threats. Just as it is for goal setting, enhancing dengue prevention requires rethinking current control principles and, in some cases, redirecting emphasis to topics that are presently unexplored or underdeveloped. In this section we examine four conceptual shifts in vector control that will substantially improve dengue prevention.

The Paradigm Shift from Top-Down Direction to Local Level Decision

The fundamental challenge for contemporary dengue control, regardless of the approach taken, is to develop a framework for determining in different ecologic and epidemiologic circumstances: (1) what control procedures should be used; (2) how they should be applied; and (3) how they should be evaluated and/ or monitored (Box 2-1). The underlying principle will be that there is no single approach that will work across all locations or circumstances. Although some may counter that the concept of “one size does not fit all” in vector control has been known for a long time, there is no denying that it is presently underdeveloped and underemployed. Improved dengue prevention will require a paradigm shift away from the currently common practice of universally prescribed and

BOX 2-1

Key Questions for Development of Innovative, Sustainable, and Cost-Effective Dengue Prevention

  • What should the site- and situation-specific goal(s) be for dengue prevention programs?

  • How should control be monitored (i.e., what surveillance and risk assessment programs should be used)?

  • What disease prevention tools are effective and currently available and which ones needed to be developed?

  • What are the best integrated and adaptive control programs (e.g., dynamic application of vector control in concert with other disease prevention and management strategies)?

  • What major steps need to be taken to develop, evaluate, disseminate, and ensure application of effective and sustainable dengue prevention?

Application will require:

  1. Validation with longitudinal cohort studies that examine mosquito vectors and human DV infection.

  2. Capacity for programmatic adaptation to site-specific circumstances.

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