Patterns of change in vector-borne diseases.

The statuses of vector-borne diseases have changed over recent years. How a few such diseases have changed and the primary causes of change (urbanization, increased conflict, changes in water-resource management, ecological and environmental change, and reduced health service resourcing) are the subjects of the present review. The key impacts which these primary causes have on selected vectors and the infections they transmit are tabulated. The success of vector-control programmes against onchocerciasis and Chagas disease is discussed, and the methods used to evaluate the epidemiological impact of such controls are described. Bednet programmes for control of malaria are recognized as a potential future means of reducing morbidity and mortality in children. In contrast to the success achieved in limiting Simulium and Triatoma populations through vertical programmes, control of tsetse, whilst successful in Uganda, has not been utilized to stem recent epidemics of sleeping sickness in resource-stressed settings in Central Africa. Vector-borne diseases will continue to be a problem because of the adaptability of vectors, the potential problems of managing effective vector controls within decentralized health systems, and the influence of activities outside the health sector itself. Changes beyond the health sector can increase the problem posed by a vector and increase the frequency of transmission.