 – Antigua/ Barbuda 18 2 Aruba 223 8 Bahamas – 2 BVI 42 14 Dominica – 3 Jamaica – 3 St Kitts/Nevis 3 – St Martin – 3 St Vincent/Grenadines 182 1 Trinidad/Tobago 26 – a. CMSs not reporting data:– Belize; Bermuda; Bonaire/Saba/St. Eustatius; Cayman Is.; Curacao; Grenada; Guyana; Haiti; Montserrat; N. Antilles; St. Lucia; Suriname; Turks/Caicos Is. b. – Indicates no data. c. Latest data provided by CARPHA, May 2017.

3.6. Zika Virus Disease Zika is an RNA virus disease which is spread by Ae aegypti (or Ae albopictus), but the former, so well adapted to life in the tropics is likely to be the major transmitter of the disease in our region. The disease is accompanied by symptoms which last 2-7 days and are:– • Fever • Headache • Conjunctivitis • Malaise • Muscle/Joint/Back Pain

47 A Toolkit on Integrated Mosquito Vector Management for the Caribbean

The disease was shown to be present in virtually every CMS by August 2016 (CARPHA Zika Update #3). Virtually everyone in the Region now knows of the special potential impact on the unborn child with the risk of, microcephaly and congenital anomalies. This makes it a fearsome disease to be acquired during pregnancy. Guillain-Barre Syndrome (GBS) is also reported to be one of the adverse events which accompany Zika virus infection. In the Americas it was first recorded in Brazil by 2015 and by later that year, there was transmission of Zika in Central America and the Caribbean. By August 2016, some 42 countries in the Americas reported locally transmitted cases, and some 20 countries in the CARPHA countries (CARPHA Zika Update, 2016). This quick spread indicates how important the travel industry was in introducing VBD viruses from country to country! By May, 2017, projected losses due to Zika virus infection were enormous. In the US, Zika virus stood to cost the nation billions of dollars! There is an estimate of cost ranging up to $1.2 billions depending on the infection rates in several states in the South – especially the gulf states. We hope that these losses get nowhere these projected estimates! But it just goes to show how great losses could be brought about by a small insect like a mosquito!

Table 25. Laboratory Confirmed Cases of Zika Virus Infection reported to CARPHA for 2015 and 2016

Country Cases reported in 2015 2016 Anguilla – 23 Antigua/Barbuda – 13 Aruba – 30 Bahamas – 25 Barbados 3 25 Bermuda – 5 BVI – 50 Cayman Is. – 1 Dominica – 61 Grenada – 324 Jamaica – 72 St Lucia – 1 St Kitts/Nevis – 26 St. Martin – 170 St. Vincent /Grenadines – 76 Suriname 99 624 a. Countries not reporting data:– Belize; Bonaire/Saba/St. Eustatius; Curacao; Guyana; Haiti; Montserrat; N. Antilles; Trinidad/Tobago; Turks/Caicos Is. b. – Indicates no reported data. c. Latest data provided by CARPHA, May 2017.

48 Chapter 3: The Common Mosquito Vector-Borne Diseases in the Caribbean Region

Figure 15. Zika Virus Fever Transmission

Source: CDC, PLOS, Reuters. Credits: David Foster, Laurie Garrett, Doug Halsey, Gabriella Meltzer

3.7. Malaria

What is Malaria? Malaria is a disease caused by one of four species of Plasmodium – a human blood-borne protozoan parasite:– P vivax, P falciparum, P malariae & P ovale. They all have in common that they are transmitted by the bite of an Anopheles mosquito, of which there are several species in habiting the CMSs, which have varying levels of efficiency as vectors of the disease. Falciparum malaria (endemic in the island of Hispaniola and CMSs mainland countries of Guyana, Suriname and Belize) is the most serious form of the disease, and must be treated promptly, since complications of this disease may prove lethal especially in endemic countries. WHO indicates that there may be as much as 1-2 million deaths due to malaria – especially in children – each year. The Anopheles vector becomes infected by taking an infectious blood meal from a malaria-positive patient, with parasites in peripheral blood. The organisms undergo sexual reproduction and multiplication within the mosquito, which after the incubation period of 12-30 days (depending on the species), the vector becomes infectious, and on biting a susceptible human host, may transmit the disease. There are no vaccines for malaria at this time, so persons travelling to a malaria–endemic country need to be wary of the symptoms of high fever alternating with chills at specific intervals – 36-48hr or 72hr intervals. Chemoprophylaxis starting before the entry into a malarious country is important, bearing in mind that P falciparum in most countries is now resistant to once useful drug such as chloroquine. On returning from a visit to a malarious country, any sign of alternating fever and chills symptoms should be investigated for the disease and treatment be done promptly. We need to beware the re-introduction of the transmission of malaria in the CMS countries as occurred in Jamaica, 10-12 years ago, and took a long period and lots of resources to eliminate the disease once more.

49 A Toolkit on Integrated Mosquito Vector Management for the Caribbean

There is no evidence of current malaria transmission in any of the CMS island countries other than Hispaniola, but in most of them there is the occurrence of the vector, Anopheles spp. It is thus possible that if there were an imported case of malaria and if conditions were appropriate, then transmission of the disease could resume back to what occurred before 1962 - before malaria elimination was successfully achieved. In Hispaniola (by An albimanus) and mainland countries of Guyana and Suriname there is transmission – mainly by Anopheles darlingi – and in Belize probably transmitted by An albimanus. There are occasional reports of limited transmission of malaria in selected other CMSs after the importation of malaria, presumably by an infected malaria patient and transmitted by the local Anopheles mosquitoes – resulting in autochthonous malaria. Fortunately, any occurrences such as these were promptly addressed, and transmission eliminated. Such efforts in terms of patient treatment, and tracing as well as appropriate vector management to eliminate the small focus of infection, has proved to be quite expensive. It underlines the need for active programmes of surveillance and vector management, which will become part of our IVM programme region wide.

Figure 16. Malaria Transmission Cycle

Source: Taina Litwak, USAID VBC Project

50 Chapter 3: The Common Mosquito Vector-Borne Diseases in the Caribbean Region

Table 26. Cases of Imported Malaria reported to CARPHA by CMSs for 2015 and 2016

Country Number of Cases reported 2015 2016 Anguilla 1 – Barbados 1 3 Bermuda 1 1 Cayman Is. 1 – Jamaica 4 1 St Martin 1 – Dominica – 1 St. Lucia – 1 a. – Indicates no data b. Latest data provided by CARPHA, May 2017.

Table 27. Cases of Autochthonous Malaria (native) reported to CARPHA for 2015 and 2016

Countries Cases reported in 2015 2016 Belize 1 – Haiti – – Guyana 2807 – Suriname – – a. – Indicates no data provided. b. Latest data provided by CARPHA, May 2017. c. These data from malaria-endemic CMSs suggest a break-down of the case reporting system – save for the2015 data from Guyana.

3.8 Lymphatic Filariasis Lymphatic filariasis (LF) is included in this section, because although there have not been many recent cases of this disease reported in most CMS countries, the known vectors of LF - Culex quinquefasciatus and Mansonia species are fairly common here. In addition, because visitors from coastal South American and other LF-endemic countries such as Guyana and Suriname, and Hispaniola may visit other CMSs and may be carrying infectious organisms in peripheral blood, such reservoirs could in theory serve to infect the local susceptible mosquitoes. LF is caused by the infection by a nematode worm, Wuchereria bancrofti, which has a nocturnal periodicity of its microfilaria (infectious larvae) occurring in peripheral blood, which coincides well with the biting periodicity of mosquitoes such as Culex quinquefasciatus. The adult parasites occur in lymphatic vessels of man, while female worms produce larvae of the parasite. The mosquitoes on taking a blood meal become infected; larvae develop in the thoracic muscles of the mosquito, mature and migrate as infective stage larvae into the mouthparts of the mosquito and enter the broken skin of the human host, when the mosquito takes a blood meal, and the LF transmission cycle is completed (Figure 17).

51 A Toolkit on Integrated Mosquito Vector Management for the Caribbean

Figure 17. Lymphatic Filariasis Transmission Cycle

Source: Taina Litwak, USAID VBC Project

LF infection may present in human beings with symptoms which range from recurrent fever in the acute phase to chronic features such as swellings in legs (big foot), breasts and the genitalia. To some extent, this disease may be quite disabling. However, in the early stages of the infection, patients with microfilaria (mf) in peripheral blood (infectious) may be asymptomatic. This explains why mosquitoes such as Culex quinquefasciatus which are regarded primarily as nuisance mosquitoes need to be controlled by the IVM partnership teams. Because Cx quinquefasciatus shares habitats with Ae aegypti such as discarded tyres and a variety of other containers, these two mosquitoes will be ideal targets for our IVM programme.

52 Chapter 3: The Common Mosquito Vector-Borne Diseases in the Caribbean Region

3.9. West Nile Virus Infection The West Nile life cycle is included here to familiarise local IVM partners of another risk of native Culex spp may run in spreading exotic foreign infections. West Nile virus (WNV) is found principally in E Africa as the name of the virus suggests. However, about 20 years ago or so, WNV emerged in New York, and more recently, WNV activity was demonstrated in migratory birds in Jamaica, Dominican Republic and Puerto Rico in 2002. The only confirmed human cases in the Caribbean so far occurred in 2002 in Cayman and in the Bahamas.

Figure 18. West Nile Virus Transmission Cycle

Birds are the vertebrate reservoirs of WNV, and most are usually not adversely affected by the virus. However some bird species especially those belonging to the Corvidae family (crows etc.), do succumb to WNV. In 1999 when large numbers of crows died in New York from WNV, there were some 700 human cases, 59 laboratory confirmed cases and 7 deaths in that state. WNV is a flavivirus (like DF) which has an incubation period of 3-12 days. The virus is transmitted via an infective bite by a Culex mosquito, and there may be transovarial transmission from egg to larvae, which means that the virus may be passed from an adult mosquito to her eggs and larvae without the adult mosquito taking an infectious blood meal in that generation. This is another reason why Culex mosquitoes need to be managed.

53 A Toolkit on Integrated Mosquito Vector Management for the Caribbean

3.10. Yellow Fever There has been a reported resurgence of Yellow Fever (YF) transmission in some South American countries, in 2017, and in at least one neighbouring CMS, there has been a reported case of locally acquired (autochthonous) YF.As a result, there is a concern over the risk of resumption of transmission of the disease, especially in countries which currently have the presence of the potential sylvatic vectors well as the urban vector, the infamous Yellow Fever Mosquito – Ae aegypti!

YF Life Cycle Sylvatic YF. Sylvatic or Jungle or Campestral Yellow Fever (YF) has the potential to appear by being imported from endemic countries into an environment in which the appropriate vector exists. In our region, known potential vectors of YF are:– • Haemagogus janthinomys • Hg leucocelanus • Sabethes chloropterus. (Tikasingh et al., 1991). The CMS countries in which potential YF vectors have been recorded are:– • Belize: Sabethes chloropterus • Guyana: S. chloropterus • Suriname: Hg janthinomys • Tobago: Hg leucocelanus • Trinidad: Hg janthinomys; Hg leucocelanus; S. chloropterus. (Rawlins et al. 1990). Emeritus CAREC scientist Dr. Elisha Tikasingh has recently forecast (pers. comm. 2017) that based on the past pattern of the occurrence of YF sylvatic transmission in Trinidadian mosquitoes, 2017/2018 may be the year that YF presents as a threat of reoccurrence of transmission.

Figure 19. Diagram of the Life Cycle of Sylvatic (Jungle) and Urban Yellow Fever

Sylvan Urban cycle cycle

Forest mosquito A aegypti vector

Source: Yan-Jang S Huang, Stephen Higgs, Kate McElroy Horne, Dana L Vanlandingham

54 Chapter 3: The Common Mosquito Vector-Borne Diseases in the Caribbean Region

Urban YF

Ae aegypti, the urban YF vector is present in all CMSs. Urban YF is a rare phenomenon – almost non-existent in modern times in the Caribbean, but it is a distinct possibility. If the YF virus were imported into any urban Caribbean community, the omnipresence of Ae aegypti could facilitate an outbreak of the disease. Thus, if an outbreak of jungle YF occurred and one of the victims – say a wood cutter/charcoal burner, farmer, hunter – made his way to an urban environment where Ae aegypti was prevalent, this mosquito could become infected and in turn, on taking a blood meal transmit the virus to an urban population and thus, a potential start of an epidemic. This is another argument for eliminating Ae aegypti and for preventing the importation of the YF virus into our CMSs. The good news in the case of YF is that there are effective vaccines available to protect communities where YF presents a risk.

55 A Toolkit on Integrated Mosquito Vector Management for the Caribbean

CHAPTER 4 INTEGRATED VECTOR MANAGEMENT: THEORY AND PRACTICE

56 Chapter 4: Integrated Vector Management: Theory and Practice

4.1. MODULE 1: INTRODUCTION TO IVM

EXPECTATIONS

At the end of this module, all partners in the IVM programme will:– 1. Have a basic understanding of the determinant issues involved in VBDs transmission. 2. Be aware of how their own specific attitudes and practices impact on VBDs. 3. How their own roles in an integrated approach in the “Combination of strategies” impact VBD mitigation. 4. Be able and willing to build new partnership with a range of stakeholders/ partners, previously not known to have an interest or to actively participate in management of VBDs. 5. While partners involved in IVM will have different areas of competence, they will all share responsibility for the overall outcome of the IVM programme.

Integrated Vector Management (IVM) is a rational decision-making process to optimise the use of resources for vector control. IVM requires a management approach that improves the efficacy, cost-effectiveness, ecological soundness and sustainability of vector control interventions with the available tools and resources (WHO. 2012a). It is the term applied to the combination of all available methods in the most effective and safe manner to obtain required vector management. The need for effective IVM became apparent since our regular vector control (VC) programmes in the Caribbean maybe focused on a single disease and not fully integrated into the health systems, and thus, may not be easily sustainable; this may occur in an environment where two or more VBDs such as Dengue fever (DF), Chik V, Zika and lymphatic filariasis infections may be co-existing. The different vectors may share habitats and therefore an integrated response could be appropriate. Also, other sectors such as Agriculture, Construction and Communities may not be fully aware of the consequences of their various actions when it comes to vector production. For example, since pesticides may be important tools in fighting disease vectors, the prevalent use of pesticides in agriculture, may unintentionally drive the selection pressure for insecticide resistance in the vector population. Thus, we need to collaborate with all sectors who may have a common interest in the use of the tools that we may need in IVM. The term “Combination” for IVM is used because it is clear that our traditional VC methods of “source reduction” or “insecticide treatments” alone have not worked very well in the Caribbean region. However, there is evidence from our region and elsewhere that appropriate combinations of strategies against a vector such as Ae aegypti and other mosquitoes have resulted in significant reduction in mosquitoes and VBDs. The following are a few examples of how IVM worked against Ae aegypti and other mosquito pests:–

57 A Toolkit on Integrated Mosquito Vector Management for the Caribbean a. In 1981, in Cuba, the virtual elimination of Ae aegypti resulted from a Combination of:– • Source reduction. • Modification of water storage tanks, • Health education • Use of biological and chemical control tools and • Sanctions against offending householders. b. In Fiji in 1978, Ae aegypti and Cx quinquefaqsciatus significant reduction was brought about by:– • Appropriate communication (Health education) for the community • Clean up campaigns for and by the community • House inspections • ULV sprays with malathion • Threat of legal sanctions. c. In Singapore in 1981, premises indices for Ae aegypti were brought from 27.2% own to 1.6% by:– • Provision of mosquito proofing to water tanks of housing settlement • Health education • Strict legal enforcement of sanctions., d. In South Sudan where numerous VBDs such as malaria, African trypanasomiasis (HAT), visceral leishmaniasis, loiasis, onchocerciasis, schistosomiasis etc. abound, Chanda et al (2013) found that the potential for integrating VBD control is enormous if there is:– • Strengthened co-ordination, • Intersectoral collaboration • Institutional and technical capacity for entomological monitoring and evaluation (M&E) • Enforcing appropriate legislation, were crucial. e. In India, Srivastava et al. (2014), reported that public health programmes previously for control of malaria were integrated into an IVM programme, now covering six VBDs:– malaria, DF, Chik V, Japanese encephalitis, visceral leishmaniasis and LF. Strategies were based on parasite control and vector management, proved to be successful in interrupting disease transmission with high coverage. The synchronised and different tools used in the IVM programme with flexible approach was successful rather than the over-reliance on a single intervention of VC. They warned however of later weaknesses due to technology and management issues. f. The WHO in 2016 published “A Toolkit for Integrated Vector Management (IVM) in Sub-Saharan Africa”, which was designed to help national and regional managers to coordinate across sectors, to design and run large IVM programmes. Of course, this applied to a geographical area with immense and diverse challenges of vectors and VBDs, unlike the Caribbean region where our VBDs are currently limited largely to Ae aegypti – transmitted DF, Zika and Chik V diseases and a few other mosquito-borne diseases and other mosquito challenges. But who can tell what VBD challenges lie around the corner, in need of IVM intervention? But the principles of IVM presented in other WHO publications on IVM – WHO (2012) a, b & c are being presented here to encourage the culture of IVM to be adopted and applied in the Caribbean, whenever and wherever VBDs emerge.

58 Chapter 4: Integrated Vector Management: Theory and Practice

The IVM control of one or more VBD (co-endemic) is critical in that it:– • Uses a multiple strategy of a range of interventions and used synergistically. • Relies on multiple partners and sectors of stakeholders, including the private sector for effective participation. • Is based on good sound evidence of local vector biology, disease transmission and morbidity • Uses a public health regulatory framework • Has good management practices. (WHO 2012a) And is different from routine VC which has been reliant on:– • Use of a single intervention tool e.g. insecticides etc. • Is largely a Vertical programme • Is a single disease and intervention focused • Is run solely through the Health sector. The Integrated approach. While in a multi-partner strategy, there should be a single focal person who acts as IVM coordinator, typically, that person should be within the Ministry of Health with responsibility for VC. He or she should have an overview of all IVM-related activities and should have access to each member of the intersectoral steering committee and to the major implementation partners (WHO, 2012c). The IVM strategy calls for collaboration between health and other sectors and civil society The intersectoral committee responsible for IVM should include representatives from:– • The Health Sector, Capable of addressing Disease control as well as Public Health issues • Agriculture Sector, partner who is knowledgeable of Pesticide use and integrated pest management, irrigation and hydropower etc. • Environmental Sector; involved in environmental issues, urban planning etc. • Local government with community involvement • Intersectoral experienced persons for the National IVM and for Interministerial meetings; • Tourism – since this is the major occupation sector in most Caribbean countries, but also contributes to vector proliferation and put people at risk for infection. (Interestingly, the IVM concept was developed from “Integrated Pest Control (IPC)”, with lessons learnt from pest management from the Agricultural sector). Main IVM stakeholders. The primary stakeholders are:– • The communities that will benefit from improved vector-borne disease control, and other entities such as:– • Health, • Agriculture, • Environment, • Commerce, and • Local Government. • Civil society organisations – involved in advocacy

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• Service organisations – Clubs such as Rotary International (local chapters) • Churches • Schools. The interesting issue of IVM is that there is a wide range of stakeholders. As such, an IVM training manual (toolkit) must be aimed at a diverse range of participants and partners and their interests, such as:– • The community level, where we all have a vested interest in good public health, including vector management, to prevent the transmission of disease. • The Vector Management officials of the Ministry of Health and other ministries who will have direct hands-on participation in the control of VBDs. This will include the Vector Control Officer/ Operator (VCO), who will have daily interaction with the householders. • Various administrative partners and functionaries who will become involved in the IVM programme, be it personnel from the Agriculture, Works, Community Development etc. • Academics and students who will have an interest in following the progress of the IVM, if only from a scientific background, though as members of the community, they would already be involved. Our review of the IVM for VBDs in the Caribbean Region will be based on six modules:– 1. An introduction to vectors and disease (VBDs) prevalent in our region 2. Planning and implementation of IVM 3. Organisation and management 4. Policy and Institutional framework 5. Advocacy and Communication 6. Monitoring and Evaluation. The core functions of IVM will in the end affect all of us, but some of our participants will be more impressed by a particular module than others e.g.:–

Core function Field of Competence Module Basic Understanding of Vectors Technical knowledge 1 Epidemiology and Vectors Technical knowledge 2 Local planning and Implementation Analysis & decision-making 2 Implementing health interventions Operational skills 2 Local vector surveillance Technical knowledge 2 Organisation and Management Management 3 Intersectoral partnership established Access, communication 3 Setting strategic direction Planning 4 Advising on policy Policy analysis 4 Advocacy Access, communication 5 Education and awareness Communication 5 Monitoring and Evaluation Technical knowledge 6

60 Chapter 4: Integrated Vector Management: Theory and Practice

4.2. MODULE 2. BASIC INTRODUCTION TO VECTORS OF DISEASE AND IVM

EXPECTATIONS

At the end of this module it is expected that:– 1. All VCO and interested parties such as academics, will have a sound understanding of the issues of vectors and VBDs e.g. the Identification; the Life Cycle; Ecology; potential for disease transmission. 2. For Managers and the General public, a general understanding of these subjects will be obtained.

A range of animal invertebrate hosts can qualify to be called “Vectors of Disease”, being transmitters of pathogens of various sorts – including snail hosts e.g. of schistosomiasis etc. and a vast array of arthropods. For this discussion however, based on our current vector challenges in the Caribbean, we are limiting our reference to arthropod invertebrate hosts, especially to members of the Culicidae – the mosquitoes. Most of the subject for this module – understanding the vectors of disease and the VBDs of our region –have already been dealt with in Chapters 1 & 2. The great diversity of and the number of mosquito species in CMSs have varied depending on country size and location, ranging from some 140 species in countries such as Trinidad (close to the South American mainland) to as little as 4 spp. in the Atlantic CMS of Bermuda. However, the critical presence of the vector that has challenged most countries in the last few years – that of Ae aegypti being omnipresent in the region – is of great significant. This fact requires that IVM for DF, Chik V, Zika and any other VBD which will adversely affect us in the future and will be a high priority for all CMSs. a. Vector Identification. Recognition of a vector mosquito is important since for each species, its behaviour and natural habitat are important tools to be used for its control. In Chapter 2, we have described the characteristics of the main common mosquitoes of each CMS of our region. Also, the species collected in mosquito surveys are recorded. Mosquito control staff have already been trained to distinguish the common species both on adult and on larval (immature) features. In addition, in Chapter 7, we have reviewed some of the non-mosquito vectors and reservoirs of disease that may bring public health challenges to our region and may therefore be subject to the IVM strategy. CARPHA offers a reference and referral service for CMSs, thus in the case of any unusual difficulty in recognition of a sample, it could be sent to CARPHA laboratories for expert determination or other referral service as may be required. b. Vector Life-Cycle. This topic has likewise already been dealt with in Chapter 2. The understanding of the life cycles will help to determine the most likely control strategy for a vector mosquito species. Also, the length of each stage of the life cycle may determine its usefulness as a vector of a particular VBD.

61 A Toolkit on Integrated Mosquito Vector Management for the Caribbean c. Vector Ecology. Vectors live and thrive in ecosystems that provide suitable habitats for breeding and appropriate conditions for feeding on their hosts. In Chapter 2, the commonly preferred habitats of Ae aegypti and strategies for their elimination have been detailed. Since source reduction has been the main control message for this species, knowing and exploiting this could be strategic in managing the vector. For other species however, there are as many micro-habitats as there are species of vectors. For the main three common genera of mosquitoes, the following table summarises, in a very general way, some of the characteristics that the various genera may prefer. In order to manage these species and others, observations will have to be made to identify them and their own preferred habitat. It’s important to note the large diversity of genera and species beyond the three genera mentioned below. Surveillance and ecology of our main DF/Zika and Chik V. vector, Ae aegypti, have been dealt with in detail in Chapter 2 (Surveillance) and Chapter 5 (Environmental Sanitation).

Table 28. Characteristics of breeding sites for three types of common mosquito genera

Characteristic Aedes Culex Anopheles Types of water body Containers Drains/puddles Sunlit pools Permanent or temporary Temp. Temp Temp. Large or small Small Small or large Small/large Flowing or stagnant Stagnant Stagnant/Slow flowing Stag/Slow

Characteristic Aedes Culex Anopheles Clear or turbid Clear/turbid Turbid Clear Sunlit or shady Shady Shady Sunlit Deep or shallow Shallow Shallow Shallow Predators Rarely Rarely Rarely

Adapted from WHO (2012c)

These generalisations for these three genera are so overwhelming, to the point that the vast number of species in a particular genus make them perhaps meaningless, but it just shows the variety of ecotypes and conditions in which immature mosquitoes may thrive. In any one CMS, observations will have to be done to assess the vector potential of one or more mosquito species for any newly introduced VBD pathogen. For example, in the Trinidad records, there are some 55 Culex spp. of mosquitoes (Chapter 2). There will be great diversity of habitats even among the Culex spp; their vector potential is something else. At least, we know that they are there in the event that information emerges that one or more spp. of a particular genus is implicated in disease transmission and that they may be subject to IVM strategy. d. Disease Transmission. The cycle of VBDs involves parasites and or other pathogens, vectors, humans (susceptible or immune) and the environment. Some of the VBDs and their cycles of transmission have been described in Chapter 3. Participants in IVM will learn to understand the cycle of VBDs and the role of the vector. The vector role will differ significantly if the VBD is: • Malaria where the vector, Anopheles spp. is the primary host • Dengue, Chik V., Zika where the vector is Ae aegypti, • Lymphatic filariasis, where the vector is Culex quinquefasciatus or another species such as Mansonia titillans etc. See details in Chapters 2 and 3.

62 Chapter 4: Integrated Vector Management: Theory and Practice

4.3. MODULE 3. PLANNING AND IMPLEMENTATION

EXPECTATIONS

1. All partners and participants – including the general public (community) – are expected to have acquired by the end of this module, a general understanding of the Technical issues – epidemiological, vector issues etc., impacting on the Operational issues such as local determinants of disease. 2. Managers, academics, Senior VCOs and administrators of the IVM programme should have a more advanced (in depth) knowledge of the Technical issues and those of the Operational issues such as local determinants of disease, selection of vector control methods, implementation strategy etc., and how these in turn feed back to re-impact the Technical issues. Topics for discussion will include:– • Background Introduction • Epidemiological assessment • Vector Assessment • Local Determinants of Disease • Selection of VC Methods • Requirements and resources • Implementation Strategy.

Background Introduction WHO (2012a) has advised that in planning for the implementation of the IVM programme, various decisions must be taken; e.g. types of intervention to be undertaken, their targeting and timing, management of resources and stakeholder participation. These decisions need to be based on accurate data and a proper analysis involving both technical and operational issues. The Figure 20, below from WHO (2012c), shows how technical components such as the disease situation – epidemiological, vector assessment and stratification - impact and are impacted by operational issues such as local determinants of disease, selection of vector control methods, implementation strategies etc. This is a dynamic feedback process which must be in constant review.

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Figure 20. Decision Making in IVM

Technical Operational 1. Disease situation • Epidemiological assessment 2. Local determinants • Vector assessment of disease • Stratification

6. Monitoring and 3. Selection of vector evaluation control methods

5. Implementation 4. Needs and strategy resources

Source: Handbook for Integrated Vector Management. Geneva World Health Organization, 2012.

The Epidemiological Assessment Conducting an epidemiological assessment is the first step to be taken – to assess the burden of the disease(s) in the community that we are studying. It is only natural to determine whether the disease issue was worth committing resources to battle the problem. This would help in decision-making in the programme. Essentially, it would be important in the monitoring and evaluation process. The burden of disease could be measured from disease incidence, prevalence and mortality data. These data could be supplemented from information on work days and school days lost. • Active case detection data could come from recording current disease and evidence of pathogens detected; these could come from sentinel surveillance or special studies. For example, during the large dengue fever epidemic in Barbados of 1995, excellent data were collected, which helped to comprehensively define the cost of DF in a Caribbean country. • Passive case information would depend on reports on diagnosis at clinics and hospitals. Because they could be obtained retrospectively, these would be the commonest sort of epidemiological data.

Vector Assessment For Vector control (VC) or IVM, a thorough understanding of the “vector” is essential. Knowing which species could be expected in certain habitats, or knowing when one could expect a surge in blood-meal taking – biting - activity would be important. For the average person in most Caribbean countries, a “mosquito is a vector”. Thus, they do not distinguish between the real vector Ae aegypti and the “nuisance sp” e.g. Ae taeniorhynchus. Thus according to WHO (2012c), the following five questions need to be addressed before implementation of a control strategy could be put into place:– • Which species can be expected to occur in a certain ecosystem? • Are the suspected vectors actually responsible for transmitting disease? • Where and when do vectors breed? • Where and when do they bite and rest? • Are the vectors tolerant or resistant to the available insecticides?

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Vector ecosystem needs to be well understood, in order to incriminate what we perceive as the “vector”, and also to plan for an appropriate intervention. The association of the vector with man in real time and space is essential. E.g. the potential vector of jungle yellow fever in Trinidad, Haemagogus sp would only be effective in transmission of the virus to man, if man intrudes into its jungle habitat, and if the vector were infected with this organism. As indicated in Chapter 3, vectors have preferences for breeding in certain microhabitats. Thus the peridomestic mosquito Ae aegypti is known for its wide range of habitats, but removing these may be a key in limiting the transmission of DF in part of the source reduction component of IVM in Caribbean countries. Also, the timing and preference for feeding on humans rather than on other animals could be critical in establishing its vector status. The insecticide-resistance status of the vector needs to be established and re-evaluated, since there is demand in virtually all CMS for insecticide intervention in periods of transmission risk. Thus, the population needs to know that their confidence is placed in an efficacious chemical and that it is appropriately applied to achieve the required control. Perhaps this assessment could be performed at the national level or through the intervention of CARPHA.

Stratification Because disease and disease risk are not uniformly distributed, but occur in some areas more than in others, it is important to identify the criteria that promote such differences. Stratification refers to classification of disease- endemic areas for identifying the approaches required for disease control. Overlaying of maps with different diseases may help in identifying areas in which several diseases are prevalent. There may be strongly associated issues such as incidence of disease with:– • Some topography such as altitude • Rainfall • Ecosystem But other issues may be involved with enhanced disease occurrence such as:– • Unplanned housing • Need for water storage - thus the risk of abundance of container breeding vectors such as Ae aegypti. Such stratification data may be necessary since they may indicate where an allocation of the national budget may be appropriately placed.

Local Determinants of Disease The epidemiology of vector-borne diseases is complex and depends on a variety of local factors. Those that determine the spread of VBDs are the determinants of the disease. It is important to understand all the determinants of disease so that appropriate actions can be taken to reduce the risk. This will lead to a comprehensive approach to disease prevention. Determinants of disease may be divided into four categories as follows:– • Those related to the pathogen e.g. the various strains of the DF virus • Those related to the vectors – the dominant Ae aegypti or Ae albopictus • Those related to human activities – behavioural and activities that affect transmission. • Those related to the environment – factors in the environment that influence transmission.

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VBD control programmes usually focus on addressing only two categories of determinants: the pathogen and the vector. In contrast, the aim of the IVM strategy is to address all determinants of disease, when possible. If the human and environmental determinants are ignored, people will continue to be at risk, and the vectors will continue to proliferate.

Selection of Vector Control Methods for IVM As indicated in Chapters 2 and 5, Vector control methods can be:– • Environmental • Mechanical • Biological or • Chemical • Control of disease by reducing vector populations or by reducing human-vector contact. To ensure appropriate selection of vector control methods, the advantages and disadvantages of each method in the local context should be appraised, taking into account:– • Effectiveness • Safety • Sustainability and • Affordability. If possible, non-chemical methods and methods that prevent vector breeding should be used, leaving chemical methods as the last resort. This has been the recommendation for DF, Chik V and Zika prevention and control in CMSs. Remember, that the issue of insecticide resistance is an increasing problem in vector control programmes in our region, especially as the choice of insecticides for use in public health is limited. As a special plus for IVM, many control methods are effective against the vectors of more than one disease. Consequently, the complementary effects of VC methods on several diseases should be used and monitored.

Requirements and Resources The resources required to effect IVM, may not be available in the health sector, and other sectors and communities, should contribute and participate in the activities. Here, we are identifying the available human, financial and technical resources at the island/local level. Human and other resources will include:– • Skilled and general staff in the health and other public and private sectors, • Schools, • Civil society organisations and • Community representatives. Financial resources are: • The Government health budgets, • Vector-borne disease control programme committed funds, • Support from other sectors (agriculture, local government, education, construction, private sector, non-governmental organisations (NGOs), and in-kind contributions from communities. • Technical resources include expertise, skills, materials and equipment.

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Determination of requirements and resources require the participation of many sectors, local stakeholders and community representatives. Links should be made with the local programmes or government services in order to coordinate activities, ensure consistency and avoid duplication. As planning and implementation of IVM requires knowledge, skilled people, local capacity-strengthening requirements must be identified, and drafted in as partners in the IVM programme.

Implementation Strategy The implementation strategy will bring together the pieces in the form of an action plan for the country/district / island. The strategy is based on the VC methods selected, with decisions when and where to implement, what to target and who to involve in implementation and evaluation. The participation of stakeholders in preparing the strategy is essential. The strategy should be regularly adapted to changes in local eco-epidemiological or socioeconomic conditions. In order for the strategy to be Monitored and Evaluated (M&E), targets must be set with a schedule and interim goals. There are two types of target: Operational and Impact. Operational targets represent the achievements to be made in the implementation stage of the programme.(E.g. 75% of the people trained or covered by bed nets). They can be monitored separately for each VC method. Impact targets are specific reductions to be achieved in the human impact indicators (e.g. human behaviour, vector density, transmission rate, parasite prevalence, disease morbidity).They are used to evaluate the effectiveness of the IVM strategy as a whole (WHO 2012c).

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4.4. MODULE 4. ORGANISATION AND MANAGEMENT

EXPECTATIONS

By the end of this module, 1. All partners and participants should have a general understanding of Organisation and Management aspects for IVM. 2. Managers and administrators in particular, should have acquired an in depth knowledge of the topics. 3. Local government personnel and the community representatives will be expected to have a significant involvement. 4. Academics, while needing the basic knowledge, may not need to be involved with the details of the management aspects of the IVM programme.

WHO (2012c) has indicated that in order to obtain the desired outcome by efficient and safe use of resources, IVM as a management strategy must involve the integration of:– • A variety of VC methods • Covering a number of diseases • Being executed in association with a diversity of partners. This requires new organisational structures and new roles and responsibilities both within the health sector and its partnership with other sectors and the participation of the communities. This is going to be new for those who have been involved in VC solely as an arm of the Ministry of Health. What is even newer is the suggestion of WHO (2012c) that IVM strategy should be based on the principle that analysis and decision-making should be done at the lowest possible administrative level in order to respond better to local needs. Thus IVM could promote VC and surveillance services into a decentralised health system. This association with the health system would help the sustainability of IVM, as a unit within the Health services, from which there could be access to its regular budget allocations and yet have its flexibility to respond to locally changing circumstances. To establish IVM within the health sector, staff should be trained and there should be strengthened managerial and technical capacities. Thus staff retention and production could be maximised in IVM.

Partnership with other sectors As mentioned before, VC programmes often do not have a link with other relevant sectors such as Agriculture, Local Government, The Environment, Construction and Tourism. But now for the proper establishment of IVM, these sectors will become key partners. WHO (2012c) suggest that these partnerships should be facilitated and coordinated by the health sector. And that in order to make this effective, the partnerships should be initiated at the national level by establishing a policy framework and then an intersectoral steering committee on IVM, with a high-level participation and ministerial support.

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While active partnerships in IVM are needed in particular at the local level, care should be taken to avoid duplication; this could be avoided by regular meetings to discuss progress. As mentioned before, in all this, the health sector should have the overall responsibility for coordination and facilitation of partnerships and for training, monitoring and evaluation. Other sectors, civil society organisations and communities would have roles and responsibilities in their assigned areas of implementation, and also in monitoring and evaluation.

Mobilisation of Resources Because the transformation from a “regular” VC to an IVM system will require significant investments for establishing and maintaining the new structures, initial significant financial planning will be needed in order to get started, and also for recurrent costs. It would be expedient to convince the whole society that a contribution to the IVM represents an investment in the community that we share. Financial resources could be obtained from:– • The Health sector, since IVM will be replacing the already funded VC system. • Additional funding at the national level for budgetary support from sectors other than health; these other sectors may need to be persuaded of the benefits that would accrue due to the reduction of the risks of VBD transmission. • Private Sector and Civil Society contributions. • Economic zones - business zones, plantations, tourist zones, mining zones may also be persuaded to contribute. • Perhaps the community may contribute in kind. • Funding for the proposed IVM system might also be sought from external donors where these are appropriate.

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4.5. MODULE 5. POLICY AND INSTITUTIONAL FRAMEWORK

EXPECTATIONS

At the end of this module, it is expected that:– 1. All partners and participants would have acquired a general understanding of the issues of analysis of the problems of vector control; will see more clearly the scenario of policy environment for IVM, etc. 2. Managers and Administrators – including some with political clout – need to be more heavily involved in the training programme.

Setting up the various approaches for IVM will require substantial changes from the existing system of VC in most CMSs, with implications for political, institutional, managerial, technical and social structures. Thus, there is a need for policy-setting at the outset of initiating an IVM strategy (WHO 2012c; Van Den Berg et al. 2012c). First, one needs to analyse existing problems in vector management. Already we know that these present problems might reduce the efficiency of vector control and may have undesirable side effects etc. The problems which require analysis may include:– • What expertise in vector control currently exists: in the CMS, vector control staff very often are minimally trained of most of the health sector. • What evidence-base is used for decision-making. Again, there is not a strong tradition to use all the body of data collected in vector control surveillance for deciding on VC activities. • Which diseases are targeted: usually our VC staff are used to targeting one VBD at a time, be it Ae aegypti –transmitted DF, Zika e.g. or malaria (in endemic countries). There is now the challenge in IVM to address concurrently, several VBDs in the environment. • How do the activities of other sectors such as agriculture, construction etc. influence vector production and disease transmission. • The various VC methods to be used. Policy Environment for an Integrated Vector Management: As suggested before, IVM should be based within the health sector, but integrated with the other sectors as well. There must thus be appropriate policy to oversee collaboration among sectors and to promote transparency in planning and execution of the programme. The policy tools that the government may use to set up and implement IVM may include:– legislation, regulations, persuasion programmes and health impact assessments. As WHO (2012c) tells us, “Good policies do not necessarily result in good outcomes. To be effective, a policy must be translated into strategies and action plans with budgets, activities and indicators. Furthermore, laws and regulations must be enforced appropriately. Gaps between policy and actual practice should be made apparent in order to be filled.”

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Institutional Arrangements: These are the set of rules for who does what, when and how. Generally, in the public sector there is independence on the way things are done. This might present a problem for the introduction of the IVM programme. Coordination and collaboration among sectors and with research institutes is desirable and could be improved by promoting policy integration, common goals and synergy. There should be partnerships among stakeholders including public and private sectors, research and training agencies and civil organisations. Evidence-based IVM will require certain technical expertise such as that of public health entomologists who are specialised in IVM. For a start, because of the novelty of the IGM discipline, these skills may be rare and hard to find. At the same time, opportunities for higher education and professions and careers in IVM should be fostered or created.

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4.6. MODULE 6. ADVOCACY AND COMMUNICATION

EXPECTATIONS

At the end of this module, it is expected that:– 1. All participants/partners will benefit from a general understanding that having communication tools for IVM is an important resource for change. 2. All partners and participants will feel comfortable in using “social media” in promoting appropriate IVM messages. 3. Policy makers (decision makers), educators etc. will to be involved in advocacy and communication in the support of IVM. 4. VCOs and the community representatives will be able to effectively communicate the message of habitat modification for the IVM fight against the Zika vector and others.

The objective of advocacy is to communicate effectively the aims of IVM at all levels. And since there will be major changes in the IVM strategy from what obtained with vector control, there will be much to be communicated in the health sector, in partnerships with other sectors and in participation of the various communities. For Policy-makers: The strength of the IVM strategy vs. the weaknesses in the VC system have already been reviewed. This case must now be made to the policy-makers and decision-makers – that IVM works and can be much more effective and efficient when compared with the old VC system. The evidence of this in the form of case studies must now be communicated, specifying in an “advocacy package”, what IVM is, the need for IVM, and the evidence that IVM will be beneficial. Communication strategies: Since the community is responsible for the propagation of some VBDs – by their behaviour of permitting vector habitats (e.g. Ae aegypti) to exist in the peridomestic environment – they could be the target in helping to eliminate such habitats. Communication of appropriate messages to the community could be very useful in this regard. In a very real way, responsibility for reduction in vector breeding could be transferred from the health sector to the communities. Communities could be targeted with these messages through the mass media in IVM. In VC, this was already practiced to some extent, but in a minor way. Using the Mass Media to distribute simple messages to the wide audience of the community could be very powerfully strategic in IVM – being part of the “Information, Education and Communication” approach. Based on the principles of marketing, a wide audience could be impacted with simple but effective messages. The current widespread use of “social media” could also spread appropriate messages, tackling a range of VBDs, where communities could be motivated to take whatever is deemed to be necessary action for changes in Knowledge, Action and Practices (KAP) as part of the IVM.

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The health equivalent version of the “Farmer Field School” designed by the FAO, where citizens could meet in the community to discuss common VBDs problems and the appropriate responses to the problems, demonstrated could be very useful part of IVM (WHO 2012c). Community Empowerment: Community participation could be strategic in the IVM effort. The use of the “Carrot or Stick” approach could be useful in empowering the community to become involved in rewarding individuals and communities which eliminate peridomestic vectors and their habitats – the Carrot. The alternative to this is the sanctions in the form of penalising those who fail to eliminate vector habitats in their environment – the Stick. In the Caribbean countries, virtually all have public health regulations which, permit the prosecution of offenders who tolerate vector production in their environment. These could be administered by village or other community councils. This aspect of IVM will thus empower the community to take charge of vector control in their own environment. Advocacy and Communication could be a powerful tool for use in disease prevention especially where the vectors and habitats and behaviour are dependent on us in the community. We could modify the disease transmission patterns with appropriate messages, if we could convince our communities that their Knowledge, Attitude and Practices impact on the transmission of some VBD. “Without Ae aegypti (and Ae albopictus), there is no Dengue, Chik V or Zika Virus infection, if we take appropriate action!”

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4.7. MODULE 7. MONITORING AND EVALUATION

EXPECTATIONS

At the end of this module, it is expected that:– 1. All participants and partners will understand the value of Monitoring and Evaluation (M&E) in the aspect of management for IVM from general aspects of the training. 2. VCOs especially SVCOs, as well as Academics will benefit from a more in depth aspects of the course for measurement of the impact assessment of the interventions. 3. Administrators who will have to justify expenditure for the intervention, need to have an advanced understanding of M&E for IVM.

Monitoring and evaluation (M&E) reveal the achievements and effects of an IVM project (WHO. 2012b). They have two separate but overlapping functions:– • Monitoring refers to the measurement of a programme’s performance – the process – which is done by observing and reporting the activities and their immediate outcomes. • Evaluation, on the other hand is the assessment of the outcomes and impacts that can be attributed to a programme’s activities. Monitoring addresses cause and evaluation addresses effect. All the above units of this Chapter on IVM could be subject to M&E, since they strengthen the participation and learning of a programme’s stakeholders. Figure 21, adapted from WHO (2012c) show three types of indicators which may result from an IVM programme. Process indicators are used to describe the performance of a programme. The outcome indicators are used to describe the direct outcomes of the activities, while impact indicators are used to describe the direct effects which are attributable to the programme. For example, field implementation begins with analysis and decision-making in villages and islands, which result in vector control activities – the process. This affects the vector population, which in turn affects disease transmission. The impact is measured by the effects on prevalence of disease as a result of the pathogen, the morbidity and mortality. The Monitoring process is straight forward enough to measure. After the process of analysis and decision- making with the local partners, the implementation activities of the vector control by participants could be easily measurable. Methods of Evaluation. It may be more challenging to attribute the observed effects to an IVM programme or intervention. As WHO (2012b) suggests, it is difficult to demonstrate convincingly that the observed pattern is an effect (e.g. reduced vector density) or is due to natural variation in the data (e.g. between locations or times).

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Figure 21. Processes & Outcomes in Planning for M&E in IVM

Process or OutcomeImpact

1. Analysis and decision-making 4. Density, period of occurence procedures established and infection rate of vectors

2. Analytical and decision-making 5. Intensity and duration skills of local partners of transmission

3. Evidence-based vector 6. Parasite incidence and control activities prevalence, disease morbidity and mortality

Source: Handbook for Integrated Vector Management. Geneva World Health Organization, 2012.

An experimental method, using a treatment and a similar control site – using similar villages or islands for comparison may prove useful. Treatment in the village of Clifton, on Union Is. (St. Vincent and the Grenadines) for Toxorhynchites montezuma predation studies on Ae aegypti, as opposed to the control village of Ashton on the same island, proved a helpful comparison (Tikasingh, 1990; Rawlins et al, 1990). A Longitudinal evaluation with measurements taken before (baseline) and after the intervention may also be useful. The difference may be attributable to the intervention; however, there is a note of caution. Other factors may have changed (e.g. season, socioeconomic conditions) and thus the observed effects might not be attributable to the intervention alone. A combination of cross-sectional (with and without control) and longitudinal (before and after) designs could be the most robust for an M&E. See Figure 22. With appropriate numbers, this may allow for sufficient statistical analysis of the results.

Figure 22. Schematic Representation of M&E for IVM

I 1. Cross-sectional (with/without) C

2. Longitudinal (before/after) C I

C I 3. Longitudinal-control C C

I, intervention; C, control

Source: WHO 2012c

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Vector Surveillance Disease and Vector Surveillance are important aspects of the IVM strategy. Here, we’ll only deal with the surveillance of the vector. Surveillance with regard to the peridomestic mosquito Ae aegypti has already been dealt with in detail in Chapter 2 and in Chapter 5. Vector surveillance serves two purposes:– • To provide evidence for decision-making in IVM, and • Evaluation of a programme’s impact on vector populations. Vector surveillance can be used for M&E if the surveillance sites are located in or near the implementation sites. Surveillance data may include:– • Species composition • Vector behaviour (resting and biting) • Infectivity rates • Parous rates • Insecticide susceptibility rates etc. Surveillance systems are often concentrated on one disease and one vector. But the IVM strategy may measure vector surveillance of more than one vector, inhabiting the same habitat e.g. the tyre habitat may often be colonised by Ae aegypti and Culex quinquefasciatus (the potential vector of lymphatic filariasis in some Caribbean countries). Thus the IVM surveillance may prove to be a more efficient resource in providing more data for the unit cost of surveillance.

Conclusion This new IVM strategy that incorporates management tools such as:– • Planning and Implementation • Organisation and Management • Policy and Institutional Framework • Advocacy and Communication, as well as • Monitoring and Evaluation, tools, seems destined to be accepted and to succeed in the fight against VBDs in our region, if only because it makes sense by applying required resources unlike the previous VC programme which was starved of these resources and partners. Once the management tools are utilised for IVM, it is clear that we will be assured of a superior outcome in the fight against the VBDs!

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CHAPTER 5 TOOLS FOR VECTOR MANAGEMENT IN THE IVM PROGRAMME

AFTER COMPLETING THIS CHAPTER, THE GENERAL PUBLIC WOULD:

• Have been sensitised as to their role in reducing vector habitats in their environment • Exercise ownership of the IVM programme • Expect and be willing to participate reasonably in the IVM programme • Provide feedback in the Monitoring and Evaluation (M&E) aspect of the IVM programme.

VCOs WILL BE:

• Familiar with the traditional methods and practices used for the management of vectors and the diseases they transmit • Aware of the Integrated strategies for common vectors in the IVM programmes CMS countries • Willing to share with various partners in responding to the vector problem.

ADMINISTRATORS OF THE IVM PROGRAMME WILL:

• Be aware of the integrated strategies for common vectors in the IVM programme of CMS countries • Be able to use best judgment to incorporate appropriate partners to become involved in this IVM programme • Will access appropriate resources for this programme • Will be ready to utilise the mass media to inform the public of their role in this IVM programme.

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5.1. Introduction There is a vast array of tools for “Vector Control”, but there are remarkably poor results in practical vector management, especially against the vectors of diseases which are most prevalent in the Caribbean region e.g. DF, Chik V, Zika. This can prove embarrassing to the VC units of the Ministries of Health, suggesting a state of incompetence or incapability to fulfill the task for which we are employed – in the judgment of non-VC people. In times of outbreaks of VBDs, the criticism is even more severe. But as we have seen in Chapter 4, the key answer should be the use of the IVM strategy. The acceptance of this IVM strategy of vector management where: • All the available VC tools are used in combination in the most efficient and safe manner to achieve an acceptable level of vector/pest production. • The whole community (all stakeholders) accepts some ownership and responsibility for habitat mitigation – and thus VC for peridomestic vectors such as Ae aegypti. There is collaboration within the health sector for IVM • Collaboration with all partners for VC including strategic partners such as Ministries of Agriculture, Works, Education whose functions could impact on the work of the IVM programme. • NGOs who could help promote the vector management programme. • There is an appropriate carrot and stick programme to support IVM: Incentives for communities who do the right things correctly and use of the existing laws and regulations to sanction individuals and communities who encourage and promote vector production. In this Chapter on tools available for Vector Management in our region, we shall focus on the most important vector – that of DF, Chik V and Zika – Ae aegypti. However, we shall also where appropriate make the case for IVM, using the tools for all other vectors of disease and pest species which could be attacked and managed with the same tools and efforts in the IVM programme. As WHO (2012) reminds us, “Many control methods are effective against the vectors of more than one disease. Consequently, the complementary effects of vector control methods on several diseases should be used and monitored.” In Chapter 4, in our discussion on IVM generally, we made reference to some of these tools which we are now detailing here.

5.2. Chemical Control Methods for Common Vectors of Disease Chemicals have been an important part of the armory in the fight against vectors of disease since the early 20th century, and they continue to be utilised against mosquitoes generally, and strategically against Ae aegypti and Chik V, Zika and DF. There is a risk of our over-reliance on these insecticides in the vector fight, especially with the emergence of resistance to some of the insecticides, thus a balanced approach is necessary in utilising chemicals in an Integrated Vector Control (IVM) programme. Some communities interpret the response by the authorities involving the use of insecticides especially a mass response such as a community-wide spray of thermal fogging or ULV application of an adulticide, that surely something great is being done against the vectors and VBDs in the community. This may also be inferred by some communities that the authorities are “taking care of vector issues, therefore there is no further need for our participation”, which is wrong. From the outset, it is hereby being emphasised that any one VC tool is being recommended to be used in association with other tools and with other partners, as may be appropriate, as part of the IVM strategy. Methods available for Insecticide Treatments for Vector Control. To recap, there are three main methods of applying these chemicals against Ae aegypti vectors. These will be reviewed and reference made to the application of these to the management of other vector/pest species that we may need to manage in the public health arena.

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Chemicals are applied as:– • Focal (Larviciding) control of mosquitoes at their production sites • Perifocal treatment of containers, and • Space-spraying operations for adulticiding effect.

5.2.1. Focal Control of Mosquito Production Sites Larviciding or “focal” control of Ae aegypti is usually limited to domestic-use containers which are not disposable or otherwise managed. Three examples of insecticides that are recommended for treating containers that hold potable (drinking) water are:– • One per cent (1%) temephos sand granules (Abate), applied to containers to make a concentration of 1ppm. On average, this dosage can remain effective for 8-12 weeks, but more frequent emptying and filling of treated containers may change the length of effectiveness of this treatment. Temephos has been used in the CMSs for over 40 years and there have been various reports of varying levels of resistance to this insecticide. However, because of its low mammalian toxicity, it has been used even in potable water. • Methoprene (Altosid), the insect growth regulator is used in the form of briquets. • BTI (Bacillus thuringiensis H-14).

Table 29. Recommended dilution rates for Abate (Temephos 1% sand granules)

Water Capacity Quantity of Abate One imperial gallon or less 2gm (a pinch) 20 gal. container 10gm or 1 plastic teaspoon 40 gal. container 20gm or two (2) plastic teaspoons 400 gal. container 200gm or twenty (20) teaspoons

5.2.2. Perifocal Treatment Hand or power sprayers are used to apply wettable powder (WP) or emulsifiable concentrate (EC) formulations of insecticides as peripheral sprays in and around of containers. This will destroy existing and subsequent larval infestations, as well as mosquitoes that frequent the sites. Examples of insecticides used for such an exercise include:– malathion, fenthion, and some pyrethroids such as permethrin and resmethrin. Treatment extends to all containers other than drinking (potable) water containers whether they hold water or not, as long as they are exposed to the elements and are uncovered to permit the entry of both water and mosquitoes for oviposition. The containers are sprayed both externally and internally so that they are completely covered by residue of insecticide. Spraying is also extended to cover any surface area within 60cm (3 ft.) of the container. For application:– • Fill spray can with one and a half litres of water. • Add one ounce (28.4 gm.) of malathion WP 50% or some such suitable insecticide to the can and mix well. • Apply to containers and surrounding areas.

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5.2.3. Space Sprays Space spraying involves the application of small droplets of insecticide into the air in an attempt to kill adult mosquitoes. This method is only recommended for use during the height of an epidemic of disease to reduce the contact of mosquito and man, and to supplement normal mosquito control activity. It is also useful for battling the broods of other pest mosquitoes such as the salt marsh mosquito Ae taeniorhynchus, which emerge in the wet season. There are two main methods of space sprays:– Thermal fogs which are produced by special equipment in which the insecticide, usually mixed in an oil such as diesel is vapourised by injection into a high velocity stream of hot gas (carrier). The oil carrying the insecticide condenses in the form of a fog. Insecticides such as malathion, fenitrothion, fenthion and pyrethroids e.g. permethrin, deltamethrin etc. are used in thermal fogging operations. The machine produces a cloud of hot fine droplets, which remain suspended in the air near ground level, drifting through areas inhabited by adult mosquitoes. Mosquito death is by contact only. Thermal fogs should be applied only when weather conditions are favourable for allowing the insecticidal fog to remain close to the ground; in particular when the wind speed is low – about six (6) km/hr. and when the mosquito is most active. Generally, for Ae aegypti control, the early evening and early morning are best suited. The malathion solutions used by most mosquito control Divisions in the CMS countries is usually a five percent (5%) spray. The fog may be applied from a portable hand-held device or from a truck-mounted spray machine. For application:–

To make a four hundred (400) litres of finished fog solution 5% spray using malathion 96% TG (technical grade):– • Fill the mixing tank with three hundred and eighty three (383) litres of diesel oil (the carrier). • Add seventeen (17) litres of malathion (96% TG) to the mixing tank. • Mix until the solution is clear. • Use as required. Ultra-low volume (ULV) aerosols (cold fog) and mist, involve the application of a small quantity of concentrated liquid insecticide. Usually, less than 4.6 litres/ha (0.5 gall./acre), is considered as ULV application. Organophosphorous insecticides such as malathion, fenitrothion as well as pyrethroids such as permethrin, deltamethrin, cypermethrin etc. are used as ULV. (Pl see the following section for practical advice on guidelines for adulticide spraying operations). These insecticides are applied as:– • House-to-house Applications using Portable Equipment. When the area to be treated is not very large or in areas where vehicle-mounted equipment cannot be used, portable back- pack spray can be used to apply insecticidal mists. • Street Applications using Vehicle-mounted Equipment. Vehicle-mounted generators can be used in urban areas with a good road system. One machine could cover up to 1,500- 2,000 houses (approx. 80 ha) per day. As mentioned above, ULV and thermal fogging have been used by some health authorities and the private sector to fight the occurrence of pest mosquitoes such as Ae taeniorhynchus and Ae sollicitans, especially at the height of the wet season when there are broods of mosquitoes. Often this is done as a response to requests of the local community, but also the tourist industry.

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• Aerial application. Aerial spraying can be used in emergency situations when an extensive area must be treated in a short time. E.g. during the dengue epidemic in Jamaica, 1995, aerial sprays of the Kingston and St Andrew area with malathion (220 ml to 440 ml/ha) helped to bring this epidemic to an end. However, the costs of such large scale treatment and the impact on non-target animals such as bees in the apiary business must be taken into consideration. During the recent Chik V and Zika outbreaks in various CMSs, there were strident calls by some members of the community – including some politicians - for the use of this tool by the authorities for bringing about an end of the epidemic. ULV offers the following advantages:– • It eliminates the use of diesel fuel. • It reduces insecticide cost – usually less insecticide. • Reduces labour cost. • It eliminates dense fogs that obscure visibility. Precautions. Daily, after work, the operator must wash his pump and other equipment, inside and outside. The nozzle deserves special care and should be cleaned with air pressure, but never with pins, needles or wires. The movable parts of the pump must always be kept lubricated with a suitable oil.

5.2.4. Safety All workers must have knowledge of the chemicals being used, hence Material Safety Data Sheets must be available and accessible for all chemicals used. Cholinesterase testing should be done once or twice per year on operators to ensure their health and safety is maintained.

Operating Guidelines • Avoid contact with the insecticide on any part of the body or skin. • Avoid inhalation of the insecticide at all times. Use respirators. • When applying any insecticide, never stand downwind from area of application. • Do not smoke, eat, drink, chew gum or bite nails when applying insecticides. • Wash hands thoroughly after applying insecticides, before eating, smoking etc. • Bathe and change clothes as soon as possible on completion of the day’s work. • Protective clothing (coveralls, gloves etc.) used when applying insecticide should be washed after use. • Report any occurrence of blurred vision, or excessive watering of the mouth to the Supervisor, and seek medical attention at the nearest health facility. All insecticides are toxic to varying degrees and must be handled with care. The announcement made on the regional aircraft of “We’re spraying the cabin with a non-toxic pesticide” is nonsensical! However, at the dilutions used by the VC unit, the insecticides can be considered safe once all the precautions are taken, and they should have no ill-effects on the health of persons of any age. If the spray accidentally gets into the eyes, they should be washed out immediately with clean water; if it gets on the skin, it should be washed off with soap and water.

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Covering Drums and Barrels with Potable Water These and other containers with potable water should be covered, and re-covered after opening to take water, to prevent the entry of gravid (mature and ready to lay eggs) mosquitoes, seeking an oviposition site. The householder should be informed as to the importance of keeping these habitats covered. Containers already treated with mosquito fish for control of mosquitoes do not need to be treated with insecticides. Also, any insecticide treatment in the vicinity of beehives should only be done with great caution, since bees generally, are very sensitive to insecticides used for mosquito control. Containers used for feeding and watering animals should not be insecticide-treated, (except when they are found to be habitats for mosquitoes). The householders should be requested to empty and clean these food/water trays daily.

5.2.5. Residual Spraying Residual Spraying involves the coating of walls and other surfaces of buildings with insecticides that have long-lasting (residual) activity. It is done by using a pump spray can, e.g. the Hudson eight (8) gallon can. The pump spray produces an air mass promoting liquid spray droplets. Residual spray deposits may remain active for several weeks. The duration of activity is dependant on the insecticide used, as well environmental factors such as temperature and exposure to sunlight. For Anopheles and Culex mosquitoes it is applied to entire wall surfaces of buildings using an upward and downward motion of the hand while spraying. Such treatments using organochlorine insecticides were of strategic use in the successful fight against malaria in the 1950s in the Caribbean. For Ae aegypti mosquitoes, organophosphate residual insecticides may be applied to dark areas and the under surfaces of furniture and the lower areas of walls. Although malaria has been eliminated in most Caribbean countries, residual sprays are done as part of the disease control programmes for malaria (in the event of an imported case).

5.2.6 Environmental Sanitation (ES) Householders must be encouraged to regularly clean and grade drains in their yards so as to ensure that water does not collect and provide breeding grounds for mosquitoes. Similarly, public drains with stagnant water must be reported to the local authority for remedial action. The householder must be made aware of his/her part in ES in the form of elimination of potential habitats of mosquitoes. This collaboration with the public health sector must be emphasised as being mutually beneficial. Thus, source reduction – elimination of all disposable mosquito habitats – should become a number one priority for the householder.

Promotion of ES The Environmental Health Department is an essential partner in the IVM strategy as is the householder. The VCOs should be involved in householder education for the control of mosquito vectors of disease – especially the DF vector Ae aegypti. Special programmes of sensitising the population as to the mosquito risk of disease transmission should be launched with the aim of incorporation the community involvement in mosquito production prevention and control.

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5.2.7. Carrot and Stick approach The Carrot. A system of incentives should be designed to reward communities which are diligent in eliminating mosquito production habitats in the communities. In building this awareness, the younger members of the community – school children – are likely to be more willing to participate in such activities. Rewards and recognition should be given to community active groups such as schools, localities etc. which prove to be responsible in eliminating mosquito habitats; though this will be its own reward. Awarding prizes will be of further advantage in the sense that these ES activities are positive and commendable community activities, which may be extended into other aspects of public health in the community. The Stick. Virtually all EC countries have public health laws which should be used to sanction communities and individuals which contaminate the environment such as create mosquito production habitats. Enforcement of such public health laws by the prosecution of a few persons – as a last resort after verbal and written complaints could help to make the individual and the community take seriously the issue of ES for the prevention of VBDs and nuisance mosquitoes breeding in our communities. To enforce such sanctions, the SVCO, EHO and CEHO of the Ministry of Health will need to be involved.

5.3. Biological Control Methods The use of living organisms as an intervention tool in the fight against mosquito vectors is an attractive component of IVM. This involves the introduction of living organisms that will prey upon, parasitise, compete with or otherwise reduce the abundance of the vector population. Unfortunately, most use of biocontrol tools remain mostly experimental, but there are a few – including larvivorous fish and the use of Bacillus thuringiensis H-14 (BTI) – that are most frequently employed, as well as some predaceous copepods (water fleas) which have also been used routinely. The advantage of biocontrol tools include the absence of chemical contamination (as for a pesticide), and self dispersion by certain of these agents. The disadvantages may include the expense in rearing these agents. Also, some of these agents may be given bad publicity since after the reduction in the larval stages of the vector, there may not have had immediate result in a reduction of disease transmission. Fish. Larvivorous fish have been used to eliminate Ae aegypti larvae from a variety of containers, ranging from the drum to the cistern environment. In the CMS countries, Poecilia spp. and Gambusia affinis have been effective in controlling Ae aegypti. Poecilia reticulata has been used very commonly and in some VC centres there are stock populations from which supplies are made to the community on demand. The observation made in some cistern, habitats is “Where there is no presence of guppies there is Ae aegypti; where there are guppies there are no mosquitoes”. This biocontrol tool can be recommended further for this type of habitat.

Figure 23. Larvivorous fish – the Guppy Mosquito Fish (Poecilia. Spp.) and Gambusia affinis

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Source: Illustrations: Vector Control Methods for Individuals and Communities (WHO); Photos: Gambusia affinis: Megan Gibbons, Birmingham-Southern College; oeciliaP spp.: Mich de Mey

Toxorhynchites spp. This large larvivorous mosquito (in the larval stage) lives in similar habitats as Ae aegypti and feeds on larvae of this species. Since it acquires its protein requirement in the larval stage, it does not take a blood meal in the adult stage (and its mouthparts are not adapted for this either, but for sucking plant juices). In Trinidad and Union Is., (St Vincent and the Grenadines), we demonstrated the ability of T montezuma to control Ae aegypti when introduced into Ae aegypti habitats, but in the dry urban environment, there was no evidence that populations were self sustaining.

Figure 24. Toxorhynchites spp.

Source: 1. © Lynn Bergen; 2. Food & Environmental Hygiene Department, Government of Hong Kong; 3. Omar Fahmy

Copepods, are small crustaceans (water fleas) which may be predatory on early stages of mosquito larvae – especially Ae aegypti. The use of local strains of Macrocyclops albidus in habitats of Ae aegypti was demonstrated in Trinidad, suppressing the mosquito survival over several months even though fresh mosquito 1st instar larvae were added to the Macrocyclops habitat weekly. This is a potentially useful biocontrol tool which could be used in the drum and cistern habitats, especially that they cannot be seen with the naked eye and discarded by the discriminating householders. Thus this is an attractive alternative to some community members who refuse mosquito fish which some of them insist brings a “fishy” taste to the water!. The disadvantage of the use of copepods is that there is a need for scientific expertise for the selection of native strains of the predator.

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Figure 25. Copepod (Macrocyclops albidus)

Source: Environmental Protection Agency, US Government; Gerald Marten

Bacteria. Bacillus thuringiensis H-14 (BTI) is sold commercially under trade names such as Teknar, Vectobac and Bactimos, and can be bought for large scale use of the product. Weekly treatment of the product may be necessary, thus, there is some expense. BTI may also be sold in briquette forms, and this may be suitable for potable water usage. BTI is a proven adjunct to a dengue control programme. Bacillus sphaericus, another bacterial larvicide is effective against Culex mosquitoes, but is not recommended against Ae aegypti.

Figure 26. Bacillus thuringiensis

Source: PR Johnston and Jim Buckman

5.4. Environmental Control Methods Environmental Management is any change in the environment that prevents or minimises vector propagation or man-vector-pathogen contact, and is an important component of the IVM programme. WHO has defined three kinds of environmental management:–

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• Environmental modification: long-lasting physical transformations to vector habitat, such as improved delivery of potable water in the case of Ae aegypti. • Environmental manipulation: temporary changes to vector habitat involves the management (covering, protecting) of “essential” containers; proper storage, recycling or disposal of “nonessential“ containers; and management or removal of “natural” breeding sites. • Changes to human habitation or behaviour: efforts to reduce man-vector-pathogen contact, such as screening of windows and use of mosquito nets and repellents. The main environmental methods used to control Ae aegypti and Ae albopictus and reduce man-vector contact are naturalistic methods:– • Improvement of water supply, • Solid waste management, • Modification of man-made breeding sites, • Improved house design and • Personal protection. Improved Water Supply and Storage, is key for the control of Ae aegypti in most of our CMS countries. Water storage systems can be designed to prevent Ae aegypti oviposition and emergence. For example, a mosquito- proof rainwater collection and storage container could be made of high-density polythene plastic, with a fiberglass screen in the lid that allows rainwater to enter but prevent adult mosquitoes from entering and exiting. Storage tanks, drums and jars should be covered with tight lids or screens. The use of expanded polystyrene beads in pit toilets or other water holding containers could be useful for the control of Culex quinquefasciatus or other mosquitoes. The floating beads form a physical layer at the top and prevent mosquitoes from emerging or from oviposition since they can’t get to the water surface. In some situations, the beads have also proved useful against Ae aegypti in Trinidad, where stored water is drawn from below and not dipped from above (Figure 27).

Figure 27. Diagram of a Water Tank protected with Polystyrene beads to prevent mosquito access to water

Source: WHO

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5.5. Environmental Sanitation for Zika, Chik V and DF control Environmental management as part of IVM should:– • Focus on those man-made containers and natural breeding sites that produce the greatest number of adult Aedes in each community. These containers could be targeted for destruction. • Modify human behaviour through health education and public health communication in order to reduce the number of breeding sites by the community. • Community participation in the planning, execution and evaluation of container management programmes is a necessary prerequisite for a successful environmental management programme.

5.6. Solid Waste Management With regard to the environmental management of Ae aegypti, since it is a peridomestic species, its control will involve environmental sanitation (ES). Thus control will involve the householder, for search and destroy efforts. It will also involve the VCO for inspection and advice in appropriate sanitation practices. It will also involve the community for promotion of incentives for communities controlling the vector and public health authorities using sanctions for communities which persistently produce vectors. Ae aegypti is a highly domesticated mosquito which breeds mainly in clean, clear water. Its larvae are almost always found in artificial containers – such as drums, buckets tyres etc. - in and around human habitations. They are also found in natural containers such as coconut shells, leaf axils, tree holes, rock holes etc. Thus all containers that can hold water, should be considered as potential breeding places for these mosquitoes. (See Figure 31). showing the variety of breeding places for Ae aegypti). On the other hand, Culex mosquitoes are less particular about the quality of water in which they breed, As a result, the common Culex quinquefasciatus mosquito is often found in drains and water bodies contaminated with organic materials. However, it is often possible to detect both species of mosquitoes co-habiting in the same container, such as discarded tyres.

Elimination of Mosquito Breeding Places This activity of elimination of the mosquito breeding places is intricately linked to the surveillance activity which has already been reviewed in the section on Surveillance (Chapter 2, Chapter 4.). Also, in Chapter 6, (in work of the VCO), the concept of “Search and Destroy” of vector habitats has been shown to be an essential part of the Environmental Sanitation (ES) strategy. Integrated Vector Management efforts employing solid waste management may protect public health and conserve natural resources. Proper collection, storage and disposal of solid wastes and that involve waste reduction, recycling and reuse of items which are potential mosquito production habitats are strategic. Items such as:– • Used tyres • Old vehicle bodies • White goods (old fridges, utilities etc.) • Plastic containers These should be scrapped, compressed and exported in the scrap form. e.g. in some islands, a business has been developed of compressing used tyres and exporting these to countries where the used rubber could be utilised for a variety of purposes. There may be a cost to this operation. Tyres which cannot be exported could be shredded locally to prevent them holding water and thus be a mosquito habitat.

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Alternatively, they may be treated with insecticides, salt or soap for chemical control of immature mosquitoes. The same has been done with scrap metal. The following three photos (Figs. 28 a, b & c) show part of a solid waste facility in Anguilla where waste (scrap) metal – such as discarded vehicle bodies is stock-piled, compressed and stored for export for recycling purposes.

Figure 28a. Scrap metal pile (potential vector habitats) before being compacted (Anguilla)

Figure 28b. Compacting machinery at work

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Figure 28c. Body of a motor car after compaction

Source: Mr. Leroy Richardson, SEHO, Anguilla

5.7. Personal Protection The use of insecticide-impregnated materials such as pyrethroid- impregnated bed nets, curtains are being used to protect against malaria mosquitoes, Anopheles, and have proven to be very successful in malaria-endemic areas. Against Aedes spp. which are day-time biters, there are some recommendations for the use of bed nets, especially for the protection of babies, the sick and the elderly who may need to rest during the day time. However, for the average adult who does not sleep in the daytime, use of impregnated bed nets against Aedes spp. of mosquitoes may seem to have limited value. Perhaps windows and doors fitted with a fine anti-mosquito mesh would be more effective. Also, the use of air conditioning when the doors and windows are closed could be efficacious in reducing the mosquito/person contact. For the fight against night-biting spp such as Culex spp and Aedes and other mosquitoes – e.g. Ae taeniorhynchus, a nuisance biter just around dusk in some places, the use of repellents is recommended. Repellents such as DEET in the form of skin sprays, or saturated anklets, wristlets headbands and detachable patches placed on the exterior clothing have proved very useful in warding off mosquito bites. Mosquito aerosol sprays (bombs) are used throughout the region, with some confidence by the community and apparently success.

5.8. Integrated Vector Management in VBD Emergency Situations “Emergency situations” refers to epidemic conditions in which there is an outbreak of disease and transmission beyond levels of normal occurrence.“ Management” speaks principally to the integrated control of the vector population to reduce it to the point that the disease transmission locally could be suppressed. However, clinical management of the disease would have been initiated by the information gathered by the VCO on the interaction with the community and transmitted upward in the MOH to all necessary partners.

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Emergency vector management involves any tool that can impact on a rapid reduction of the vector population which could in turn result in disease suppression. These measures could include:– • Chemical (insecticidal) control of immature (larvicidal) and adult (adulticidal) stages of the vector • Environmental manipulation (source reduction) • Other physical control measures (e.g. drum covers; meshing to exclude vectors etc.) (Please see above) For an emergency response to be effective, there must be the involvement of all stakeholders whose work could impact on vector and disease mitigation, including:– • MOH staff e.g.: VCO, EHOs, SEHOs, CEHO etc. • National Epidemiologist / National Emergency Response Team /CMO • The Permanent Secretary • Health Education / Information Teams • The Media • The Focal Officer for IVM situated in the MOH • Other appropriate Government Ministries • Private Sector organisations e.g. Rotary and Kiwanis International Clubs • The general public The combination of all these groups working together in a timely manner could downgrade the “emergency” vector/disease situation to one of “normal” occurrence or to elimination of the VBD problem.

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CHAPTER 6 WORK OF THE VECTOR CONTROL OPERATOR OR OFFICER (VCO) AND THEIR INVOLVEMENT IN IVM

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6.1. Introduction The duties of the VCO in IVM will have certain differences from that under the old Vector Control programme. No longer will the VCO hurriedly enter a property, inspect it and move on to the next one, but the VCO will engage the householder in conversation, as a follow up to the previously aired public communication on the subject, expressing the fact that in IVM, we are now supposed to be partners in the activity of vector management. In an IVM programme, the Vector Control Operator (VCO) is the front-line agent of the IVM team including Environmental Health Dept. of the Public Health Authority, the public and all the other partners, in dealing with prevention and control of VBDs and insect vectors of disease. In the case of the fight against the VBDs such as DF, Zika and Chik V, and the peridomestic vector, Ae aegypti, and the prevalent Cx quniquefasciatus, the VCO and the public will need to develop a close bond of partnering if the IVM strategy is to be successful. As such, the VCO’s main role is to be an essential part of partnering to conduct surveillance for vectors, with the community, and to coordinate vector mitigation. In this “new IVM strategic operation”, the VCO also has responsibility to interact with the community members in eliminating by the most appropriate means, the foci of mosquito production and to demonstrate to the public and to educate them on the significance of the vectors and to put in place strategies to prevent the recurrence of vector infestation. We anticipate the use of the “Vector Mitigation Field School” concept (as mentioned in Chapter 4) of participation between the VCO and the general public.

6.2. Expectations of the role of the VCO Based on the description of the IVM and the role of VCOs in this strategy (Chapter 4), the following are some of the issues that the VCO will be involved in the execution of the IVM programme.

6.21. General 1. Possessing a basic understanding of the determinant issues involved in VBDs transmission. 2. Being aware of how their own specific actions impact on VBDs 3. Knowing how their own roles in an integrated approach in the “Combination of strategies” impact VBD mitigation. 4. Being able and willing to build new partnership with a range of stakeholders/ partners, previously not known to have an interest or to actively participate in management of VBDs. 5. While partners involved in IVM will have different areas of competence, they will all share responsibility for the overall outcome of the IVM programme.

6.22. Vector and Disease knowledge All VCO and interested parties, will have a sound understanding of the issues of vectors and VBDs e.g. the Identification; the Life Cycle; Ecology; Potential for disease transmission.

6.23. Planning and Implementation All partners and participants – including the VCO and the general public (community) - are expected to have acquired by the end of this module, a general understanding of the Technical issues – epidemiological, vector issues etc., impacting on the Operational issues such as local determinants of disease.

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6.24. Advocacy and Communication All partners and participants – including the VCO and the general public (community) - are expected to have acquired by the end of this module, a general understanding of the technical issues – epidemiological, vector issues etc., impacting on the Operational issues such as local determinants of disease. They will share information as a critical tool in vector mitigation.

6.25. Monitoring and Evaluation VCOs and especially SVCOs will gather vector information for measurement of the process and impact assessment of the interventions. Of all the partners in the IVM programme, the role of the VCO is so critically significant in the management of the peridomestic vectors. It is the VCO who interacts directly with our most important partner in this fight – the general public or the householder. As a result, we are dedicating the whole of this Chapter to the work of the VCO. In this “new IVM strategic operation”, the VCO also has responsibility to interact with the community members in eliminating by the most appropriate means, the foci of mosquito production and to demonstrate to the public and to educate them on the significance of the vectors and to put in place strategies to prevent the recurrence of vector infestation. We anticipate the use of the “Vector Mitigation Field School” concept (as mentioned in Chapter 4) of participation between the VCO and the general public. Overall, the main functions of the VCO are:– • To educate the public by demonstrating these mosquito production sites and habitats, and show how these could be prevented from recurring. • To search for, in association with the householders, and to find any areas that are mosquito production sites. • To jointly with the householders to eliminate these mosquito breeding sites. • To emphasise to the householders at this “field training programme”, their role in participating in this vector control programme. • Having collected the surveillance data, the VCOs will organise them in appropriate formats so that they may be analysed and shared with the senior VCOs and strategies put into place for further vector control. It is important to recognise that while the detection and elimination of mosquito production is one of the major objectives of the visit of the VCO, other public health issues should be noted and advised on. These issues should also be reported on to the senior VCOs back at the centre.

6.3. Work Schedule/Work Plan

Meeting Place At the beginning of each work day, at the specified time, the VCOs will meet with the Senior VCOs (SVCOs) at their work centre, where they will receive instructions and work assignments. All equipment will be checked and materials supplied before they leave for their work area. While on duty the VCOs will at all times carry the following equipment based on the following checklist:–

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Table 30. Equipment Checklist

1 Credentials Identification card which certifies him to be an employee of the Insect Vector Control Division in the Ministry of Health

2 Block Plan Sketch showing the area to be covered and the houses therein 3 Printed Forms In sufficient quantities for the day’s work. (Daily worksheets, list of closed houses, larval identification forms, house cards, checklist for breeding areas, and other forms as required by the programme)

4 Mirror A small mirror to examine containers by reflection of sunlight 5 Pipette Large enough to withdraw larvae and pupae from containers 6 Larval vials For collection of samples 7 Folder/Clipboard For keeping worksheets 8 Lead Pencil For recording on worksheets 9 Chalk For marking houses and positive containers as required 10 Notebook For keeping notes and recording closed houses, refusals, etc. 11 Tacks and hammer For securing house cards 12 Yellow Tag For indicating presence on premises 13 Haversack To carry equipment 14 Empty plastic bottles and plastic spoons To store Abate sand granules and measure Abate 15 Spray can To apply insecticide 16 Malathion WP or other adulticide Packets 17 Abate Sand Granules or other larvicide 18 Other Equipment As required by the Insect Vector Control Division

At the end of the workday, VCOs must report to the SVCO and submit their report sheets. Also, all materials and equipment for which they are responsible must be stored in a convenient place.

6.4. Organisation of Work Most of the emphasis on VCO work in CMS is placed on the control of Aedes aegypti, since this is by far, the major mosquito vector/pest species in our countries. For the purpose of the Ae aegypti, Zika, Chikungunya and DF campaign, the country is divided into numbered sections within a County (catchment area), and each sections sub-divided into zones. A Zone is a well-defined group of about 400-800 houses on average; it is the basic unit for the organisation of the work of the programme and it is identified by a letter following the section to which it belongs. A map is prepared for each zone showing in detail, the main roads, streets, rivers and other natural features, and the location of each house in relation to these. The houses in each zone are numbered starting from house #1, and are grouped into blocks for the convenience of carrying out the fieldwork. Blocks may be regular or irregular and consist of one or more houses, Public Squares, Gardens, houses under construction etc. Regular blocks are those which can be circled without interruption by streets, roads, canals, valleys etc. Irregular blocks are those which start at one corner and end at another interrupting point, such as a river, the sea, or a valley so that they cannot be circled to reach the starting point. During operations, each operator is assigned a block plan. A definite starting point is indicated in each block where the operator starts, and he works the houses in a systematic manner until he reaches the last house in the block.

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Itinerary. A daily itinerary is posted at the work centre or other selected locality, giving the work of each operator for the day. This is done by a supervisor. A Senior VCO (Charge hand) assigns the blocks to his operators in such a manner as to facilitate supervision and control, and in accordance with his itinerary. The VCO will begin each day’s work with a block plan and must start work at the appointed place in the block, and continue working until the block is completed. Each morning, he must start work at the first house in his block or in the case of an incomplete block, at the house next to the one at which he stopped the previous day. A Zone must be completed before moving on to a new area. At the end of each day completed forms must be submitted to the Charge hand and any problems or incidents reported. All equipment must be cleaned and stored in the assigned place. The VCO should present his/her credentials by displaying a legitimate VCD ID and ask permission to carry out the inspection, briefly explaining the purpose of the visit and invite the householder to accompany him/her on the inspection. The VCO must use this time not only to make the inspection, but to educate the householder on the removal of any conditions that are or may cause the breeding of mosquitoes. Having made a thorough inspection, the VCO should not pass from one house to another by using an entrance between them but he must return to the street and enter the next house through its street entrance.

6.5. Refusal to Permit Inspection When permission is not granted, the VCO must make a note of it on his/her worksheet and inform his/her supervisor. It is absolutely prohibited to argue with the householder. In his/her replies he/she should limit him/ herself to explaining that the inspection is necessary. Under no circumstances should an inspection be made without permission. VCOs must comply with this rule of conduct. Police Protection. In some countries, operators are not authorised to call the police, except in cases of threatened violence. All threats must be reported to Senior Officers. Visits with a Supervising Officer. When an operator is working together with a senior officer of the Division, as would occur in a re-check, the inspection must be carried out in the usual manner. The VCO should introduce himself to the householder, state his purpose of the visit and then introduce his supervisor. The VCO must enter together with the supervisor, but must allow the supervisor to determine when the inspection is completed. Complaints. When the VCO receives complaints of mosquitoes or other unsanitary conditions, it must be reported to his/her supervisor with all details, so that necessary action may be taken by the Environmental Health Officer.

6.6. Inspection Procedures Not only must all procedures be followed during inspection, but all the information gathered recorded in daily worksheets. This is the basic report on which all evaluations are made on the presence of mosquito vectors. For this reason, it is essential that all VCOs understand the worksheet and make every effort to ensure that they are properly filled out.

6.6. Daily Worksheets This is the basic and most important form used in the service and it must be accurate, legible and carefully kept, for on it depends the planning of work, evaluation of mosquito breeding and also planning long-range strategies. The VCO must hand in the original worksheets to his/her Charge hand (SVCO). Even if they get smudged, he/she is not permitted to make copies of them. So the original records must be kept neat and clean.

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Figure 29. Daily Worksheet

Table 31. Information required on Daily Worksheets

The Headings Activities County/Parish/Catchment Area: Fill in Locality: Fill in name of place (Street/locality) Section: Fill in the section number followed by the Zone letter No. of houses: Fill out the number of houses in the Zone Date: Write the date on which the inspections were done Name of Householder: Fill out the name or/and address of the premises Cycle: Several cycles of inspection are conducted per year. This refers to the actual cycle being conducted: first, second etc. Census No.: As designated on the VCD Map

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The sheets are formatted into rows and columns. The rows run across the page on under the other and information is recorded for each householder/addresses of the premises, across the row. The columns run vertically down the page from top to bottom. The heading at the top of each column makes filling in information self-explanatory, however special attention must be given to the abbreviations:– • F: focus/breeding site of any species other than Ae aegypti, e.g. Culex sp. • FA: focus of eggs or larvae of Ae aegypti only • FAP: focus of pupae of Ae aegypti only All totals must be recorded in their respective columns. Completed worksheets must be signed by the VCO and the Supervisor/Charge hand. The House Card (Figure 30) recording detailed data on the physical location of the premises, the date of the visit, the findings and work performed by the VCO should be completed. The card should be reviewed with the householder, then placed in a prominent place in the property (e.g. near the electricity meter) so that future VCO inspectors could easily access it for reference.

Figure 30. An example of the House Card for Vector Management Home Record

6.7. Mosquito Breeding Places Aedes aegypti is a highly domesticated mosquito which breeds mainly in clean, clear water. Its larvae are almost always found in artificial containers – such as drums, buckets tyres etc. - in and around human habitations. They are also found in natural containers such as coconut shells, leaf axils, tree holes, rock holes etc. Thus all containers that can hold water, should be considered as potential breeding places for these mosquitoes. (See Figure 31. showing the variety of breeding places for Ae aegypti).

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Figure 31. The Variety of breeding places of the Dengue, Chik V or Zika mosquito in your surroundings

On the other hand, Culex mosquitoes are less particular about the quality of water in which they breed, As a result, the common Culex quinquefasciatus mosquito is often found in drains and water bodies contaminated with organic materials. However, it is often possible to detect both species of mosquitoes co-habiting in the same container, such as discarded tyres.

The VCO will record in the worksheet the number of all exposed containers which he/she finds whether they contain water or if he/she considers them liable to collect water and breed mosquitoes.

6.8. Inspecting Water Containers Inspection of premises should start on the right hand side and move in an anti-clockwise direction. The VCO must try to approach a container holding water without disturbing it or even letting his/her shadow fall across the container. When this is not possible, e.g. where a drum has to be uncovered or a small container moved to facilitate inspection it may be necessary to wait quietly for a short while to allow larvae and pupae which descended to the bottom on being disturbed, to return to the surface. The VCO must first inspect the surface of the water particularly the areas near the sides of the container. He/she must next look down through the water along the sides and bottom of the container.

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Then, still looking carefully for small larvae, he/she must tap the sides of the container lightly several times. If the available light is not sufficient for proper inspection he/she should use a flashlight to shine a beam of light into the container. Also, the operator must be equipped with a small mirror to reflect sunlight into the container.

6.9. Appropriate Technology for Vector Surveillance In addition to the use of GIS technology for surveillance – mentioned above- it is recommended that each Vector Management Authority consider the introduction of some sort of “Hand Held Computer Technology” for improvement of the accuracy of the record keeping, and ease of effort of transcription into the Divisional data base. The format of the Daily worksheet could be stored on the hand-held computer; the vector data could be added on the spot in the field and stored (down-loaded) back at the VC office. This process could be repeated for all the premises inspected by the one and all the other VCOs. The data could then be analysed without risk of human error due to the transcriptional processes. Thus, adding to the economy of time in the field, there would be the benefit of knowing there would have been at least one less source of error in the VC office in the data analysis. The outcome of all this would be that results from the day’s surveillance would be available by the end of the day; if there was any indication of the need for an immediate intervention, then this could be considered, and if necessary, executed the same day. Eventually, the initial cost of outlay of the equipment (hand-held computers) would result in improved efficiency in the delivery of the VC surveillance and response to the community.

6.10. Elimination of Mosquito Breeding Places and Conversations for Health Education with the Householder In addition to chemical treatment of containers liable to breed mosquitoes, the VCO must himself/herself eliminate potential foci and empower the householder to manage his/her environment (premises). The Health Education message should include:– • The relationship between mosquitoes, breeding places, feeding/biting – to the spread of diseases (Dengue, Malaria, West Nile virus etc.) • Showing the householder where breeding occurs so that corrective measures can be undertaken, e.g. the removal of garbage and discarded containers, turning containers over so they cannot continue to hold water, use of covers on containers holding water, putting fish or other biocontrol agents into large containers such as cisterns etc. • The householder should be made aware of existing laws and seriousness of offences.

6.11. Dealing with Closed and Vacant Premises/Houses A “Vacant house” is one that is not occupied. A “Closed house” is one in which the occupier is absent temporarily, that is, a house in which there are furniture and objects of daily use. Inspection of Closed Houses: Houses, which are found closed on regular visits by the VCO, should be entered on the work sheet at the designated place/remarks column. The VCO should revisit the closed house at the end of his /her block. If after several inquiries no information is obtained, the VCO should state this on his/her “List of Closed Houses” and inform the Supervisor, who would take the necessary action. A Health Education leaflet should be left in the post box of the closed house. Contact information is provided.

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Houses Partially Inspected: In the case of premises which can only be partially inspected, the VCO must record the results of his/her inspection on the daily work sheet. If the VCO is unable to inspect a vacant house in his/her block, he/she should enter it into the remarks column and also enter it on his/her List of Closed houses. Vacant Lot – VL: When a vacant lot is inspected, the operator must write “V.L.” under the ”Name of Householder” and record the total number of containers inspected and those positive, if any, and fill in the number of foci in the respective columns. If the vacant lot cannot be inspected, the VCO must make a note of it and give it to his Charge hand who will take the necessary action to see that the vacant lot is inspected. Public Places: Public places, such as parks, sports grounds, schools, offices shopping centres, car parks, open drains, utility manholes, cesspits etc. must be considered as premises requiring inspection and appropriate action taken by the VCOs. Problems with public places must be reported to the local authority for their remedial action e.g. cleaning of drains and collection of garbage.

6.12. Collection of Samples When mosquito foci are found, in addition to showing them to the householder, a representative sample of the mosquito larvae/pupae should be taken from each premises and placed in separate vials that are properly labeled for submission to the laboratory for identification. A pipette and covered test tube/vial with water is recommended for collection of the samples.

Definition of Water Containers All water containers are divided into two categories:– • Accessible • Inaccessible Accessible containers are those that can be reached and examined with ease by the VCO. Inaccessible containers are those that cannot normally be reached without the use of a ladder or without dangerous climbing, e.g. eaves/guttering. The VCO must make a note of all inaccessible water containers on his daily worksheet. Special arrangements will be made to deal with these.

Types of Water Containers

Cisterns and Tanks These are large storage containers and may be made of metal, wood, plastics, or cement and located above, below or at ground level. When an old bathtub is used for water storage or as a watering trough for animals, it is classified as a cistern or tank. Ornamental pools in a garden with or without fish and vegetation are also containers of this type.

Drums and Barrels These are the most important group of containers as they are very commonly used for water storage, are not usually protected, and are favourite breeding places for the Ae aegypti mosquito. There is often much difficulty in getting them properly covered by the householder. Incidentally, surveys in Trinidad confirm that these are the most productive Ae aegypti habitats.

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Tubs and basins These are not usually used for water storage but may become breeding places when used.

Special Artificial Containers Special artificial containers may be found inside or outside of houses. In order to point out the different types of water containers which must be inspected under this heading, the following list is given in places in which Ae aegypti has been found breeding. This is also shown diagrammatically in Figure 31: “The Variety of Breeding Places in the Dengue Mosquito in your Surroundings”.

Eaves/Gutters These are often inaccessible but they must be inspected wherever possible. If stagnant water is found, due to obstructions of poor gradient in the guttering, then the householder should be instructed to have them cleaned out and/or repaired. The VCO must indicate on his worksheet remarks column, if eaves and/or gutters are present, and if they appear to be blocked, holding water etc.

Tyres All tyres, and especially discarded tyres, are easy collectors of water. Thy must always be stored under cover to prevent rain water from entering the rims, or be cut to allow water to flow out.

Brick Holes Walls made of bricks that have not been properly plastered, or bricks that are stored out-of-doors, can collect water. Exposed brick holes on fence walls can also collect water and must be filled in – e.g. with sand. Notice however that breeding may be out of sight, since water may collect up to 10 bricks down from the top, but mosquitoes may access this breeding focus.

Utility Manholes This may be an important source of Ae aegypti production and goes undetected very easily. Collaboration with the utility companies is important for surveillance and treatment of such breeding foci.

Others Other water containers which can support the breeding of Ae aegypti and other mosquitoes, are small ponds, cesspools, fish ponds, crab holes (esp. Deinocerites mosquitoes), rock holes and animal hoof prints. In addition to containers that can hold clean water, there may be dirty drains and cesspits on premises that can also serve as breeding places for Culex mosquitoes. These foci must also be inspected, recorded and treated in an appropriate way.

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Figure 32. Twenty pictures of potential Ae aegypti breeding habitats

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Table 32. List of possible breeding places

Antiformicas (water containers to Lavatory cisterns and pans Bamboo sections prevent access by ants)

Leaf axils Bilge water of boats (fresh only) Machinery of all kinds

Bird baths Metal sheets Bodies of old automobiles

Mortars Partially buried bottles Mortice holes in timber

Bowls Old boilers Brick holes

Old pieces of iron Buckets Old shoes

Coconut and other shells Pans Cow horns and hooves

Pieces of broken bottles Crockery of all kinds Plumbing pipes and joints (broken) (ground and stuck in walls)

Cups Pools of water on floors or flooded Curved roof tiles basements

Pots Dishes under plants Refrigerator pans

Enamel pots and basins Sea shells Epiphytes

Sink Flower pots Skulls of animals

Flower vases Tins of all kinds Flush tanks of water toilets

Old tyres Utility box manholes Walls (interior and surface)

Garden jars Water coolers Grind stone troughs

Water pots or troughs for poultry Hydrants Watering cans and small animals

6.13. Some Calculations On the daily Work Sheet forms all totals should be recorded in their respective columns. The information collected is then used to calculate the level of infestation by noting the presence of mosquito larvae and / or pupae (premises positive). At the Vector control office two basic calculations are made. One is the Aedes aegypti (house) index, the other is the Breteau Index.

The Ae aegypti House Index (HI) is calculated as follows:-

Aedes aegypti Index = No. of premises positive x 100 Total No. of premises inspected

e.g. no. of premises inspected = 30 no. of premises positive = 5

Aedes aegypti Index = 5 x 100 = 16.7% 30

The Ae aegypti House or premises Index (HI) shows the percentage of premises infested by the mosquito. Control measures can be considered successful if the Ae aegypti Index is below 5%. The Breteau Index (BI) provides information on the relationship between the number of positive containers per 100 premises inspected.

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The Breteau Index (BI) is calculated as follows:-

Breteau Index (BI) = No. of positive Containers x 100 Total No. of premises Inspected

e.g. no. of premises inspected = 40 no. of positive containers = 7

Breteau Index (BI) = 7 x 100 = 17.5% 40

The Container Index (CI) is calculated as follows:-

The percentage of water-holding containers infested with Ae aegypti larvae or pupae

Container Index (CI) = Containers positive x 100 Containers inspected

e.g. if the number of containers positive for Ae aegypti = 15 the number of wet containers inspected = 85

Container Index (CI) = 15 x 100 = 17.6% 85

The Pupal Index (PI) is calculated as follows:-

Number of pupae per 100 premises inspected

Pupal Index (PI) = Number of pupae x 100 No. of Premises Inspected

e.g. if the number of Ae aegypti pupae found = 25 the number of premises inspected = 90

Pupal Index (PI) = 25 x 100 = 27.8% 90

In the course of collecting data on positive containers, the type of container is also noted. In this way one can determine the most common containers that breed mosquitoes and these can be targeted for removal or treatment. The details for vector surveillance and various sampling procedures have already been dealt with in Chapter 2.

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CHAPTER 7 OTHER SELECTED ARTHROPODS AND RESERVOIRS OF PUBLIC HEALTH IMPORTANCE WHICH MAY BE SUBJECTED TO IVM

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There is a range of other arthropod pests and potential vectors of disease which the VCO may be called upon to identify and advise on. These may be the subject of integrated pest management in our IVM programme. In addition, complaints on commensal rodents which can be reservoirs of disease such as leptospirosis are very likely to engage the attention of most VCOs in the field. In a survey on Knowledge, Attitude and Practices (KAP) of issues affecting pest and diseases in Trinidad and Tobago, a vast majority of citizens identified rodents as being the most important pest in that country, and not Ae aegypti as we (of the vector management group) had anticipated (Rosenbaum et al., 1997). Now that our minds are engaged in the IVM mode, and bearing in mind that some known vectors and other pests and reservoirs may occupy the same habitat and resources, their management by IVM must be of interest to all of us. Here are summarised some basic information on some of these pests and reservoirs as well as suggestions for their control.

7.1. Biting Midges (Sand flies) (Ceratopogonidae) Biting midges of the Ceratopogonidae family such as Culicoides spp., and Leptoconops spp. are very small biting flies usually 0.6-5.0 mm in length (Figure 33). They are pests of humans, pets and livestock in virtually every Caribbean country. They are popularly known by a variety of names such as “punkies”, “no-see-ums”, and “sand flies” (not the same as the Phlebotomine sand flies, mentioned below). These sand flies are essentially severe pest species which are known to bite voraciously at dusk and after dawn especially near coastal areas. The bites of these sand flies cause a burning sensation and may have a local allergic sensation that cause significant itching. As a result, these biting midges can have an adverse impact on the tourist industry, since early morning or late afternoon visits to the beach may be severely affected.

Figure 33. Adult “Sand Fly” (Culicoides)

Source: Animal Health UK

These midges are not known to transmit any disease to man, though they are known to transmit non-pathogenic filarial “parasites” such as Mansonella ozzardi and Dipetalonemasp worms to man. For livestock, they are the transmitters of the viral organism that cause “blue tongue” disease.

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Female sand flies require a blood meal for egg development, thus the biting behaviour. The eggs are laid in masses on various moist surfaces and hatch in 2-7 days. There are 4 larval stages, which develop into the pupal stage in about two weeks to a year, depending on the temperature and food supply. The pupal stage lasts about 2 days, after which they emerge into the adult stage. Adults can live between 2 to 7 weeks, during which time the females can take their blood meal and mating can take place and the life cycle completed. (Figure 34).

Figure 34. The biting midge (sand fly) life cycle

Source: Purdue University

The larval stages may develop in semi-aquatic or aquatic habitats, depending on the species. The larvae of some species are found in rich semi-aquatic sites such as marshes, bogs, tree holes and saturated rotting wood, livestock manure. Females of Culicoides are reported to disperse between 0.5-1 mile from the site of larval development in search of a blood meal, though other species and genera may be able to fly greater distances.

Control This is very difficult for sand flies and may involve some of the following:– • Timing out-door activities to avoid peak biting times such as late evenings and early mornings in areas known to be frequented by the biting midges. • Environmental management may be achieved by attacking the larval development of some species which require shallow water; this may be disrupted by modifying the bank structure of waste water ponds (their natural habitats) by periodic altering the water levels. • The installation of screens of fine mesh in windows and doors to prevent the intrusion into homes. • Space insecticide sprays may have a temporary impact in the evening hours when the flies are most abundant. • Personal protection by the use of repellents such as Deet may be effective.

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7.2. Sand flies (Phlebotomines) The Phlebotomine sand flies (moth flies), (Family Psychodidae) are known in the public health world to be vectors of the parasitic protozoan Leishmania. Fortunately, there have not been any recent reports of this parasite in the island CMS countries (except Trinidad), though cases have been reported in South American countries such as Guyana (e.g. Rawlins et al. 2001) and Suriname, where cutaneous leishmaniasis (e.g. bush yaws) occurs mainly in rural areas. The vectors of this disease and a pest species in its own right occurs in some of our island CMSs, e.g. Lutzomyia spp. has been recorded in some of the countries.

Figure 35. Plebotomine Sand fly (Lutzomia sp)

Source: Frank Collins, CDC

Phlebotomine spp. of sand flies are day/night-time biters – depending on the species, when the female seeks a blood meal for ovarian development. They seek protection in shelters either in dark corners of buildings or crevices when they are not biting.

Life History of Phlebotomine Sand Flies Breeding places tend to be under stones or in masonry, but not aquatic as in the case of the Ceratopogonidae. They require dark, humid conditions with organic matter for food. Rodent burrows, tree holes etc. are acceptable locations. • The eggs require 6-17 days for development into whitish larvae with setae. • There are four larval stages, lasting 4-6 weeks. • The pupa requires about 10 days for development. • In all, the egg-to-egg cycle takes about 7-10 weeks. See Figure 36.

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Figure 36. The Life Cycle of Plebotomine Sand Fly

7.3. Black Flies (Simulium spp.) Blackflies (Simulium spp.) are small, dark, stout-bodied flies about 1-5mm long. They have short legs and relatively large eyes. The wings are short, broad and colourless.

Figure 37. The Black Fly (Simulium spp.)

Source: Omar Fahmy

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Figure 38. The Life Cycle of the Black Fly

The eggs of blackflies are laid in streams and rivers where the water is fast-flowing and rich in oxygen. The eggs hatch after 1-4 days. The larvae do not swim, but instead remain attached to submerged vegetation or hay substrate. The larval stages last from one to several months. Pupae are also attached to submerged objects and the adults emerge after 2-6 days. Blackflies bite in the daytime and outdoors, especially along river banks. Simuliids are important pests particularly of livestock in some South American countries. Onchocerciasis is a filarial worm (Onchocerca volvulus) disease “river blindness” transmitted to humans by the simuliid flies in some parts of the world. This disease is not known in the Caribbean countries, but the Simulium fly e.g. Simulium antillarum has been reported in some islands.

7.4. Fleas Fleas are small (about 1-4 mm long), wingless, bloodsucking insects. They have a laterally compressed body with legs well developed for jumping. While there are thousands of species of fleas, feeding mainly on mammals, only a few species are important for biting humans. The most important ones are the rat flea (Xenopsylla sp.), the cat and dog flea (Ctenocephalides sp.) and the human flea (Pulex irritans), which causes irritation, serious discomfort and blood loss. The rat flea is an important vector of bubonic plague which in the middle ages had dramatic impact on human existence; it also transmits flea-borne typhus. Fleas avoid light and are found mostly among hairs or feathers of animals, in carpets or in beds and in people’s clothing. Dog and cat fleas prefer these hosts, but in absence they would bite humans. Both male and female fleas take blood meals. Diseases associated with fleas include:– • Plague: the organism transmitted by infected fleas • Flea-borne typhus • Tapeworms carried by infected fleas • Skin irritation: rash and/or inflammation • Chigga (Chiggoe) fleas (Tunga penetrans)

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Control Measures • Bathe and treat cats and dogs with chemicals that have anti-flea properties • Keep premises clean • Spray infested locations with a residual insecticide and repeat as necessary

Figure 39. The Cat Flea (Ctenocephalides felis) Adult

Source: Wikimedia

Figure 40. The Life Cycle of the Cat Flea

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7.5. Lice Lice are small (4.5 mm long) bloodsucking insects that live on the skin of mammals and birds. There are three types of lice of importance to public health:– • The head louse (Pediculus humanus capitis) • The body louse (Pediculus humanus corporis) • The crab or pubic louse (Pthirus pubis). Lice can develop in a warm environment close to the human skin and die within a few days if they lose contact with the warmth of the body. They feed several times per day. Spread. Lice are normally spread by close contact between people, through sharing bedding, clothing, and towels or by sitting on infested sheets and cushions. Vector capacity. Only the body louse of these three is a vector of human disease. It may transmit:– • Typhus fever • Relapsing fever • Trench fever

Figure 41. Human Lice spp – Body and Pubic Lice

Source: Centers for Disease Control (CDC)

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Figure 42. The Life Cycle of Human Lice spp – Body and Pubic Lice

Source: Purdue University

7.6. House Flies The house fly Musca domestica, is the most familiar, and in some respects, the medically most important member of the Muscidae family. Because it vomits on solid food in order to eat, it can spread several food-borne illnesses because it feeds on garbage and animal wastes, thus becoming infected with a multitude of infectious organisms. The house fly spreads organisms via its mouth, hair, feet, faeces and vomit. It is a grey species, 6-9mm in length with four dark stripes running lengthwise on the thoracic dorsum. (Figure 43).

Figure 43. The Adult House Fly (Musca domestica)

Source: Avril Ramage, Oxford Scientific Films Ltd.

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The House Fly Life Cycle The house fly lays its eggs in moist, warm, decaying matter, protected from direct sunlight, so that the eggs can hatch into larvae (maggots). Breeding places include animal manure, organic waste, garbage heaps, decaying fruit, which will provide food for the maggots. The larvae rapidly grow and develop through the larval instars to a pupal stage, to the adult, in about 6 days, as demonstrated in the LC diagram (Figure 44).

Figure 44. The Life Cycle of the House Fly

Diseases which are known to be transmitted by the house fly include the following gastro intestinal tract diseases:– • Cholera • Dysentery • Gastro enteritis • Typhoid Fever Control Measures are centred around Environmental Sanitation (ES) such as:– • Storage of rubbish in bags for collection/removal to the secure landfill • Keeping homes and yards free of rubbish • Storing food safely to prevent contact with flies and other pests.

7.7. Ticks and Mites Mites and ticks are arthropods like insects – having a hard exo-skeleton – but unlike insects, they have 8 legs and a body with little or no segmentation, which place them in a group called the acarines.

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Mites are small, ranging in size from 0.5-2.0mm. The major mite pests of man include the:– • Biting mites (Trombicula spp.) • Scabies mites (Sarcoptes scabiei) • House dust mite (Dermatophagoides complex) Generally, biting mites are bright red or reddish-brown in colour. The larvae called chiggers, are about 0.15- 0.3mm in length and have only three pairs of legs. Neither the adults nor the nymphs bite humans. The larvae however feed on skin tissue. (Figure 45)

Figure 45. Biting mites (Trombicula spp.), Scabies mites (Sarcoptes scabiei) and House dust mite (Dermatophagoides complex)

Source: Luc Viatour; Wikimedia; FDA

Figure 46. The Life Cycle of the Biting Mite

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The Scabies mite – Sarcoptes scabiei is between 0.2-0.4 mm long and virtually impossible to see with the naked eye. It spends most of its entire life cycle on and in the skin of humans. In order to feed and lay eggs, fertilised females burrow winding tunnels in the surface of the skin. Scabies is normally transmitted by close person to person contact, as children holding hands. House dust mites are about 0.3 mm in length and live in furniture, beds, pillows and carpets where they feed on organic debris. The inhalation of house dust mites produces allergic reactions such as asthma and inflammation of the nasal mucous membrane. Ticks are acarines that suck blood from humans and other animals. Adult ticks have the capability to live years in the absence of a blood-meal and can survive years of starvation. Both sexes feed on blood and therefore can be disease vectors. There are two major families of ticks: the hard ticks (Ixodidae) and the soft ticks (Argasidae). Adult hard ticks are flat and oval in shape and between 3 and 25mm long. Hard ticks can be differentiated from soft ticks by a shield like plate or scutum behind the head on the back of the body and visible mouthparts at the front of the body. (Figure 47).

Figure 47. Features of Hard and soft ticks

Source: CDC Archive, Centers for Disease Control and Prevention (CDC), bugwood.org; Mat Pound, USDA Agricultural Research Service, bugwood.org

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Figure 48. The Life Cycle of Hard and Soft Ticks

Adult soft ticks are flat and oval in outline and have tough leathery, wrinkled bodies. The mouthparts are situated underneath the body and are not visible from above. The following are some of the diseases known to be transmitted by ticks:– • Tick-borne relapsing fever • Tick-borne encephalitis (TBE) • Rocky Mountain spotted fever • Q fever • Lyme disease Of these, Lyme disease and TBE had the outstanding distinction of being two of the diseases of man that were definitely proven to be affected by global warming impact. Ticks are also important vectors of diseases of domestic animals in the Caribbean, such as babesiosis and anaplasmosis; they can cause great economic loss – especially among imported exotic cattle.

7.8. Cockroaches The cockroach is one of the commonest species of arthropods that shares homes with human beings. Everyone is familiar with some of the species such as:– • The “German cockroach (Blatella germanica), • The American cockroach (Periplaneta americana) • The Oriental cockroach (Blatta orientalis) etc.

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Figure 49. Three Common Cockroach Species – American cockroach (Periplaneta americana), German cockroach (Blatella germanica), Oriental cockroach (Blatta orientalis)

Source: CDC Archive, Centers for Disease Control and Prevention (CDC), bugwood.org; Mat Pound, USDA Agricultural Research Service, bugwood.org

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Cockroaches live and breed in dark warm, moist environments of the home which are difficult for the householder to access. e.g.:– • Dead spaces and corners • Behind bulky equipment like utilities • Behind boxes, bags etc. Cockroaches have been assumed to be vectors of disease because of:– • Cockroaches favour environments where both human pathogens and human food are found and they pass readily from to another • They may carry pathogens in and on their bodies, and these may remain viable on the cuticle and in the digestive tract and faeces to the extent that the insects may even be chronic carriers and • The evidence though circumstantial is strong enough to justify any cockroach control programmes where human health is endangered. Cockroaches have been accused of transmitting many disease organisms such as:– • Salmonella typhimurium agent of Typhoid fever • Entamoeba histolytica, causing dysentery • Toxoplasma gondii, which causes toxoplasmosis • Agents that cause cholera, food poisoning, diarrhea, anthrax, tetanus etc. Control Measures should include:– • Keeping homes and yards clean and free of rubbish • Store rubbish securely • Store food to prevent access to cockroaches • Appropriate use of available insecticides.

7.9. Rodents In surveys performed in Caribbean countries by CAREC staff to determine the greatest pest species in domestic situations, householders by an overwhelming number identified “rodents” as the major culprits. Not because of the disease transmitting potential, but because of their ability to spoil food and other household materials. Despite all this, rodents are also a major reservoir of disease which brings illness to man and his household. Rodents by urinating and defecating as they move about are likely to transmit infections which they are carrying. Three main species of rodents are almost universally sharing with man, his home:– • Norway or brown rat (Rattus norvegicus) • Roof rat or black rat (Rattus rattus) • House mouse (Mus musculus). Rats are so commonly present in our environment that most people know them. The Figures below (Figs. 50, 51 & 52) summarise some of the features of the two main rat species., and of a young rat and a house mouse.

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Figure 50. Roof Rat (Rattus rattus), Norway Rat (Rattus norvegicus) and House Mouse (Mus musculus)

Source: Wikimedia; National Human Genome Research Institute; H. Zell

Figure 51. Distinguishing features of the two main rat species

120 Chapter 7: Other Selected Arthropods and Reservoirs of Public Health Importance which may be subjected to IVM

Figure 52. Field identification of a young rat and a house mouse

Signs of Rodent Infestation include:– • Living or dead rodents. • Droppings: fresh droppings are shiny black, stale droppings are grey. • Urine stains. • Gnawed wood or other items. • Tracks or rub marks. • Nests and burrows/holes.

Rats can accomplish the following:– • Climb both horizontal and vertical wires/pipes. • Gain entrance through openings that are larger than 0.25 sq. cm. • Jump horizontally 1.2 m (4ft) on a flat surface. • Drop 15 metres (50ft) without being killed or injured. • Swim as far as 0.8 km (1 mile) in open water. • Burrow vertically in earth to a depth of 1.2 metres (4ft).

Diseases associated with rats • Rats host fleas and mites which are potential vectors of plague, murine typhus and salmonellosis. • Infected rats may transmit leptospirosis through their urine. • Rat droppings contaminate food. • Rat bites can cause rat bite fever.

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Control Measures • Environmental Sanitation. Keep yards and vacant lots clean and prevent the accumulation of debris. • Cut branches of trees growing close to the house. • Rodent traps baited with meat, peanut butter or other foods. • Use rodenticides.

122 Conclusions

CONCLUSIONS May we continue to live in “interesting times”, but let us work and pray that we will be in a position of preparedness so that whatever challenges in the realm of VBDs will confront us now and in the future, we will be prepared to use our skills in Integrated Vector Management (IVM), to prevent major disruptions in our health conditions in the region and eventually our economy as has happened in the recent past. The evidence on IVM in the scientific literature shows that the strategy and its application will be efficacious when there is:– • Good knowledge of vectors and VBDs by all partners and participants. • Awareness of the new roles of the various sectors and partners – new and old – all taking ownership to ensure the programme’s success, even if these partners were not traditionally involved in addressing vector management issues. Collaboration by all partners and participants, willing to work as never before – outside of our traditional comfort zones.

• Collaboration by whatever our specialty may be – from the householder (laymen), to professionals with a health background, previous members of various sectors (civil society, local government, service clubs, school children). • Utilising all the available tools that are required for IVM. • A management approach that improves the efficacy, cost-effectiveness, ecological soundness and sustainability of vector control interventions, applied to the combination of all available methods in the most effective and safe manner to obtain required vector management. It was noteworthy that Srivastava et al. (2014) explained that despite their significant improvement in the management of VBDs when IVM was introduced to replace the old VC strategy, good management of the programme was the key. The only occasions that they experienced setbacks was when there were “instances of weakness in management”. The lesson learnt here was to utilise all the management tools at our disposal for success against the VBDs. The comparison between the new IVM strategy and the old VC practice is like “chalk and cheese”; and on reflection, one may ask, how it could be any different. When all the management tools required for the IVM strategy were appropriately applied, including:– • Planning and Implementation • Organisation and Management • Policy and Institutional Framework • Advocacy and Communication, as well as • Monitoring and Evaluation Tools. This seems to make this comparison of IVM to the older VC practice sort of unfair, when there were little or no management tools and strategy. Moreover, the saccess to all the various partners for collaboration against the range of VBD and vectors, when in the old VC, we depended on the vertical programme in the Ministry of Health without much partnership. Once the management tools are utilised for IVM, it is clear that we will assured of a superior outcome in the fight against the VBDs! These would surely be the mark of “ interesting times”!

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GLOSSARY

Abate Trade name for a one percent concentration of the insecticide temephos (often formulated in sand granules). This insecticide has been used in the Caribbean region for about 40 years as a larvicide against container breeding mosquitoes such as Aedes aegypti. Temephos has a low mammalian toxicity, and therefore can be utilised in potable water. Adulticide Insecticide which may be used to kill adult insects (mosquitoes). Antiformica Container used to prevent access of ants. CAREC The Caribbean Epidemiology Centre. CARPHA The Caribbean Public Health Agency. Climate Change Reference to global warming over a long time period. This is thought to be an effect of the release of green house gases by man into the atmosphere. Climate Variability An aspect of climate changes, but over a shorter period of time. This may refer to seasonal changes or even to El Nino/La Nina (Southern Oscillation) Changes, which may impact on vector-borne and other health indicators. Chemoprophylaxis Chemicals/drugs used to prevent illness. Chikungunya virus disease A febrile illness caused by Chikungunya virus (Chik V). It is an Alpha virus of the Togaviridae family. It is spread by Ae aegypti and Ae albopictus. Cholinesterase Chemical (enzyme) in the body – both humans and invertebrates (including mosquitoes) – that is essential for the proper functioning of the nervous system. Cholinesterase can be destroyed by some insecticides. Container Index (CI) The percentage of containers on a premises, that are found to be infested with mosquito larvae or pupae. Credentials Personal identification card that is issued to VCOs by the appropriate authorities of the Ministry of Health. The picture card identifies the officer and his/her role in the mosquito surveillance duties. Dengue Fever (DF) A febrile illness caused by one of the flaviviruses. There are four types (serotypes) of the virus which may cause disease, which may be transmitted the peridomestic mosquito Aedes aegypti and or Ae albopictus. Dengue Haemorrhagic A more dangerous form of DF which has the characteristic of internal Disease (DHF) bleeding and may prove to be fatal if the patient is not treated appropriately. DHF is thought to be associated with the sequential infection with a different serotype of the DF virus. Epidemic An outbreak of an infection or disease, that is not normally present. Epidemiology The study of epidemics; literally, this means “disease among men (humans)”. Filariasis A disease caused by a nematode parasite that can be transmitted by the bite of an infected Culex or Mansonia mosquito. Infection may be asymptomatic, but it may lead to lymphatic filariasis due to Wuchereria bancrofti, the cause of “elephantiasis”, or “big foot”.

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Flavivirus A group of mosquito-borne viruses that cause diseases such as dengue fever, yellow fever and St Louis encephalitis. Focal Treatment This refers to the treatment of containers in which mosquitoes can lay eggs and in which the larvae and pupae develop. Foci Sites with mosquito eggs or larvae or pupae. Haematophagous Blood feeding. This is typical of mosquitoes which need a blood meal to support egg development (vitellogenesis). Immunisation To make immune to a disease through the injection with a vaccine. There is still no effective vaccine against VBD such as DF and malaria. Infectious host A host (patient) that is carrying disease agents such as DF viral particles in peripheral blood. Infective mosquito An infected mosquito that is capable of transmitting pathogens to cause an infection. Insecticide A chemical used to destroy an insect. Integrated Pest Control A combination of methods used together to control (manage) pest (IPC) or Pest Management populations. (IPM)

Integrated Vector A rational decision-making process to optimise the use of resources for Management(IVM) vector control (VC). It requires a management approach that improves the efficacy, cost-effectiveness, ecological soundness and sustainability of VC interventions with the available tools and resources. Itinerary A route to be taken and instructions to follow. Larvicide A chemical (pesticide) used to kill larvae of a pest species. Leptospirosis A bacterial disease that may be transmitted to humans through the urine of infected rodents. Malaria An illness caused by infection of the Plasmodium parasite. It is a febrile illness characterised by periodic fever and chills. It is transmitted by Anopheles mosquitoes. Malathion An organophosphorous insecticide used in the Caribbean for the last 30-40 years for the control of various insect pests – especially adult mosquitoes. Pathogen Any organism that may cause disease – especially disease in man such as DF. PAHO The Pan American Health Organization. The arm of the World Health Organization (WHO) that operates in the Americas. Peridomestic One that lives in and around human habitation. Perifocal Treatment Pesticides applied in and around containers that can be or are breeding sites for mosquitoes. Protocol An accepted or approved way of operating.

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Residual Spraying Application of an insecticide onto a surface with the intention of killing pests by the contact route; generally, such treatment has a relatively long lasting activity. Resistance (Insecticide) An inheritable trait of reduced susceptibility to insecticides in an insect population due to the exposure to the chemical and survival of past generations of the same population of insects. Respirator Protective gear used over the nose to prevent the breathing in of harmful substances. Siphon In a mosquito larva, this is a tube-like organ used to breathe air from the surface of the water in which the larva lives. Source Reduction The systematic removal of potential water holding containers, thus preventing the collection of water in which mosquitoes can breed. This practice is part of the environmental sanitation method for vector control. Space spraying The application of small droplets of insecticide into the air in an attempt to kill adult mosquitoes. Stratification Classification of a disease in endemic areas for identifying approaches required for the control of the disease. Surveillance The study of disease and its vectors. This is an essential part of the inspection work of VCOs in the activity of search and destroy of vector habitats. Susceptible A population of animals (mosquitoes) which are sensitive to a pesticide and therefore likely to be killed by this agent. Sylvatic Of the jungle or forest: e.g. sylvatic or jungle yellow fever. Thermal fogging The activity of using special equipment to form a hot gas of oil carrying pesticide (hot fog) discharged to attempt to kill adult (flying) mosquitoes. Transovarial The capability of some mosquitoes to pass an organism from one generation to another (via the egg) so that infection occurs in subsequent generation(s) without an infectious blood meal. ULV Ultra-low volume aerosols (cold fogs or mists) of concentrated insecticides that can be applied to kill adult mosquitoes. Vector Carrier of disease: often invertebrate or mosquito host of the disease. Vertebrate reservoir An animal (with a backbone) that is host to a disease agent. Zika virus disease This is febrile disease caused by the Zika virus, an RNA virus, first recovered from the Zika region of Uganda in 1947. It is spread by Ae aegypti and Ae albopictus.

126 References

REFERENCES

1. Anon. (2005). Training Manual: Insect Vector Control Operators. Prepared by the Insect Vector Control Div., MOH, Trinidad and Tobago, In collaboration with the PAHO. 2. Belkin, JN & Heinemann, SJ. (1975a). Collection records of the Project “Mosquitoes of Middle America”. 2. Puerto Rico (PR, PRA, PRX) and Virgin Is. (VI, VIA). Mosquito Systematics. 7 (3), 269-296. 3. Belkin, JN & Heinemann SJ (1975b). Collection Records of the Project “Mosquitoes of Middle America”. 3 Bahamas (BAH), Cayman Is., (CAY), Cuba (CUB), Haiti (HAC, HAR, HAT), and Lesser Antilles (LAR). Mosquito Systematics. 7 (4), 367-393. 4. Belkin, JN & Heinemann, SJ. (1976a). Collection records of the Project “Mosquitoes of Middle America”. 4 Leeward Islands: Anguilla (ANG), Antigua (ANT), Barbuda (BAB), Montserrat (MNT), Nevis (NVS). St Kitts (KIT). Mosquito Systematics 8: 123-162.

5. Belkin, JN & Heinemann SJ. (1976c). Collection records of the Project “Mosquitoes of Middle America.” 6 Southern Lesser Antilles: Barbados (BAR), Dominica (DOM), Grenada (GR, GRR), St Lucia (LU), St Vincent (VT). Mosquito Systematics 8(3), 237-297. 6. Belkin, JN, Heinemann SJ & Page, WA. (1970). The Culicidae of Jamaica. Bulletin of the Institute of Jamaica. Science Series No. 20. 7. CAREC (2002) Entomology Training Manual. Prepared by Rawlins SC, Martinez, R & Mahadeo, S. 8. Chanda, E, Govere, JM, Macdonald MB, Lako, RL, Haque, U, Baba, SP, Mnzava, A. (2013). Integrated Vector Management: a Critical Strategy for Combating Vector-borne Diseases in South Sudan. Malaria Journal 2013; 12:369. 25/10/2013. DOI: 10.186/ 1475-2875-12-369. 9. Heinemann SJ & Belkin, JN. (1977b). Collection records of the project “Mosquitoes of the Americas”. 8 Central America: Belize (BH). Guatemala (GUA), El Salvador (SAL), Honduras (HON), Nicaragua (NIC). Mosquito Systematics 9 (4), 403-454. 10. Heinemann, SJ & Belkin, JN. (1978b). Collection records of the Project “Mosquitoes of Middle America”. 11. Venezuela (VZ), Guianas: French Guiana (FGC), Guyana (GUY), Suriname (SUR). Mosquito Systematics 10 (3), 365-459. 11. Heinemann, SJ, Aitken, ST, & Belkin, JN.(1979). Mosquito Systematics 12 (2). Collection of records of the Project “Mosquitoes of Middle America”. Trinidad and Tobago. (TR, TRM, YOB) Vol.14. 12. Parks W & Lloyd, L. 2004. Planning social mobilisation and communication for dengue fever prevention and control. A step-by-step guide. WHO. 138pp. 13. PAHO (1995). Dengue and Dengue Hemorrhagic Fever in the Americas: Guidelines for Prevention and Control. Scientific Publication # 548. 98pp. 14. Polson, KA., Rawlins, SC., Brogdon, WG., & Chadee, DD. (2010). Organophosphate resistance in Trinidad and Tobago strains of Aedes aegypti. J. American Mosquito Control Assoc. 26 (4): 403-410. 15. Rawlins, SC, Hinds, A & Rawlins JM. 2008. Malaria and its vectors in the Caribbean: The continuing challenge of the disease, forty-five years after its eradication from the islands. West Indian Med. J. 57 (5): 462-469.

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16. Rawlins, SC, Clark, GG & Martinez, R. (1990). Effects of a single introduction of a Toxorhynchites montezuma upon Aedes aegypti on a Caribbean island. J. Am. Mosq. Control Assoc. 7: 7-10. 17. Rawlins, SC, Tikasingh ES & Martinez R. (1992). Catalogue of Haematophagous Arthropods in the Caribbean Region. CAREC. 168pp. 18. Rawlins SC, Baboolal, S, Chadee, DD, Validum, L, Alexander, H, Nazeer, R & Rawlins, SRS. (2001). American cutaneous leishmaniasis in Guyana, South America. Annals of Trop. Med. & Parasitol. 95(3), 245-251. 19. Rawlins, S. (2011). Manual on Integrated Vector Management in the Eastern Caribbean.106 pp. 20. Rosenbaum, J, Nathan, MB, Ragoonanansingh, R, Rawlins, SC, Gayle, C, Chadee, DD, Lloyd, L. (1995). Community participation in dengue prevention and control: a survey of knowledge, attitudes and practice in Trinidad and Tobago. Am. J. Trop, Med. Hyg. 53: 111-117. 21. Reinert, JF, Harbach, RE & Kitching, IJ (2004). Phylogeny and Classification of Aedini (Diptera: Culicidae), based on morphological characters of all life stages. Zoological Journal of the Linnean Society, 142:289- 368. 22. Srivastava, PK., Sharma, RS. Sharma, SN., & Dhariwal, AC. (2014).Integrated Vector Management: Policy and Implementation under National VBD Control Program, India. Research Gate. (Online). 23. Stone, A.et al. (1959). Synoptic catalogue of the Mosquitoes of the World. The Thomas Say Foundation. Vol. 6. 24. Van den Berg, H. Mutero CM. and Ichimori, K. (2012). Guidance on Policy-making for Integrated Vector Management. WHO/HTM/NTD/VEM/2012.2. 11pp. 25. WHO (1997). Vector Control. Methods for use by Individuals and Communities. Prepared by Jan A. Rozendaal. 26. WHO (2004). Global Strategic Framework for Integrated Vector Management. WHO/CDS/CPE/2004.10 27. WHO (2012a). Handbook for integrated Vector Management. WHO. WHO/HTM/NTD/VEM/2012.3. 67pp. 28. WHO (2012b). Monitoring and Evaluation for Integrated Vector Management. WHO/HTM/NTD/ VEM/2012.4. 26pp. 29. WHO (2012c). Core structure for training on integrated vector management. WHO/HTM/NTD/ VEM/2012.1. 44pp. 30. WHO (2016). A Toolkit for Integrated Vector Management in Sub-Saharan Africa. 221pp. Numerous other publications on Vector-borne disease control; Medical Entomology, etc. A special effort was made not to encumber this working manual with references.

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