Non-household environments make a major contribution to dengue transmission: implications for vector control

The incidence of <i>Aedes</i>-borne pathogens has been increasing despite vector control efforts. Control strategies typically target households (HH), where <i>Aedes</i> mosquitoes breed in HH containers and bite indoors. However, our study in Kenyan cities of Kisumu and Ukunda (2019-2022) revealed high <i>Aedes</i> abundance in public spaces, prompting the question: How important are non-household (NH) environments for dengue transmission and control? Using field data and human activity patterns, we developed an agent-based model simulating transmission across HH and five types of NH environments, which was then used to evaluate preventive (before an epidemic) and reactive (after an epidemic commences) vector control scenarios. Our findings estimate over half of infections occurring in NH settings, particularly workplaces, markets and recreational sites. Container removal was more effective in NH than in HH areas, contrasting with the global focus on HH-based management. Greater reductions in dengue cases occurred with early, high-coverage interventions, especially in NH locations. Additionally, local ecological factors, such as uneven water container distribution, influence control outcomes. This study underscores the importance of vector control in both HH and NH environments in endemic settings. It highlights a specific approach to inform evidence-based decision-making to target limited vector control resources for optimal control.