Personal Actions to Minimize Mosquito-Borne Illnesses, Including Zika Virus
Authors: Regina L. LaRocque, Edward T. Ryan
Journal: Annals of Internal Medicine (2016)

Ideas and Opinions18 October 2016Personal Actions to Minimize Mosquito-Borne Illnesses, Including Zika VirusFREERegina L. LaRocque, MD, MPH and Edward T. Ryan, MDRegina L. LaRocque, MD, MPHFrom Massachusetts General Hospital and Harvard University, Boston, Massachusetts. and Edward T. Ryan, MDFrom Massachusetts General Hospital and Harvard University, Boston, Massachusetts.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-1397 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Many viral and parasitic diseases are transmitted by mosquitoes. Different species of mosquitoes spread different illnesses and bite at different times of the day. Anopheline mosquitoes usually bite from dusk until dawn and can transmit malaria. Culex mosquitoes often bite from evening until morning and can transmit West Nile virus. Aedes mosquitoes primarily bite during the day, although they can also bite at night; these are the mosquitoes that can transmit Zika, dengue, and chikungunya viruses (1–4).Diseases spread by aedes mosquitoes have raised increasing concern in the Caribbean Basin and areas of Latin America in recent years. Dengue virus has long been endemic in the region and can manifest as a nonspecific febrile or hemorrhagic illness. Chikungunya virus was first recognized in the Americas in late 2013 and can manifest as a nonspecific febrile illness with arthritis that may be prolonged. Most recently, in 2015, the Pan American Health Organization issued an alert after the first confirmed cases of Zika virus infection in the Americas were reported in Brazil. Since that time, the epidemic has grown. Although most patients who acquire Zika virus remain asymptomatic, approximately 1 in 5 develops a nonspecific febrile illness that may include conjunctivitis. Of greatest concern, Zika virus can cause fetal microcephaly in women who acquire it while pregnant.Since the recent introduction of chikungunya and Zika viruses into the Western hemisphere, both have spread rapidly, reflecting the widespread distribution of 2 aedes mosquito vectors that are capable of transmitting these pathogens: Aedes aegypti and A albopictus. Of note, both are distributed across substantial regions of the United States, raising concern for the possibility of local transmission (www.cdc.gov/zika/vector/index.html). Many steps fortunately can be taken to limit mosquito-borne illnesses, including trip planning; personal protective measures; household treatment; and, in the case of malaria, chemoprophylaxis (www.cdc.gov/zika/prevention/index.html and www.cdc.gov/malaria/travelers/index.html).First, persons can restrict travel to areas with active transmission of such mosquito-borne illnesses as Zika, chikungunya, or dengue viruses. Up-to-date surveillance data and travel recommendations are available through the Centers for Disease Control and Prevention (CDC) (www.cdc.gov). Pregnant women should not travel to areas with Zika virus transmission (wwwnc.cdc.gov/travel/page/zika-information).Second, exposure to mosquitoes should be limited, especially during peak biting times. Persons should wear long-sleeved shirts and long pants and cover their feet when outside. The use of window screens and air conditioning can minimize mosquito exposure while indoors. Bed nets should be used at night, particularly in areas where malaria is present.The correct and consistent use of insect repellents is essential for preventing mosquito and tick bites. Although many products that purport to have repellent activity are available (5), the CDC recommends use of only Environmental Protection Agency–registered repellents with one of the following active ingredients: DEET (N,N-diethyl-meta-toluamide), picaridin, IR3535, oil of lemon eucalyptus, or para-menthane-3,8-diol (www.cdc.gov/zika/prevention/index.html). The Environmental Protection Agency maintains a Web site that allows direct comparison of various products containing these active ingredients, including whether they protect against mosquitoes, ticks, or both; their active ingredients; and their duration of protection (www.epa.gov/insect-repellents/find-insect-repellent-right-you). Manufacturers' instructions should be followed carefully, specifically applying and reapplying the repellent as directed and not applying it under or directly to clothes. If used, sunscreen should be applied before insect repellent. Persons also may treat clothing and other gear with permethrin, which often remains protective through multiple washings. Product directions should be followed, and permethrin should not be used directly on skin.Mosquito avoidance measures in children and pregnant women raise special concerns. The CDC recommends dressing children in clothing that covers arms and legs; covering cribs, strollers, and baby carriages with mosquito netting; not applying insect repellent onto a child's hands, eyes, mouth, or open or irritated skin or at all on babies younger than 2 months; and not using any product containing oil of lemon eucalyptus or para-menthane-3,8-diol on children younger than 3 years (www.cdc.gov/chikungunya/pdfs/fs_mosquito_bite_prevention_travelers.pdf). When used as directed, Environmental Protection Agency–registered insect repellents are safe and effective, including in breastfeeding and pregnant women.Third, measures should be taken to control mosquitoes in and around the home (www.cdc.gov/zika/prevention/controlling-mosquitoes-at-home.html). Aedes mosquitoes often lay eggs in small containers that hold standing water in houses; covering or discarding such items and emptying, draining, and scrubbing water-holding items, such as vases and flower pot saucers, should be done at least weekly. Persons can also kill mosquitoes in their homes by using indoor flying insect fogger or indoor insect spray. These products work immediately but need to be reapplied. Label instructions should be carefully followed. Mosquitoes often rest in dark, humid places, such as in laundry rooms, under furniture, in closets, or under sinks.Any items around the home that can catch or collect water, such as trash or leaves, should be picked up and discarded. Once a week, persons should empty and scrub, turn over, cover, or throw away such items, as well as buckets, tires, planters, toys, pools, birdbaths, flower pots and their saucers, or trash containers. Any outdoor item that could collect water and thus permit mosquitoes to lay eggs should be tightly covered or drained, including buckets, cisterns, and rain barrels.To prevent malaria, additional precautions include the use of destination-appropriate chemoprophylaxis. Further resources for minimizing illness during travel are available at www.HeadingHomeHealthy.org.Integrated vector-control programs that include surveillance activities, elimination and removal of habitats that produce mosquitoes (source reduction), larvicidal application, neighborhood and environmental insecticide spraying to target adult mosquitoes, as well as other interventions are usually directed by public health authorities and tailored to the particular vector or vectors being targeted (www.cdc.gov/zika/vector/vector-control.html).Of note, if persons believe that they have acquired a mosquito-borne illness, they should continue to minimize the likelihood of being bitten by mosquitoes to reduce possible transmission to household members or within the community. Because many persons with Zika virus are asymptomatic, the CDC also recommends that even travelers returning to the mainland United States from an area with Zika virus who do not feel sick should take steps to prevent mosquito bites for 3 weeks after their return so that they do not spread this virus to uninfected mosquitoes (wwwnc.cdc.gov/travel/diseases/zika). In addition to limiting mosquito exposure, persons who have been exposed to or become ill from Zika virus should follow the CDC's recommendations to limit the likelihood of sexual transmission of this virus, including through abstinence or the consistent and correct use of condoms (www.cdc.gov/zika/prevention/index.html#prevent).References1. Anderson KB, Thomas SJ, Endy TP. The emergence of Zika virus: a narrative review. Ann Intern Med. 2016. [PMID: 27135717]. doi:10.7326/M16-0617 LinkGoogle Scholar2. Chen LH, Hamer DH. Zika virus: rapid spread in the Western hemisphere. Ann Intern Med. 2016;164:613-5. [PMID: 26832396]. doi:10.7326/M16-0150 LinkGoogle Scholar3. Petersen LR, Jamieson DJ, Powers AM, Honein MA. Zika virus. N Engl J Med. 2016;374:1552-63. [PMID: 27028561] doi:10.1056/NEJMra1602113 CrossrefMedlineGoogle Scholar4. Weaver SC, Lecuit M. Chikungunya virus and the global spread of a mosquito-borne disease. N Engl J Med. 2015;372:1231-9. [PMID: 25806915] doi:10.1056/NEJMra1406035 CrossrefMedlineGoogle Scholar5. Lupi E, Hatz C, Schlagenhauf P. The efficacy of repellents against Aedes, Anopheles, Culex and Ixodes spp.—a literature review. Travel Med Infect Dis. 2013;11:374-411. [PMID: 24201040] doi:10.1016/j.tmaid.2013.10.005 CrossrefMedlineGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From Massachusetts General Hospital and Harvard University, Boston, Massachusetts.Grant Support: By U01CK000175 from the Centers for Disease Control and Prevention.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1397.Corresponding Author: Edward T. Ryan, MD, Division of Infectious Diseases, Massachusetts General Hospital, Jackson 504, 55 Fruit Street, Boston, MA 02114; e-mail, [email protected]harvard.edu.Current Author Addresses: Drs. LaRocque and Ryan: Division of Infectious Diseases, Massachusetts General Hospital, Jackson 504, 55 Fruit Street, Boston, MA 02114.Author Contributions: Conception and design: R.L. LaRocque, E.T. Ryan.Drafting of the article: R.L. LaRocque, E.T. Ryan.Critical revision of the article for important intellectual content: E.T. Ryan.Final approval of the article: R.L. LaRocque, E.T. Ryan.Obtaining of funding: R.L. LaRocque.This article was published at www.annals.org on 12 July 2016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byContemporary Understanding of Ebola and Zika Virus in PregnancyInsecta Class: Flies and MosquitoesSupport for the Transmission-Clearance Trade-Off Hypothesis from a Study of Zika Virus Delivered by Mosquito Bite to MiceGoing Viral 2019Travel MedicineDaniel T. Leung, MD, Regina C. LaRocque, MD, and Edward T. Ryan, MDTravel Characteristics and Pretravel Health Care Among Pregnant or Breastfeeding U.S. Women Preparing for International TravelRepellency of 29 Synthetic and Natural Commercial Topical Insect Repellents Against Aedes aegypti (Diptera: Culicidae) in Central MexicoZika Virus: Epidemiology, Pathogenesis and Human Disease 18 October 2016Volume 165, Issue 8Page: 589-590KeywordsChildrenDengue feverDisclosureInfectious diseasesMalariaMosquitoesOilsPregnancyTicksZika virus ePublished: 12 July 2016 Issue Published: 18 October 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...