Comparative Effectiveness of Dengue Vector Control Strategies: A Network Meta-Analysis of Randomized Trials

Abstract

Abstract

Background:
Dengue is a rapidly expanding mosquito-borne disease with substantial global burden, particularly in tropical regions. In the absence of widely effective antiviral therapies, vector control remains the cornerstone of prevention. However, the comparative effectiveness of available interventions remains unclear. This study aimed to compare the effectiveness of chemical, biological, environmental, and physical vector control strategies for dengue prevention.

Methods:
A systematic review and network meta-analysis were conducted following PRISMA-NMA guidelines. PubMed, Scopus, Sage, ProQuest, EBSCO, and ClinicalTrials.gov were searched from inception to March 2026. The primary outcome was dengue incidence; secondary outcomes were entomological indices (Breteau, House, and Container Indices; mosquito density). Effect sizes were risk ratios (RRs) with 95% confidence intervals (CIs). Heterogeneity was assessed using I² statistics, and treatment rankings were estimated using P-scores.

Results:
Twenty‑three studies were included; seven studies (1.88 million participants) contributed to the primary network. Wolbachia‑based interventions demonstrated the greatest reduction in dengue incidence compared to chemical control (RR 0.25, 95% CI 0.17–0.35; P‑score = 1.00). Environmental interventions also significantly reduced dengue incidence (RR 0.69, 95% CI 0.50–0.97) and showed the strongest effects on mosquito density (RR 0.18, 95% CI 0.03–0.97). No significant difference was observed between chemical control and control (RR 0.86, 95% CI 0.69–1.07). For entomological outcomes, chemical interventions significantly reduced the Breteau Index (RR 0.47, 95% CI 0.24–0.91). Heterogeneity was low for dengue incidence (I² = 32.1%) but substantial for entomological outcomes (I² = 81–94%). No significant global inconsistency was detected.

Conclusions:
Wolbachia-based interventions are the most effective strategy for reducing dengue incidence, while environmental approaches remain important for vector suppression. Integrated approaches combining biological and environmental strategies are recommended to optimize dengue prevention efforts.

Keywords: Aedes aegypti, dengue, network meta-analysis, vector control, Wolbachia