Long-Term Durability and Public Health Impact of City-Wide wMel Wolbachia Mosquito Releases in Niterói, Brazil, During a Dengue Epidemic Surge

In 2024, the Americas experienced the largest dengue outbreak on record and Brazil was among the worst affected countries, reporting 6.6 million cases and 6200 deaths. We report the long-term entomological and epidemiological effectiveness of city-wide deployment of <i>w</i>Mel-strain <i>Wolbachia</i>-infected <i>Aedes aegypti</i> in Niterói, a city of half a million people in Rio de Janeiro state, where <i>Wolbachia</i> releases across three-quarters of the urban population in 2017-2019 were expanded to remaining populated areas in 2023. <i>w</i>Mel was durably established at ≥95% prevalence in <i>Ae. aegypti</i> populations throughout Niterói four years post-release, and up to seven years in the earliest release sites. Notified dengue case incidence in Niterói was 89% lower following <i>Wolbachia</i> releases, compared to the 10-year pre-intervention period of 2007-2016. Dengue incidence in Niterói in 2024, during a period of record high incidence in Brazil and the region, was 374 per 100,000 population, substantially lower than overall in Rio de Janeiro state (1884 per 100,000) and nationwide in Brazil (3157 per 100,000). Our findings show that city-wide <i>Wolbachia</i> coverage in Niterói provided sustained population-level reduction in dengue incidence throughout the five years post-intervention, including during the 2024 epidemic surge, averting an estimated three-quarters of the dengue case burden that may otherwise have been expected in Niterói in 2024.