Strategies for controlling Aedes aegypti: lessons from Puerto Rico

Dengue viruses, transmitted by Aedes aegypti mosquitoes, pose a significant public health challenge in the tropics, including Puerto Rico. Dengue outbreaks have shifted from being sporadic to reaching a hyperendemic state marked by the co-circulation of multiple virus serotypes. The control of dengue has been hindered by the persistent evolution of insecticide resistance. This narrative review examines historical and contemporary efforts to control Ae. aegypti in Puerto Rico, highlighting the development of insecticide resistance and the promising results with the Centers for Disease Control and Prevention (CDC) Autocidal Gravid Ovitraps (AGO traps). Community-based initiatives have shown promise in raising acceptance of novel mosquito control methods yet sustained behavioral change of residents to prevent the production of Ae. aegypti in their premises remains elusive. Biological control methods, such as the use of copepods and Wolbachia-infected males, offer potential alternatives to chemical insecticides. Mass trapping techniques, particularly using the CDC AGO traps, have demonstrated effective reductions in mosquito populations and associated arboviral infections. The continued use of insecticides necessitates ongoing monitoring and evaluation of resistance mechanisms and the efficacy of new insecticides. Additionally, identifying and targeting hidden mosquito aquatic habitats is crucial for effective control. This review underscores the need for a multifaceted approach that combines innovative control strategies, community involvement, and ongoing research to mitigate the impact of Ae. aegypti and reduce the risk of mosquito-borne diseases in Puerto Rico.