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Background:  Rio de Janeiro and Niterói are neighbouring cities in southeastern Brazil which experience large dengue epidemics every 2 to 5 years, with >100,000 cases notified in epidemic years. Costs of vector control and direct and indirect costs due to the  Aedes -borne diseases dengue, chikungunya and Zika were estimated to total $650 million USD in 2016, but traditional vector control strategies have not been effective in preventing mosquito-borne disease outbreaks. The  Wolbachia  method is a novel and self-sustaining approach for the biological control of  Aedes -borne diseases, in which the transmission potential of  Aedes aegypti  mosquitoes is reduced by stably transfecting them with the  Wolbachia  bacterium (  w Mel strain). This paper describes a study protocol for evaluating the effect of large-scale non-randomised releases of  Wolbachia­ -infected mosquitoes on the incidence of dengue, Zika and chikungunya in the two cities of Niterói and Rio de Janeiro. This follows a lead-in period since 2014 involving intensive community engagement, regulatory and public approval, entomological surveys, and small-scale pilot releases.    Method:  The  Wolbachia  releases during 2017-2019 covered a combined area of 170 km  2  with a resident population of 1.2 million, across Niterói and Rio de Janeiro. Untreated areas with comparable historical dengue profiles and demographic characteristics have been identified  a priori  as comparative control areas in each city. The proposed pragmatic epidemiological approach combines a controlled interrupted time series analysis of routinely notified suspected and laboratory-confirmed dengue and chikungunya cases, together with monitoring of  Aedes -borne disease activity utilising outbreak signals routinely used in public health disease surveillance.    Discussion:  If the current project is successful, this model for control of mosquito-borne disease through  Wolbachia  releases can be expanded nationally and regionally.

f1000research

The impact of large-scale deployment of Wolbachia mosquitoes on dengue and other Aedes-borne diseases in Rio de Janeiro and Niterói, Brazil: study protocol for a controlled interrupted time series analysis using routine disease surveillance data