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“Help Your Patients Protect Themselves”

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Personal ProtectionPersonal Protection

• Avoid areas with dense mosquito Avoid areas with dense mosquito populations (wet, wooded, etc.)populations (wet, wooded, etc.)

• Avoid the peak times for mosquitoes: Avoid the peak times for mosquitoes: two hours before & after dawn & dusktwo hours before & after dawn & dusk

• Use clothing as a protective barrierUse clothing as a protective barrier

• Use EPA-registered insect repellents Use EPA-registered insect repellents on exposed skinon exposed skin

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Why Repellents?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)

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Regulation of RepellentsRegulation of Repellents

• CDC and California public health agencies CDC and California public health agencies recommend consumers use EPA-registered active recommend consumers use EPA-registered active ingredients:ingredients:– DEET, oil of lemon eucalyptus (OLE), DEET, oil of lemon eucalyptus (OLE), picaridin, IR 3535picaridin, IR 3535

• EPA registers products after reviewing extensive EPA registers products after reviewing extensive efficacy, safety dataefficacy, safety data– The EPA says registration “indicates the materials have The EPA says registration “indicates the materials have

been reviewed and approved for efficacy and human safety been reviewed and approved for efficacy and human safety when applied according to the instructions on the label.” when applied according to the instructions on the label.” (CDC) (CDC)

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Types of Active IngredientsTypes of Active Ingredients

• EPA-registered products most effective EPA-registered products most effective (CDC)(CDC)- “conventional repellents” – DEET & picaridin- “conventional repellents” – DEET & picaridin- “biopesticide repellents” – OLE & IR3535- “biopesticide repellents” – OLE & IR3535

• ““Natural” productsNatural” products− Many are untested for efficacyMany are untested for efficacy− Very little toxicity data availableVery little toxicity data available− Less effective (Fradin & Day 2002)Less effective (Fradin & Day 2002)− Possible allergens (Day & Rutlege, 2008)Possible allergens (Day & Rutlege, 2008)− Many last at most 20 minutesMany last at most 20 minutes

• No more effective than cooking oil or other barrierNo more effective than cooking oil or other barrier

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““Natural” RepellentsNatural” 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

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DEETDEET

• DEET used for more than 50 years, most widely DEET used for more than 50 years, most widely studied repellent active ingredientstudied repellent active ingredient

• ““DEET has been shown to be an extremely safe and DEET has been shown to be an extremely safe and effective repellent and remains a very important effective repellent and remains a very important option for consumers.” CDC’s Lyle R. Petersen, option for consumers.” CDC’s Lyle R. Petersen, M.D., M.P.H. M.D., M.P.H.

• Urban legends on safety have a life of their own and Urban legends on safety have a life of their own and are generally without foundationare generally without foundation

(For specifics, please ask during Q&A)(For specifics, please ask during Q&A)

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The ScienceThe Science

• Industry-sponsored studiesIndustry-sponsored studies– Leading companies conduct rigorous studies per Leading companies conduct rigorous studies per

EPA guidelinesEPA guidelines– Competitive claims from less effective, non-Competitive claims from less effective, non-

registered products lead to consumer confusion registered products lead to consumer confusion • Examples on the internet Examples on the internet

• Independent studiesIndependent studies – Scientists continually study DEET, potential Scientists continually study DEET, potential

alternativesalternatives– Fradin, Day 2002 Fradin, Day 2002 NEJMNEJM considered benchmark considered benchmark

• Copies available upon requestCopies available upon request

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Concentration = Protection TimeConcentration = Protection Time

• DEET DEET – 5% provides approx. 90 minutes5% provides approx. 90 minutes– 10% provides approx. 2 hours10% provides approx. 2 hours– 30% provides approx. 5 hours30% provides approx. 5 hours

• Protection Time VariablesProtection Time Variables– Weather conditionsWeather conditions– Biting pressure Biting pressure – RaceRace– GenderGender– Activities (swimming, perspiring heavily)Activities (swimming, perspiring heavily)– Body chemistryBody chemistry

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Adverse EventsAdverse Events

• The most commonly reported AEs– Eye irritation• Formulations contain alcohol

– VERY rarely, skin rash• Thought to be associated with other

ingredients

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Registry DetailsRegistry Details

• More than 5 billion applications of More than 5 billion applications of DEET during 7-year Registry periodDEET during 7-year Registry period

• ““Overall risk of clinically significant Overall risk of clinically significant adverse events is very low” Thomas G. adverse events is very low” Thomas G. Osimitz, Ph. D., CDC conference, 2005Osimitz, Ph. D., CDC conference, 2005

• No association with seizuresNo association with seizures

• Copies of Registry Poster presentation Copies of Registry Poster presentation at CDC meeting available upon requestat CDC meeting available upon request

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Using RepellentsUsing Repellents

• Read, carefully follow label directionsRead, carefully follow label directions

• Apply to exposed skin, not under Apply to exposed skin, not under clothingclothing

• Apply evenly, rub product onto skin to Apply evenly, rub product onto skin to ensure even coverage (mosquitoes can ensure even coverage (mosquitoes can find an uncovered spot the size of a find an uncovered spot the size of a dime)dime)

• Wash off after returning indoorsWash off after returning indoors

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Repellents on ChildrenRepellents on Children

• AAP recommendations AAP recommendations - Up to 30% concentration DEET-based repellent for Up to 30% concentration DEET-based repellent for

all over 2 months oldall over 2 months old

• Adults should apply to young children Adults should apply to young children – Adult puts repellent on his/her hands, then Adult puts repellent on his/her hands, then

applies on child’s skinapplies on child’s skin

• Don’t spray randomly in the airDon’t spray randomly in the air• OLE should not be used on children younger OLE should not be used on children younger

than 3 years oldthan 3 years old• After time outdoors, check for insect bites After time outdoors, check for insect bites

and ticksand ticks

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Special PopulationsSpecial 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

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SummarySummary

• Encourage patients to:

– use EPA-registered repellents

– read the instructions before use

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More information:More information:www.cdc.govwww.cdc.gov

www.cdph.ca.govwww.cdph.ca.govwww.sdcounty.ca.govwww.sdcounty.ca.govwww.deetonline.orgwww.deetonline.org

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Further questions to:Further questions to:Ms. Susan LittleMs. Susan Little

Executive DirectorExecutive DirectorDEET Education ProgramDEET Education Program

202-833-7315202-833-7315 / / slittle@cspa.org1-800-No-Bites 1-800-No-Bites www.deetonline.org