**Acknowledgements**

part of institutional prevention and control programs. In addition to the challenges exposed earlier, other limitations include a lack of scientific and technological infrastructure of the quality and capacity necessary for the implementation of novel methods of mosquito control. This extends to laboratories, systems for the mass rearing of mosquitoes and processes such as quality control, transportation, field release, monitoring and evaluation of effectiveness. Both WHO and the Pan American Health Organization (PAHO) are offering their technical cooperation to support pilot studies using innovative methods. The technical advisory group on entomology in public health and vector control explicitly recommended to PAHO "Promoting rapid, robust and accelerated evaluation of new tools complementary to the control of *Aedes*, with particular attention to the use of mosquitoes infected with the bacteria

Vector control programs do not use "single" methods. Innovations should be considered complementary tools to control programs, not substitutes. Traditional and/or new interventions of greater complexity can be implemented proactively using a risk stratification approach calling for different intensity and greater coverage in priority areas. However, we can anticipate complications on monitoring and evaluation, since there is little evidence and experience

Traditional vector control has demonstrated limited impacts and transitory decreases in larval and adult mosquito populations. Monitoring of these traditional control programs is performed on an irregular basis throughout the year, without taking into account that there are important seasonal effects on vector populations. Furthermore, these evaluations are unstructured and usually not conduced at the time intervals necessary in order to estimate the magnitude and longevity of the effects on vector populations. In the case of GMM-BCMW, in addition to performing entomological monitoring to estimate the effects of suppression on target populations, in the case of substitution or population replacement strategies, it is necessary to include measurements of the reproductive and biological performance of the

Estimates of the effect of traditional actions (larval density) do not imply impacts on disease transmission (incidence). The IVM strategies share these limitations, although they diversify the indicators due to the multidisciplinary nature of their interventions. In the case of GMM-BCMW, the evaluations ought to incorporate continuous monitoring of adult mosquito populations (wild and introduced): their survival, performance (or *fitness*), competence as vectors or capacity to transmit the infectious agents, reproductive capacities, flight range, dispersal, and so on. The indicators should purvey information relevant to measuring the effects on reproductive capacity; reduction in infection and other entomological, epidemiological and even ecological parameters that describe the dynamics of adaptation of introduced populations.

Despite intense research on *Ae. aegypti*, we still do not have entomological parameters linking vector density to risk of transmission. It is also still difficult to define the transmission risk's direct impact on human populations and its duration (days, weeks and months) in mosquito populations—and even more difficult to count on indicators that allow for efficient evaluation

of multiple or combined interventions with intersectoral participation and IVM.

*Wolbachia* and sterile and genetically modified insects."

106 Dengue Fever - a Resilient Threat in the Face of Innovation

introduced populations.

To the Canadian Institutes of Health Research (CIHR) and IDRC (Preventing Zika disease with novel vector control approaches Project 108412) and Fondo Mixto CONACYT–Gobierno del Estado De Yucatán (Project YUC-2017-03-01-556). Abdiel Martin-Park is supported by the Cátedras–CONACYT program. Special thanks to Ana García-Moreno Malcolm for grammar corrections.
