8.2 Vector Control

General: policies and actions

The Seventieth World Health Assembly resolution WHA70.16 and WHO report Global vector control response 2017–2030 (17) promote effective, locally adapted and sustainable vector control by:

·       strengthening of inter- and intra-sectoral collaboration

·       engaging and mobilizing communities

·       enhancing vector surveillance, and monitoring and evaluation of interventions scaling up and integrating tools and approaches.

 

1.

Guidance:

Develop or update national and regional vector control policies and action plans in line with the WHO global vector control response strategy (17).

Priority activities include the following.

·       Conduct/update national vector control needs assessment and develop resource mobilization plan (including for outbreak response).

·       Appraise and enhance national entomology and cross-sectoral workforce to meet identified requirements for vector control.

·       Train relevant staff from ministries of health and/or their supporting institutions in public health entomology.

·       Establish national and regional institutional networks to support training/education in public health entomology and technical support.

·       Establish/review progress of national agenda for basic and applied research on entomology and vector control.

·       Establish national inter-ministerial task force for multisectoral engagement in vector control.

·       Develop national plan for effective community engagement and mobilization in vector control.

·       Strengthen national vector surveillance systems and integrate them with health information systems to guide vector control.

·       Align national targets for protection of at-risk population with appropriate vector control across vector-borne diseases.

 

Sector principally involved in planning/ implementation:

Health, environment, education, housing, waste, water/sanitation, research, other sectors

 

Level of implementation:

National

 

Instruments:

Regulation

 

ICHI code:

UBQ.WJ.ZZ

Policy change in relation to animals as vectors of disease

 

UBQ.TB.ZZ

Planning in relation to animals as vectors of disease

 

UBQ.PH.ZZ

Training about animal vectors of disease

 

UBQ.VA.ZZ

Capacity building targeting animal vectors of disease

 

2.

Guidance:

Strengthen inter- and intra-sectoral action and collaboration on vector control (17).

·       Re-align programmes so that staff are equipped to address multiple vectors and diseases and integrate efforts for greater efficiency and effectiveness.

·       Broaden collaborations within and beyond the health sector.

 

Sector principally involved in planning/ implementation:

Health, environment, education, housing, waste, water/sanitation, other sectors

 

Level of implementation:

National

 

Instruments:

Governance

 

ICHI code:

UBQ.TD.ZZ

Collaboration in relation to animals as vectors of disease

 

3.

Guidance:

Enhance vector surveillance, and monitoring and evaluation of interventions (17).

·       Strengthen and integrate national surveillance systems for vectors, interventions and diseases.

·       Coordinate surveillance and action between neighbouring countries.

 

Sector principally involved in planning/ implementation:

Health, education

 

Level of implementation:

National, community

Universal health coverage

 

Instruments:

Assessment and surveillance

 

ICHI code:

UBQ.VC.ZZ

Public health surveillance in relation to animals as vectors of disease

 

UBQ.AA.ZZ

Assessment of animal vectors of disease

 

4.

Guidance:

Scale up and integrate tools and approaches for vector control (17).

·       Ensure vector control methods are selected and combined appropriate to the local setting.

·       Integrate innovations as recommended by WHO.

 

Sector principally involved in planning/ implementation:

Health, research

 

Level of implementation:

National, community

Universal Health coverage

 

Instruments:

Other management and control

 

ICHI code:

UBQ.VE.ZZ

Infection control measures in relation to animals as vectors of disease

+

UBQ.VN.ZZ

Establishing health services or health-related services in relation to animals as vectors of disease

 

5.

Guidance:

Combine different vector control methods and interventions and integrate vector control efforts for different vectors and diseases in an appropriate and evidence-based way (17, 20)

Vector control strategies need to be adapted to and appropriate for the local context. Aspects of effectiveness, human and environmental safety, risk for development of resistance, affordability, community participation and policy and logistic support need to be considered when choosing vector control methods.

 

Sector principally involved in planning/ implementation:

Health

 

Level of implementation:

National, community

Universal health coverage

 

Instruments:

Other management and control

 

ICHI code:

UBQ.VE.ZZ

Infection control measures in relation to animals as vectors of disease

 

6.

Guidance:

Support improved water resource, wastewater and solid waste management for improved control of many disease vectors (17, 24)

 

Sector principally involved in planning/ implementation:

Health, water/sanitation, education, waste, environment

 

Level of implementation:

National, community

Universal health coverage

 

Instruments:

Infrastructure, technology and built environment

 

ICHI code:

UBQ.TK.ZZ&UET&UEU&UEV

Public facilities or infrastructure development in relation to animals as vectors of disease

Water collection, treatment and supply services, systems and policies

Sewerage services, systems and policies

Waste collection and disposal services, systems and policies

 

Awareness raising and capacity building

 

7.

Guidance:

Educate the community, community health workers and community leaders and raise awareness about the linkages between vector occurrence and disease prevalence, transmission mechanisms and ways of avoiding exposure (17, 20)

Strengthening capacity in the community should consider special training requirements of, for example,community health workers and agricultural extension workers.

 

Sector principally involved in planning/ implementation:

Health, other sectors

 

Level of implementation:

National, community

Universal health coverage

 

Instruments:

Information, education and communication

 

ICHI code:

UBQ.PM.ZZ

Education in relation to animals as vectors of disease

 

UBQ.VB.ZZ

Awareness raising in relation to animals as vectors of disease

 

8.

Guidance:

Engage and mobilize the community in vector control efforts for achieving greater coverage and sustainability and thereby effectiveness of vector control (17).

Enable communities to lead and sustain vector control activities, such as eliminating vector habitats from their environment and improving housing.

 

Sector principally involved in planning/ implementation:

Health

 

Level of implementation:

Community

Universal health coverage

 

Instruments:

Information, education and communication

 

ICHI code:

UBQ.VA.ZZ

Capacity building in relation to animals as vectors of disease

 

Note:

The examples below summarize recommendations on malaria and dengue, which are two major vector-borne diseases.

 

Malaria

The two core interventions for malaria vector control recommended by WHO are insecticide-treated nets and indoor residual spraying. One of these core interventions should be chosen and supplied to the entire population at risk for malaria. In specific settings, and under special circumstances, these core interventions can be supplemented by larviciding (conditional recommendation) or other forms of larval source management (no recommendation). As yet there is no evidence for the public health value for deployment of personal protection measures such as repellents and clothing (conditional recommendation against deployment of topical repellents and insecticide-treated clothing as interventions with public health value), however topical repellents and insecticide-treated clothing may provide personal protection against malaria. Due to limited evidence no recommendation is given on the non-chemical methods for malaria vector control listed below. They should only be applied supplementary to (one of) the core interventions. Space spraying against malaria should be strongly discouraged given the limited evidence of the intervention’s effectiveness and the potential for wastage of resources (23).

 

9.

Guidance:

Support larval source management as supplementary interventions for mosquito reduction.

Larval source management as a supplementary intervention for malaria vector control includes environmental management such as habitat modification and manipulation, larviciding and biological controls.

In general and where feasible, environmental management (habitat modification and manipulation) should be the primary strategy to reduce the availability of larval habitats. However, no systematic reviews have so far been conducted to inform the development of WHO guidance in this area (23). This may include the management of wetlands and drains and management of irrigation (20).

 

Sector principally involved in planning/ implementation:

Health

 

Level of implementation:

National, community

Universal health coverage

 

Instruments:

Other management and control

 

ICHI code:

UBQ.TM.ZZ&UBB

Environment modification in relation to animals as vectors of disease

Bodies of water

 

10.

Guidance:

Support housing improvements as potential additional measures to reduce the transmission of malaria and other vector-borne diseases (23).

Available evidence indicates that poorquality housing and neglected peridomestic environments are risk factors for the transmission of malaria and other vector-borne diseases. However, specific evidence-based recommendations on housing and vector-borne diseases are still needed. The evidence base for housing improvement as an approach for malaria prevention and control is currently under review.

 

Sector principally involved in planning/ implementation:

Housing, construction, health

 

Level of implementation:

National, community

Universal health coverage

 

Instruments:

Infrastructure, technology and built environment

 

ICHI code:

UBQ.TA.ZZ&UAL

Advocacy in relation to animals as vectors of disease

Design, construction and building products and technology of buildings for private use

 

Dengue

Dengue mosquito control will reduce dengue, particularly when targeting Aedes aegypti in urban habitats, though a sustainable tool to do so is lacking. Novel delivery methods have been developed to control Aedes vector populations using residual killing agents, including targeted indoor residual spraying, which shows promise for reducing dengue. Adulticiding for dengue prevention is most effective when it is conducted as part of an IVM plan that includes source reduction and larviciding. Successful dengue prevention programmes include a combination of tools and strategies that are applied with enhanced intersectoral and interdisciplinary cooperation and strong community engagement.

 

11.

Guidance:

Implement environmental management (source reduction) measures as the main pillar of dengue vector control (25).

Environmental management measures for dengue vector control include the following.

·       Environmental modification such as installation of reliable piped water on premises.

·       Environmental manipulation such as frequent emptying, cleaning or mosquito-proof covering of water containers, removal or filling of nonessential water containers, improved solid waste management, and screening of construction sites, open drains, and water bodies with stagnant water.

·       Changes to human habitation and behaviour such as installing mosquito screens on windows, doors and other entry points.

·       Perifocal treatment of larval habitats and peripheral mosquito resting surfaces or targeted residual spraying in homes and other settings such as schools and workplaces as part of an integrated dengue vector management programme.

 

Sector principally involved in planning/ implementation:

Health, other sectors

 

Level of implementation:

National, community

Universal health coverage

 

Instruments:

Other management and control

 

ICHI code:

UBQ.TM.ZZ#ICD-11 1DZZ

Environment modification in relation to animals as vectors of disease

Dengue fever

 

UET.TM.ZZ#ICD-11 1DZZ

Environment modification in relation to water collection and treatment

Dengue fever

 

UGN.AA.ZZ

Assessment of health effects of construction of buildings

 

Selected tools 

·       WHO 2019: Guidelines for malaria vector control (23)

·       WHO 2017: Global vector control response 2017–2030 (17)

·       WHO 2017: Framework for a national vector control needs assessment (26)

·       WHO 2016: A toolkit for integrated vector management in sub-Saharan Africa (19)

·       WHO 2016: Technical handbook for dengue surveillance, dengue outbreak prediction/detection and outbreak response (27)

·       WHO 2013: Larval source management (28)

This report is an operational manual on larval source management.

·       WHO 2012: Handbook for integrated vector management (20)

·       WHO 2012: Core structure for training curricula on integrated vector management (29

This report provides guidance on IVM training.

·       WHO 2011: Operational guide for assessing the productivity of Aedes aegypti breeding sites (30)