An immune System for the City: A New Paradigm for Surveillance and Control of Disease Vectors

Vector-borne pathogens continue to emerge, kill and harm humans with unrelenting regularity. Conventional strategies to controlling insect vectors grew out of the military; communication is hierarchical, responses unilateral, and regulation predetermined. We developed an alternative approach, modeled after the adaptive immune system, and compared the approaches through a cluster-randomized trial in the context of an ongoing urban Chagas disease vector control campaign in Arequipa, Peru. We report here early results from a pre-planned interim analysis. In the intervention (immune) arm 23 infested households were detected in 10 separate foci; in the control arm 5 infested households were detected in 1 focus. The immune approach was adaptive and required more effort (1085.2 person days vs 864.2 in the control; Rate ratio 3.66 [1.35 12.38], p-value =0.0062). Vector surveillance approaches modeled after the immune system may be more effective than conventional approaches, especially in cities and other complex civilian environments.