A mosquito-based method to reduce dengue fever could


image: Estimate of disability-adjusted life years (DALY, in thousands) caused by dengue each year from 2010 to 2020 in Singapore according to different scenarios: A) disability weight as a function of age (DW), constant expansion factors B) age-dependent disability weights, age dependent expansion factors C) constant disability weights, constant expansion factors D) constant disability weights, factors age dependent expansion.
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Credit: Soh et al., 2021, CC-BY 4.0 (https://creativecommons.org/licenses/by/4.0/)

New research suggests that dengue, a viral infection spread by mosquitoes, could be suppressed in Singapore very cost effectively through the release of mosquitoes infected with Wolbachia bacteria. Stacy Soh of the National Environment Agency of Singapore and colleagues present these findings in the new open-access journal PLOS Global Public Health on October 13, 2021.

Singapore experiences periodic outbreaks of dengue, including a 2020 outbreak that peaked at 1,792 weekly cases. Mosquitoes infected with the naturally occurring Wolbachia bacteria are less likely to spread dengue, and evidence suggests that dengue can be suppressed by releasing mosquitoes infected with Wolbachia into local mosquito populations. However, the overall cost-effectiveness of this strategy had not been studied.

To assess the potential cost-effectiveness of removing Wolbachia from Singapore, Soh and colleagues first used economic and epidemiological data to calculate the impact of dengue fever in the country from 2010 to 2020. They estimated that , over that 10-year period, dengue cost Singapore between $ 1.014 and $ 2.265 billion in 2010 US dollars, as well as 7,645 to 21,262 disability-corrected life years (DALY) – the total number of years of human life lost due to illness, disability or death.

Next, the researchers calculated the hypothetical cost of a Wolbachia program over the same 10-year period. They envisioned a strategy in which males infected with Wolbachia would be released, as opposed to infected females, in the hopes of suppressing existing mosquito populations. In this scenario, the researchers modeled an efficiency of at least 40%, consistent with the results of actual studies.

The researchers calculated that, under such a program, avoiding a single DALY would cost $ 100,907, for a total of $ 329.40 million saved in total. The authors note that future work may help refine these cost estimates. For example, future research could focus on how a Wolbachia suppression program might work in the context of the distribution of a newly developed dengue vaccine, or alongside other existing vector control efforts, such than the elimination of mosquito breeding sites.

Regardless, the authors consider their estimates to indicate that a Wolbachia program would be highly cost-effective and suggest that its deployment be a priority in Singapore to suppress the spread of dengue.

The author, Dr Lim, sums up: “The release of mosquitoes infected with Wolbachia is a promising disease intervention strategy aimed at controlling dengue and other arbovirus infections. However, the overall cost-effectiveness of the technology is not well studied as part of the suppression approach which aims to suppress the wild-type mosquito population through the release of males infected with Wolbachia. Using Singapore as the main case example, this study found that the versions of Wolbachia in Singapore are expected to be highly profitable and its deployment should be a priority to reduce the spread of dengue. “


Quote: Soh S, Ho SH, Seah A, Ong J, Dickens BS, Tan KW et al. (2021) Economic impact of dengue fever in Singapore from 2010 to 2020 and profitability of Wolbachia interventions. PLOS Glob Public Health 1 (10): e0000024. https://doi.org/10.1371/journal.pgph.0000024

Author countries: Singapore

Funding: ARC is supported by the National Medical Research Council through the Singapore Center for Population Health Improvement Grant NMRC / CG / C026 / 2017 NUHS and COVID19RF-004. Funders played no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have stated that there is no conflict of interest.

In your cover, please use this URL to provide access to the article available for free in PLOS Global Public Health: https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0000024

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