School is out (but don’t let mosquitoes bite)

“School’s out forever
School’s out for summer
School’s out with fever
School’s out completely” Alice Cooper

The end of the school year for students completing high school is here. School is out so the partying can start! Lets hope fever isn’t part of the story too.

For many students, this means traveling overseas for “schoolies” celebrations. The health and wellbeing of students attending “schoolies” has been front of mind of many parents and local authorities. This isn’t surprising given the risk taking behaviours many engage in.

Health authorities are often warning about potential health risks. However, with many travelling overseas for end of school celebrations, a range of mosquito related health risks may be experienced. The steps taking to avoid mosquito bites at home need to be changed if travelling to regions of the world where different mosquitoes and more serious mosquito-borne pathogens are found.

Overseas travel brings different risks

The risks may be significantly greater if travelling overseas to tropical regions such as SE Asia and the Pacific. Bali is a particularly popular party destination and also one with a high risk of mosquito-borne disease, especially dengue.

There are other mosquito-borne diseases to be wary of. Fortunately, the steps taken to avoid dengue will also assist in preventing exposure to Zika or Chikungunya too. There are occasionally cases of Japanese encephalitis virus in Australian travellers but they are rare.

Some regions will have a risk of malaria too. If you’re traveling to one of those regions, best consult your local travel health professional.

One of the main differences Australian travellers will face when spending time in regions prone to dengue outbreaks is that the mosquitoes that spread the virus bite during the day. We’re familiar with the local warnings to avoid mosquitoes at dawn, dusk, and overnight here in Australia. The mosquito that drives dengue outbreaks is most commonly Aedes aegypti, a mosquito that bites during the day.

We’re also likely to reach for the mosquito repellent when mosquitoes are abundant, as they often are, during summer coastal holidays. Bu Aedes aegypti is generally not that abundant. Don’t wait to notice the mosquitoes biting before putting on repellent.

These mosquitoes are also most likely to be present around urban areas and villages. These mosquitoes aren’t found in wetlands, they like living in water-filled containers where people live. Don’t think that just because you aren’t visiting wetlands or rainforests that there won’t be a risk of mosquito-borne disease!

Here are three tips on protecting yourself against mosquito-borne disease if you’re travelling overseas for “schoolies” celebrations:

1. Protect yourself against day-biting mosquitoes. Apply a repellent before breakfast and apply it like sunscreen. An even cover of exposed skin is required. Don’t bother applying it to clothing or “spraying it around the room”, that won’t protect you from bites.

2. Take repellent with you. Australian repellents must be registered with the Australian Pesticides and Veterinary Medicines Authority who test for efficacy and safety. You may not be able to get a hold of similar products overseas. Use a repellent that contains either diethyltoluamide (aka DEET) or picaridin; these formulations are readily available in local supermarkets and pharmacies. Oil of Lemon Eucalyptus is useful too but these formulations are often difficult to find.

3. Even if you’re staying at an expensive resort, where mosquito control is probably in place, take insect repellent for those day trips to local villages or markets. These are places and times where you may be exposed to “dengue mosquitoes”.

Don’t forget to check out Smart Traveller before heading off to Bali…or anywhere else for that matter. They provide all the updates on health and security concerns.

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Photo at top of this post by Jed Villejo on Unsplash

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Could a boombox (playing Skrillex) save you from mosquito bites?

There has been quite a buzz about some new research that suggests the music playing at your next backyard party may keep the mosquitoes at bay. Could it actually be true?

“As music is loved by many people, the development of music-based anti-mosquito control measures may represent an appealing alternative to strategies involving the use of harmful chemical insecticides.” – Dieng et al. 2019

Are mosquitoes monsters or sprites?

The study was recently published in the peer-reviewed journal Acta Tropica. The researchers (including one of my previous PhD students) exposed mosquitoes to the song “Scary Monsters And Nice Sprites” by U.S. electronic dub-step artist Skrillex while recording how long it took Aedes aegypti (these are the mosquitoes that transmit dengue viruses) to find a blood meal, how long they spent feeding, as well as tracking how much time was spent mating. The “blood meal” was provided by a restrained hamster and all experiments were conducted in the laboratory.

“Adults entertained with music copulated far less than their counterparts kept in the environment where there was no music entertainment.” – Dieng et al. 2019

Unfortunately, the researchers didn’t explain why they decided to use this particular song, only describing it as “…characterized as noisy based on the resulting vibragram and strong sound pressure/vibration with constantly rising pitches”. It would have been interesting to include a couple of other songs in the testing too. Perhaps something a little more downbeat?

Once they had the song playing (ensuring the speakers weren’t located close enough to cause vibration to the cage containing mosquitoes), mosquitoes were released into the cage and behaviour was recorded for 10 minutes. Researchers recorded the time to first blood feeding attempt, number of blood feeding events, and number of mating events.

The results were interesting. Mosquitoes took longer to find a host, spent less time blood feeding and mated less often when exposed to the music. These differences in each measurement were statistically different too.

What does this mean for prevention of mosquito-borne disease?

This study has received plenty of media attention. See here and here and here. I spoke to ABC Sydney about it too (tune in from the 1:07).

While the results demonstrated some reduced likelihood of biting, it shouldn’t be interpreted that playing Skrillex’s music will protect yourself from mosquito bites. The reduced likelihood was pretty short lived, you’re pretty much guaranteed to get bitten despite the dub step blasting from the boombox.

There has always been an interest in understanding how sound impacts the behaviour of mosquitoes. Ultrasonic insect repellents have been sold in one way or another for a couple of decades. Now you can download apps to your smartphone that purport to use sound to repel mosquitoes. There really is no evidence that sound can provide protection from mosquito bites.

Digging deeper into the “Skrillex study”, the results indicate that even though there may be less chance you’ll be bitten while listening to this music, you’ll still be bitten. Even over the relatively short exposure periods in the laboratory study, the mosquitoes were still biting. Notwithstanding your tolerance of Skrillex’s brand of electronic music, who knows how loud you need to be playing it or how shifts in songs (and their associated pitches, frequencies, buzzes, and beats) may change the activity of local mosquitoes.

To prevent mosquito-borne disease, you need to stop all bites, not just some of them. Topical insect repellents will still provide better protection. Keep in mind that even a low dose DEET-based insect repellent will prevent all bites from Aedes aegypti for a few hours in laboratory testing.

See the full paper here:

Dieng, H., Chuin, T.C., Satho, T., Miake, F., Wydiamala, E., Kassim, N.F.A., Hashim, N.A., Vargas, R.E.M. and Morales, N.P., 2019. The electronic song “Scary Monsters and Nice Sprites” reduces host attack and mating success in the dengue vector Aedes aegypti. Acta Tropica. [online]

 

Join the conversation on Twitter, if music could keep mosquitoes away, what music would you want that to be?

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Photo at the top of this article by Eric Nopanen on Unsplash

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Are mosquitoes disappearing?

There’s been a swarm of headlines recently about the global decline of insects. Could mosquitoes be disappearing too? Probably not but how would we know?

Recent research suggests that over 40% of insects worldwide are in decline. Some of the most vulnerable insects are those that occupy specific ecological niches. When scientists reviewed over 70 historical reports of insect declines, environmental degradation, the spread of agriculture, and widespread insecticide use were suspected for causing the decline.

What about mosquitoes? Sadly, they’re not a group of insects many people would care too much about if they were threatened with extinction.

Some of the most important mosquitoes, those that transmit dengue viruses or malaria parasites, are evading our efforts to eradicate them. For these insects, the insects authorities the world over actively are trying to kill, they’re surviving quite well. They’re becoming resistant to commonly used insecticides and they’re thriving living in habitats in and around our cities.

The reality is that some mosquitoes are probably doing very well , while those potentially under threat are probably those we know least about.

Tracking change in mosquito populations

There are over 300 mosquitoes in Australia. The mosquitoes that bring with them the greatest pest and public health risks are well studied. Mosquitoes such as Aedes camptorhynchus, Aedes vigilax, and Culex annulirostris are nuisance-biting pests and have been associated with outbreaks of Ross River virus disease. Their populations are monitored as part of mosquito control and surveillance programs around the country. But these programs probably won’t reliably pick up declines in lesser known mosquitoes.

There are mosquito surveillance programs around the country that provide information on local mosquito populations to health authorities. That’s how scientists know if this really is the “worst year for mosquitoes ever”! There is little evidence that the major pest mosquitoes are in decline. But these programs probably won’t reliably pick up declines in lesser known mosquitoes.

Mosquitoes under threat?

It is entirely possible that there are mosquitoes under threat.

What about the mosquitoes that specifically feed on frogs, how will they be impacted by declining frog populations?

Mosquitoes that are highly specialised to certain environments or ecological niches or close interactions with wildlife may struggle if their ecosystems are disrupted. Habitat degradation may hit some mosquitoes in much the same way it’ll hit other insects. It won’t end well.

What about mosquitoes associated with snow-melt pools in the Australian alps? Could climate change see their habitats destroyed?

Mosquitoes can adapt

Mosquitoes can be some of the most adaptable animals on the plant. That’s probably why they’ve been such persistent pests. In fact many insects are quite adaptable to change and that’s why we may not be facing an “insect apocalypse” as many headlines suggest.

We’ve found that mosquitoes are more abundant in mangrove forests that are degraded or surrounded by industry. Some mosquitoes are even becoming resistant to commonly used insecticides. Those same issues threatening many thousands of insects are no problem for some mosquitoes.

The reality is, mosquitoes have already been around for millions of years, they’ll probably be around long after. Its just that we could take a few species with us…

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The image at the top of this article is of a carbon-dioxide baited mosquito trap, there were thousands of mosquitoes inside; collected late in 2018 along the Georges River in southern Sydney.

Join the conversation on Twitter, are there any mosquitoes you think are under threat?

 

West Aussies versus the local mozzies

This is a special guest post from Dr Abbey Potter, Senior Scientific Officer, Environmental Health Hazards, WA Health. I’m currently mentoring Abbey as part of The Public Health Advocacy Institute of WA (PHAIWA) Mentoring Program. Its been a great experience as we navigate through some of the strategies to raise awareness of mosquito-borne disease and advocate for better approaches to addressing the public health risks associated with mosquitoes.

Living in WA, we’re all too familiar with the pesky mosquito. We know they bite but what we often don’t consider is that they can transmit serious and sometimes deadly diseases. In fact, a recent survey of locals indicated that knowledge of mosquito-borne disease is pretty limited, particularly among younger adults aged 18-34 years and those living in the Perth Metro. It’s pretty important we’re aware of the risks posed by these pint-sized blood suckers and how you can avoid them… and here’s why!

The Facts

On average, more than 1,000 people will be infected with a mosquito-borne disease in WA every year. Our mossies can transmit Ross River virus, Barmah Forest virus, West Nile virus (Kunjin substrain) and Murray Valley encephalitis virus. All four cause diseases that are debilitating at best, causing weeks to months of symptoms. Murray Valley encephalitis is limited to the north of the State but is so serious it can result in seizures, coma, brain damage and even death.

Forget the bush, most people bitten in their own backyard. West Aussies are all very prone to getting eaten alive while socialising outdoors but if you’re up in the north of the State, you’ve also got a much higher likelihood of being bitten while boating, camping or fishing or working outside, compared to the rest of the state.

And don’t think you’re off the hook when you head off on holidays. A further 500 WA residents return from overseas travel with an exotic mosquito-borne disease every year. Heading to Bali? Beware of dengue, especially young adult males who return home with the illness more than others. There is limited mosquito management in many overseas countries where disease-transmitting mozzies can bite aggressively both indoors and throughout the day. This catches West Aussies off guard, as we are accustomed to mozzies biting outdoors, around dusk and dawn. When you’re in holiday mode it’s likely that you’ll be relaxing, having a couple of drinks and not thinking about applying repellent. Oddly enough, mosquitoes may actually be more attracted to people whose body temperature is higher. This happens naturally when you consume alcohol, so best pull out the repellent before you crack your first beer.

Despite our attractiveness to mosquitoes, we aren’t really aware of the most effective ways to avoid bites or how we can do our bit to reduce breeding in our own backyards. If you live by the mantra Cover Up. Repel. Clean Up you’ll have no problems!

Western Australia has some amazingly beautiful wetlands but these saltmarshes around Mandurah can produce large populations of nuisance-biting mosquitoes!

Cover Up

If you know you are going to be outdoors when mosquitoes are active, wear loose, long-fitting clothing that is light in colour. Believe it or not, mosquitoes can bite through tight pants as tough as jeans – I’ve witnessed it!

If you’re staying in accommodation that isn’t mosquito-proof, consider bed netting.

Try to keep children indoors when mosquitoes are most active. If exposure can’t be avoided, dress them appropriately and cover their feet with socks and shoes. Pram netting can also be really useful.

Admittedly, it’s not always practical to wear long sleeves during our warm summer nights, so there are going to be times when you need to use repellent. Choose a product that actually works and apply it appropriately so it does the job. Despite our best intentions, this is where we often go wrong. There are a few basic things to cover here, so stick with it!

Ingredient: Science tells us that the best active ingredient for repelling mosquitoes is diethyltoluamide (DEET for short) or picaridin. You need to look for either one of these names on the repellent label under the ‘active constituents’ section.

Unfortunately, natural repellents and anything wearable (e.g. bands, bracelets or patches) have very limited efficacy. Experts don’t recommend you use them and I consider this very wise advice. It only takes a single mosquito bite to become infected and chances are you will receive at least one if you rely solely on a product of this nature. It just isn’t worth the risk.

Percentage: The next thing to consider is the percentage of the active ingredient. This can range anywhere from 7% to 80% which can make choosing a repellent confusing. Just remember, the higher the percentage, the LONGER the product will remain active for. It doesn’t mean it will repel mosquitoes better.

A repellent containing 16-20% DEET will provide around 4-6 hours of protection, and is a good place to start. Repellents labelled ‘tropical strength’ usually contain greater than 20% DEET – they are useful when you spend longer periods exposed to mosquitoes or if you are heading to a region where dengue, malaria or Zika is problematic. Kids repellents usually contain picaridin or <10% DEET.

Sometimes it can be tricky to work out the percentage of the active ingredient. You can see the Bushmans example below states this clearly, but the other bottles list the ingredient in grams per litre (g/L). No need for complex maths – just divide by 10 and you have the magic number! For example, the RID label below reports the product contains 160g/L of DEET. This would convert to 16% DEET – easy!

You can see a few examples here of effective repellents:

How to Apply: No doubt we would all prefer if repellents didn’t feel quite so gross on our skin or didn’t smell so bad. Even I have to admit that before I moved into this field, I was guilty of putting just a dab here and a dab there. Unfortunately, this is flawed logic that will only result in you being bitten!

Repellents must be applied correctly to be effective. That means reading the label and applying it evenly to all areas of exposed skin. Remember to reapply the product if you are exposed to mosquitoes for longer than the repellent protects you for. You’ll also have to reapply the repellent after sweaty activity or swimming.

For more information on repellent use in adults and children, click here.

Clean Up

Mosquitoes need water to breed, but only a very small amount. Water commonly collects in a range of things you may find in your backyard including pot plant drip trays, toys, old tyres, trailers and clogged up gutters. Mosquitoes also love breeding in pet water bowls, bird baths and pools if the water is not changed weekly or they are not well maintained. Rain water tanks can also be problematic so place some insect proof meshing over any outlets. When you’re holidaying, cover up or remove anything that may collect water.

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If you need more official info from WA Health about mosquito-borne disease or simple ways to prevent being bitten click here. And if you want to read more about how much West Aussies know (or don’t know) about mossies, check out Abbey’s excellent paper here! Joint the conversation too on Twitter by following Abbey and Cameron.

Should we mix mosquito repellents and sunscreens?

Combining mosquito repellents with sunscreens, as well as other cosmetics, sounds like a great idea but perhaps it isn’t to best way to protect ourselves from exposure to both the sun and mosquitoes.

There are formulations that combine mosquito repellents with various skin moisturizers but the most common combination formulations contain sunscreen and repellents. A combined formulation make sense given that Australia has one of the highest rates of skin cancer anywhere in the world. Even the Cancer Council have their own “Repel Sunscreen” formulations.

Combined formulations but conflicting risks

As well as questions regarding the efficacy of these formulations, there have also been some questions regarding their safety. Do they lessen the protection against the sun? Do they lessen the protection against mosquitoes? Do they increase the potential risk of toxic reactions to mosquito repellents?

One study found that the inclusion of mosquito repellent in sunscreen actually reduced the sun protection factor of the sunscreen. In 2009, I published a paper in Australian and New Zealand Journal of Public Health that investigated the efficacy of combined sunscreen and insect repellent formulations. The key finding was that no loss of protection from mosquito bites was provided by these combined formulations when compared to low and high dose “mosquito repellent only” formulations. The finding supported previous studies that indicated sunscreen does not reduce the efficacy of insect repellent. However, where we went further was to try and provide some guidelines for use of these products to maximise mosquito bite protection but also to minimise any potential adverse reactions to repellents.

I’ve provided plenty of detail of how to choose and use mosquito repellents in the “Beating the Bite” guidelines freely available for download

This issue of conflicted use was highlighted in a review of sunscreen labelling recommendations and combination sunscreen/insect repellent products that outlined concerns that “the application of a combination product too frequently poses the risk of insect repellent toxicity, whereas application too infrequently invites photodamage”.

Could combined formulations raise potential over exposure to mosquito repellents?

It is important to note that many published studies and reviews have shown that DEET does not pose a significant health concern (see here too). A recent review of safety surveillance from extensive humans use reveals no association with severe adverse events. In short, if a DEET-based mosquito repellent is used as recommended, there are no major concerns for health risk.

What if the use of a combined repellent and sunscreen formulations results in the application rate of repellent above and beyond recommended rates?

How much repellent are you using with sunscreen?

The recommended use of sunscreens and repellents are quite different. As well as the frequency of reapplications (sunscreen every two hours; repellent reapplication is determined by the “strength” but may be up to four hours for mid-range formulations), the quantity used will vary. Mosquito repellents require a thin application over all exposed skin to provide effectiveness. When the applications rates providing effective protection in mosquito repellent studies are compared to those for sunscreen use (i.e. approximately 30ml applied across the forearms, legs, torso and back 20 minutes before going outside and reapplied every two hours), application rates for sunscreens are approximately 3-5 times greater.

Are you using repellent when you don’t need to?

It is interesting to note the differences in the use pattern of sunscreen and mosquito repellent use. In many instances, nuisance-biting mosquitoes will generally be more active during periods when sun exposure risk is low (e.g. late afternoon, evening and early morning). However, as I pointed out in this paper on mosquito repellent use to reduce the risk of dengue, protection against these day-biting mosquitoes could call for the use of both products simultaneously. There is also no doubt that under some circumstances in coastal regions of Australia, mosquitoes can be out and about biting in shaded environments (places like mangrove forests and coastal swamp forests) during the day.

The Yellow Fever Mosquito, Aedes aegypti (Photo: Stephen Doggett)

What should you do?

I’m not aware of any review in Australia to reconsider the registration or recommendations surrounding the use of combined mosquito repellent and sunscreen formulations. In most instances, the advice provided by local authorities is simply to “follow label instructions”.

Combined mosquito repellent and sunscreen formulations are not recommended by the CDC. It is worth noting that also in Canada, combined sunscreen and insect repellents are not recommended. It is suggested to apply the sunscreen first, then the insect repellent over the top. The only problem is that as repellent will generally last longer than sunscreen, you end up alternating application of the two products.

We tested the idea that repellents should be applied first and then sunscreen over the top. While testing the efficacy of sunscreen wasn’t in the scope fo our study, we found that the efficacy of repellent (as measured by the duration of protection) was actually reduced. The reduction, we concluded, was probably due to physical disruption of the original mosquito repellent application during subsequent sunscreen application.

It should be noted once again that repeated reviews have concluded that DEET-based repellents pose a very low risk of adverse health impacts. However, if you were to take a cautious approach, if there is a risk of possible adverse reaction to repellents, this may be more likely to happen when using high dose DEET-based repellents (e.g. “tropical strength” repellents that may contain over 80% DEET) in combination with sunscreen. If you want to lower the risks as much as possible, using a low-dose DEET-based (e.g. containing less than 10% DEET), or picaridin-based, repellent will more closely align the recommended reapplication times of the two products.

If you’re looking for sunscreen advice, visit the Cancer Council website here.

The full reference for our 2009 paper is below:

Webb, C. E. and Russell, R. C. (2009) Insect repellents and sunscreen: implications for personal protection strategies against mosquito-borne disease. Australian and New Zealand Journal of Public Health, 33: 485–490.

Want to learn more about the amazing world of Australian mosquitoes? Check out “A Field Guide to Mosquitoes of Australia” out now through CSIRO Publishing. Over 200 pages containing a pictorial guide to almost 100 different mosquitoes along with tips on beating their bite and protecting your family from the health risks of mosquitoes. You can order online or through your favourite local bookstore or online retailer.

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Read more at The Conversation: Are mosquito coils good or bad for our health?

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Read more at The Conversation: What can I eat to stop mosquitoes biting me?

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Read more at The Conversation: The best (and worst) ways to beat mosquito bites

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