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Entomological Surveillance

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Entomological Surveillance

CARPHA recognizes that entomological surveillance in CMS is inadequate not only because of resource constraints, but also because the system of Integrated Vector Management (IVM) is archaic. The reliance of IVM on paper-based data collection and processing, especially as it relates to entomological indices and epidemiological data, cripples the effectiveness of the vector control teams in CMS. The inability to predict increases in vector populations coupled with limited knowledge of the spatial epidemiological trends, often leads to recurrent outbreaks of vector-borne arboviral diseases such as Dengue.

In response, CARPHA is attempting to modernize the data collection and processing capacities of the CMS by implementing Geographic Information Systems to the vector control programmes as follows:

Training and Implementation of Novel Geographic Information System (GIS) Technology for combatting vector-borne diseases.

The Epi Info for Vector Surveillance App was developed by the Centers for Disease Control and Prevention (CDC) as a Novel GIS tablet-based solution for vector surveillance and control.

In 2018, CARPHA began a regional rollout process by doing a GIS Epi-Info training workshop for 13 CMS (Anguilla, Antigua and Barbuda, Cayman Islands, Dominica, Grenada, Guyana, Jamaica, Montserrat, St. Kitts and Nevis, St. Lucia, St. Maarten, St. Vincent and Trinidad) with a total of 26 persons benefitting from the training. GIS-capable tablets were procured for all the attending CMS. The workshop was held from May 23rd to 25th, 2018 at the Insect Vector Control Division, Ministry of Health, Trinidad.

The Objectives of the workshop were:

1. To strengthen CARPHA Member States’ capacity implementation of GIS technology in entomological surveillance.
2. To do a follow up of the receipt, installation and use of the QGIS platform.
3. To introduce vector control personnel to a novel GIS solution for entomological surveillance.
4. To provide field training in the use of Epi Info App for vector surveillance.
5. To demonstrate the improvement of Integrated Vector Management Systems through implementation of GIS technology.

Geographic Information For Vector Surveillance (Gives) Training I&Ii

Geographic Information For Vector Surveillance Training

CARPHA did a follow-up training to the introductory level, Geographic Information for Vector Surveillance (GIVeS) course that was held in July of 2017 at the University of the West Indies, St. Augustine, Trinidad. To do this, we partnered with the Emory University Center for Humanitarian Emergencies and the Liverpool School of Tropical Medicine, together with the US Centers for Disease Control and Prevention. This project was developed in conjunction with the US Centers for Disease Control and Prevention, to help develop capacity in the use of GIS-systems to aid in the combat of Zika and other arboviruses in Latin America and the Caribbean. The follow-up training was held on the 12th- 16th August 2019 in Port of Spain, Trinidad.

GIS-capable desktop computers were procured for 22 CMS.

Integrated Vector Management

The operations of several vector control programs show limited adoption of the PAHO/ WHO IVM strategies. For example, some CMS may have a decentralized vector management system, whereas others utilize the services of non-specific, cross-disciplined health control officers in the execution of activities. However, even in the decentralized system, non-health stakeholders such as agriculture or sanitation are rarely involved. There is also a lack of community involvement in the vector control operations. The CMS require expert advice in restructuring their IVM strategies to be more in line with the PAHO/WHO IVM strategies, thereby improving their ability to effectively manage, prevent and control outbreaks of emerging and re-emerging arboviral diseases.

CARPHA has responded to the IVM needs in the Caribbean through the following:

IVM Toolkit

In response to the need for standardized guidelines for vector control, specific to the Caribbean Region, CARPHA, through a consultancy under the previously awarded CDC-Zika Project, developed a “Toolkit on Integrated Vector Management in the Caribbean”.

The IVM Toolkit was reviewed by vector control managers, for which it was intended, through a two-day training workshop from December 5-6, 2017, in Port of Spain, Trinidad.

This Toolkit is an expansion and update on the previously published “PAHO Manual on Integrated Vector Management (IVM) in the Eastern Caribbean” and incorporates teaching materials from the World Health Organization’s (WHO’s) series of manuals on IVM.

CARPHA’s IVM Toolkit is designed to be used by vector control programme managers as a guide in the planning, implementation, monitoring and evaluation of an IVM approach. The Toolkit also provides information on common mosquito vectors and vector-borne diseases in the Caribbean and the tools for vector control operations within the IVM context.

The expectation is that vector control managers will introduce and begin to utilize the Toolkit as they implement and/or strengthen their respective vector control programmes through the IVM.

The IVM toolkit can be found HERE.

Capacity-building in the area of Integrated Vector Management (IVM) through technical assistance provided to CMS. These included the following country-specific activities:

1. Assessment of the existing and potential entomology laboratory facilities.
2. Training of vector control personnel in the entomology laboratory techniques associated with the collection and data management of Ae. aegypti mosquito indices.
3. Development and implementation of feedback mechanisms for entomological indices and vector control field operations.
4. Alignment of country IVM practices to WHO IVM best practice.

Seventy-six (76) public health officials from five (5) CMS (Antigua and Barbuda, Jamaica, Aruba, Suriname, Turks and Caicos) were trained in data management techniques associated with entomological indices under their vector control programmes. Details of this and other key achievements can be summarised as follows:

Evaluation of five (5) entomology laboratory facilities Aruba, Antigua and Barbuda, Jamaica, Suriname and Turks and Caicos. Using the WHO Laboratory Assessment Tool, laboratory facilities were ranked in 53-90%.
The 76 Entomology Laboratory, Environmental Officers and others were tested on Mosquito Indices Calculations of (HI, CI, BI).
Review of weekly and monthly reports of all CMS visited was completed to ensure mosquito indices were accurately being calculated. Also review of indices threshold systems used for Vector Control was also investigated.
Review of House Surveillance forms in all CMS visited was done. Jamaica and Aruba showed data from field was sufficiently recorded on forms. Forms in Turks and Caicos were also sufficient but historic records were destroyed by the hurricane. In Suriname, the last House Surveillance was recorded in 2016 due to chikungunya outbreak.
Information Flow Diagrams were completed for all CMS visited. Recommendations on improving sharing of information was completed.

Insecticide Resistance Testing (IRT)

Most CMS still rely heavily on the use of chemical insecticides for the control of Ae. aegypti adults as well as immature stages. Preliminary Insecticide Resistance Testing (IRT) done at CARPHA, shows that in a few CMS, these mosquitoes are already resistant to several classes of chemicals commonly used in vector-control programmes in the Region. CARPHA provides IRT as an ongoing service to its Member States, however, few CMS have the capacity to provide CARPHA with the required entomological specimens used in IRT. As part of an initial response to this challenge, CARPHA has recently developed and circulated an ovitrapping guide which the CMS are currently reviewing. Additionally, CARPHA has responded to the IRT needs in the Caribbean through the following:

Capacity-building in the area of Insecticide Resistance Testing (IRT) through technical assistance provided to CMS and strengthening of CARPHA’s Laboratory services. These included the following specific activities:

1. Development and implementation of national guidelines for IRT for medically important species of mosquitoes such as Ae. aegypti.
2. Training of vector control officials in advanced ovitrapping techniques for IRT and in other entomological techniques required for the capture and processing of entomological specimens for IRT.
3. Development of Standard Operating Procedures for CARPHA’s Entomology Laboratory to carry out biomolecular assays, specific to the detection of the mechanisms for insecticide resistance in Ae. aegypti mosquitoes.
4. Strengthening CARPHA's laboratory capacity to conduct biomolecular IRT.

One hundred and one (101) public health officials from five (5) CMS, namely Guyana, Grenada, Bahamas, BVI and St. Lucia, benefitted from training in Advanced Ovitrapping Techniques for Insecticide Resistance Testing (IRT). Other key achievements included the development of Draft National IRT Guidelines for the five (5) CMS.

Specific equipment and reagents to conduct biomolecular assays for insecticide resistance testing have been implemented at CARPHA.

Microscopic identification of mosquito vectors and new methods and techniques in vector control

CARPHA’s highly skilled entomology experts and advanced microscopic technology allow for quick identification of arthropod vectors that are of medical importance. This is an ongoing service that is offered to all CMS.

Additionally, the entomology team is always at the bleeding edge of research and knowledge in new methods and techniques in vector control. This expertise is an ongoing service that is available to all CMS. The following related activities have recently been completed by CARPHA:

Combatting the Zika Virus through training of vector control officials in “Microscopic species identification of mosquito vectors” and training in “New methods and techniques in Vector Control”.

The Microscope Identification workshop was held from March 5th-7th, 2018 at the Training Lab CARPHA Trinidad Campus.

The Objectives of the workshop were:

1. To review the theoretical aspects of the biology, ecology and morphology of the adult and larvae stages of the mosquito.
2. To illustrate the use of taxonomic keys for the identification of adult and larvae stages of the mosquito.
3. To provide specialized microscopy skills for the identification of mosquitoes.
4. To provide hands-on exposure in the identification of medically important species of mosquitoes to genus and species level.

The New Method and Techniques workshop was held from March 8th -9th 2018 at the Insect Vector Control Division, Ministry of Health Trinidad and Tobago.

The Objectives of the workshop were:

1. To review the traditional aspects of the vector control strategies used in Integrated Vector Management (IVM) of Aedes aegypti mosquitoes.
2. To illustrate the development of insecticide resistance in adult and larvae stages of the mosquito and the impact of insecticide resistance on the field efficacy of traditional vector control.
3. To provide theoretical knowledge of the new tools and strategies used in vector control.
4. To provide hands-on, practical training in the new tools used in vector control.

Nine (9) persons from eight CMS were trained across both areas. The participating CMS included: Anguilla, Barbados, BVI, Dominica, Grenada, St. Lucia, St. Vincent and the Grenadines and Tobago.