August 2020
- Data demonstrates 77% efficacy against virologically confirmed dengue
- Trial conducted over three years across area with population of 312,000
- First ever gold-standard trial to successfully target the Aedes aegypti mosquito and reduce dengue cases
The World Mosquito Program (WMP) of Monash University, and its Indonesian partners the Tahija Foundation and Universitas Gadjah Mada have announced the first results of a cluster randomised controlled trial of its Wolbachia method, showing a 77% reduction in the incidence of virologically-confirmed dengue in Wolbachia-treated areas of Yogyakarta, Indonesia, compared to untreated areas.
The trial, “Applying Wolbachia to Eliminate Dengue (AWED)”, was conducted to test whether wMel establishment would reduce the incidence of virologically-confirmed dengue amongst 3 to 45yr olds living in Yogyakarta.
The trial was conducted by the World Mosquito Program with its Indonesia partners the Tahija Foundation and Universitas Gadjah Mada.
More than two years after completion of mosquito releases, Wolbachia has persisted at a very high level in the local mosquito population.
Detailed results will be presented at an international scientific congress in November 2020 and published in a peer-reviewed journal.
Dengue is the most rapidly spreading mosquito-borne disease in the world.
An estimated 50 million cases occur globally every year.
Indonesia is highly endemic for dengue. Recent estimates suggest nearly 8 million cases occur per year.
WMP Indonesia Principal Investigator, Prof. Adi Utarini from Universitas Gadjah Mada, said “This exciting result of the trial is a great success for the people of Yogyakarta. Indonesia has 7 million dengue cases every year. This trial result shows the significant impact the Wolbachia method can have in reducing dengue in urban populations.”
Principal Investigator and WMP Oceania Director, Prof. Cameron Simmons said, “This result is incredibly exciting. A safe, durable and efficacious new product class for dengue control is just what the global community needs.”
About the “Applying Wolbachia to Eliminate Dengue” trial in Yogyakarta, Indonesia
Twelve of twenty-four similarly-sized and predefined areas of Yogyakarta city were chosen at random to receive wMel Wolbachia-deployments in addition to routine dengue control measures; the remaining 12 continued to receive routine dengue control efforts. The trial area had a total population of ~312,000 people.
The trial enrolled 8,144 participants aged 3 to 45yrs who presented to one of 18 primary care clinics with acute undifferentiated fever of between 1 to 4 days duration. A case test-negative design was used to measure the efficacy of wMel in reducing the incidence of virologically-confirmed dengue cases over a 27-month period. Wolbachia deployments were well-accepted by the community and there have been no safety concerns.
This trial is the culmination of a decade of laboratory and field studies, beginning first in Australia and then expanding to 11 dengue endemic countries.
World Mosquito Program Director, Scott O’Neill said, “This is the result we’ve been waiting for. We have evidence our Wolbachia method is safe, sustainable and reduces incidence of dengue. Now we can scale this intervention across cities. It gives us great confidence for how we can scale this work worldwide across large urban populations.”
WMP’s Director of Impact Assessment Katie Anders said, “This is the first trial of an intervention against the dengue mosquito to demonstrate an impact on disease incidence. The trial result is consistent with our findings from previous non-randomised studies in Yogyakarta and northern Queensland, and with epidemiological modelling predictions of a substantial reduction in dengue disease burden following Wolbachia deployments.”
The AWED Trial's independent statistician, Prof. Nicholas Jewell, Professor of Biostatistics and Epidemiology at the London School of Hygiene & Tropical Medicine (and also Professor of the Graduate School at the University of California, Berkeley) said "The results are compelling. Doubly exciting is that the trial design used here provides a template that other candidate health interventions can follow."
Dr Yudiria Amelia
Head of Disease Prevention & Control Division. Health Agency, Yogyakarta City
“Yogyakarta city is an endemic dengue area. For us, Wolbachia is the right method to be integrated with the existing dengue control program. We are delighted with the outcome of this trial. We hope this method can be implemented in all areas of Yogyakarta and further expanded in all cities in Indonesia.”
Mrs Riyan
local Yogyakarta community member
Head of Community Reference Group for AWED trial
“The community has so much hope and expectation for the success of this research. That is why we are so positive. We have welcomed this project to our community.”
Dr Sjakon Tahija
Chairman of the Tahija Foundation
“As the funder for WMP’s in-country program, we would like to thank all partners and stakeholders for this multi-year, excellent collaboration that has had such an impact reducing the burden of dengue in Yogyakarta, and globally in the near future. As a venture philanthropy foundation, we are proud that our investment will surely bring sustainable impact. We are very excited and proud of this result.”
ABOUT DENGUE
Dengue is a self-limited, systemic infection caused by any of the four serotypes of dengue virus. Dengue viruses are transmitted between humans primarily by Aedes aegypti mosquitoes. These mosquitoes also spread the Zika virus and chikungunya virus.
Dengue is endemic throughout the tropics where it is a threat to nearly half the world’s population. The rapidly expanding global footprint of dengue is a public health challenge and an economic burden that is currently unmet by effective vaccines, specific therapeutic agents, or efficient vector-control strategies . In 2019 the World Health Organisation declared it one of the top ten global health threats because of the absence of effective interventions.
The clinical manifestations of dengue occur on a spectrum of severity. Mild cases typically experience fever, lethargy, headache, retro-orbital pain, nausea and rash for 5-7 days. More severe cases may present with one or more of; severe abdominal pain, persistent vomiting, rapid breathing, signs of bleeding and vascular leakage. Life threatening complications include dengue shock syndrome and/or severe organ dysfunction. Severe dengue is a leading cause of serious illness in some tropical countries and requires intensive care by experienced medical professionals.
Vector control, through chemical or biologic targeting of mosquitoes and removal of their breeding sites, is the mainstay of dengue prevention, but this approach has failed to stop disease transmission in almost all countries where dengue is endemic
ABOUT THE WORLD MOSQUITO PROGRAM
Working to help protect the global community from mosquito-borne diseases, the World Mosquito Program, formerly the Eliminate Dengue Program, is a not-for-profit initiative led by Monash University, Australia. It uses a safe, natural, and effective method to reduce the threat of viruses such as Zika, dengue, chikungunya and yellow fever. Through our collaborative and innovative approach, we are helping to protect local communities from these diseases in Australia, Asia, Latin America, and the Pacific Islands. Following many years of laboratory research and field trials with promising results, the World Mosquito Program is now operating in 11 countries around the world.
World Mosquito Program’s work in Indonesia is made possible by the support of our partners the Tahija Foundation.
WMP’s work is made possible by our supporters around the world, including:
Wellcome Trust
Bill & Melinda Gates Foundation
Macquarie Foundation
View a full list of WMP's supporters.
ABOUT THE WORLD MOSQUITO PROGRAM’S SELF-SUSTAINING WOLBACHIA METHOD
The World Mosquito Program method works by introducing Wolbachia into Aedes aegypti mosquitoes that transmit the dengue, chikungunya, Zika and yellow fever viruses. These Wolbachia mosquitoes are released in areas where mosquito-borne viruses are endemic. Once Wolbachia mosquitoes are released, they breed with wild mosquitoes. Over time, the percentage of Wolbachia mosquitoes grows until it remains high without the need for further releases. WMP’s self-sustaining method offers a safe, effective, and long-term solution to reducing the burden of these diseases.
ABOUT UNIVERSITAS GADJAH MADA
Universitas Gadjah Mada is an Indonesian public ivy league research university located in Yogyakarta, Indonesia, founded on December 19, 1949. UGM is the oldest and largest institution of higher learning in Indonesia. Located in Yogyakarta, Indonesia, the 360-acre university comprises 18 faculties, 68 undergraduate study programs, 23 diploma study programs, 104 master and specialist study program, and 43 Doctorate study programs.
ABOUT MONASH UNIVERSITY
For more than 60 years, we’ve been working hard to change the world. Every project we support is driven by a desire to make a difference.
We're tackling climate change, developing new drugs to save millions of lives, using virtual reality to treat addiction, bringing sight to the visually impaired, and so much more.
Our work improves health, solves complex global challenges and empowers whole communities.
We're working every day to create real, lasting global change and we encourage and challenge our students to be at the forefront of innovating for a better future. Combining world-leading teaching, research, facilities and experiences, Monash University ranks in the world’s top 100 universities.
Find out more: monash.edu/research
ABOUT THE TAHIJA FOUNDATION
The Tahija Foundation is a non-profit organization established in Jakarta by the late Mrs. Jean Tahija and Mr. Julius Tahija on March 21, 1990. The Tahija Foundation is a formal vehicle for the philanthropic initiatives of the Tahija family.
It seeks to bring about a better Indonesia through partnership for sustainable initiatives in education, culture, health, environmental conservation and social services.
World Mosquito Program Media contact (English Language Media):
Dale Amtsberg, Senior Media Advisor
E dale.amtsberg@worldmosquito.org | T +61 437 873 071
