Critical review of Aedes aegypti control programs in the Caribbean and selected neighboring countries.

In recent years the region of the Americas has experienced increasing dengue activity with circulation of multiple virus serotypes. Associated with this trend has been the occurrence of sporadic dengue hemorrhagic fever (DHF) cases and of DHF epidemics in both the Caribbean and Latin America. High vector infestation levels persist even though most countries in the Caribbean conduct national Aedes aegypti control programs and despite the fact that in some instances, expenditures exceed US$5 per capita per annum. This paper critically reviews the resources and vector control strategies employed in the region and in selected neighboring countries. Reasons for the lack of progress include continued overreliance on eradication-style larviciding routines and the passive role of communities in addressing the problem. A policy of health promotion aimed at improving environmental health practices at the household and community levels has been endorsed by the governments of the region but as yet has not been widely adopted.