Suspected dengue cases notified in Port Vila from January 2016 –January 2022 by (A) hospitalisation status and (B) diagnostic test result.

Blue shading indicates release period for Wolbachia (wMel)-infected Ae. aegypti. Suspected dengue cases without any laboratory diagnostic testing are included in panel A, but excluded from panel B.</p

<i>w</i>Mel introgression in two areas in South Tarawa, Kiribati.

A) South Tarawa, Kiribati showing the two release areas: Betio (left) and Bairiki (right). B) Introgression of wMel. The line (left axis) represents the percent of Ae. aegypti tested that were infected with wMel Wolbachia, between May 2018 and December 2019. The bars (right axis) indicate the number of Ae. aegypti tested. Data points with less than five screened mosquitos have been omitted. Shaded orange areas indicate wMel mosquito release times. Map produced in QGIS version 3.16.1 using the enumeration area boundaries freely available from the Pacific Data Hub (https://pacificdata.org/data/dataset/2010_kir_phc_admin_boundaries) and OpenMapTiles basemap layer (https://openmaptiles.org/) with CARTO light design (https://carto.com/).</p

Release & monitoring of <i>w</i>Mel-infected <i>Ae</i>. <i>aegypti</i> within 12 areas of Port Vila, Vanuatu.

Each release area was divided into a grid with 100 x 100 meter squares. Grid squares lacking mosquito releases were omitted. Release gradient was determined by using GPS coordinates of each release event and assigning the number of wMel-infected mosquitos to a corresponding grid square. Monitoring numbers were determined in the same way. Map produced in QGIS version 3.16.1 using boundaries aggregated from the enumeration area boundaries freely available from the Pacific Data Hub (https://pacificdata.org/data/dataset/2016_vut_phc_admin_boundaries) and OpenMapTiles basemap layer (https://openmaptiles.org/) with CARTO light design (https://carto.com/)). (PNG)</p

Insecticide Resistance (IR) Profiles of Release Strains determined by WHO Biosaay.

A) Fiji release strain IR profile. B) Vanuatu release strain IR profile. C) Kiribati release strain IR profile. Each data point is the mean of five biological replicates (± s.d.) using approximately 20 mosquitoes per replicate. (TIFF)</p

<i>Wolbachia</i>-mediated reduction in DENV genome copy number per mosquito.

All mosquitoes were aged for 6–7 days prior to intrathoracic injection with DENV. Fifty mosquitoes were used for each data point but some died prior to testing (S3 Table). DENV copy number was determined 7 days post injection using qRT-PCR. All wMel Ae. aegypti lines had a significant reduction in DENV viral RNA concentration (Wilcoxon rank-sum est). A) Fiji release strain, Fij-wMel, and wild-derived control, Fij-WT,vector competence. B) Vanuatu release strain, Van-wMel, and wild-derived control, Van-WT, vector competence. C) Kiribati release strain, Kir-wMel, and wild-derived control, Kir-WT, vector competence. D) Australian Cairns strain, Aus-wMel, and tetracycline cured control, Aus-TET, vector competence. Data are shown as the median DENV copies per mosquito (thick line) ± interquartile ranges (box), extended by the whiskers indicating 1.5× the interquartile range, with dots indicating outliers. Individual data points are included as smaller partially opaque points. Data from uninfected mosquitoes are not included in the median estimates (S3 Table). (TIFF)</p

Public Acceptance Surveys.

Outcome of community surveys taken at baseline (prior to engagement activity) and pre-release (prior to deployment of Wolbachia-infected mosquitoes). Awareness was determined by asking participants if they had heard of the World Mosquito Program. Acceptance was determined by asking participants if, once it was explained to them, they approved of releasing mosquitoes with good bacteria to reduce dengue.</p

DENV Prevalence in <i>Wolbachia</i>-infected Mosquitoes.

Pacific Island countries have experienced periodic dengue, chikungunya and Zika outbreaks for decades. The prevention and control of these mosquito-borne diseases rely heavily on control of Aedes aegypti mosquitoes, which in most settings are the primary vector. Introgression of the intracellular bacterium Wolbachia pipientis (wMel strain) into Ae. aegypti populations reduces their vector competence and consequently lowers dengue incidence in the human population. Here we describe successful area-wide deployments of wMel-infected Ae. aegypti in Suva, Lautoka, Nadi (Fiji), Port Vila (Vanuatu) and South Tarawa (Kiribati). With community support, weekly releases of wMel-infected Ae. aegypti mosquitoes for between 2 to 5 months resulted in wMel introgression in nearly all locations. Long term monitoring confirmed a high, self-sustaining prevalence of wMel infecting mosquitoes in almost all deployment areas. Measurement of public health outcomes were disrupted by the Covid19 pandemic but are expected to emerge in the coming years.</div

Release & monitoring of <i>w</i>Mel-infected <i>Ae</i>. <i>aegypti</i> within six areas of Nadi and five areas of Lautoka, Fiji.

Each release area was divided into a grid with 100 x 100 meter squares. Grid squares lacking mosquito releases were omitted. Release gradient was determined by using GPS coordinates of each release event and assigning the number of wMel-infected mosquitos to a corresponding grid square. Monitoring numbers were determined in the same way. Map produced in QGIS version 3.16.1 using boundaries aggregated from the enumeration area boundaries freely available from the Pacific Data Hub (https://pacificdata.org/data/dataset/2007_fji_phc_admin_boundaries) and OpenMapTiles basemap layer (https://openmaptiles.org/) with CARTO light design (https://carto.com/)). (PNG)</p

<i>w</i>Mel introgression in 12 release areas in Port Vila, Vanuatu.

A) Port Vila, Vanuatu showing the 12 release areas. B) wMel introgression. The line (left axis) represents the percent of Ae. aegypti screened that were infected with wMel Wolbachia, between August 2018 and May 2021. The bars (right axis) indicate the number of Ae. aegypti tested. Data points with less than five screened mosquitos have been omitted. Shaded orange areas indicate wMel mosquito release times. Map produced in QGIS version 3.16.1 using boundaries aggregated from the enumeration area boundaries freely available from the Pacific Data Hub (https://pacificdata.org/data/dataset/2016_vut_phc_admin_boundaries) and OpenMapTiles basemap layer (https://openmaptiles.org/) with CARTO light design (https://carto.com/)).</p

Pre-release Mosquito Strain Health Checks.

Pacific Island countries have experienced periodic dengue, chikungunya and Zika outbreaks for decades. The prevention and control of these mosquito-borne diseases rely heavily on control of Aedes aegypti mosquitoes, which in most settings are the primary vector. Introgression of the intracellular bacterium Wolbachia pipientis (wMel strain) into Ae. aegypti populations reduces their vector competence and consequently lowers dengue incidence in the human population. Here we describe successful area-wide deployments of wMel-infected Ae. aegypti in Suva, Lautoka, Nadi (Fiji), Port Vila (Vanuatu) and South Tarawa (Kiribati). With community support, weekly releases of wMel-infected Ae. aegypti mosquitoes for between 2 to 5 months resulted in wMel introgression in nearly all locations. Long term monitoring confirmed a high, self-sustaining prevalence of wMel infecting mosquitoes in almost all deployment areas. Measurement of public health outcomes were disrupted by the Covid19 pandemic but are expected to emerge in the coming years.</div