Testing the Efficacy of Wolbachia Against Dengue Virus Transmission With Randomized Trials

The successful introduction of the intracellular bacterium Wolbachia into Aedes aegypti mosquitoes enables a practical approach for dengue prevention through release of Wolbachia-infected mosquitoes. Wolbachia reduces dengue virus replication in the mosquito and, once established in the mosquito population, it is possible that this will provide a long-term and sustainable approach to reducing dengue transmission. A critical next step is to assess the efficacy of Wolbachia deployments in reducing dengue virus transmission in the field. We describe and discuss the statistical design of large-scale (i) cohort, (ii) cluster randomized test-negative, and (iii) stepped wedge studies to measure efficacy of such interventions.