Insect Bites and Stings General Prevention Measures

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Although vaccines or chemoprophylactic drugs are available against important insect and arthropod (spiders, mites, etc.) borne diseases such as yellow fever and malaria, there are none for most other mosquito-borne diseases such as dengue, and travelers still should avail themselves of repellents and other general protective measures against arthropods.

The effectiveness of malaria chemoprophylaxis is variable, depending on patterns of resistance and compliance with medication. For many vector-borne diseases, no specific preventatives are available.

General Preventive Measures

The principal approach to prevention of vector-borne diseases is avoidance.

Tick- and mite-borne infections characteristically are diseases of “place;” whenever possible, known foci of disease transmission should be avoided. 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 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 outdoor 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 is 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, bed nets are essential to provide protection and comfort. Bed nets 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.

Repellents

Permethrin-containing repellents (Permanone®) are recommended for use on clothing, shoes, bed nets 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 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 (N,N-diethylmetatoluamide) as an active ingredient. DEET repels mosquitoes, ticks, and other arthropods when applied to skin or clothing. Formulations containing < 35% 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 (Skedaddle®) may have a longer period of activity than liquid formulations.

DEET is toxic when ingested. High concentrations applied to skin may cause blistering. Rare cases of encephalopathy in children, some fatal, have been reported after cutaneous exposure. Other neurologic side effects also have been reported. Toxicity did not appear to be dose-related in many cases and these may have been idiosyncratic reactions in predisposed individuals. However, a dose-related effect leading to irritability and impaired concentration and memory has been reported.

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