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Although vaccines or chemoprophylactic drugs are available against important vector-borne diseases such as yellow fever and malaria, there are none for most other mosquito-borne diseases such as dengue, and travelers should still use repellents and other general protective measures. The effectiveness of malaria chemoprophylaxis is variable, depending on patterns of resistance and compliance with medication, and for many vector-borne diseases, no specific preventatives are available.
The principal approach to prevention of vector-borne diseases is avoidance. Tick and mite-borne infections characteristically are diseases of "place". Although many vector-borne infections can be prevented by avoiding rural locations, certain mosquito and midge-borne arboviral and parasitic infections are transmitted around human residences and in urban locations. Most vector-borne infections are transmitted seasonally and simple changes in itinerary may greatly reduce the risk for acquiring certain infections.
Exposure to arthropod bites can be minimized by modifying patterns of activity or behavior. Some vector mosquitoes are most active in twilight periods at dawn and dusk or in the evening. Avoidance of outside activity during these periods may reduce risk of exposure. Wearing long-sleeved shirts, long pants, and hats will minimize areas of exposed skin. Shirts should be tucked in. Repellents applied to clothing, shoes, tents, mosquito nets and other gear will enhance protection.
When exposure to ticks or mites are a possibility, pants should be tucked into socks and boots should be worn; sandals should be avoided. Permethrin-based repellents applied as directed (see below) will enhance protection. During outdoor activity and at the end of the day, travelers should inspect themselves and their clothing for ticks. Ticks are detected more easily on light colored or white clothing. Prompt removal of attached ticks may prevent infection.
When accommodations are not adequately screened or air-conditioned, bednets are essential to provide protection and comfort. Bednets should be tucked under mattresses and can be sprayed with repellent. Aerosol insecticides and mosquito coils may help to clear rooms of mosquitoes; however, some coils contain DDT and should be used with caution.
Permethrin-containing repellents (Permanone) are recommended for use on clothing, shoes, bednets and camping gear. Permethrin is highly effective as an insecticide/acaricide and as a repellent. Permethrin-treated clothing repels and kills ticks, mosquitoes and other arthropods and retains this effect after repeated laundering. There appears to be little potential for toxicity from permethrin-treated clothing.
Permethrin-containing shampoo (Nix) and cream (Elimite), marketed for use against head lice and scabies infestations, potentially could be extremely effective as repellents when applied on the hair and skin. However, they are approved only to treat existing conditions. Most authorities recommend repellents containing deet (diethyl-methylbenzamide) as an active ingredient. Deet repels mosquitoes, ticks, and other arthropods when applied to skin or clothing. Formulations containing less than 30% deet are recommended because the additional gain in repellent effect with higher concentrations is not significant when weighed against the potential for toxicity. A microencapsulated formulation (Skeedadle) may have a longer period of activity than liquid formulations.
Deet is toxic when ingested. High concentrations applied to the skin may cause blistering. Recommendations and precautions to minimize potential adverse reactions to the use of repellents are as follows:
Apply repellent sparingly only to exposed skin or clothing.
Avoid applying high-concentration (>30% DEET) products to the skin, particularly of children.
Do not inhale or ingest repellents or get them into the eyes.
Wear long sleeves and long pants, when possible, and apply repellents (e.g., permethrin) to clothing to reduce cutaneous exposure.
Avoid applying repellents to portions of children's hands that are likely to have contact with eyes or mouth.
Pregnant and nursing women should minimize use of repellents.
Never use repellents on wounds or irritated skin.
Use repellent sparingly; one application will last approximately 4 hours. Saturation does not increase efficacy.
Wash repellent-treated skin after coming indoors.
If a suspected reaction to insect repellents occurs, wash treated skin, and call a physician. Take the repellent container to the physician.
Excerpted from:U. S. Department of Health and Human Services, Centers for Disease Control and Prevention. HHS Publication No. (CDC) 94-8280. June, 1994. pgs. 158-160.
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