Burden of mosquito-borne diseases across rural versus urban areas in Cameroon between 2002 and 2021: prospective for community-oriented vector management approaches.

BACKGROUND: Over the past two decades, Cameroon has recorded one of the highest rates of urban population growth in sub-Saharan Africa. It is estimated that more than 67% of Cameroon's urban population lives in slums, and the situation is far from improving as these neighbourhoods are growing at an annual rate of 5.5%. However, it is not known how this rapid and uncontrolled urbanization affects vector populations and disease transmission in urban versus rural areas. In this study, we analyse data from studies conducted on mosquito-borne diseases in Cameroon between 2002 and 2021 to determine the distribution of mosquito species and the prevalence of diseases they transmit with regards to urban areas versus rural areas. METHODS: A search of various online databases, such as PubMed, Hinari, Google and Google Scholar, was conducted for relevant articles. A total of 85 publications/reports were identified and reviewed for entomological and epidemiological data from the ten regions of Cameroon. RESULTS: Analysis of the findings from the reviewed articles revealed 10 diseases transmitted by mosquitoes to humans across the study regions. Most of these diseases were recorded in the Northwest Region, followed by the North, Far North and Eastern Regions. Data were collected from 37 urban and 28 rural sites. In the urban areas, dengue prevalence increased from 14.55% (95% confidence interval [CI] 5.2-23.9%) in 2002-2011 to 29.84% (95% CI 21-38.7%) in 2012-2021. In rural areas, diseases such as Lymphatic filariasis and Rift valley fever, which were not present in 2002-2011, appeared in 2012-2021, with a prevalence of 0.4% (95% CI 0.0- 2.4%) and 10% (95% CI 0.6-19.4%), respectively. Malaria prevalence remained the same in urban areas (67%; 95% CI 55.6-78.4%) between the two periods, while it significantly decreased in rural areas from 45.87% (95% CI 31.1-60.6%) in 2002-2011 to 39% (95% CI 23.7-54.3%) in the 2012-2021 period (*P = 0.04). Seventeen species of mosquitoes were identified as involved in the transmission of these diseases, of which 11 were involved in the transmission of malaria, five in the transmission of arboviruses and one in the transmission of malaria and lymphatic filariasis. The diversity of mosquito species was greater in rural areas than in urban areas during both periods. Of the articles reviewed for the 2012-2021 period, 56% reported the presence of Anopheles gambiae sensu lato in urban areas compared to 42% reported in 2002-2011. The presence of Aedes aegypti increased in urban areas in 2012-2021 but this species was absent in rural areas. Ownership of long-lasting insecticidal nets varied greatly from one setting to another. CONCLUSIONS: The current findings suggest that, in addition to malaria control strategies, vector-borne disease control approaches in Cameroon should include strategies against lymphatic filariasis and Rift Valley fever in rural areas, and against dengue and Zika viruses in urban areas.

Patterns of Kdr-L995F Allele Emergence Alongside Detoxifying Enzymes Associated with Deltamethrin Resistance in Anopheles gambiae s.l. from North Cameroon.

Understanding how multiple insecticide resistance mechanisms occur in malaria vectors is essential for efficient vector control. This study aimed at assessing the evolution of metabolic mechanisms and Kdr L995F/S resistance alleles in Anopheles gambiae s.l. from North Cameroon, following long-lasting insecticidal nets (LLINs) distribution in 2011. Female An. gambiae s.l. emerging from larvae collected in Ouro-Housso/Kanadi, Be-Centre, and Bala in 2011 and 2015, were tested for susceptibility to deltamethrin + piperonyl butoxide (PBO) or SSS-tributyl-phosphoro-thrithioate (DEF) synergists, using the World Health Organization's standard protocol. The Kdr L995F/S alleles were genotyped using Hot Ligation Oligonucleotide Assay. Tested mosquitoes identified using PCR-RFLP were composed of An. arabiensis (68.5%), An. coluzzii (25.5%) and An. gambiae (6%) species. From 2011 to 2015, metabolic resistance increased in Ouro-Housso/Kanadi (up to 89.5% mortality to deltametnrin+synergists in 2015 versus <65% in 2011; p < 0.02), while it decreased in Be-Centre and Bala (>95% mortality in 2011 versus 42-94% in 2015; p < 0.001). Conversely, the Kdr L995F allelic frequencies slightly decreased in Ouro-Housso/Kanadi (from 50% to 46%, p > 0.9), while significantly increasing in Be-Centre and Bala (from 0-13% to 18-36%, p < 0.02). These data revealed two evolutionary trends of deltamethrin resistance mechanisms; non-pyrethroid vector control tools should supplement LLINs in North Cameroon.

Pyrethroid and Etofenprox Resistance in Anopheles gambiae and Anopheles coluzzii from Vegetable Farms in Yaoundé, Cameroon: Dynamics, Intensity and Molecular Basis.

Previous studies have indicated widespread insecticide resistance in malaria vector populations from Cameroon. However, the intensity of this resistance and underlying mechanisms are poorly known. Therefore, we conducted three cross-sectional resistance surveys between April 2018 and October 2019, using the revised World Health Organization protocol, which includes resistance incidences and intensity assessments. Field-collected Anopheles gambiae s.l. populations from Nkolondom, Nkolbisson and Ekié vegetable farms in the city of Yaoundé were tested with deltamethrin, permethrin, alpha-cypermethrin and etofenprox, using 1× insecticide diagnostic concentrations for resistance incidence, then 5× and 10× concentrations for resistance intensity. Subsamples were analyzed for species identification and the detection of resistance-associated molecular markers using TaqMan® qPCR assays. In Nkolbisson, both An. coluzzii (96%) and An. gambiae s.s. (4%) were found together, whereas only An. gambiae s.s. was present in Nkolondom, and only An. coluzzii was present in Ekié. All three populations were resistant to the four insecticides (<75% mortality rates-MR1×), with intensity generally fluctuating over the time between mod-erate (<98%-MR5×; ≥98%-MR10×) and high (76-97%-MR10×). The kdr L995F, L995S, and N1570Y, and the Ace-1 G280S-resistant alleles were found in An. gambiae from Nkolondom, at 73%, 1%, 16% and 13% frequencies, respectively, whereas only the kdr L995F was found in An. gambiae s.s. from Nkolbisson at a 50% frequency. In An. coluzzii from Nkolbisson and Ekié, we detected only the kdr L995F allele at 65% and 60% frequencies, respectively. Furthermore, expression levels of Cyp6m2, Cyp9k1, and Gste2 metabolic genes were highly upregulated (over fivefold) in Nkolondom and Nkolbisson. Pyrethroid and etofenprox-based vector control interventions may be jeopardized in the prospected areas, due to high resistance intensity, with multiple mechanisms in An. gambiae s.s. and An. coluzzii.

Patterns of anopheline feeding/resting behaviour and Plasmodium infections in North Cameroon, 2011-2014: implications for malaria control.

BACKGROUND: Effective malaria control relies on evidence-based interventions. Anopheline behaviour and Plasmodium infections were investigated in North Cameroon, following long-lasting insecticidal net (LLIN) distribution in 2010. METHODS: During four consecutive years from 2011 to 2014, adult mosquitoes were collected indoors, outdoors and in exit traps across 38 locations in the Garoua, Pitoa and Mayo-Oulo health districts. Anophelines were morphologically and molecularly identified, then analysed for blood meal origins and Plasmodium falciparum circumsporozoite protein (Pf-CSP). Blood from children under 5 years-old using LLINs was examined for Plasmodium infections. RESULTS: Overall, 9376 anophelines belonging to 14 species/sibling species were recorded. Anopheles gambiae (s.l.) [An. arabiensis (73.3%), An. coluzzii (17.6%) and An. gambiae (s.s.) (9.1%)] was predominant (72%), followed by An. funestus (s.l.) (20.5%) and An. rufipes (6.5%). The recorded blood meals were mainly from humans (28%), cattle (15.6%) and sheep (11.6%) or mixed (45%). Pf-CSP rates were higher indoors (3.2-5.4%) versus outdoors (0.8-2.0%), and increased yearly (χ2 < 18, df = 10, P < 0.03). Malaria prevalence in children under 5 years-old, in households using LLINs was 30% (924/3088). CONCLUSIONS: The present study revealed the variability of malaria vector resting and feeding behaviour, and the persistence of Plasmodium infections regardless the use of LLINs. Supplementary interventions to LLINs are therefore needed to sustain malaria prevention in North Cameroon.

Spatial and temporal development of deltamethrin resistance in malaria vectors of the Anopheles gambiae complex from North Cameroon.

The effectiveness of insecticide-based malaria vector control interventions in Africa is threatened by the spread and intensification of pyrethroid resistance in targeted mosquito populations. The present study aimed at investigating the temporal and spatial dynamics of deltamethrin resistance in An. gambiae s.l. populations from North Cameroon. Mosquito larvae were collected from 24 settings of the Garoua, Pitoa and Mayo Oulo Health Districts (HDs) from 2011 to 2015. Two to five days old female An. gambiae s.l. emerging from larval collections were tested for deltamethrin resistance using the World Health Organization's (WHO) standard protocol. Sub samples of test mosquitoes were identified to species using PCR-RFLP and genotyped for knockdown resistance alleles (Kdr 1014F and 1014S) using Hot Ligation Oligonucleotide Assay (HOLA). All the tested mosquitoes were identified as belonging to the An. gambiae complex, including 3 sibling species mostly represented by Anopheles arabiensis (67.6%), followed by Anopheles coluzzii (25.4%) and Anopheles gambiae (7%). Deltamethrin resistance frequencies increased significantly between 2011 and 2015, with mosquito mortality rates declining from 70-85% to 49-73% in the three HDs (Jonckheere-Terstra test statistic (JT) = 5638, P< 0.001), although a temporary increase of mortality rates (91-97%) was seen in the Pitoa and Mayo Oulo HDs in 2012. Overall, confirmed resistance emerged in 10 An. gambiae s.l. populations over the 24 field populations monitored during the study period, from 2011 to 2015. Phenotypic resistance was mostly found in urban settings compared with semi-urban and rural settings (JT = 5282, P< 0.0001), with a spatial autocorrelation between neighboring localities. The Kdr 1014F allelic frequencies in study HDs increased from 0-30% in 2011 to 18-61% in 2014-2015 (JT = 620, P <0.001), especially in An. coluzzii samples. The overall frequency of the Kdr 1014S allele was 0.1%. This study revealed a rapid increase and widespread deltamethrin resistance frequency as well as Kdr 1014F allelic frequencies in An. gambiae s.l. populations over time, emphasizing the urgent need for vector surveillance and insecticide resistance management strategies in Cameroon.

Changes in malaria vector bionomics and transmission patterns in the equatorial forest region of Cameroon between 2000 and 2017.

BACKGROUND: Increased use of long-lasting insecticidal nets (LLINs) over the last decade has considerably improved the control of malaria in sub-Saharan Africa. However, there is still a paucity of data on the influence of LLIN use and other factors on mosquito bionomics in different epidemiological foci. The objective of this study was to provide updated data on the evolution of vector bionomics and malaria transmission patterns in the equatorial forest region of Cameroon over the period 2000-2017, during which LLIN coverage has increased substantially. METHODS: The study was conducted in Olama and Nyabessan, two villages situated in the equatorial forest region. Mosquito collections from 2016-2017 were compared to those of 2000-2001. Mosquitoes were sampled using both human landing catches and indoor sprays, and were identified using morphological taxonomic keys. Specimens belonging to the An. gambiae complex were further identified using molecular tools. Insecticide resistance bioassays were undertaken on An. gambiae to assess the susceptibility levels to both permethrin and deltamethrin. Mosquitoes were screened for Plasmodium falciparum infection and blood-feeding preference using the ELISA technique. Parasitological surveys in the population were conducted to determine the prevalence of Plasmodium infection using rapid diagnostic tests. RESULTS: A change in the species composition of sampled mosquitoes was recorded between the 2000-2001 collections and those of 2016-2017. A drop in the density of the local primary vectors An. nili and An. moucheti in the forest region was recorded, whereas there was an increase in the density of An. gambiae (s.l.), An. marshallii, An. ziemannii and An. paludis. A change in the biting behaviour from indoor to outdoor was recorded in Olama. Very few indoor resting mosquitoes were collected. A change in the night biting cycle was recorded with mosquitoes displaying a shift from night biting to late evening/early in the night. Several mosquitoes were found positive for Plasmodium infection, thus sustaining continuous transmission of malaria in both sites. Reduction of malaria transmission in Nyabessan was lower than that seen in Olama and associated with deforestation and the construction of a dam that may have enabled a more efficient vector, An. gambiae (s.l.), to invade the area. A high level of resistance to pyrethroids (permethrin and deltamethrin) was detected for An. gambiae in both sites. High parasite prevalence was recorded in both sites, with children of 0-16 years being the most affected. In both Olama and Nyabessan, bed net usage appeared to correlate to protection against malaria infection. CONCLUSIONS: The study shows important changes in the bionomics of vector populations and malaria transmission patterns in the equatorial forest region. The changes call for more concerted efforts to address challenges such as insecticide resistance, environmental modifications or behavioural changes affecting the performance of current control measures.

Insecticide susceptibility status of Anopheles gambiae (s.l.) in South-West Cameroon four years after long-lasting insecticidal net mass distribution.

BACKGROUND: Members of the Anopheles gambiae (s.l.) complex are one of the major vectors of malaria in Africa. LLINs and IRS are the most effective tools used in vector control of malaria. However, their effectiveness may be hampered by the development and spread of insecticide resistance in the target vectors species. The objective of this study was to assess the susceptibility of Anopheles gambiae (s.l.) mosquitoes from South-West Cameroon to deltamethrin, permethrin and to malathion, four years after the mass deployment of LLINs. METHODS: Anopheles larvae were collected from Limbe, Tiko and Buea, three cities of the Fako division and reared until adult emergence. Adult mosquitoes from field larvae were identified as belonging to the Anopheles gambiae (s.l.) complex using standard identification keys. Susceptibility of mosquito samples to deltamethrin, permethrin and malathion was assessed using WHO susceptibility tests protocol for adult mosquitoes. Molecular identification of tested samples was performed using the PCR SINE200 protocol and by PCR-RFLP. The kdr alleles were genotyped using the hot ligation oligonucleotide assay (HOLA). RESULTS: Two species of the An. gambiae (s.l.) complex, An. coluzzii and An. gambiae (s.s.) were identified in all three study locations with high proportions of An. coluzzii in Limbe (84.06%) and Tiko (92.2%), while in Buea, An. coluzzii (55.6%) and An. gambiae (s.s.) (44.4%) occurred almost in the same proportions. Tested samples were found resistant to pyrethroids (deltamethrin and permethrin) in all locations (< 90% mortality), with > 3-fold increase of KDT50 values compared with the Kisumu susceptible reference strain of An. gambiae (s.s.). However, the mosquito populations from Limbe and Buea were fully susceptible to malathion. The L1014F kdr was found in both An. coluzzii and An. gambiae (s.s.) with the highest frequencies found in An. gambiae (s.l.) populations from Tiko (94%) and Buea (90%) compared with the Limbe population (66%) (P = 0.00063, df = 2). No kdr L1014S was observed in analyzed samples. CONCLUSIONS: These findings reemphasize the ongoing development of An. gambiae (s.l.) resistance to pyrethroids used in impregnating LLINs and suggest the use of malathion as an alternative insecticide for IRS in complementarity with LLINs.