Personal Protection Measures Against Mosquitoes, Ticks, and Other Arthropods

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Key points

  • Bite avoidance and personal protection measures should be recommended to all travelers.

  • Traveler characteristics and destination-specific factors should be considered when deciding which personal protection measures to recommend.

  • DEET, picaridin, PMD, and IR3535 are insect repellents that provide adequate protection for travelers against arthropod bites, with the exception of IR3535, which should not be recommended for use in malaria-endemic areas.

  • Insecticide-treated clothing in combination with

Destination and vector considerations

During the pretravel visit, obtaining a detailed travel itinerary is a key aspect of risk assessment. The planned destination, urban versus rural setting, length of stay, modes of transportation, reason for visit, and accommodation all affect one’s risk for arthropod exposures and subsequent vector-borne diseases. Having an understanding of the arthropod vectors present at one’s destination is essential to adequately advising the traveler on mitigating risk. For instance, the Anopheles

Traveler considerations

In addition to considering destination-specific risk factors, individual traveler-specific characteristics also should be considered when assessing risk. Some types of travelers are at greater risk of vector-borne disease than others. Higher-risk travelers may be stratified based on age, purpose of their trip, and activities during the trip. Younger age is a risk factor for nonadherence to health prevention measures during travel.7, 8 “Visiting Friends and Relatives” (VFR) travelers, defined as

Topical insect repellents

The active chemical ingredient, its concentration, and resultant duration of protection are the most important considerations when choosing an insect repellent.26 The Centers for Disease Control and Prevention (CDC) has identified 4 active ingredients found in over-the-counter Environmental Protection Agency (EPA)-registered products with sufficient evidence for protection against arthropod bites in travelers.19 A table summarizing the characteristics of the 4 insect repellents can be found in

N,N-diethyl-m-toluamide

N,N-diethyl-m-toluamide (DEET) is a broad-spectrum insect repellent, first developed by the US Department of Agriculture in 1946 for use by the US military.28 Marketing for the product began in 1957, and it is now the most widely used and studied insect repellent available.29 Products are sold in multiple formulations, including aerosols, pump sprays, lotions, creams, gels, towelettes, and wristbands. Products include Off! (SC Johnson, Racine, WI), Repel, Cutter (United Industries, Beloit, WI),

Permethrin

Permethrin is an odorless, biodegradable pyrethroid insecticide derived from the plant Chrysanthemum cinerariifolium. It is the most common insecticide available for use on fabrics, and is unique in its role as both a contact insecticide via neural toxicity, and as an insect repellent.41 It requires direct contact with arthropods and is ineffective when applied directly to skin. It can be applied directly to clothing, as well as shoes, bed nets, and camping gear.38

Insecticide-Treated Clothing

Permethrin is the most common

Spatial Repellents and Aerosols

Insecticide vaporizers using permethrin prevent against nuisance biting but there is no evidence for prevention against malaria. In addition, travelers should be aware of a low-level health hazard risk and use these devices with caution.27 Mosquito coils are effective against nuisance biting involving all mosquito species, and may reduce the risk of transmission of malaria. There have been concerns of an increased incidence of lung cancer in individuals using mosquito coils; however, given the

Future considerations/summary

In conclusion, personal protection measures, which include protective clothing, topical insect repellents, and ITNs and insecticide-treated clothing, are the primary means of protection against vector-borne diseases. These personal protective measures should be recommended to all travelers visiting endemic areas. Air conditioning and well-screened rooms also should be used, especially if ITNs are not available. Although DEET is the most studied insect repellent available, picaridin, IR3535, and

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    Disclosure Statement: The authors have no disclosures or conflicts of interest.

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