1. 1 “Help Your Patients Protect Themselves”

2. 2 Personal Protection Avoid areas with dense mosquito populations (wet, wooded, etc.)Avoid areas with dense mosquito populations (wet, wooded, etc.) Avoid the peak times for mosquitoes: two hours before & after dawn & duskAvoid the peak times for mosquitoes: two hours before & after dawn & dusk Use clothing as a protective barrierUse clothing as a protective barrier Use EPA-registered insect repellents on exposed skinUse EPA-registered insect repellents on exposed skin

3. 3 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)

4. 4 Regulation of Repellents CDC and California public health agencies recommend consumers use EPA-registered active ingredients:CDC and California public health agencies recommend consumers use EPA-registered active ingredients: –DEET, oil of lemon eucalyptus (OLE), picaridin, IR 3535 picaridin, IR 3535 EPA registers products after reviewing extensive efficacy, safety dataEPA registers products after reviewing extensive efficacy, safety data –The EPA says registration “indicates the materials have been reviewed and approved for efficacy and human safety when applied according to the instructions on the label.” (CDC)

5. 5 Types of Active Ingredients EPA-registered products most effective (CDC)EPA-registered products most effective (CDC) - “conventional repellents” – DEET & picaridin - “biopesticide repellents” – OLE & IR3535 “Natural” products“Natural” products −Many are untested for efficacy −Very little toxicity data available −Less effective (Fradin & Day 2002) −Possible allergens (Day & Rutlege, 2008) −Many last at most 20 minutes No more effective than cooking oil or other barrierNo more effective than cooking oil or other barrier

6. 6 “Natural” 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

7. 7 DEET DEET used for more than 50 years, most widely studied repellent active ingredient DEET used for more than 50 years, most widely studied repellent active ingredient “DEET has been shown to be an extremely safe and effective repellent and remains a very important option for consumers.” CDC’s Lyle R. Petersen, M.D., M.P.H. “DEET has been shown to be an extremely safe and effective repellent and remains a very important option for consumers.” CDC’s Lyle R. Petersen, M.D., M.P.H. Urban legends on safety have a life of their own and are generally without foundation Urban legends on safety have a life of their own and are generally without foundation (For specifics, please ask during Q&A)

8. 8 The Science Industry-sponsored studiesIndustry-sponsored studies –Leading companies conduct rigorous studies per EPA guidelines –Competitive claims from less effective, non- registered products lead to consumer confusion Examples on the internetExamples on the internet Independent studiesIndependent studies –Scientists continually study DEET, potential alternatives –Fradin, Day 2002 NEJM considered benchmark Copies available upon requestCopies available upon request

9. 9 Concentration = Protection Time DEETDEET –5% provides approx. 90 minutes –10% provides approx. 2 hours –30% provides approx. 5 hours Protection Time VariablesProtection Time Variables –Weather conditions –Biting pressure –Race –Gender –Activities (swimming, perspiring heavily) –Body chemistry

10. 10 Adverse Events The most commonly reported AEs –Eye irritation Formulations contain alcohol –VERY rarely, skin rash Thought to be associated with other ingredients

11. 11 Registry Details More than 5 billion applications of DEET during 7-year Registry periodMore than 5 billion applications of DEET during 7-year Registry period “Overall risk of clinically significant adverse events is very low” Thomas G. Osimitz, Ph. D., CDC conference, 2005“Overall risk of clinically significant adverse events is very low” Thomas G. Osimitz, Ph. D., CDC conference, 2005 No association with seizuresNo association with seizures Copies of Registry Poster presentation at CDC meeting available upon requestCopies of Registry Poster presentation at CDC meeting available upon request

12. 12 Using Repellents Read, carefully follow label directionsRead, carefully follow label directions Apply to exposed skin, not under clothingApply to exposed skin, not under clothing Apply evenly, rub product onto skin to ensure even coverage (mosquitoes can find an uncovered spot the size of a dime)Apply evenly, rub product onto skin to ensure even coverage (mosquitoes can find an uncovered spot the size of a dime) Wash off after returning indoorsWash off after returning indoors

13. 13 Repellents on Children AAP recommendationsAAP recommendations - Up to 30% concentration DEET-based repellent for all over 2 months old Adults should apply to young childrenAdults should apply to young children –Adult puts repellent on his/her hands, then applies 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 than 3 years oldOLE should not be used on children younger than 3 years old After time outdoors, check for insect bites and ticksAfter time outdoors, check for insect bites and ticks

14. 14 Special 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

15. 15 Summary Encourage patients to: –use EPA-registered repellents –read the instructions before use

16. 16 More information: www.cdc.govwww.cdph.ca.govwww.sdcounty.ca.govwww.deetonline.org

17. 17 Further questions to: Ms. Susan Little Executive Director DEET Education Program 202-833-7315/ slittle@cspa.org 1-800-No-Bites www.deetonline.org slittle@cspa.orgwww.deetonline.orgslittle@cspa.orgwww.deetonline.org