JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
Mosquito Repellents for Zika
Rachel J. Kaye, BA, James H. Diaz, MD, DrPH, Mark R. Jones, MD, Alan D. Kaye, MD, PhD
The rapidspreadand increasedpathogenicityof Zikavirusdisease transmittedby Aedes speciesmosquitoes has prompted a vigorous search for a newvaccine, aswell as renewed awareness of other effective primary preventionmethods, including insecticide-impregnated clothing and insect repellents. In order to inform practitioners and patients about selecting themost effective insect repellents to preventmosquito-borne transmission of Zika virus disease and to recommend the best application methods for repellents and insecticides, Internet search engines were used to select peer-reviewed scientific articles for descriptive analyses of the efficacy of repellents and insecticides. Topical repellents containing DEET or picaridin were more effective for longer periods at preventing Aedes mosquito bites in humans than other topical mosquito repellents, such as IR3535 and oil of lemon eucalyptus. In addition, treating or impregnating items such as clothing, bed nets, sleeping bags, and shoes with permethrin-containing insecticides also reduced Aedes mosquito bites. Although the adverse effects of mosquito repellents were minimal, DEET maintained the best safety profile over the years with the longest duration of effectiveness topically.
INTRODUCTION Zika virus, a flavivirus transmitted by Aedes species mosquitoes, has become a global human health threat in the U.S. with an expanding human reservoir of imported and locally acquired disease. In addition to mosquito-borne transmission, Zika virus disease is transmitted congenitally and sexually, and is likely transmitted by blood transfusion and organ transplants like its related flavivirus, West Nile virus.¹ In the U.S., the predominant Aedes species capableof transmittingZika virus are Aedesaegypti , the yellow fever mosquitoes (Figure 1), with a distribution range restricted to the Southern US; and Aedes albopictus , the Asian tiger mosquitoes (Figure 2), with a much broader distribution range.
Figure 2. Female Aedes albopictus mosquito feed on blood from a human host. Note the long longitudinal white stripe on the cephalothorax for identification.Source: CDC Public Health Image Library, James Gathany 2000. No copyright permission required. Although most cases of Zika virus disease are asymptomatic, about 20% of the cases will present with fever, rash, joint and muscle pain, and dry conjunctivitis.² In addition, severe post- infectious neurological complications have included the Guillain-Barré syndrome in adults; andmicrocephaly, intracranial calcifications, and optic nerve and retinal damage in newborns.² Without an effective vaccine, vector control and personal protection from mosquito bites with proper clothing and insect repellents remain the only primary preventive strategies for Zika virus disease.
Figure 1. Female Aedes aegypti mosquito blood feeding on a human host. Note the lyre-shaped white markings on the thorax for identification. Source: CDC Public Health Image Library, James Gathany 2006. No copyright permission required.
J La State Med Soc VOL 170 JULY/AUG 2018 119
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