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Resistance Management Map

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					 Regional Network to Monitor
Insecticide Resistance in EMR


       Abraham Mnzava

   Scientist, Vector Control
      RBM WHO/EMRO
        CAIRO, EGYPT
            Network Objectives
1. Establish a regional network to monitor
   insecticide resistance
2. Develop and adopt a standardized protocol for
   monitoring insecticide resistance
3. Build and strengthen national capacity for
   appropriate monitoring of vector resistance
   status
4. Utilize GIS to map the distribution of the vector
   species and their resistance based on climate,
   vegetation and other relevant databases
5. Strengthen     national  capacity   to   manage
   emergence and spread of insecticide resistance
  Current Status of
Insecticide Resistance
                                                                                                                                                                                                                                                       Maculipennis
                                                                                                                                                        Plucherimus

                                                                                                                                                                      Labranchiae
                                                                        Superpictus
                                            Culicifacies




                                                                                                                             Pharoensis




                                                                                                                                                                                                        Multicolour
                                                                                       Arabiensis
                                                            Stephensi




                                                                                                     Sacharovi
                                Countries
Status of insecticide




                                                                                                                                                                                                                                            Hyrcanus
                                                                                                                                          Fluviatilis




                                                                                                                                                                                    Funestus




                                                                                                                                                                                                                      Coustani
                                                                                                                 Sergentii




                                                                                                                                                                                                                                 Claviger
                                                                                                                                                                                                D
                                                                                                                                                                                                thali
                                                                                                                                                                                                ’
resistance in malaria vector
species in the EMR              AFG 1,2,6?                  1,2             1                                                             1,2           1,2                                                                                 1,2

                                BAH
1.    DDT                       CYP
                                DJI
2.    Dieldrin/BHC              EGY                                                                              1,2,5 1,2,3,                                                                  3,11,1 1,2,3, 1,2,3,
                                                                                                                       4,11,1                                                                  2,13,1 4,11,1   4
3.    Malathion                                                                                                        2,13,1                                                                     4   2,13,1
                                                                                                                         4                                                                               4
4.    Fenitrothion              IRA              1         1,2,3                                        1                                                                                                                                                   1

5.    Temephos                  IRQ                        1,2,3,
                                                            4,7
                                                                                                     1,2                                                    1                                                                               1,2


6.    Propoxur                  JOR                                                                              2,5                                                                             5          5
                                KUW
7.    Primiphos methyl          LEB                                                                 1,2,4
                                LIB
8.    Chlorophoxim              MOR                                                                                                                                   1,2
9.    Phoxim                    OMA 1,2,3,
                                    4,5,6,
                                             1

10.   Iodophenphos                    15
                                PAK 1,2,3, 1,2,3,                                                                                         1,2               1                                                                               1,2
11.   Chlorpyriphos                   4     4,6
                                QAT
12.   Fenthion                  SAA                         1,2                            1                                                  2                                                         1,2              2                  1,2

13.   Bromophos                 SOM
                                SUD                                                   1,2,3,                                     1                                                  1,2
14.   Carbaryl                                                                        6,15,1
                                                                                        6
15.   Pyrethroid (permethrin)   SYR                                                                 1,2,4,
                                                                                                      15
16.   Phenthoate                TUN                                                                                                                                       1
                                UAE 1,3,4, 1,15
17.   Diazinone                     5,6,11
                                      ,15
                                YEM         1,2
Insecticide Resistance Status




 culicifacies
  stephensi
superpictus
 arabiensis
  sacharovi
   sergentii
 pharoensis
  fluviatilis
plucherimus
labranchiae
  funestus
    d’thali
 multicolour
   coustani
   claviger
  hyrcanus
maculipennis
       An Integral Part of IVM
           Implementation
• Involving the following stages of activities:
   – Detection of resistance, using standard
     bioassay procedures and interpretation of
     results
   – Identification of resistance mechanisms
     involved and their potential implications
   – Evaluation of the entomological and
     epidemiological impact of resistance
   – Operational decision to change insecticide
     and implement a resistance management
     plan
Diagnostic Concentrations – detect
     presence of resistance


  Susceptibility testing – using
   WHO standardized bioassay
  tests is the method of choice
   Testing of Mosquito Larvae
• Larval testing using standard bioassay
  tests has limited value
• Resistance levels betn adults and larvae
  differ significantly esp. with pyrethroids
• Handling of insecticide solutions is crucial
• Low adult mosquito nos. limit their testing
• Where skills to raise mosquitos are
  available – attempt to test progenies (F1)
    Mechanisms of Resistance
• Several mechanisms are involved
• There is no simple method to detect the
  different mechanisms
• Those that are available cannot be done
  routinely by Control Programmes
• Such methods include PCR and biochemical
  tests
• Best if done in the framework of a network
Selection of sites, insecticides and
              species
• Well-chosen sentinel sites representative of the
  country
   – Available resources, disease risks, previous
     and current use of insecticides – including
     agriculture
• Insecticides
   – based on history of resistance
• Vector species
   – Vectorial potential, reported history, biting
     nuisance
   – Usually 1-3 days-old female mosquitoes
      Frequency of testing….
• How frequent should sampling surveys be
  conducted?

  – Annually or once every two years in
    sentinel sites?

  – If resources are limiting – how should a
    programme go about it?
Goal of the EMR Network
        (EMNVR)


Assist Member States to
optimally use insecticides in
    the context of IVM
   Network Terms of Reference
• Assist Member States to monitor and
  manage resistance through:
  – supervision of field testing activities
  – identification of vector species and
    resistance mechanisms
  – Development and assessment of new
    monitoring tools
  – Continuous production of updated vector
    distribution and resistance maps for
    each country and for the whole region
 Network Terms of Reference contd.
• Strengthen collaboration betn. NMCP and
  research institutions
• Strengthen capacity building for vector
  control, training and supervision of nationals
  in monitoring and management of insecticide
  resistance
• Collaborate with partner institutions to train,
  standardize methodologies, protocols and
  guidelines, analyse data and interpret results
• Co-ordinate, facilitate and promote the
  dissemination and exchange of information on
  vector resistance to insecticides
  Composition of Network Members

• Disease/malaria control programmes
• Relevant national research institutions or
  centres
• Key regional reference laboratories
• Specialised partner laboratories
• International experts
• WHO/RO and WHO/HQ
N.B These institutions will nominate their focal
  persons to serve in the Network
         Coordination of Network
• Coordinated by WHO/EMRO to ensure its
  management:
  – Serve as the interface between national disease control
    programs, research centre and partner institutions
  – timely and effective support to national disease control
    programs e.g. provision of supplies and technical
    support
  – Manage database on distribution of vector species and
    resistance to insecticide
  – Implement the network plan of action
  – Monitor the activities of EMNVR and provide feedback
    to the Steering Committee
  – Prepare and disseminate network annual reports
    through annual meetings
          Country VC Focal Points
• Country VC Focal Points automatically
  Members:
  – Develop detailed/coasted plan for monitoring
    insecticide resistance in country sentinel sites
  – Identify training and technical support needs for
    insecticide resistance monitoring
  – Acquaint with the WHO standardized protocol and
    reporting for susceptibility testing
  – Train their entomology teams to conduct such
    susceptibility tests
  – Ensure timely availability of test kits/papers from RO
  – Submit reports of tests to RO and a copy to the
    reference laboratory/center
  Regional Reference Laboratories
• Identification of vector species and
  resistance mechanisms:
  – Train participating teams from countries on
    molecular and/or biochemical techniques
  – Adapt the introduction of new techniques
    and tools as they become available
  – Quality control services
  – Assist countries in the identification of
    vector species and resistance mechanisms
    using molecular and/or biochemical
    techniques
  – Conduct country-support visit when
    deemed necessary
Centre for Databases and Mapping
• Regional Centre with PC software and
  GIS capability:
  • Develop and finalize tools for data
    collection and reporting
  • Receive data from countries and reference
    laboratories
  • Develop and maintain databases on vector
    species and insecticide resistance
  • Produce and disseminate appropriate
    vector and resistance distribution maps
    Specialised Laboratories
• They will be co-opted based on
  interest to support EMNVR:
 – Train technicians from regional reference
   laboratories and from countries on tools
   for identification of species and
   resistance
 – Develop and introduce new tools for
   vector identification of species and
   resistance
 – Mobilize resources for country-specific
   activities as part of the EMNVR
 Steering Committee of EMNVR
Composition:
  – Reference laboratories
  – Database and mapping center
  – Specialised laboratories
  – Other WHO Regional Networks (AFRO
    and SEARO)
  – International experts
  – Representative from the control
    programmes
  Steering Committee of EMNVR
Functions:
  – Provide guidance and leadership for
    network activities
  – Identify scientific and operational issues
    that need to be addressed by the network
  – Finalize and approve activities for the
    network plan of action
  – Review and approve network annual report
    and propose action plan for the subsequent
    year
  – Mobilize financial resources for supporting
    the activities of EMNVR
THANK YOU

				
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posted:7/15/2011
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Description: Resistance Management Map document sample