While we can all be excited by the approaching start of summer, one thing many healthcare providers will be thinking about as temperatures and humidity rise is the Zika virus, the spread of which has caused the WHO to declare a public health emergency. With 472 known cases in the US today, the risks of infection are well publicized, especially as they pertain to pregnant women, fetal infection and the frightening reported instances of Guillain-Barré syndrome and one reported death. Sexual transmission from a male to his partner is a well documented risk.
All this leads to important questions on proper protection against getting bitten in the first place. For all that we still don’t know about the virus, we do know that the Aedes mosquito species is to blame as well as the aedes albopictus or ‘tiger’ mosquito. Moreover, as one of the first recognizable symptoms of Zika infection includes a rash, or conjunctivitis, we may see the dermatology field increasingly involved in conversations surrounding protection, management, and even detection. It is not however advisable to test each healthy patient bitten by a bug for evidence of the virus. We know that a major challenge will be properly assessing patients with symptoms of ordinary viral infections to send out blood tests for highly specialized lab testing offered in limited numbers of medical labs. The history of travel to areas known to have Zika will be of great importance.
What does the CDC advise?
The Center for Disease Control and Prevention (CDC) has started issuing recommendations on clothing and mosquito repellants that have a record of providing efficacy against mosquito bites. They advice using only products that include Environmental Protection Agency (EPA)-registered insect repellants including one of the following: DEET, picardin, IR3535, oil of lemon eucalyptus of para-menthane-diol. DEET in particular has been around since 1957 and has been deemed safe and effective at commercial concentrations by the US agency of Toxic Substances and Disease Registry and is a favorite among many dermatologists as, in specific formulations, it has proved effective at helping to prevent bites for up to 8 hours. Safe concentrations range from 20-50% for adults and 10-30% for children. It is not advised, however, to use DEET over cuts, abrasions or broken skin.
Alternatives to DEET and other protection measures
For anyone who is uncomfortable with DEET, or who has very sensitive skin, lemon-eucalyptus products or treating clothes with permethrin (which can last for six washes) can be a viable alternatives. For children and babies, contraindications vary but a general rule is to not use any insect repellent on babies under 2 months old and not to use lemon eucalyptus products on children under 3 years of age. It’s best to keep small children indoors, protected with mosquito netting on their cribs, baby carriers and strollers. Of course, it is always our recommendation to visit with your physician directly to receive complete advice for you and your family.
As with any health risks, one solution is never the only right answer and mosquito repellent can only ever be one part of any patient’s protection strategy. As a dermatologist, I always advise that patients wear long sleeves and pants as much as possible to help reduce the incidence of mosquito bites. To avoid excessive absorption, cuffed pants and long sleeved shirts may be worn with the application of the insecticide on the edges of the clothing nearest exposed skin. Nets at home are also very effective and even essential in some areas, especially around the bed and resting areas.
Hopefully with a comprehensive and rigorous approach that can work with every patient’s needs and lifestyle indoors and out, we’ll be able to help prevent as many cases of the Zika virus as possible. As the government mobilizes finance and engages the CDC, a vaccine is developed and local health authorities address the hygiene of stagnant water in high-risk areas, we can hope to see fewer outbreaks.