Dengue fever is a mosquito-borne illness transmitted primarily by the Aedes aegypti mosquito. Dengue poses a significant public health threat, with several countries in South America and Asia facing severe outbreaks. Recurrent dengue outbreaks cause substantial illness and death, making it a formidable challenge for healthcare systems. Factors such as warmer and wetter weather and new subtypes of the virus are driving an explosion of cases in countries such as Brazil and Argentina. In response to this crisis, health authorities are trialling an innovative approach utilising the Wolbachia method. This method releases Wolbachia-infected mosquitoes as a tool to decrease the transmission of dengue. Wolbachia is a naturally occurring bacterium that can interfere with the ability of mosquitoes to transmit viruses. This approach to dengue control offers a sustainable and effective alternative to short-term measures such as insecticide spraying.

In areas where dengue is endemic and outbreaks occur regularly, the Wolbachia method holds significant epidemiological implications in the fight against dengue because it prevents the disease, creates a form of herd immunity, impacts the incidence of dengue, and offers long-term control and adaptability to different settings. Currently, six Brazilian cities are set to release these mosquitoes to combat a severe outbreak of dengue fever in the country. The results of this intervention are expected to be released later in 2024. However, the results from a 2021 pilot study conducted in Niteroi, Brazil, were promising. Pinto and colleagues reported in the PLOS Neglected Tropical Disease journal that Wolbachia-infected mosquito deployments were associated with a 69% reduction in dengue cases, compared to a control area of Niteroi that did not receive Wolbachia releases. The areas with Wolbachia deployments also saw a 56% decrease in chikungunya and a 37% reduction in the incidence of Zika. This is significant because chikungunya is expected to increase from approximately 260,000 incident cases in 2024 to 267,000 cases by 2029 in nine major markets (9MM: Argentina, Bolivia, Brazil, Colombia, India, Jamaica, Kenya, Malaysia, and Mexico) according to GlobalData’s epidemiology forecast. Historical data on dengue fever shows that in the last decade, confirmed incident cases of dengue fever increased from 290,000 in 2013 to 341,000 cases in 2023 in six major markets (Australia, Brazil, India, Mexico, Singapore, and Thailand). The increase in vector-borne illness is expected to continue as climate change creates favourable conditions for mosquitos to proliferate.

As Wolbachia-infected mosquitoes establish themselves, they may create a form of ‘herd immunity’ within the community. As the proportion of Wolbachia-infected mosquitoes grows, the overall transmission of virus-causing dengue, Zika, and chikungunya decreases within the population, leading to a drop in illness. By reducing dengue fever, the Wolbachia method can alleviate the burden on healthcare systems by decreasing hospitalisations and demand for medical resources, and lowering healthcare costs. Another advantage to this approach is the potential of long-term control, because unlike pesticide spraying (which can lead to insecticide resistance), once Wolbachia-infected mosquitoes are established, they can persist and continue to exert inhibitory effects on viral transmission. However, studies have shown that Wolbachia-infected mosquitos may lose their Wolbachia infections due to seasonal climate fluctuations. While the Wolbachia method shows promising results, ongoing monitoring will show whether it is a sustainable control for vector-borne disease.

The Wolbachia method represents a shift in dengue control strategies, offering communities combating outbreaks of dengue, Zika, and chikungunya illness a promising self-sustaining public health intervention. Harnessing the symbiotic relationship between Wolbachia and mosquitoes can lead to a dramatic decrease in the disease and alleviate the pressure on healthcare systems. As ongoing research and implementation efforts continue, collaboration between health professionals, researchers, and governments will be critical to scale up this innovative approach. Wolbachia technology has the potential to help countries move closer to their goals of dengue control and population safeguarding.

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