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Skip to 0 minutes and 13 seconds I am Juliana Quintero, a medical doctor and epidemiologist at the Fundación Santa Fe de Bogotá, one of the main private non-profit health organisation of my country, Colombia. I have been working as a researcher for the past 10 years at the Public Health Division, conducting dengue research from different perspectives. I live in Bogotá, the capital of Colombia, where the virus is not present. And I travel every week to the municipality of Girardot to conduct our research activities. This is the municipality located in the southwest of Bogotá, approximately two hours drive. These are propitious environment for the transmission of dengue, chikungunya, and Zika. It has two seasons, the dry season between December and April and the rainy season between May and October.

Skip to 1 minute and 0 seconds Its population is over 105,000 people. But it triples during high season of holidays. Regarding Zika, I want to first mention that Colombia has reported over 70,000 cases, making it the second most affected country after Brazil. And in Girargot, the situation is the following. We have identified 1,936 cases in the local surveillance systems. Of these, 98% were clinically confirmed. 58% occurred in females. Then the first suspected cases was reported on October 23, 2015. The median age of the cases was 34 years old. And what we have identified right now that 16 pregnant women Zika virus were reported in Girardot, but are being followed according to national guidelines.

Skip to 1 minute and 54 seconds By March 2016, seven of them have given birth with no complications or microcephaly reported. Nine cases of the Guillain-Barré syndrome have been reported. Lab confirmation is pending. And there are no deaths attributed to these viruses. One of the big questions has been is the emerge of Zika has changed the control methods. And I can say that the emerge of Zika did not change the control methods. Rather, each of the levels about the awareness of the need to maintain and improve all the activities of control of vector control methods. And it has heightened the prevention strategies in the public agenda. What have we been doing in the community to prevent the spread of Zika?

Skip to 2 minutes and 39 seconds Well, we have been working in the past years to reduce Aedes population. We first just thought about dengue. But as it’s the same mosquito that transmit different diseases like chikungunya and Zika, we focus our research in identifying options for innovative community based system, management interventions, including communities, steakholders, participation and promotion of local leadership to guarantee long term sustainability of interventions developed. We began first by exploring the ecological, biological, and social factors that can contribute to the increase of these Aedes population, and then move into the design and implementation of tools and strategies that were most appropriate to the local conditions.

Skip to 3 minutes and 25 seconds And in this process it was possible to identify the most productive containers and target them with a cover made from insecticide treated nets in a aluminium frame. The covers were designed and styled by the community members. And we initially proved that these covers or that this measure reduces the pupae-per index up to 71% compared to those containers that didn’t have covers. Right now, we are scaling up the intervention to much larger areas, 2,000 households, with the intention to reduce the Aedes density, but more importantly the disease or the incidence of the diseases transmitted by the Aedes aegypti. What is working so far with the measures or the concern methods we are using?

Skip to 4 minutes and 16 seconds So far, we have demonstrated that efficacy in reducing the pupae-per activity when we target the most productive containers. Literature have already evidenced that it is a cost effective strategy. But when we develop it and think with the community and work closely with the community, it overcomes one of the most barriers we found when adapting this intervention. And it is that when we are talking about sustainability. But additionally, we think we need more work to be done to impact the disease incidence. Regarding to what is not working, I think that more than thinking in what is not working is why measures are not having the intended effect. There are several technical reasons for the ineffectiveness of the measures.

Skip to 5 minutes and 4 seconds And we can list some of them. For example, that developmental resistant of larvicides and insecticides, the lack of appropriate control coverage, that poor oversight of field activities. Control programmes are inadequate to urban reality. This means that they don’t take into account the heterogeneity of the localities and the ecology of the Aedes. And the staff visits are not done often enough, for example. It is necessary that these programmes have staff who know the social and economical conditions of the communities and can apply appropriate control measures within the community and with the support of them. There also is a lack of effective methods or entomological surveillance.

Skip to 5 minutes and 50 seconds Given there is a background of the other viruses in the community, how are the community members responding to the control efforts? Well, outbreak situations in general as emergent problems favours the mobilisation of the society of all members of the community. I refer to local authorities, researchers, inhabitants, community leaders, to face such a problem. It really represents an opportunity to strengthen the already known prevention and control strategies and to introduce new effective and innovative ones. In general, it seems that the community wants and is willing to work together in a multisector, intersectoral way.

Skip to 6 minutes and 30 seconds There is like a collective wish to adopt comprehensive strategies aiming to provide integral solutions to these complex problematic vector-borne diseases. To effectively contain future epidemics, in this epidemic and endemic municipality and other endemic municipalities of the country, I can mention that it’s really important or it seems appropriate to suggest to review the objectives and structure of the vector control programmes. It is necessary to deepen the entomological knowledge to better understand the complexity and the heterogeneity of transmission cycles, that the control and the monitor must be a local activity that needs qualified personnel, and integrate scientifically based and context sensitive control actions.

Case study: control methods in the field

In this step we hear from Dr Juliana Quintero, a Colombian epidemiologist and medical doctor working in the Public Health Division at the Fundación Santa Fe de Bogota. Dr Quintero has been involved in dengue research for over a decade, and has recently been conducting research in Girardot, Colombia.

In this case study, Dr Quintero describes which control methods are working, which have been less effective, and how approaches can and should change in the future.

Please note that the audio for this step was captured remotely and its quality will not be of the same standard as a studio recording. If you experience problems with the audio please use the subtitles or transcript file.

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Preventing the Zika Virus: Understanding and Controlling the Aedes Mosquito

London School of Hygiene & Tropical Medicine

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