Mitigating Diseases Transmitted by Aedes Mosquitoes: A Cluster-Randomised Trial of Permethrin-Impregnated School Uniforms
Open accessAbstract
BACKGROUND: Viral diseases transmitted via Aedes mosquitoes are on the rise, such as Zika, dengue, and chikungunya. Novel tools to mitigate Aedes mosquitoes-transmitted diseases are urgently needed. We tested whether commercially insecticide-impregnated school uniforms can reduce dengue incidence in school children. METHODS: We designed a cluster-randomised controlled trial in Thailand. The primary endpoint was laboratory-confirmed dengue infections. Secondary endpoints were school absenteeism; and impregnated uniforms' 1-hour knock-down and 24 hour mosquito mortality as measured by standardised WHOPES bioassay cone tests at baseline and after repeated washing. Furthermore, entomological assessments inside classrooms and in outside areas of schools were conducted. RESULTS: We enrolled 1,811 pupils aged 6-17 from 5 intervention and 5 control schools. Paired serum samples were obtained from 1,655 pupils. In the control schools, 24/641 (3.7%) and in the intervention schools 33/1,014 (3.3%) students had evidence of new dengue infections during one school term (5 months). There was no significant difference in proportions of students having incident dengue infections between the intervention and control schools, with adjustment for clustering by school. WHOPES cone tests showed a 100% knock down and mortality of Aedes aegypti mosquitoes exposed to impregnated clothing at baseline and up to 4 washes, but this efficacy rapidly declined to below 20% after 20 washes, corresponding to a weekly reduction in knock-down and mosquito mortality by 4.7% and 4.4% respectively. Results of the entomological assessments showed that the mean number of Aedes aegypti mosquitoes caught inside the classrooms of the intervention schools was significantly reduced in the month following the introduction of the impregnated uniforms, compared to those collected in classrooms of the control schools (p = 0.04). CONCLUSIONS: Entomological assessments showed that the intervention had some impact on the number of Aedes mosquitoes inside treatment schools immediately after impregnation and before insecticidal activity declined. However, there was no serological evidence of protection against dengue infections over the five months school term, best explained by the rapid washing-out of permethrin after 4 washes. If rapid washing-out of permethrin could be overcome by novel technological approaches, insecticide-treated clothes might become a potentially cost-effective and scalable intervention to protect against diseases transmitted by Aedes mosquitoes such as dengue, Zika, and chikungunya. TRIAL REGISTRATION: ClinicalTrials.gov NCT01563640.
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They did detect a reduction in the number of Ae. aegypti mosquitoes captured in classrooms randomized to treated clothing during the first month of the study, prior to washout of the permethrin, suggesting that the clothing did have a repellent effect on mosquitoes.
“However, they did detect a reduction in the number of Ae. aegypti mosquitoes captured in classrooms randomized to treated clothing during the first month of the study, prior to washout of the permethrin, suggesting that the clothing did have a repellent effect on mosquitoes.[8]”
From Pyrethroid insecticides maintain repellent effect on knock-down resistant populations of Aedes aegypti mosquitoes (2018) · cites this paper as [8]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThe largest field-based trial of factory-treated clothing found no effect on 5-month dengue incidence of permethrin-impregnated school uniforms in a cohort of 1811 Thai children, but poor quality cloth that permitted rapid washout of insecticide with laundering was a major limitation to this study.
“The largest field-based trial of factory-treated clothing found no effect on 5-month dengue incidence of permethrin-impregnated school uniforms in a cohort of 1811 Thai children, but poor quality cloth that permitted rapid washout of insecticide with laundering was a major limitation to this study.”
From Pyrethroid insecticides maintain repellent effect on knock-down resistant populations of Aedes aegypti mosquitoes (2018) · cites this paper as [8]
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- Authors
- Kittayapong, P., Olanratmanee, P., Maskhao, P., Byass, P., Logan, J., Tozan, Y., Louis, V., Gubler, D. J., & Wilder-Smith, A.
- Affiliations
- Mahidol University (TH)
- Rajabhat Rajanagarindra University (TH)
- Umeå University (SE)
- London School of Hygiene & Tropical Medicine (GB)
- Heidelberg University (DE)
- Duke-NUS Medical School (SG)
- Corresponding author
- Kittayapong, Pattamaporn
- Venue
- PLOS Neglected Tropical Diseases
- Publisher
- Public Library of Science (PLoS)
- Published
- 2017-01-19
- Volume
- 11
- Issue
- 1
- Pages
- e0005197
- ISSN
- 1935-2727 (ISSN-L)
- 1935-2735
- PMC
- PMC5245776
- OpenAlex
- W2577527799
- Cited by
- 44
- References
- 24
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 4 · 2023: 5 · 2022: 4 · 2021: 5 · 2020: 3 · 2019: 8 · 2018: 8 · 2017: 1
- FWCI
- 5.14
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS neglected tropical diseases (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- DiVA at Umeå University (Umeå University) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- DR-NTU (Nanyang Technological University) (submittedVersion, cc-by)
- Figshare (submittedVersion, cc-by)
- Greater South Information System
- Funders
- European Commission (282589)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Mosquito-borne diseases and control
- Social Sciences › Sociology and Political Science › Dengue and Mosquito Control Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Keywords
- permethrin, Aedes aegypti, dengue, vector control, school absenteeism, dengue seroprevalence, Zika virus, chikungunya, vector-borne disease prevention, insect monitoring
- MeSH terms
- Zika Virus Infection, Zika Virus, Adolescent, Aedes, Animals, Chikungunya virus, Child, Dengue, Dengue Virus, Female, Humans, Insect Vectors, Insecticides, Male, Mosquito Control, Protective Clothing, Schools, Thailand, Permethrin, Chikungunya Fever
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