article · PLoS ONE
A novel long-lasting insecticidal net, MiraNet Combi, combining alpha-cypermethrin, pyriproxyfen, and piperonyl butoxide, was evaluated for effectiveness against pyrethroid-resistant malaria mosquitoes in western Kenya. Laboratory and experimental hut trials tested the net against existing nets before and after twenty standardised washes. In laboratory tests across wash points, the net achieved 94.5 percent mosquito mortality and 93.8 percent blood-feeding inhibition against susceptible and resistant strains. In hut trials, MiraNet Combi caused the highest mosquito mortality, reaching 23 percent unwashed and 25 percent washed, significantly outperforming pyrethroid-only and permethrin plus synergist alternatives. Blood-feeding inhibition in hut trials ranged from 90.2 to 98.4 percent across all tested nets. The net also reduced mosquito ovary development by 37.5 percent unwashed and 14.3 percent after washing. These findings indicate that combining a pyrethroid, insect growth regulator, and synergist improves vector control in insecticide-resistant settings.
Widespread resistance to pyrethroid insecticides threatens global progress in controlling malaria vectors. By pairing a standard insecticide with an insect growth regulator and a synergist, multi-active ingredient nets can maintain protective barriers and suppress resistant mosquito populations. This strategy helps extend the viable lifespan of treated bed nets in communities heavily affected by resistant malaria-transmitting mosquitoes.
This research demonstrates an applied, tested intervention ready for operational evaluation in public health procurement. The net directly targets malaria control programmes, international procurement agencies, and healthcare organisations operating in areas with high pyrethroid resistance. Having undergone standardised World Health Organization laboratory and experimental hut testing, MiraNet Combi represents a near-market vector control product designed to replace less effective single-agent or dual-agent bed nets.
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BACKGROUND: The widespread use of pyrethroid-only long-lasting insecticidal nets (LLINs) has contributed substantially to malaria control; however, increasing pyrethroid resistance in malaria vectors threatens their continued effectiveness. To address this challenge, LLINs incorporating additional active ingredients have been developed. MiraNet® Combi is a novel LLIN incorporating alpha-cypermethrin, the insect growth regulator pyriproxyfen (PPF), and the synergist piperonyl butoxide (PBO). METHODS: We evaluated the efficacy of MiraNet® Combi against pyrethroid-resistant Anopheles funestus in western Kenya using WHO cone bioassays, tunnel tests, experimental hut trials, and chemical analysis. Non-inferiority of MiraNet® Combi to Royal Guard® (alpha-cypermethrin + PPF) and superiority to Olyset® Plus (permethrin + PBO) and MiraNet® (alpha-cypermethrin-only) were assessed for mosquito mortality and blood-feeding inhibition following 20 standardized washes, in accordance with WHO guidelines. RESULTS: In laboratory assays, MiraNet® Combi achieved high efficacy, inducing 94.5% mortality (95% CI: 91.2-97.8%) and 93.8% blood-feeding inhibition (95% CI: 90.5-97.1%) across all wash points against susceptible and resistant mosquito strains. In experimental hut trials, MiraNet® Combi produced the highest mortality, with 23% (95% CI: 21-25%) in unwashed and 25% (95% CI: 23-27%) in washed nets, significantly exceeding unwashed Olyset® Plus (19.9%, p = 0.0002) and MiraNet® (21.9%, p = 0.03). Blood-feeding inhibition was comparable across all ITNs (90.2-98.4%). Unwashed MiraNet® Combi reduced ovary development by 37.5% (95% CI: 32.1-42.9%), decreasing to 14.3% (95% CI: 10.2-18.4%) after washing. MiraNet® Combi was non-inferior to Royal Guard® for mosquito mortality but not for blood-feeding inhibition, superior to Olyset® Plus and MiraNet® for mosquito mortality, superior to MiraNet® for blood-feeding inhibition, and inferior to Olyset® Plus for blood-feeding inhibition. CONCLUSIONS: MiraNet® Combi provides improved personal protection and enhanced efficacy against pyrethroid-resistant An. funestus compared with existing LLINs. The combination of a pyrethroid, PBO, and PPF represents a promising strategy for resistance management and malaria vector control in areas with high pyrethroid resistance.
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DOI: 10.1371/journal.pone.0331995
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