{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T22:49:44Z","timestamp":1792190984368,"version":"4.4.0"},"update-to":[{"DOI":"10.1371\/journal.pntd.0013252","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000}}],"reference-count":57,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T00:00:00Z","timestamp":1753142400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81060096 and 81560202"],"award-info":[{"award-number":["81060096 and 81560202"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Hainan Natural Science Foundation Innovative Research Team Projects","award":["2016CXTD010"],"award-info":[{"award-number":["2016CXTD010"]}]},{"name":"High-level Talents Program of the Hainan Natural Science Foundation","award":["820RC759"],"award-info":[{"award-number":["820RC759"]}]},{"name":"Hainan Key Scientific Research Projects","award":["14A110060"],"award-info":[{"award-number":["14A110060"]}]},{"name":"Key Educational Reform Projects of Hainan Province","award":["Hnjg2019ZD-15"],"award-info":[{"award-number":["Hnjg2019ZD-15"]}]},{"name":"Key R&D Plan Projects of Hainan Province","award":["ZDYF2021SHFZ091"],"award-info":[{"award-number":["ZDYF2021SHFZ091"]}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Effective dengue management hinges on targeting key vector breeding sites and understanding transmission risks. Despite recurring outbreaks in Pakistan\u2019s Khyber Pakhtunkhwa (KP) Province since 2013, comprehensive entomological and virological data remain scarce. This study identified key larval-based indicators (habitats, <jats:italic><jats:italic>Stegomyia<\/jats:italic><\/jats:italic> indices), mosquito species composition, and dengue virus (DENV) infection rates in <jats:italic><jats:italic>Aedes<\/jats:italic><\/jats:italic> mosquitoes, evaluating their contributions to outbreak risk.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methodology\/principal findings<\/jats:title>\n<jats:p>From July to December 2021, a cross-sectional larval survey of <jats:italic><jats:italic>Aedes aegypti<\/jats:italic><\/jats:italic> and <jats:italic><jats:italic>Ae. albopictus<\/jats:italic><\/jats:italic> was conducted across epidemiologically high-risk KP districts, inspecting water-holding containers located indoors, outdoors, and on rooftops. Additionally, adult mosquitoes were collected using aspirators and nets, with weekly dengue case data sourced from Peshawar\u2019s Directorate of Health Services. A subsample of 200 adult mosquito pools (20 per district) underwent RT-PCR to determine minimum infection rates (MIR). Larval indices revealed a House Index (HI) of 19.4%, a Container Index (CI) of 20.4%, and a Breteau Index (BI) of 89%. <jats:italic><jats:italic>Aedes aegypti<\/jats:italic><\/jats:italic> was the dominant species, accounting for 62% of larvae and 67.8% of adult mosquitoes. Peshawar (BI\u2009=\u200989.3), Nowshera (BI\u2009=\u200971.4), and Mardan (BI\u2009=\u200957) reported the highest Breteau indices and corresponding dengue case counts: 2,584 (48.8%), 404 (7.6%), and 327 (6.2%), respectively. The peak larval positivity was recorded in October (29.3%) and September (24.7%), aligning with dengue patient hospitalization rates of 52.8% and 46.8%, respectively. Common breeding sites included indoor flowerpots (25.4%), outdoor rubber tyres (16%), and roof tap water (23.7%). Container type and location significantly (P\u2009&lt;\u20090.00) predicted larval abundance. Regression analysis revealed significant associations between dengue incidence, population density, and <jats:italic><jats:italic>stegomyia<\/jats:italic><\/jats:italic> indices. Of 38 positive pools (19%), DENV-2 and DENV-3 predominated (47.4% each), with peak MIRs recorded in Peshawar (30), Mardan (25), and Haripur (25).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions\/significance<\/jats:title>\n<jats:p>High larval indices and dual-serotype circulation in adaptable <jats:italic><jats:italic>Aedes<\/jats:italic><\/jats:italic> vectors signal substantial outbreak risk in KP. These findings underscore the need for targeted vector strategies, focusing on containers with the highest breeding potentials and epidemiological significance, particularly in high-transmission areas. Further molecular and entomological investigations are critical to corroborate these findings and inform more effective interventions.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0013252","type":"journal-article","created":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T17:34:52Z","timestamp":1753205692000},"page":"e0013252","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Assessing Aedes mosquito larval indicators, dengue virus infection rates, and risk factors in Khyber Pakhtunkhwa: Insights for improved vector control strategies"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4328-5459","authenticated-orcid":true,"given":"Jehangir","family":"Khan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Adil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsheten","family":"Tsheten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo","family":"Manrique-Saide","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongjing","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul","family":"Aziz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1792-2805","authenticated-orcid":true,"given":"Zhiyue","family":"Lv","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,7,22]]},"reference":[{"key":"pntd.0013252.ref001","doi-asserted-by":"crossref","first-page":"923277","DOI":"10.3389\/fpubh.2022.923277","article-title":"A cross-sectional study to assess the epidemiological situation and associated risk factors of dengue fever; knowledge, attitudes, and practices about dengue prevention in Khyber Pakhtunkhwa Province, Pakistan","volume":"10","author":"J Khan","year":"2022","journal-title":"Front Public Health"},{"key":"pntd.0013252.ref002","article-title":"Entomological investigations of dengue vectors in epidemic-prone districts of Pakistan during 2006\u20132010","volume":"35","author":"M Mukhtar","year":"2011","journal-title":"Deng Bull"},{"issue":"1","key":"pntd.0013252.ref003","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1186\/s12889-018-5676-2","article-title":"Epidemiological trends and risk factors associated with dengue disease in Pakistan (1980-2014): a systematic literature search and analysis","volume":"18","author":"J Khan","year":"2018","journal-title":"BMC Public Health"},{"issue":"3","key":"pntd.0013252.ref004","doi-asserted-by":"crossref","first-page":"272","DOI":"10.2987\/09-5908.1","article-title":"Arboviruses isolated from mosquitoes collected from urban and peri-urban areas of eastern Australia","volume":"25","author":"CC Jansen","year":"2009","journal-title":"J Am Mosq Control Assoc"},{"issue":"1","key":"pntd.0013252.ref005","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1186\/s12889-020-08846-8","article-title":"A spatial-temporal study for the spread of dengue depending on climate factors in Pakistan (2006-2017)","volume":"20","author":"W Shabbir","year":"2020","journal-title":"BMC Public Health"},{"key":"pntd.0013252.ref006","unstructured":"WHO. 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