Juckett G. Arthropod bites. Am Fam Physician. 2013 Dec 15;88(12):841-7. PMID: 24364549.
The risk of developing an infection transmitted by insects (mosquitoes, sandflies, fleas, tsetse flies, and triatomine bugs) and other arthropods (ticks) depends on the geographic region and activity-related exposure, eg, at work or during travel.
Personal protective measures against insect and tick bites should be selected based on the local epidemiology of vector-borne diseases and characteristics of the vectors, including peak activity time (day or night), breeding sites, and feeding patterns (indoors or outdoors). Probability of bite increases in marshlands, grassy or wooded areas, and with close contact with animals (including pets).
Many aspects of prevention require public health measures, which are beyond the scope of this text. Proper local sanitation at the dwelling level is an important part of prevention.
1. Insect repellents should be applied to uncovered parts of the body before going out: N,N-diethyl-meta-toluamide (DEET), icaridin, ethyl butylacetylaminopropionate (IR3535), citronella oil, or lemon eucalyptus oil (p-menthane-3,8-diol [PMD]). Repellents are available in various formulations: as sprays, liquids, creams, and sticks. Protection time depends on the concentration of the active substance, for instance, a 30% to 50% DEET ensures protection for 5 to 10 hours (a concentration >50% does not increase the strength or time of protection). Repellents containing 20% icaridin have similar effectiveness. The majority of cases of neurotoxic complications following the use of DEET-containing repellents in humans have been associated with intentional or incidental consumption or improper use of the product. How to use repellents safely:
1) Do not apply the repellent more frequently than recommended by the manufacturer.
2) Choose a repellent with the concentration of the active substance adjusted to the planned duration of your outdoor stay.
3) Apply the repellent to the uncovered parts of the body or clothing, not under the clothing.
4) Do not apply the repellent in the eye and mouth areas or on damaged skin.
5) After returning indoors, wash off the repellent with soap and water.
6) Do not use spray repellents in enclosed areas or near food.
7) Do not use products containing both a repellent and ultraviolet (UV) filter.
2. Protection of overnight accommodation (particularly important in regions with active transmission of tropical diseases spread by nocturnal mosquitoes, eg, malaria, Japanese encephalitis): The room should be screened and have air-conditioning, or a mosquito bednet should be used, preferably sprayed with an insecticide (permethrin or its derivatives). Use window and door screening if necessary. Use a bed mosquito net with openings ≤1.5 mm (openings <0.6 mm also protect from flies and other insects smaller than mosquitoes). Regular use of a mosquito net treated with permethrin in endemic regions decreases the incidence of malaria by 60%. Insecticides in the form of incenses and sprays can be used to eliminate insects both outdoors and indoors. In well-screened, air-conditioned rooms no additional protection is usually needed.
3. Protective clothing, depending on the expected exposure, climate, and species present in a particular region: Long sleeves, long trouser legs tucked into long socks, generally loose clothing, headwear such as a cap or hat, preferably in bright colors (ticks can be noticed more easily on a light background), tall boots worn particularly at the time of the highest activity of insects and ticks. To improve the protective properties of clothing, its material can be impregnated with an insecticide (eg, permethrin; ready-to-use products are available on the market).
4. Mosquito repellents for pregnant women: Pregnant women can apply repellents only to the exposed parts of the body and should wash the substance off as quickly as possible when it is no longer needed. Protective clothing that covers possibly the largest area of the body and bed mosquito nets treated with permethrin are safe and effective protective measures against insects in this population.
Management after exposure to ticks: see Lyme Borreliosis.