2The modification and release of insects to suppress or replace natural insect vectors constitutes 3 a promising tool for vector control and disease prevention, facing the unprecedented global 4 emergence of vector-borne diseases. Little is known regarding these innovative modification 5 strategies and available evidence is not standardized turning it difficult to reflect on their actual 6 efficacy and eventual effects. 7This work conducted a systematic review, gathering and analyzing research articles from PubMed 8 and Biblioteca Virtual em Saúde databases whose results directly report efficacy and effects of 9 the use of modified insects for disease prevention until 2016. Within more than 1500 publications 10 that were screened a total of 349 where analyzed. 11A total of 12/3.4% reported field-based evidence, and 41/11.7% covered modification stretagies' 12 efficacy after insects' release, their epidemiology impact or its long-term efficacy. Examples of 13 successful results were the replacement of natural field populations by wolbachia-infected 14 mosquitoes in 5 weeks, and the elimination of a population in laboratory cages after transgenic 15 mosquitoes release over 10-20 weeks. Variability in the effective results were described 16 (90/25.7%) questioning its reproducibility in different settings. We also found 38/10.9% 17 publications reporting reversal outcomes, such as an increase of vector population after release. 18Ecological effects such as horizontal transfer events to non-target species (54/15.5%), and 19 wolbachia-induced worsening pathogenesis on mammal filarial diseases (10/2.9%) were also 20 reported. 21Present work revealed promising outcomes of both suppressing and replacing approaches. 22However, it also revealed a need of field-based evidence mainly regarding epidemiologic and 23 long-term impact of insect modification strategies. It pointed out some eventual irreversible and 24 important effects that must not be ignored when considering open-field releases, and that may 25 constitute constraints to generate the missing field evidence. Moreover, the level of variability of 26 existing evidence suggests the need of local/specific evidence in each setting of an eventual 27 release. 28 29 30 31 32 33 34 35