Efficacy of Interceptor® G2, a Long-Lasting Insecticide Mixture Net Treated with Chlorfenapyr and Alpha-Cypermethrin Against Anopheles Funestus: Experimental Hut Trials in North-Eastern Tanzania

BackgroundThe effectiveness of long-lasting insecticidal nets (LLINs), the primary method for preventing malaria in Africa, is compromised by evolution and spread of pyrethroid resistance. Further gains require new insecticides with novel modes of action. Chlorfenapyr is a pyrrole insecticide that disrupts mitochrondrial function and confers no cross-resistance to neurotoxic insecticides. Interceptor® G2 LN (IG2) is an insecticide-mixture LLIN which combines wash-resistant formulations of chlorfenapyr and the pyrethroid alpha-cypermethrin. Our objective was to determine IG2 efficacy under controlled household-like conditions for personal protection and control of wild, pyrethroid-resistant Anopheline funestus mosquitoes. MethodsExperimental hut trials tested IG2 efficacy against two positive controls - a chlorfenapyr-treated net and a standard alpha-cypermethrin LLIN, Interceptor LN (IG1) - consistent with World Health Organisation (WHO) evaluation guidelines. Mosquito mortality, blood-feeding inhibition, personal protection, repellency and insecticide-induced exiting were recorded after zero and 20 washing cycles. The trial was repeated twice and analysed using multivariate and meta-analysis. ResultsIn the two trials held in NE Tanzania, A. funestus mortality was 2.27 (risk ratio 95% CI 1.13-4.56) times greater with unwashed Interceptor G2 than with unwashed Interceptor LN (p=0.012). There was no significant loss in mortality with IG2 between 0 and 20 washes (1.04, 95% CI 0.83-1.30, p=0.73). Comparison with chlorfenapyr treated net indicated that most mortality was induced by the chlorfenapyr component of IG2 (0.96, CI 0.74-1.23), while comparison with Interceptor LN indicated blood-feeding was inhibited by the pyrethroid component of IG2 (IG2: 0.70, CI 0.44-1.11 vs IG1: 0.61, CI 0.39-0.97). Both insecticide components contributed to exiting from the huts but the contributions were heterogeneous between trials (heterogeneity Q=36, P=0.02). WHO susceptibility tests with pyrethroid papers recorded 44% survival in A. funestus. ConclusionsThe high mortality recorded by IG2 against pyrethroid-resistant A. funestus provides first field evidence of high efficacy against this primary, anthropophilic, malaria vector.