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Table 2 Advantages and disadvantages between Direct Skin Feeding Assay (DSFA) and Membrane Feeding Assay (MFA)

From: Membrane feeding of dengue patient’s blood as a substitute for direct skin feeding in studying Aedes-dengue virus interaction

Advantages • Closely resembles natural feeding
• No delay between obtaining patient blood sample and and mosquito feeding
• Prevents needle-stick injury
• Higher mosquito feeding rates
• Most diagnostic assay require venous blood
• Patient more likely to give consent
• Fewer ethical considerations/constraints
• Allows sampling from wider age-range group (including children)
• Allows using large number of mosquitoes and/or different species of mosquitoes
• Allows manipulation of  viral titre
Disadvantages • Patient less likely to provide consent
• Ethical approval required (difficult or impossible to obtain in some countries)
• Exclusion of children based on ethical considerations
• Potential exposure of patients to other arboviruses
• Risk of experiments being terminated during feeding due to patient’s discomfort
• Delay between sampling and mosquito feeding
• Potential exposure of phlebotomist to blood-borne pathogens (needle-stick injury)
• Need for patient to undergo needle penetration (potentially aversive in some cases)
• Low mosquito feeding rates