1
Help Your Patients Protect Themselves

2
Personal Protection

• Avoid areas with dense mosquito populations (wet,
  wooded, etc.)
• Avoid the peak times for mosquitoes two hours
  before after dawn dusk
• Use clothing as a protective barrier
• Use EPA-registered insect repellents on exposed
  skin

3
Why Repellents?

• Help prevent mosquito- and tick-borne disease
• Repellent use decreased risk by 2x in a
  case-controlled study in Australia (Harley, et
  al., 2005)
• Respondents with no/infrequent insect repellent
  use 2x more likely to have evidence of past
  dengue infection vs. those using always/often in
  Matamoros, Mexico (Ramos, et al., 2008)
• Loveland, Colo., had 3x higher WNV rate vs.
  nearby Fort Collins in 2003. Difference in
  repellent use (significantly great in Ft.
  Collins) possible factor (Zielinski, et al.,
  2008)

4
Regulation of Repellents

• CDC and California public health agencies
  recommend consumers use EPA-registered active
  ingredients
• DEET, oil of lemon eucalyptus (OLE),
• picaridin, IR 3535
• EPA registers products after reviewing extensive
  efficacy, safety data
• The EPA says registration indicates the
  materials have been reviewed and approved for
  efficacy and human safety when applied according
  to the instructions on the label. (CDC)

5
Types of Active Ingredients

• EPA-registered products most effective (CDC)
• - conventional repellents DEET picaridin
• - biopesticide repellents OLE IR3535
• Natural products
• Many are untested for efficacy
• Very little toxicity data available
• Less effective (Fradin Day 2002)
• Possible allergens (Day Rutlege, 2008)
• Many last at most 20 minutes
• No more effective than cooking oil or other
  barrier

6
Natural Repellents

• Limited efficacy
• Efficacy testing not required
• Many consumers make their own OLE concoctions
• These are ineffective
• Many essential oils are highly irritating to skin
  and must be used cautiously on children

7
DEET

• DEET used for more than 50 years, most widely
  studied repellent active ingredient
• DEET has been shown to be an extremely safe and
  effective repellent and remains a very important
  option for consumers. CDCs Lyle R. Petersen,
  M.D., M.P.H.
• Urban legends on safety have a life of their own
  and are generally without foundation
• (For specifics, please ask during QA)

8
The Science

• Industry-sponsored studies
• Leading companies conduct rigorous studies per
  EPA guidelines
• Competitive claims from less effective,
  non-registered products lead to consumer
  confusion
• Examples on the internet
• Independent studies
• Scientists continually study DEET, potential
  alternatives
• Fradin, Day 2002 NEJM considered benchmark
• Copies available upon request

9
Concentration Protection Time

• DEET
• 5 provides approx. 90 minutes
• 10 provides approx. 2 hours
• 30 provides approx. 5 hours
• Protection Time Variables
• Weather conditions
• Biting pressure
• Race
• Gender
• Activities (swimming, perspiring heavily)
• Body chemistry

10
Adverse Events

• The most commonly reported AEs
• Eye irritation
• Formulations contain alcohol
• VERY rarely, skin rash
• Thought to be associated with other ingredients

11
Registry Details

• More than 5 billion applications of DEET during
  7-year Registry period
• Overall risk of clinically significant adverse
  events is very low Thomas G. Osimitz, Ph. D.,
  CDC conference, 2005
• No association with seizures
• Copies of Registry Poster presentation at CDC
  meeting available upon request

12
Using Repellents

• Read, carefully follow label directions
• Apply to exposed skin, not under clothing
• Apply evenly, rub product onto skin to ensure
  even coverage (mosquitoes can find an uncovered
  spot the size of a dime)
• Wash off after returning indoors

13
Repellents on Children

• AAP recommendations
• Up to 30 concentration DEET-based repellent for
  all over 2 months old
• Adults should apply to young children
• Adult puts repellent on his/her hands, then
  applies on childs skin
• Dont spray randomly in the air
• OLE should not be used on children younger than 3
  years old
• After time outdoors, check for insect bites and
  ticks

14
Special Populations

• Pregnant women/ Nursing mothers
• CDC recommends pregnant and lactating women use
  repellents as needed
• Elderly
• At special risk for serious WNV illnesses
• Children under 2 months old
• Use mosquito netting
• Children at camp
• Use higher concentrations for extended coverage
  (30)
• Reapply only when bugs start biting again

15
Summary

• Encourage patients to
• use EPA-registered repellents
• read the instructions before use

16
More information www.cdc.gov www.cdph.ca.gov www.
sdcounty.ca.gov www.deetonline.org

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Further questions toMs. Susan LittleExecutive
DirectorDEET Education Program202-833-7315 /
slittle_at_cspa.org1-800-No-Bites
www.deetonline.org