Background cytochrome P450, esterase, and GST-mediated metabolic detoxification; cuticular thickening reducing insecticide penetration; and microbiome-mediated xenobiotic degradation. In Asia, 58% of surveyed Ae. aegypti populations and 6% of surveyed Ae. albopictus populations have been classified as pyrethroid-resistant, whilst DDT resistance has been documented in 68% and 64% of surveyed Ae. aegypti and Ae. albopictus populations, respectively, based on WHO bioassay mortality thresholds. Southeast Asia exhibits pronounced super-resistance hotspots. Wolbachia population replacement interventions achieved 73-76% dengue incidence reductions independent of resistance status; economic evaluations indicate favourable cost-effectiveness, with benefit-cost ratios ranging from 1.75× in Vietnam to 110× in Brazil, reflecting differences in local deployment costs and dengue burden. Interpretation & conclusion: Addressing pyrethroid obsolescence requires integrated management combining Wolbachia deployment, insecticide rotation, agricultural regulation, and molecular surveillance of sentinel mutations (V410L, L982W). Critical priorities include surveillance expansion into Central Africa and other data-deficient regions, and characterization of climate-resistance interactions affecting metabolic detoxification and Wolbachia thermal stability.
Ahmad Y. Alqassim (2026) studied this question.
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