Summary of findings 1. wMel‐Wolbachia infected Aedes aegypti deployments compared to no deployments for preventing dengue virus infection.
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Patient or population: children and adults at risk of dengue infection Setting: Indonesia, urban area Intervention:wMel‐Wolbachia infected Aedes aegypti deployments (population replacement strategy) Comparison: no deployments | ||||||
| Outcomes | Anticipated absolute effects (95% CI) | Relative effect (95% CI) | No of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with control | Risk with Wolbachia deployments | |||||
| Virologically confirmed dengue case incidence (any severity, any phenotype) | — | — | — | — | — | No data reported. |
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Prevalence of DENV infection (any severity, any phenotype)a Assessed with: fever onset 1–4 days before presentation + positive laboratory assays (RT‐PCR or ELISA) Time period: 27 months |
94 per 1000b | 24 per 1000 (15 to 35)c |
OR 0.23 (0.15 to 0.35) | 6306 (1 cRCT) | ⊕⊕⊕⊝ Moderated |
wMel‐Wolbachia‐infected Ae aegypti deployments (via population replacement strategy) reduce DENV prevalence. |
| Prevalence of dengue RNA in the mosquito population | — | — | — | — | — | No data reported. |
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Mosquito density (for population suppression strategy) |
— | — | — | — | — | No data reported. |
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Prevalence of Wolbachia‐carrying mosquitoes (for population replacement strategy) |
— | — | — | — | — | No reliable comparative data were available. |
| Adverse events potentially related to Wolbachia‐carrying Aedes deployments | — | — | — | — | — | No data reported. |
| *The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; cRCT: cluster‐randomized controlled trial; DENV: dengue virus; ELISA: enzyme‐linked immunosorbent assay; OR: odds ratio; RNA: ribonucleic acid; RT‐PCR: reverse transcription polymerase chain reaction. | ||||||
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GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect. | ||||||
a Absolute risk in the control group was estimated by the prevalence amongst those who reported a fever during the study period, not the entire population residing in the study area. b We have assumed that all individuals recruited to the study were distinct, i.e. no participant was enrolled more than once for separate episodes of fever. c We calculated the absolute risk in the intervention group by converting the odds ratio to a risk ratio using the formula provided in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2022), and an assumed comparator risk of 0.094 (prevalence amongst those who reported a fever during the study period, not the entire population residing in the study area). d Downgraded one level due to indirectness as only one cRCT contributed to the result and evidence from non‐randomized studies suggests that the relative effect may vary in other settings due to confounding factors.