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.

—

Photo at top of this post by Jed Villejo on Unsplash

—

Why do mosquitoes seem to bite some people more?

Back in 2015, I had an article published at The Conversation on why some people are more likely to be bitten by mosquitoes than others. It is one of the most commonly asked questions I get whenever I give public talks (or friends and family are quizzing me at summer BBQs).

This article was incredibly successful and has currently been read by approximately 1.4 million people. That is a lot of people. Hopefully the science of mosquito bites has got out there and actually helped a few people stop themselves or their family being bitten by mosquitoes!

The warm weather is starting to arrive here in Australia so I am sharing this once more for those wondering why they’re always the “mosquito magnet” among their friends…

Health Check: why mosquitoes seem to bite some people more

There are up to 400 chemical compounds on human skin that could play a role in attracting mosquitoes.  sookie/Flickr, CC BY-SA

There’s always one in a crowd, a sort of harbinger of the oncoming mosquito onslaught: a person mosquitoes seem to target more than others. What is it about these unlucky chosen few that makes them mosquito magnets?

There are hundreds of mosquito species and they all have slightly different preferences when it comes to what or who they bite. But only females bite; they need a nutritional hit to develop eggs.

Finding someone to bite

Mosquitoes are stimulated by a number of factors when seeking out a blood meal. Initially, they’re attracted by the carbon dioxide we exhale. Body heat is probably important too, but once the mosquito gets closer, she will respond to the smell of a potential blood source’s skin.

Studies have suggested blood type (particularly type O), pregnancy and beer drinking all make you marginally more attractive to mosquitoes. But most of this research uses only one mosquito species. Switch to another species and the results are likely to be different.

There are up to 400 chemical compounds on human skin that could play a role in attracting (and perhaps repulsing) mosquitoes. This smelly mix, produced by bacteria living on our skin and exuded in sweat, varies from person to person and is likely to explain why there is substantial variation in how many mozzies we attract. Genetics probably plays the biggest role in this, but a little of it may be down to diet or physiology.

One of the best studied substances contained in sweat is lactic acid. Research shows it’s a key mosquito attractant, particularly for human-biting species such as Aedes aegypti. This should act as fair warning against exercising close to wetlands; a hot and sweaty body is probably the “pick of the bunch” for a hungry mosquito!

Probably the most famous study about their biting habits demonstrated that the mosquitoes that spread malaria (Anopheles gambiae) are attracted to Limburger cheese. The bacteria that gives this cheese its distinctive aroma is closely related to germs living between our toes. That explains why these mosquitoes are attracted to smelly feet.

But when another mosquito (such as Aedes aegypti) is exposed to the same cheese, the phenomenon is not repeated. This difference between mosquitoes highlights the difficulty of studying their biting behaviours. Even pathogens such as malaria may make us more attractive to mosquitoes once we’re infected.

Only females bite because they need a nutritional hit to develop eggs.
Sean McCann/Flickr, CC BY-NC-SA

Researchers are trying to unscramble the irresistible smelly cocktails on the skins of “mosquito magnets”. But the bad news is that if you’re one of these people, there isn’t much you can do about it other than wearing insect repellents.

The good news is that you may one day help isolate a substance, or mixes of substances, that will help them find the perfect lure to use in mosquito traps. We could all then possibly say goodbye to topical insect repellents altogether.

Attraction or reaction?

Sometimes, it’s not the bite as much as the reaction that raises concerns. Think of the last time the mosquito magnets in your circle of friends started complaining about being bitten after the event where the purported mosquito feast took place. At least, they appear to have attracted more than the “bite free” people who were also at the picnic, or concert or whatever.

But just because some people didn’t react to mosquito bites, doesn’t mean they weren’t bitten. Just as we do with a range of environmental, chemical or food allergens, we all differ in our reaction to the saliva mosquitoes spit while feeding.

People who don’t react badly to mosquito bites may think they haven’t been bitten when they’ve actually been bitten as much as their itchy friends. In fact, while some people attract more mosquito bites than others, there’s unlikely to be anyone who never, ever, gets bitten.

The problem is that people who don’t react to mosquito bites may all too easily become complacent. If you’re one of them, remember that it only takes one bite to contract a mosquito-borne disease.

Finally, there is no evidence from anywhere in the world that there is something you can eat or drink that will stop you being bitten by mosquitoes. No, not even eating garlic, or swallowing vitamin B supplements.

Perhaps if we spent as much time thinking about how to choose and use mosquito repellents as we do about why mosquitoes bite our friends and family less than us, there’d be fewer bites all around.

Cameron Webb, Clinical Lecturer and Principal Hospital Scientist, University of Sydney

This article was originally published on The Conversation. Read the original article.

 

Safely avoiding mosquito bites when pregnant

Hundreds of millions of people fall ill due to mosquito-borne pathogens every year but the recent rise in birth defects associated with Zika virus emerging in the Americas has health authorities on alert.

Zika virus is transmitted by mosquitoes, primarily by the Yellow Fever mosquito, Aedes aegypti. Since its discovery in Africa around 70 years ago it has avoided the public health spotlight due to the relatively mild illness it causes. Throughout Africa and Asia it is overshadowed in importance by the diseases caused by malaria parasites as well as dengue and chikungunya viruses.

For background on the rise of Zika virus, see my article for The Conversation.

Zika and the health risks to those pregnant and their unborn children

While Zika virus has yet to be fully confirmed as the causative agent in birth defects (such as microcephaly), there is clearly enough concern among health authorities in many parts of the world to issue warnings to those pregnant to avoid travel to countries experiencing an outbreak of Zika virus.

Authorities in Columbia and El Salvador have even gone so far as to advise residents to avoid falling pregnant for up to two years.

The Australian Government issued the following advice via their SmartTraveller website:

“Until more is known about Zika virus, and taking a very cautious approach, we advise women who are pregnant (in any trimester) or who plan to become pregnant to consider postponing travel to any area where Zika virus transmission is ongoing. If you do decide to travel, talk to your doctor first and strictly follow steps to prevent mosquito bites during your trip.”

For many, the option of not travelling will be easy. But what if you still want to travel? What if you’re doing business in some of these countries? What if you need to travel to visit family? Cancelling a trip isn’t always the easiest options.

Reducing risk of mosquito-borne disease while travelling

Irrespective of the current Zika outbreak, travelling while pregnant brings various health and safety risks.  Other mosquito-borne diseases, such as malaria and dengue, also pose a risk to pregnant women and their unborn children. These serious risks existed long before Zika virus grabbed the public health spotlight.

Unfortunately, there is no vaccine currently available for Zika virus. Vaccines are in development for dengue viruses and anti-malaria drugs are available so consult your local travel health clinic.

While travelling, staying indoors as much as possible, particularly air-conditioned accommodation, will greatly reduce exposure to mosquitoes. This may not be how you expected to spend your time during a South American holiday!

Many people associate mosquito-borne disease with wetland or jungle environments but as Zika virus is spread by mosquitoes found in urban habitats (e.g. water-filled containers), travellers should not be complacent if only visiting cities. Some of the biggest recent outbreaks of mosquito-borne disease have been in major metropolitan regions in the Americas and Asia.

Mosquito control in Brazil, a striking image of the battle against container-inhabting mosquitoes (Image: Ernesto Benavides via International Business Times)

If you’re staying at a high end resort, chances are there will be a well established insect control program. This typically includes widespread spraying for insecticides to knock down any mosquito populations. This may not completely remove risk but it will substantially lower potential exposure to mosquitoes. Again, don’t be complacent and take special care to avoid mosquitoes if taking a day trip to local villages or other tourist attractions.

Sleeping under a bed net is usually recommended in regions where malaria is an annual problem but this may not offer that much protection against Zika virus as the mosquitoes that spread the virus primarily bite during the day. If you’re planning on taking some afternoon naps, make sure it is under a bed net. A range of insecticide treated bed nets are available from your local camping store.

There is also an ever increasing range of “pre-treated” insect repellent clothing but evidence is scarce on just how effective these are at preventing bites. Treating clothing with insecticide (e.g permethrin) yourself would be a better option but don’t expect that wearing treated clothing means you don’t have to put insect repellents on exposed skin.

Safe and effective use of mosquito repellents

There will be anxiety among many about using insect repellents while pregnant. Are they safe? Will they impact the baby?

Without doubt, the most commonly used, safe and effective mosquito repellents is DEET (I’ve written about these repellents extensively, see here and here but I’ll summarize below). This is found in lots of major commercial brands and is a mainstay in the recommendations issued by health authorities the world over. Problem is, it can be hard to find information on how to choose and use the repellent that’s right for you and your situation.

The first point to remember is that the the strength of the formulation determines how long you’re protected against mosquito bite, not how many mosquitoes are kept away. For example, a 10% DEET based repellent may provide 2h protection, a 20% formulation may provide 4h protection. When choosing a repellent, think about how long you need protection for and how frequently you’re happy to reapply.

Secondly, the repellent must be applied as an even coverage on all exposed skin. If there are “gaps” in the application, mosquitoes are sneaky enough to pick a spot to bite. In the case of the mosquitoes that spread Zika, dengue and chikungunya viruses, pay special attention to application around the lower legs and feet, that’s where they like to bite.

Be sure to reapply repellent after swimming or sweaty exercise too.

There is no need to apply mosquito repellents to skin under clothing.

Are repellents safe to use when pregnant?

Health authorities and regulatory agencies rarely provide specific warnings on the use of insect repellents by those pregnant. While there haven’t been many clinical trials, these papers (here and here) demonstrate a lack of documented significant health risk associated with the used of DEET-based repellents. Most notably, a study of almost 900 women using mosquito repellent in the second or third trimester and no adverse neurologic, gastrointestinal, or dermatologic effects were observed in women or their infants for a year after birth.

It is important to balance the distinct lack of evidence of major health risks associated with repellents to the rapid rise in microcephaly in Brazil. Repellents can stop mosquitoes bites, stop mosquito bites and remove the risk of infection. If you use registered mosquito repellents as directed on the label, they are effective and safe.

Common sense must prevail. Even if you’re concerned about the use of repellents, make some compromises while still protecting yourself for infection. Choose a lower dose DEET-based repellent and reply more often. This is a better approach than trying a repellent that hasn’t been proven effective.

I’m often asked what formulation works best. There are aerosol sprays, roll-ons, pump-pack sprays, creams, gels, lotions and even towelettes. There really haven’t been many scientific studies looking at which if these formulations work best, and for good reason. As the active ingredients in these formulations are the same, it doesn’t really matter. The critical issue is to choose a formulation that you’re most comfortable using to ensure you get a good coverage over exposed skin. I like creams and pump-pack sprays but I generally apply the product to my hands first and them spread across skin.

Always ensure you avoid getting repellent in your eyes or any cuts or abrasions.

I don’t like the smell or feel of mosquito repellents!

There is often a temptation for those who dislike DEET to use a “natural“, plant-based repellents. Notwithstanding that these products provide shorter periods of protection, tea-tree oil (particularly when used in home-made concoctions) also has the potential to cause skin irritation. While plant-based mosquito repellents may offer some protection against nuisance-biting mosquitoes, they shouldn’t be relied on to prevent mosquito bites in regions of mosquito-bore disease outbreaks.

Many health authorities recommend para-Menthane-3,8-diol (PMD), a product commonly known as “oil of lemon eucalyptus”. This is not an essential oil but rather the by product of the distillation process of Corymbia citriodora. The product does repel a range of biting insects and there is no evidence suggesting it should not be used in pregnancy. However, in Australia, this product is generally more difficult to find in grocery stores and pharmacies than DEET- or picaridin-based repellent formulations.

It would be brilliant if there was a non-topical options for stopping mosquito bites. Unfortunately, there is nothing that has been proven effective. Do not rely on mosquito repellent wrist bands as they do not provide adequate protection against mosquitoes. Also, remember that there is nothing you can eat or drink that will stop you being bitten by mosquitoes.

Rounding out the advice on mosquito repellents, make sure you pack some before you leave. You can never be sure of what products will be available at your destination or whether it has gone through the process of registration (e.g. APVMA in Australia or EPA-registered in the U.S.). It is not unheard of for mosquito repellent stock to sell out during outbreaks of disease.

Lastly, if you’re travelling to regions experiencing dengue, chikungunya and Zika virus outbreaks, don’t necessarily expect to be swarmed by mosquitoes in the same way you will around many of Australia’s coastal wetlands. Don’t be complacent if there are only a few about, remember, it only take one bite to transmit a pathogen. Don’t wait until you notice mosquitoes biting, wake up and put on that repellent.

There is a great set of questions with answers provided by the CDC for pregnant travellers on Zika risk and prevention and here is another reminder of the travel advice provided by the CDC and Australian Government for pregnant women.

If planning to travel while pregnant, consult your local doctor or travel health clinic for advice.

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.

 

 

Managing ‘Mozziegeddon’, Media and Public Health Messages

Beer, high tides, public holidays and blood thirsty mozzies. The perfect mix to set the media into a spin. How can you get the best public health messages out about mosquito bite protection?

It was almost as tricky managing the media this summer as it was the mozzies. Since late October, I’ve been interviewed on almost 50 occasions. A mix of pre-dawn calls from radio stations to live crossed to nationally broadcast breakfast televsion to taking talkback and dealing with mobile phone dropouts. It was a sweaty and stressful couple of months….and ‘mozzie season’ still isn’t over just yet.

The last few years have followed a pretty similar pattern. I get my first few calls around August/September. This is usually when we get our first blast of unseasonal heat and there are typically a few stories about people noticing bugs about their home and are worried about an early start to the mozzie season.

Mozzie season kicked off early

This year we genuinely did have an early start to the mozzie season. The warmest spring on record kicked off the mozzie season early and one of the first big stories I did for Channel 9 News was almost derailed by swarms of mozzies! A few of the crew needed to retreat to the safety of their car. You can listen to me speaking with ABC New Radio here.

Following plenty of rain in early December, mosquito populations starting jumping up along the coast. Just in time for the Christmas holidays. During this period it is pretty common to respond to requests from media to talk about mozzies, particularly if there have been some public health alters from local health authorities.

Getting ready for a live cross to Weekend Today (Channel 9) but what you cannot see in this shot is the hundreds of mosquitoes that were swarming around me, standing in the middle of the mangroves for 20min getting ready for the segment attracted plenty of mozzie attention!

A few things helped keep mozzies in the news. There were health warnings from local authorities after the detection of Ross River virus in southern Sydney. There were warnings about a new outbreak of dengue in Far North QLD. Flooding in central Australia also prompted warnings of outbreaks of mosquito-borne disease.

Then there was this piece I wrote on why mosquitoes bite some people more than others that attracted plenty of attention too….over 1.2 million readers in fact (thanks to republication by IFLS, SBS and Mamamia)!

Moztralia Day Mozziegeddon

As we headed towards our national holiday weekend and Australia Day celebrations, there were warnings that a big boost in mosquito populations were on their way. Yes, “mozziegeddon” was coming and the pesky little biters were set to turn our long weekend into a “moztralia day bloodbath“. Worse still, those taking part in the traditional Australia Day past time of beer drinking were being scared off the booze by fears of becoming “mozzie magnets“.

“Mozzigeddon” turns Australia Day into Mozztralia Day! Great cartoon by Paul Zanetti accompanying a story at News.com

There is little surprise that stories about beer drinking and mozzies attract plenty of attention. It does almost every year. However, this year was a little different because health authorities were concerned about potential increases in mosquito populations and given recent detections of mosquito-borne pathogens such as Ross River virus, there was concern about public health risks. Those risks range from both the north coast of NSW to north-west of WA!

There was plenty of mosquito media coverage from SE QLD too. Local authorities were battling big mosquito populations and trying to control “3000 known mosquito breeding sites” the next generation of mosquitoes hatching following heavy rain and tidal flooding of local wetlands.

Local insect repellent manufacturers were also taking advantage of the boost in mosquito numbers. I’ve noticed an increase in tv and radio ads spruiking mosquito repellents and Aerogard also sent out “swat” teams to local parklands around Sydney on Australia Day promoting their “Mozzie Index“* website!

Aerogard “Bite Busters” hit the prime picnic spots around Sydney on Australia Day

How could this media interest help spread the word on effectively stopping mosquito bites?

In the lead up to the long weekend I spoke with the breakfast show on 2UE (you can listen to the interview via link), Angela Catterns on 2UE, Chris Smith on 2GB as well as Robbie Buck and Linda Mottram on 702 Sydney. I provided a couple of brief grabs for news bulletins and even did my first live cross for the Sunrise breakfast program on Channel 7. You can also listen to interviews with 2SER, ABC Perth and ABC South East SA. [update 26 February 2015. There were a few more interviews, one fun one was with Richard Stubbs for 774 ABC Melbourne and you can listen in below, another was with Dom Knight on 702 ABC Sydney and you can read about that here. and I also chatted with Patricia Karvelas on Radio National Drive and you can listen here.]

It can be tricky getting good public health messages out during these very brief interviews, particularly for television. Radio can be pretty good as there is often plenty of time to get the message out (sometimes even time for talk back callers and questions) but for some of the commercial stations, time can be brief. Television is particularly challenging, I usually spend more time in the make up chair than being interviewed!

This summer I’ve been determined to ensure some key messages get out, particularly about choosing and using insect repellents most effectively. This is an issue I feel strongly about and I have an article coming out shortly in the Medical Journal of Australia on how local health authorities can do this a little better.

The two key messages were “if you’re using botanical based topical repellents, they need to be reapplied more frequently than the recommended DEET and picaridin based repellents” and “when using repellents, they must be applied as a thin coat over all exposed skin to get the best protection, not a dab here and there”.

Overall, I think I managed to get these two points into most radio and television interviews and I was happy to see that the general message got through in a lot of the print/online media too.

Below are some of my tips on getting a specific message out while dealing with the media.

1. Prepare. You would practice giving a conference presentation ahead of time so why not prepare for media? Think about the messages and how you can deliver them. What questions might you get asked? What will be the style of the presenter? Are there any questions you may be asked that you may want to avoid answering (e.g. questions of a political nature or something that could embarrass your employer)? How can you do that?

2. Learn from the professionals. If know you’re going to do some media in the coming weeks or months. Spend some time listening to talk back radio and reading newspapers. Take note of the number and length of quotes journalists use in articles. Make their job a little easier by providing concise quotes where possible. How do radio broadcasters conduct interviews? Listen to politicians and journalists being interviewed. How do they get their message across (or don’t in some circumstances). What makes you “switch off” from an interview – is it the topic or interviewee?

3. Create bridges between questions and your message. This is the thing I’ve found quick tricky but once you’ve got the hang of it, you can more effectively get the message out. There may not be a question asked that specifically relates to the message you need to get out. Learn how to transition from a brief response to the question asked onto the key messages you want to get out there. Don’t just launch off into your spiel at first chance, it is important to engage with presenter too, its a subtle art but like all things, it is only hard before it becomes easy.

4. Post-interview review. I’ll often take notes after an interview that help prepare for the next one. Things like the type of questions asked or how I answered questions, particularly if I feel my responses were clunky or I rambled a little! I’ve always found it interesting that slight differences in the way that questions are asked can often throw you off balance in an interview. If there are talkback callers, what questions were asked, especially if there was something out of left field! Making a note of these can help when preparing for the next batch of media.

5. Keep track of media activity. You never know when it may come in handy when applying for a promotion, grant or new job. I try to keep track of all media activities by recording the date, journalist, media outlet and brief description of topic. You can also speak to your local media and communications unit to see if they gather statistics on these things too. The team at the University of Sydney are great and it is fascinating to compare the analysis of different media activities, their reach and estimated value.

Perhaps the trickiest thing in all this is assessing whether this media activity actually helped the community prevent mosquito bites. It will be almost impossible to tell from human notification data on mosquito-borne disease given the numbers jump around so much from year to year anyway. What really need is some more attitudinal studies to see how people seek out and follow advice provided by local health authorities on mosquito-bone disease prevention strategies. Another thing for the “to do” list

[update 21 March 2015] Following the detection of Ross River virus amongst mosquitoes collected in NSW combined with a dramatic increase in human notifications of Ross River virus disease, there was another wave of interest by local media. You read a piece at the Sydney Morning Herald and watch a segment with me from Nine News.

Why not join the conversation on Twitter?

—

*A disclaimer: I provided some assistance to a local PR company back in 2012 that developed the “Mozzie Index” for Aerogard, particularly some info on the associations between mosquitoes and local environmental conditions.

Busting five myths of mosquito repellents

After a record year of West Nile virus activity in 2012, North American health authorities are on alert as the peak season of mosquitoes approaches. As of 16 July 2013, a total of 23 cases of human disease, including three deaths, had already been reported by CDC.

In many regions across the US, local mosquito control districts engage a range of strategies to reduce mosquito-borne disease risk. These may include broad scale insecticide use or the release of “mosquito fish” into derelict backyard pools. However, the first line of defense against biting mosquitoes remains the use of topical insect repellents.

In North America, the CDC provide detailed information on mosquito repellents but there still seems to be confusion amongst many in the community looking for alternatives to “chemical repellents”. These repellents are often perceived to be unsafe. For an Australian perspective, I’ve put together some guidelines on mosquito repellent use that provide a few more details than typically found on the websites of local health authorities.

In my experience of trying to promote the use of “known to be effective” repellents, I still find that there are many misconceptions and misunderstanding of how these products should be used. Below are the five myths I most commonly experience when it comes to the use of mosquito repellents.

Myth 1: Natural must be better

It isn’t surprising that most people associate “natural” products with better health. Many people perceive mosquito repellents derived from “natural” products, such as plant extracts, to be healthier choices. However, when it comes to mosquito repellents, there is clear evidence that these perceived “healthier” choices may not provide the best outcomes.

Studies have repeatedly shown that the most effective repellents are DEET and picaridin. DEET, in particular, has been shown to be very effective. Picaridin is pretty good too. Both products have shown to be effective in local field-based tests.

Unfortunately, many, many studies throughout the world have shown that botanical based repellents provide substantially less protection against biting mosquitoes than DEET or Picaridin. Products containing citronella, lavender, peppermint and Melaleuca oils are widespread and are often promoted as “DEET-Free” alternatives to the recommended repellents. There are many botanical-based insect repellents listed in the patent literature.

Essential oils of Australian native plants provide significantly less protection than DEET-based repellents. Expert review panels have suggested that products containing plant extracts should not be recommended in areas of endemic mosquito-borne disease or when biting mosquitoes are abundant.

It is important to remember that botanical-based repellents WILL provide some limited protection against biting mosquitoes. The biggest problem is that they will need to be reapplied 3-4 times as often as even a low dose DEET-based repellent to provide comparable protection. Botanical repellents may be fine for a quick trip to the backyard to hang the washing out but not for a long session of gardening or if you’re off for a hike.

It is also important to remember that using undiluted essential oils can also pose an important health risk, particularly in young children.

I often wonder if Koalas are bitten any less by mosquitoes than other Australian mammals given the amount of Eucalyptus leaves they consume! (Photo by DAVID ILIFF. License: CC-BY-SA 3.0)

What about “Oil of Lemon Eucalyptus”? That’s a botanical repellent and authorities recommend it against West Nile virus right? There is often some confusion regarding this product. It is not the essential oil, but rather a byproduct of the distillation process of the leaves of Corymbia citridora. Commonly known as PMD, it has been shown to be as effective as DEET (although generally requiring higher doses for comparable protection) and is recommended by the CDC in North America. The recommendations by CDC of this product should not be seen as an endorsement for other “botanical based” repellents.

Myth 2: Stronger repellent = fewer mosquitoes

This is probably the most common mistake made when choosing a repellent. The “strength” of a repellent (i.e. the concentration of active ingredients) doesn’t determine how many mosquitoes are kept at bay. It determines the duration of protection provided. It basically determines how long you are protected from biting mosquitoes.

The majority of published studies (the classic “arm in cage” style experiments) investigating the efficacy of repellents analyse the results in two ways, mean repellency rates (a comparison of how many mosquitoes land on a treated arm compared to an untreated arm) and mean protection time (for how long are all mosquito bites prevented). While the marketing companies may be interested in claims like “over 80% of mosquito bites prevented”, given that it only takes one mosquito bite for a pathogen to be transmitted, I’m hoping to prevent ALL bites! We should be far more interested in protection times than repellency.

Myth 3: Chemical repellents are dangerous

Both DEET and picaridin are considered safe. If used as directed, DEET-based repellents pose no substantial health risk. Despite being used by millions of people every year, there are few examples of reported serious adverse health impacts in the scientific literature.

There are many stories circulating about mosquito repellents having an unpleasant smell or creating an unpleasant feeling on the skin. There are also reports about damage to clothing and plastics in some instances. Some of these reports may be true but are most likely related to high concentration formulations. In the US, there are many brands available that contain over 95% DEET. In the vast majority of situations, however, most people would find that an approximate 10% DEET formulation would work perfectly well and not be associated with any of these unpleasant characteristics.

Myth 4: Apply repellent like perfume

A neighbor took great pleasure in telling me how ineffective mosquito repellents were. Repeatedly. One afternoon I saw him applying repellent to his children. The aerosol was sprayed around in the air above the kids as they jumped up and down. There was no way that the repellent was going to work.

While there is still some debate as to how DEET prevents mosquitoes bites, or how the response of mosquitoes to DEET is influenced by previous exposure or infection with a pathogen, we do know that to get the best results, the repellent should be applied as a thin covering on all exposed skin. It is for this reason I personally think creams and liquids are the best repellents to use.

Don’t apply repellent like a perfume. A spray “here and there” won’t work. Spraying it on your clothes won’t work either. Apply it in the same way as you would a sunscreen but keep in mind that you won’t need to apply it quite so often.

As summer approaches, the shelves of hardware stores and supermarkets are filled with various repellents, insecticides and traps. Some work better than others.

Myth 5: These gimmicks really work!

If it sounds too good to be true, it probably is! Gimmicks such as traps, ultrasonic devices and smartphone apps all sound very appealing if you find that putting on repellent is a bit of a hassle. Unfortunately, there is little scientific evidence that any of these will protect you from mosquito bites.

There is even a pill, recently approved by Canadian Health Authorities, that purports to only take 30 minutes to protect the swallower from mosquito bites. An excellent blog post, “Insect repellent you can eat – but does it work?”, refuting the claims of this product, is here. Also check this nice piece from 2012, “Homeopathic Insect Repellent: Is there anything the Natural Health Products Directorate won’t approve?”

In short, there is nothing you can eat or drink that has been scientifically proven to prevent mosquito bites. That’s right, not even vitamin B.

In summary, the mosquito repellents widely available in North America, Australia and many other parts of the world are perfectly safe to use and can be effective in preventing mosquito bites. Many of these (and more) urban myths will persist for some time and perhaps it is time health authorities worked harder to communicate the benefits and effective use of the products available.

UPDATE: Thanks to BugGirl and Laurie Sullivan for the suggested tweaks!

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.

---

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

---

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

---

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

---

---