**Abstract**

The *Wolbachia*-based approach is under evaluation as a control strategy against *Aedes aegypti* in Mexico. From 2017 to 2019, we performed a pilot study to evaluate an open-field mass-release of *w*AlbB-infected *Ae*. *aegypti* male mosquitoes, as part of an integrated vector management (IVM) plan led by the Ministry of Health in Mexico to suppress natural populations of *Ae*. *aegypti* in southern Mexico. Community engagement and social evaluation were part of the key activities conducted. Overall, results showed the positive benefits of this *Wolbachia*-based method in the reduction of *Aedes* mosquitoes (90%). Mosquito's nuisance at bedtime and the increasing circulation of mosquitoes during the releasing days were reported as the negative perceptions of this method. Importantly, participants understood the difference between wild mosquitoes and those released as part of the project, as well as the importance of the IVM. A significant number of the population accepted and supported the project, and feedback was given to improve future mosquito-releasing activities. The social license was a key factor in the success of the intervention and should be part of innovative paradigms for mosquito-vector control strategies involving community engagement. We outline the Mexican experience of community engagement and social assessment in implementing a *Wolbachia*-based strategy.

**Keywords:** *Wolbachia*-based vector control, community engagement, social assessment, mosquito-borne diseases

### **1. Introduction**

Mosquito-borne diseases remain as one of the major challenges for public health and vector control programs at global and local levels. Up-to-date, there is not a 100% effective vaccine or therapy for dengue, chikungunya, or Zika virus. Hence, traditional mosquito-vector control strategies are among the most common ways to combat these diseases, with proven efficacy [1]. Integrated vector management has been the approach recommended by the World Health Organization [2, 3] to reinforce the vector control programs.

As a result of new biotechnologies for pest control, innovative approaches have been developed for the suppression and/or replacement of mosquito populations. The "rear and releases" is the new change of paradigm in this agenda and social assessment must be a key aspect to consider. A novel strategy to suppress vector populations based on the endosymbiotic bacterium *Wolbachia pipientis* is a promising complementary strategy that potentially reduces mosquito populations and the risk of mosquito-borne disease transmission [3–12]. This approach known as the incompatible insect technique (IIT), consists of the release of male mosquitoes infected with maternally inhered *Wolbachia*. The mating between *Wolbachia*-infected males and urban/wild-type female mosquitoes in the environment (not infected with *Wolbachia*) produced non-viable eggs due to a phenomenon called cytoplasmic incompatibility (CI) [4]. However, IIT approaches can combine additional measures, such as the sterile insect technique (SIT) to minimize the unintentional release of fertile *Wolbachia*-infected female mosquitoes (IIT-SIT approach) (**Figure 1**) [7–9]. In this low-dose irradiation is used to sterilize residual pupae females after the sex sorting process, thus preventing the stable establishment of field populations derived from released *Wolbachia*-infected males [6]. The IIT-SIT approach to suppress *Ae. aegypti* populations have been tested in two recent successful pilot trials in Thailand [10] and Mexico [13] and *Ae. albopictus* in China [11]. Furthermore, the circulation of *Wolbachia* strains in native populations of *Ae. albopictus* have been already identified in the southern region of Mexico [13, 14].

Currently, the *Wolbachia*-based approach that combines both incompatible and sterile insect techniques (IIT-SIT) is under evaluation as a control strategy against *Ae. aegypti* in Mexico. From 2017 to 2019 a pilot study was performed to evaluate an open-field mass-release of *w*AlbB-infected *Ae. aegypti* males (*Wolbachia* strain *w*AlbB from *Ae. albopictus* [donor host] and successfully established in *Ae. aegypti* [novel host]), as part of an integrated vector management (IVM) plan led by the Ministry of Health in a semi-urban community called San Pedro Chimay, Yucatan, Mexico, with the collaboration of the autonomous university of Yucatan, to suppress natural populations of *Ae. aegypti* in southern Mexico [12]. In this pilot study, a protocol for the implementation of a *Wolbachia*-based biocontrol aiming to suppress *Ae. aegypti* mosquito population was designed. At first, anthropological research seeking community engagement and cultural sensitization was conducted, followed by an entomological baseline survey. Secondly, the Ministry of Health carried out an attack phase with vector control routines followed by a suppression phase, including male-mosquito releasing activities and the social assessment of the entire project [12].

*Community Engagement and Social Assessment for* Wolbachia*-Based Suppression of Natural… DOI: http://dx.doi.org/10.5772/intechopen.106137*

#### **Figure 1.**

*The combined IIT-SIT approach is depicted schematically: (A) The four types of possible crosses between wild/ urban* Aedes aegypti *mosquitos and* Wolbachia*-infected* Ae. aegypti *mosquitos; and (B) Irradiation of residual*  Wolbachia*-infected females (SIT) to prevent them from reproducing in the wild; mass-production, irradiation, and release of* Wolbachia*-infected males with residual females, as well as mating crosses with wild/urban populations.*

For the pilot study, community engagement and social evaluation were part of the key activities conducted [15, 16]. Throughout the suppression phase, we observed significant reductions in the adult females collected at the release site in comparison

to control sites, with the greatest effect observed on the number of indoor *Ae. aegypti* females collected per house (90% of reduction efficacy) [12].

In this chapter, we outline the Mexican experience, including community engagement and social assessment, in implementing a *Wolbachia*-based strategy intended to suppress the natural population of *Ae. aegypti* in San Pedro Chimay, a Mayan indigenous location situated in Yucatan, Mexico.

### **2. Principles of community engagement**

Projects based on IIT-SIT require models or frameworks for the community engagement process and activities. Every approach has its own strengths and limitations, but they offer guidance for the implementation of the plan of action. The center for disease control and prevention has developed a guideline that provides an interesting system that integrates steps for a successful engagement [17].

*Before the intervention:* (1) Establish clear purposes and goals; (2) address the main characteristics of the community (culture, economics, politics, norms, and values) and the experiences with other projects in the past or present.

*For engagement to occur*: (1) Establish a bond of trust with the community and their formal and informal leaders, as well as other local organizations; and (2) respect the self-determination of the community.

*For engagement to succeed*: (1) Build partnership with the community in order to create changes and improve topics related to health; (2) acknowledge the internal diversity of the community and the relations during the whole process of community engagement; (3) the engagement can be sustainable by the appropriation of the community; (4) the community must be involved from the beginning, be prepared, and develop decisions capacity in order to the sustainability of the engagement; and (5) the community collaboration demands wider commitment by the engaging of all sort of interested actors.

Therefore, the community engagement of the project, based on those principles for community engagement, was divided into four phases (**Table 1**), each one addressed in a transversal way the guidelines to express the social inclusion of the community targeted. Detailed information of each phase was already published elsewhere [12].


#### **Table 1.**

*Community engagement and social evaluation.*

*Community Engagement and Social Assessment for* Wolbachia*-Based Suppression of Natural… DOI: http://dx.doi.org/10.5772/intechopen.106137*

#### **3. The mosquitoes in the Mayan culture**

The very presence of the mosquitoes in the Mayan culture had been represented with ambivalence, as an unpleasant pest, a hero, and an ally. Archeological evidence in both pre-Columbian pottery and Codex portrayed the mosquito sucking women's breasts [18], while she tried to swat it (**Figure 2**). However, the narratives and interpretations are far from the current conception of the mosquito (transmitter of diseases). The plot is associated with the mythological personification of a disguised god (as a mosquito) that tries to marry the maiden represented, against the will of the father-in-law.

In the Mayan sacred book called Popol Vuh, there is a narrative about a mythic journey to the Xibalbá (Mayan underworld) led by the mythical twins Hunahpú and Ixbalanqué. In their trek, they needed to figure out the name of all the gods and gave the mosquito a mission in this plot, to push them to reveal their names, that says:

*"Bite them one by one; first bite the one sitting on the foreground and end up biting them all, because that is the part that corresponds to you, sucking the blood of man on the road." [19]*

Although no associations were linked to mosquitoes as the transmitter of diseases in pre-Columbine documents, there are historical mentions of a plague called in the Mayan language "xekik" (vomiting blood) that was associated with yellow fever [20, 21], but once again no mentions of the mosquito as the carrier of any pathogens were proposed.

In the Mayan culture, there is a worldview classification of the arthropods associated with medicine, economics, food, and religion [22]. The mosquito does not seem to be included here, but only in contemporary studies [23–26] we can identify the association with diseases, such as dengue.

Social research on cultural understanding of mosquito-borne diseases is as important as the study of the perceptions toward their vectors. Local taxonomies and

**Figure 2.** *Mosquito biting a maiden's breast [18].*

ethnoecological approaches that frame the political, historical, and cultural context of this topic, shape the way people learn, think, represent, and take action for preventing practices [27–30].
