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Journal Article
A new generation of long-lasting insecticidal nets
2022
Overview
The scale-up of malaria interventions over the past two decades has resulted in substantial reductions in malaria burden, especially in sub-Saharan Africa, which accounts for 95% of the global malaria burden.1,2 Between 2000 and 2019, an estimated 1·5 billion malaria cases and 7·6 million malaria deaths were averted, with many of the early gains attributed to widescale deployment of insecticide-treated nets and availability of effective drugs.1 However, progress in global malaria control and elimination efforts have stagnated in recent years, the reasons for which are multifactorial and include the development and spread of insecticide resistance in malaria vectors. The massive scale-up of insecticide-treated nets and, later, long-lasting insecticidal nets (LLINs), which have an insecticide incorporated into the net fibre and can last longer under typical use, was accompanied by the emergence of vector resistance to pyrethroids.3 This resistance is now present in all primary vectors throughout much of sub-Saharan Africa.3–5 Studies have shown that a new generation of LLINs that include the synergist piperonyl butoxide have improved efficacy compared with pyrethroid-only nets.6,7 However, although piperonyl butoxide can restore susceptibility in pyrethroid-resistant mosquito populations wherein the primary resistance mechanism is metabolic detoxification by oxidase enzymes, it has minimal impact on other mechanisms of pyrethroid resistance. The Royal Guard (Disease Control Technologies, Greer, SC, USA), an LLIN treated with α-cypermethrin and pyriproxyfen, provided little evidence of an added benefit relative to the standard LLINs.
Publisher
Elsevier Ltd,Elsevier Limited
