# Presentation: 135469

## What’s happening, what’s new and what’s next?In WNV personal prevention

- Emily Zielinski-Gutierrez, DrPH
- CDC/DVBID
- Fort Collins, CO

- Some national and regional trends in personal & household protection: 2002 ‘til now
- What’s New?
- What’s Next?
- And a short infomercial....

## Data sources

- Harvard School of Public Health Project on the Public and Biological Security
- Carried out through collaboration with CDC
- National and regional
- Various topics
- Porter-Novelli Healthstyles
- Data licensed to CDC

## How worried are folks?

- Harvard SPH,  nationwide samples

## How worried are folks, regionally?

- Harvard SPH/Aug 2004, * 1,014 adults, nationally rep sample; ** 1143 adults in CO, AZ and CA

- *

- **

## What are they doing about it?

- Harvard SPH, 2002 n=1001,2003 n=1015, 2004 n= 1,014 adults, nationally rep samples

## What are they doing about repellent use?

- Harvard SPH, 2002 n=1001,2003 n=1015, 2004 n= 1,014 adults, nationally rep samples

## Regional Differences

- Qualitative research has                              suggested important                                differences in attitudes                                                        toward mosquitoes btwn South/Midwest/West
- Nuisance
- Perception of environment
- Survey data likewise reflect lower use of precautions, esp. repellent use
- Anecdotally, repellent sales also reported to be lower in western regions

## What are they doing about it in the West?

- Harvard SPH/Aug 2004, * 1,014 adults, nationally rep sample; ** 1143 adults in CO, AZ and CA

- Jul-Aug 2003

- 2003

**Notes:**
Highest WN central (green) and ES central (bright red)
Lowest in pacific (red), mountain (light green) and Mid-Atlantic (bright blue)
Pacific region -- least likely to have DEET in household (23.4%) and least likely to use repellent (17.8%)
Maybe b/c WNV hasn’t really reached the Pacific yet? Underlying cultural attitude twd repellent use?
WN Central, ES Central highest usage rates 
Having DEET in the HH followed a similar pattern. 

## Oct 2004: Always/usually use repellent

**Oct 2004: Always/usually use repellent**

- 35%

- New England

- Middle Atlantic

- East North Central

- West North Central

- East South Central

- South Atlantic

- West South Central

- Mountain

- Pacific

**51% (+)**

**47% (+)**

- 40%

- 48%

- 46%

**55% (+)**

- 33%

**23% (+)**

- Healthstyles, Oct/Nov 2004 n=4211, *p=.000*

- +/- indicates change =>5% from 2003

## Regional 

- Harvard SPH/Aug 2004, * 1,014 adults, nationally rep sample; ** 1143 adults in CO, AZ and CA

- **

## Other Demographic variables

- Important behavioral differences related to
- Race/ethnicity
- Age
- Primary language spoken
- Income, to a lesser degree

## Race/ethnicity

- Harvard SPH/Aug 2004, 1143 adults in CO, AZ and CA

## So, what does this mean?

- Fairly consistent level of national concern
- Interesting, given shifting foci
- Suggest that may be a tiny trend toward increased personal protection
- But attitudes are slower than the virus
- Important regional and demographic differences remain
- Still major challenges in knowledge about repellents

## What’s New?

## Mosquito Repellent 

- CDC recommendations have focused on DEET and permethrin
- Additional active ingredients discussed in the “Yellow Book” for travelers’ health
- Changes in marketplace
- More repellents seeking EPA registration and being brought to market
- (Also more claims from products not registered as repellents)
- Public health challenged to respond
- Inquiries inevitable
- If we really believe that repellent use can help reduce risk, it’s incumbent to do what we can to reduce barriers and increase use of effective products

**Notes:**
Simply not the same consumer marketplace it was 5 years ago, due in large part to the public attn to WNV

## Repellent efficacy in the literature

- Barnard and Xue, 2004
- Tested 12 commercially available products
*Aedes albopictus, Culex nigripalpus*, and *Ochlerotatus triseriatus*
- Products w/ DEET, picaridin (KBR 3023), oil of lemon eucalyptus (p-methane-3,8 diol [PMD]) and 2% soybean oil all found effective for over 7 hours (mean estimated time of protection for three species)

## Repellent efficacy

- Fradin and Day, 2002
- Tested 17 commercial products
*Aedes aegypti*
- DEET products provided longest lasting protection
- 2% soybean oil product evidenced protection for time period roughly equivalent to lower concentrations of DEET
- Oil of lemon eucalyptus licensed at end of study period, also evidenced protection slightly greater than low concentration of DEET products
- picaridin not tested

## Heads up!

- Adjusted recommendations forthcoming, criteria likely to include...
- EPA registered as topical repellent
- A given level of efficacy (TBD) documented in peer reviewed literature
- Determine best choices for your local program
- Products available, species, type of outdoor activities, local attitudes toward repellents...

## Factors to consider

- Amount of time protection needed
- Sportpersons/gardeners/backyard BBQ– different repellent needs
- Clear information
- Continue to emphasize safety of existing products such as DEET *and* promote use of effective alternatives
- How to deal with brand names?
- Ease of recognition vs. avoiding endorsement
- All formulations are not necessarily the same

## Repellent issues, cont

- How do we tell public about multiple options w/o creating confusion?
- Hard to be pithy and to the point...
- We already have a tendency to baffle people with detail

## What’s Next?...

- Challenged to adjust messages to local environments (cultural, historical and ecological and mosquito control)
- Consider how to engage the public year after year, especially after several years of “endemic” activity? How long before you’re “crying wolf”?
- Targeting to highest risk

## The short infomercial

- 26-minute video for use with community groups
- Done with Rotary Clubs of Fort Collins
- English and Spanish
- CD and VHS
- Go ahead make copies, we won’t call the FBI (public domain)
- TV and radio public service announcements also available
- Missed the freebies? dvbid@cdc.gov