Coordination among neighbors improves the efficacy of Zika control despite economic costs
Authors: Lemanski Natalie J. , Schwab Samantha R. , Fonseca Dina M. , Fefferman Nina H. 
Published: October 2019

AbstractBackgroundEmerging mosquito-borne viruses like Zika, dengue, and chikungunya pose a major threat to public health, especially in low-income regions of Central and South America, southeast Asia, and the Caribbean. Outbreaks of these diseases are likely to have long-term social and economic consequences due to Zika-induced congenital microcephaly and other complications. Larval control of the container-inhabiting mosquitoes that transmit these infections is an important tool for mitigating outbreaks. However, metapopulation theory suggests that spatiotemporally uneven larvicide treatment can impede control effectiveness, as recolonization compensates for mortality within patches. Coordinating the timing of treatment among patches could therefore substantially improve epidemic control, but we must also consider economic constraints, since coordination may have costs that divert resources from treatment.Methodology/Principle FindingsTo inform practical disease management strategies, we ask how coordination among neighbors in the timing of mosquito control efforts influences the size of a mosquito-borne infectious disease outbreak under the realistic assumption that coordination has costs. Using an SIR/metapopulation model of mosquito and disease dynamics, we examine whether larvicide treatment triggered by surveillance information from neighboring patches reduces human infections when incorporating coordination costs. We examine how different types of coordination costs and different surveillance methods jointly influence the effectiveness of larval control. We find that the effect of coordination depends on both costs and the type of surveillance used to inform treatment. With epidemiological surveillance, coordination improves disease outcomes, even when costly. With demographic surveillance, coordination either improves or hampers disease control, depending on the type of costs and surveillance sensitivity.Conclusions/SignificanceOur results suggest coordination among neighbors can improve management of mosquito-borne epidemics under many, but not all, assumptions about costs. Therefore, estimating coordination costs is an important step for most effectively applying metapopulation theory to strategies for managing outbreaks of mosquito-borne viral infections.Author SummaryMosquito-borne viruses, such as Zika, are an urgent public health threat, particularly in tropical, low-income regions. Vector control, the main strategy for combatting outbreaks, can be challenging because the urban-adapted, container-breeding mosquitoes that transmit these viruses often exhibit metapopulation dynamics, where mortality in one population is compensated by migration from neighboring populations. The timing and spatial distribution of vector control efforts can therefore have a large impact on their efficacy. Using a model of virus transmission and vector population dynamics, we demonstrate that local mosquito control initiatives aimed at reducing the burden of Zika and other mosquito-borne infections are most effective when there is communication of surveillance findings among neighboring control agencies and coordination over the timing of mosquito reduction treatments. We find that local communication improves epidemic outcomes even when it imposes costs to resource-limited control agencies due to gains in the efficiency of mosquito control from spatial coordination.