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Özokan G, Bilginer A, Mızrak Z, Işıkoğlu S, Beler M, Ünal İ, Cansız D, Alturfan AA, Emekli-Alturfan E. Comparison of the cytotoxicity and zebrafish embryo toxicity of insect repellent ingredients: p-Menthane-3,8-diol synthesized by green chemistry from Eucalyptus citriodora and N,N-diethyl-meta-toluamide. Drug Chem Toxicol 2024:1-12. [PMID: 38738628 DOI: 10.1080/01480545.2024.2350664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 04/27/2024] [Indexed: 05/14/2024]
Abstract
Bio-sourced insect repellents are becoming more popular due to their safer applications. Known for its strong fly-repellent property, Cis, trans-para-menthane-3,8-diol (PMD) is the main component of the lemon eucalyptus essential oil and is synthesized from citronellal. In April 2005, US Centers for Disease Control approved two fly repellents that do not contain N,N-diethyl-meta-toluamide (DEET), including PMD. Due to the intentional and pervasive human exposure caused by DEET as insect repellent, concerns have been raised about its toxicological profile and potential harm to people. We hypothesized PMD would have a different toxicological profile than DEET. We synthesized PMD from Eucalyptus citriodora using green chemistry methods and analyzed its structures by 1H-NMR,13C-NMR, and GC/MS spectral methods. We used MTS assay to determine the percentage inhibition of PMD and DEET on keratinocyte (human epidermal keratinocyte [HaCaT]) cells. The xCelligence system was used and followed at real time. Effects of PMD and DEET on zebrafish embryo development were monitored and levels of lipid peroxidation, glutathione-S-transferase (GST), superoxide dismutase (SOD), and acetylcholinesterase (AchE) were evaluated at 72 h post-fertilization using spectrophotometric methods. Our results showed that while DEET inhibited human keratinocyte cell growth, while imporved cell viability and proliferation was exposed in PMD exposed group. In zebrafish embryos, PMD was less toxic in terms of development, oxidant-antioxidant status, and AChE activities than DEET. Based on these results we suggest an efficient method using green chemistry for the synthesis of PMD, which is found to be less toxic in zebrafish embryos and human keratinocyte cells.
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Affiliation(s)
- Gökhan Özokan
- BioArge Laboratories, Yıldız Technical University Technocity, Istanbul, Turkey
| | - Abdulkerim Bilginer
- BioArge Laboratories, Yıldız Technical University Technocity, Istanbul, Turkey
| | - Zülal Mızrak
- Department of Biochemistry, Institute of Health Sciences, Faculty of Pharmacy, Marmara University, Istanbul, Turkey
| | - Semanur Işıkoğlu
- Department of Biochemistry, Institute of Health Sciences, Faculty of Pharmacy, Marmara University, Istanbul, Turkey
| | - Merih Beler
- Department of Biochemistry, Institute of Health Sciences, Faculty of Pharmacy, Marmara University, Istanbul, Turkey
| | - İsmail Ünal
- Medical Biochemistry Department, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Derya Cansız
- Medical Biochemistry Department, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - A Ata Alturfan
- Department of Biochemistry, Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ebru Emekli-Alturfan
- Department of Basic Medical Sciences, Faculty of Dentistry, Marmara University, Istanbul, Turkey
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Fonzo M, Bertoncello C, Tudor L, Miccolis L, Serpentino M, Petta D, Amoruso I, Baldovin T, Trevisan A. Do we protect ourselves against West Nile Virus? A systematic review on knowledge, attitudes, and practices and their determinants. J Infect Public Health 2024; 17:868-880. [PMID: 38555655 DOI: 10.1016/j.jiph.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/01/2024] [Accepted: 03/11/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND West Nile virus (WNV) is a mosquito-borne flavivirus. In humans, 80% of infections are asymptomatic, while approximately 20% experience influenza-like symptoms. Fewer than 1% develop the neuroinvasive form which can lead to encephalitis, meningitis, acute flaccid paralysis, and even death. The global spread of the virus to areas where it was not previously present has become a growing concern. Since the 2000 s, there have been numerous outbreaks affecting local and travelling populations worldwide. Given the lack of a vaccine, preventative measures are primarily focused on surveillance, vector control, and the use of personal protective behaviours (PPBs). The importance of PPBs is central to public health recommendations. However, translating these messages into coherent action by the public can prove challenging, as the uptake of such measures is inevitably influenced by socio-economic factors, awareness, knowledge, and risk perception. METHODS A PRISMA-based systematic research was conducted on EMBASE, PubMed/MEDLINE, and Web of Science databases. PROSPERO registration number CRD42023459714. Quality of studies included in the final stage was evaluated using the Critical Appraisal Checklist for Cross-Sectional Study (CEBMa). RESULTS 2963 articles were screened, and 17 studies were included in the final round. Out of these, six were deemed of high quality, ten were of medium quality, and one was of low quality. In almost all studies considered, both awareness and knowledge of WNV transmission were above 90%, while concern about WNV ranged from 50% to 80%. Concern about the safety of repellents, either with or without DEET, ranged from 27% to 70%. The percentage of people actually using repellents ranged from 30% to 75%, with the lowest usage reported among individuals over 60 years old (29%) and pregnant women (33%), and the highest among students aged 9-11 (75%). Concern for West Nile Virus (WNV) was consistently linked to an increase in taking preventative measures, including the use of repellents, by two to four times across studies. The school-based intervention was effective in increasing the practice of removing standing water (AOR=4.6; 2.7-8.0) and wearing long clothing (AOR=2.4; 95%CI: 1.3-4.3), but did not have a significant impact on the use of repellents. CONCLUSIONS The present systematic review provides an overview of the knowledge, attitudes, and practices (KAP) of WNV and their determinants. While concern about West Nile Virus (WNV) and its effects can be a significant motivator, it is important to promote evidence-based personal protective behaviours (PPBs) to counter unwarranted fears. For example, the use of repellents among the most vulnerable age groups. Given the geographical expansion of WNV, it is necessary to target the entire population preventively, including those who are difficult to reach and areas not yet endemic. The findings of this investigation could have significant implications for public health and support well-informed and effective communication strategies and interventions.
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Affiliation(s)
- Marco Fonzo
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Chiara Bertoncello
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy.
| | - Liliana Tudor
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Liana Miccolis
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Michele Serpentino
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Daniele Petta
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Irene Amoruso
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Tatjana Baldovin
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Andrea Trevisan
- Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
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Batume C, Mulongo IM, Ludlow R, Ssebaale J, Randerson P, Pickett JA, Mukisa IM, Scofield S. Evaluating repellence properties of catnip essential oil against the mosquito species Aedes aegypti using a Y-tube olfactometer. Sci Rep 2024; 14:2269. [PMID: 38280895 PMCID: PMC10821859 DOI: 10.1038/s41598-024-52715-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/23/2024] [Indexed: 01/29/2024] Open
Abstract
The mosquito species Aedes aegypti (L.) is known to act as a vector in the transmission of various diseases, including dengue fever and yellow fever. The use of insect repellents is one of precautionary measures used to mitigate the risk of these diseases in humans by reducing mosquito biting. Nepetalactone, a potent natural insect repellent primarily found in catnip (Nepeta cataria) essential oil, has emerged as a promising candidate for mosquito repellence. Here, we evaluated the potential of catnip essential oil (> 95% nepetalactone) for use as a mosquito repellent. Using a Y-tube olfactometer and human hands as an attractant, we analysed the effectiveness of catnip oil at repelling the mosquito species Aedes aegypti. We tested a range of dilutions of catnip essential oil and found that concentrations as low as 2% were effective at repelling > 70% of mosquitoes for between one and four hours after repellent application. These findings suggest that nepetalactone could potentially be used as a natural, effective alternative to synthetic mosquito repellents, thereby offering protection against vector-borne diseases.
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Affiliation(s)
- Charles Batume
- Department of Entomology, Uganda Virus Research Institute (UVRI), Entebbe, Uganda
| | | | | | | | | | | | - Ivan M Mukisa
- Department of Food Technology and Nutrition, Makerere University, Kampala, Uganda
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Shin N, Lascarez-Lagunas LI, Henderson AL, Martínez-García M, Karthikraj R, Barrera V, Sui SH, Kannan K, Colaiácovo MP. Altered gene expression linked to germline dysfunction following exposure of Caenorhabditis elegans to DEET. iScience 2024; 27:108699. [PMID: 38299026 PMCID: PMC10829882 DOI: 10.1016/j.isci.2023.108699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/13/2023] [Accepted: 12/06/2023] [Indexed: 02/02/2024] Open
Abstract
N,N-diethyl-meta-toluamide (DEET) is a commonly used synthetic insect repellent. Although the neurological effects of DEET have been widely investigated, its effects on the germline are less understood. Here, we show that exposure of the nematode Caenorhabditis elegans, which is highly predictive of mammalian reprotoxicity, resulting in internal DEET levels within the range detected in human biological samples, causes activation of p53/CEP-1-dependent germ cell apoptosis, altered meiotic recombination, chromosome abnormalities, and missegregation. RNA-sequencing analysis links DEET-induced alterations in the expression of genes related to redox processes and chromatin structure to reduced mitochondrial function, impaired DNA double-strand break repair progression, and defects during early embryogenesis. We propose that Caenorhabditis elegans exposure to DEET interferes with gene expression, leading to increased oxidative stress and altered chromatin structure, resulting in germline effects that pose a risk to reproductive health.
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Affiliation(s)
- Nara Shin
- Department of Genetics, Blavatnik Institute, Harvard Medical School, Boston, MA 02115, USA
| | | | - Ayana L. Henderson
- Department of Genetics, Blavatnik Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Marina Martínez-García
- Department of Genetics, Blavatnik Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Rajendiran Karthikraj
- Wadsworth Center, New York State Department of Health, Empire State Plaza, Albany, NY 12237, USA
| | - Victor Barrera
- Bioinformatics Core, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Shannan Ho Sui
- Bioinformatics Core, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Kurunthachalam Kannan
- Wadsworth Center, New York State Department of Health, Empire State Plaza, Albany, NY 12237, USA
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Albany, NY 12237, USA
| | - Mónica P. Colaiácovo
- Department of Genetics, Blavatnik Institute, Harvard Medical School, Boston, MA 02115, USA
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5
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Wu R, Zhu X, Xing Y, Guan G, Zhang Y, Hui R, Cui Q, Liu Z, Zhu L. Association of N, N-diethyl-m-toluamide (DEET) with hyperuricemia among adult participants. CHEMOSPHERE 2023; 338:139320. [PMID: 37356586 DOI: 10.1016/j.chemosphere.2023.139320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/18/2023] [Accepted: 06/22/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND N,N-diethyl-m-toluamide (DEET) is a widely used active ingredient in insect repellents, and its effects on human health have been a matter of debate. This study aims to investigate the relationship between DEET exposure and hyperuricemia in the adult population. METHODS Our study utilized a cross-sectional design and analyzed data from adult participants of the National Health and Nutrition Examination Survey (NHANES) conducted between 2007 and 2016. 3-diethyl-carbamoyl benzoic acid (DCBA) was used as a specific indicator of DEET exposure. DCBA was categorized using quartiles based on its distribution within the study population. Multiple linear regression models were employed to examine the association between DCBA exposure and serum uric acid (SUA) levels in adults. The relationship between DCBA and the prevalence of hyperuricemia in adults was assessed using multiple logistic regression models. Dose-response relationships were analyzed using restricted cubic spline regression. RESULTS A total of 8708 participants were included in the study. The mean age of the participants was 46.49 years, and the total number of male participants was 50.93%. The median levels of DCBA and SUA were 2.07 ng/mL and 5.40 mg/dL, respectively. Hyperuricemia was found in 19.99% of the participants. In multivariate-adjusted linear regression models, it was found that higher SUA levels were associated with the highest quartile of DCBA compared with the lowest quartile of DCBA (β [95% CI]: 0.19 [0.08, 0.30], Ptrend<0.001). After adjusting for confounders, a positive association was found between the prevalence of hyperuricemia and DCBA levels (OR [95% CI] quartile 4 vs. 1: 1.41 [1.14-1.74], Ptrend<0.001). Furthermore, linear associations were observed between DCBA concentrations and SUA levels (P for nonlinearity = 0.479) and the prevalence of hyperuricemia (P for nonlinearity = 0.755). CONCLUSION Higher DCBA concentrations were found to have a positive association with the prevalence of hyperuricemia in the general adult population.
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Affiliation(s)
- Runmiao Wu
- Department of Respiratory and Critical Care Medicine, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710000, China.
| | - Xu Zhu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Yujie Xing
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710000, China
| | - Gongchang Guan
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710000, China
| | - Yong Zhang
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710000, China
| | - Rutai Hui
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Qianwei Cui
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710000, China.
| | - Zhongwei Liu
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710000, China.
| | - Ling Zhu
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710000, China; Department of Cardiology, The Third Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710000, China.
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Almeida AR, Oliveira ND, Pinheiro FASD, Morais WAD, Ferreira LDS. Challenges encountered by natural repellents: Since obtaining until the final product. PESTICIDE BIOCHEMISTRY AND PHYSIOLOGY 2023; 195:105538. [PMID: 37666610 DOI: 10.1016/j.pestbp.2023.105538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 09/06/2023]
Abstract
Vector-borne diseases, particularly the arboviruses dengue, Zika, chikungunya, and yellow fever caused by the Aedes aegypti mosquito, have been driving the use of repellents worldwide. The most representative synthetic repellent, DEET stands out as the market's oldest and most efficient repellent. It is considered a reference standard but presents considerable toxicity, not recommended for children up to 6 months old and pregnant women. For this reason, alternatives have been sought, and natural repellents derived mainly from essential oils have been studied, highlighting the essential oils of lemon (Corymbia citriodora), citronella (Cympobogon sp.), Andiroba (Carapa guianensis). However, the development and commercialization of products containing natural repellents are significantly lower when compared to DEET and other synthetic repellents. In order to understand the reasons, aspects related to safety, mechanism of action, efficacy as well development and complexity of the products were evaluated. It is concluded that, as for safety, there is lacking information in the literature regarding the effects on non-target organisms and robust toxicity data. The mechanism of action is based on theories, with less information on the exact mode of action, molecular targets, and interaction with the olfactory and taste receptors of insects. Despite being a current trend to search for actives from natural sources highly present in essential oils, however they reduced action time because due to rapid evaporation after application to the skin, thus requiring repellent vehicles. The development and complexity related to these products bring challenging aspects, beginning on the plant cultivation and extraction processes to produce essential oils with a more homogeneous chemical composition towards the formulation stabilization processes due to fast evaporation and short action time, with the use of pharmaceutical technology such as encapsulation techniques.
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Affiliation(s)
- Addison Ribeiro Almeida
- Department of Pharmacy, Laboratório de Farmacotécnica, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil; Department of Pharmacy, Laboratory of Quality Control of Medicines (LCQMed), Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
| | - Nicolas Dantas Oliveira
- Department of Pharmacy, Laboratório de Farmacotécnica, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil; Department of Pharmacy, Laboratory of Quality Control of Medicines (LCQMed), Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | | | - Waldenice Alencar de Morais
- Department of Pharmacy, Laboratório de Farmacotécnica, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
| | - Leandro De Santis Ferreira
- Department of Pharmacy, Laboratory of Quality Control of Medicines (LCQMed), Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
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Nguyen QBD, Vu MAN, Hebert AA. Insect repellents: An updated review for the clinician. J Am Acad Dermatol 2023; 88:123-130. [PMID: 30395919 DOI: 10.1016/j.jaad.2018.10.053] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 10/24/2018] [Accepted: 10/30/2018] [Indexed: 11/25/2022]
Abstract
Malaria, Zika virus, West Nile virus, Dengue fever, and Lyme disease are common causes of morbidity and mortality around the world. While arthropod bites may cause local inflammation and discomfort, a greater concern is the potential to develop deadly systemic infection. The use of insect repellents (IRs) to prevent systemic infections constitutes a fundamental public health effort. Cost effectiveness, availability, and high efficacy against arthropod vectors are key characteristics of an ideal IR. Currently, numerous IRs are available on the market, with N,N-diethyl-3-methylbenzamide (DEET) being the most widely used. DEET has an excellent safety profile and remarkable protection against mosquitoes and various other arthropods. Other Environmental Protection Agency-registered IR ingredients (eg, permethrin, picaridin, IR3535, oil of lemon eucalyptus, oil of citronella, catnip oil, and 2-undecanone) are alternative IRs of great interest because some of these ingredients have efficacies comparable to that of DEET. These alternative IRs possess low toxicity and favorable customer experiences in use (eg, cosmetically pleasant, naturally occurring). This review summarizes the currently available Environmental Protection Agency-registered IRs, including their origins, mechanisms of action, side effect profiles, and available formulations. This review will enable the clinician to select the best IR option to meet a patient's needs and provide the greatest protection from arthropod bites and their sequelae.
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Affiliation(s)
- Quoc-Bao D Nguyen
- Department of Dermatology, UTHealth McGovern Medical School at Houston, Houston, Texas
| | - Mai-Anh N Vu
- University of Texas Medical Branch School of Medicine, Galveston, Texas
| | - Adelaide A Hebert
- Department of Dermatology, UTHealth McGovern Medical School at Houston, Houston, Texas.
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8
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Thum MD, Weise NK, Casalini R, Fulton AC, Purdy AP, Lundin JG. Incorporation of
N
,
N
,‐diethyl‐meta‐toluamide within electrospun nylon‐6/6 nanofibers. J Appl Polym Sci 2022. [DOI: 10.1002/app.53237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Matthew D. Thum
- Chemistry Division U.S. Naval Research Laboratory Washington District of Columbia USA
| | - Nickolaus K. Weise
- Chemistry Division U.S. Naval Research Laboratory Washington District of Columbia USA
| | - Riccardo Casalini
- Chemistry Division U.S. Naval Research Laboratory Washington District of Columbia USA
| | - Ashley C. Fulton
- Chemistry Division U.S. Naval Research Laboratory Washington District of Columbia USA
| | - Andrew P. Purdy
- Chemistry Division U.S. Naval Research Laboratory Washington District of Columbia USA
| | - Jeffrey G. Lundin
- Chemistry Division U.S. Naval Research Laboratory Washington District of Columbia USA
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Yan S, Wang J, Xu J, Jiang W, Xiong M, Cao Z, Wang Y, Wang Z, Zhang T, Wang Z, Sun C, Hou S, Wei W. Exposure to N,N-diethyl- m-toluamide and cardiovascular diseases in adults. Front Public Health 2022; 10:922005. [PMID: 36267998 PMCID: PMC9576625 DOI: 10.3389/fpubh.2022.922005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 09/09/2022] [Indexed: 01/22/2023] Open
Abstract
Although growing evidence suggests that N,N-diethyl-m-toluamide (DEET) has adverse effects on public health, the relationship of DEET with cardiovascular disease (CVD) is still largely unknown. The purpose of this study was, therefore, to evaluate the association between DEET exposure and total and specific CVD among the US adults. In this cross-sectional study, a total of 5,972 participants were selected from the National Health and Nutrition Examination Survey (NHANES) 2007-2014. CVD was defined as a combination of congestive heart failure (CHF), coronary heart disease (CHD), angina, heart attack, or stroke. Logistic regression models were used to evaluate the association between DEET metabolites and the risks of total and specific CVD. Compared to the lowest quartile, 3-(diethylcarbamoyl) benzoic acid (DCBA) in the highest quartile was associated with the increased risks of CVD (odds ratio [OR]: 1.32, 95% CI: 1.03-1.68, P for trend = 0.025) and CHD (OR: 1.57, 95% CI: 1.10-2.25, P for trend = 0.017), after adjustment for potential covariates. Nevertheless, exposure to DCBA was not significantly associated with heart attack, CHF, angina, and stroke. Further studies are required to confirm these findings and identify the underlying mechanisms.
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Affiliation(s)
- Shiwei Yan
- Department of Nutrition and Food Hygiene, College of Public Health, Harbin Medical University, Harbin, China
| | - Jianing Wang
- Department of Cerebrovascular Disease, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, China
| | - Jiaxu Xu
- Department of Nutrition and Food Hygiene, College of Public Health, Harbin Medical University, Harbin, China
| | - Wenbo Jiang
- Department of Nutrition and Food Hygiene, College of Public Health, Harbin Medical University, Harbin, China
| | - Menglin Xiong
- Department of Nutrition and Food Hygiene, College of Public Health, Harbin Medical University, Harbin, China
| | - Ziteng Cao
- Department of Nutrition and Food Hygiene, College of Public Health, Harbin Medical University, Harbin, China
| | - Yu Wang
- Department of Nutrition and Food Hygiene, College of Public Health, Harbin Medical University, Harbin, China
| | - Ziqi Wang
- Department of Nutrition and Food Hygiene, College of Public Health, Harbin Medical University, Harbin, China
| | - Tongfang Zhang
- Department of Nutrition and Food Hygiene, College of Public Health, Harbin Medical University, Harbin, China
| | - Zheng Wang
- Department of Nutrition and Food Hygiene, College of Public Health, Harbin Medical University, Harbin, China
| | - Changhao Sun
- Department of Nutrition and Food Hygiene, College of Public Health, Harbin Medical University, Harbin, China,*Correspondence: Wei Wei
| | - Shaoying Hou
- Department of Nutrition and Food Hygiene, College of Public Health, Harbin Medical University, Harbin, China,Shaoying Hou
| | - Wei Wei
- Department of Nutrition and Food Hygiene, College of Public Health, Harbin Medical University, Harbin, China,Changhao Sun
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10
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Luo DY, Yan ZT, Che LR, Zhu JJ, Chen B. Repellency and insecticidal activity of seven Mugwort (Artemisia argyi) essential oils against the malaria vector Anopheles sinensis. Sci Rep 2022; 12:5337. [PMID: 35351963 PMCID: PMC8964668 DOI: 10.1038/s41598-022-09190-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 03/14/2022] [Indexed: 11/28/2022] Open
Abstract
Anopheles sinensis is the main vector of malaria with a wide distribution in China and its adjacent countries. The smoke from burning dried mugwort leaves has been commonly used to repel and kill mosquito adults especially in southern Chinese provinces. In this study, the essential oils of mugwort leaves collected from seven provinces in China were extracted by steam distillation and their chemical compositions were analyzed. Among a total of 56–87 chemical constituents confirmed by GC–MS analyses, four compounds, eucalyptol, β-caryophyllene, phytol and caryophyllene oxide, were identified with appearances from all seven distilled essential oils. The effectiveness varied in larvicidal, fumigant and repellent activities against An. sinensis from these seven essential oils with different geographic origins. The essential oil from Hubei province showed the highest larvicidal activity against the 4th instar larvae of An. sinensis, with a median lethal concentration at 40.23 µg/mL. For fumigation toxicity, essential oils from 4 provinces (Gansu, Shandong, Sichuan and Henan) were observed with less than 10 min in knockdown time. The essential oil distilled from Gansu province displayed the highest repellent activity against Anopheles mosquitoes and provided similar level of protection as observed from DEET. Eucalyptol was the most toxic fumigant compound and phytol showed the strongest larvicidal activity among all tested mugwort essential oil constituents.
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Affiliation(s)
- De-Yue Luo
- Chongqing Key Laboratory of Vector Insects, Institute of Entomology and Molecular Biology, Chongqing Normal University, Chongqing, 401331, China
| | - Zhen-Tian Yan
- Chongqing Key Laboratory of Vector Insects, Institute of Entomology and Molecular Biology, Chongqing Normal University, Chongqing, 401331, China
| | - Lin-Rong Che
- Chongqing Key Laboratory of Vector Insects, Institute of Entomology and Molecular Biology, Chongqing Normal University, Chongqing, 401331, China
| | | | - Bin Chen
- Chongqing Key Laboratory of Vector Insects, Institute of Entomology and Molecular Biology, Chongqing Normal University, Chongqing, 401331, China.
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Ho BM, Davis HE, Forrester JD, Sheele JM, Haston T, Sanders L, Lee MC, Lareau S, Caudell M, Davis CB. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Management of Tick-Borne Illness in the United States. Wilderness Environ Med 2021; 32:474-494. [PMID: 34642107 DOI: 10.1016/j.wem.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
The Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the prevention and management of tick-borne illness (TBI). Recommendations are graded based on quality of supporting evidence according to criteria put forth by the American College of Chest Physicians. The guidelines include a brief review of the clinical presentation, epidemiology, prevention, and management of TBI in the United States, with a primary focus on interventions that are appropriate for resource-limited settings. Strong recommendations are provided for the use of DEET, picaridin, and permethrin; tick checks; washing and drying clothing at high temperatures; mechanical tick removal within 36 h of attachment; single-dose doxycycline for high-risk Lyme disease exposures versus "watchful waiting;" evacuation from backcountry settings for symptomatic tick exposures; and TBI education programs. Weak recommendations are provided for the use of light-colored clothing; insect repellents other than DEET, picaridin, and permethrin; and showering after exposure to tick habitat. Weak recommendations are also provided against passive methods of tick removal, including the use of systemic and local treatments. There was insufficient evidence to support the use of long-sleeved clothing and the avoidance of tick habitat such as long grasses and leaf litter. Although there was sound evidence supporting Lyme disease vaccination, a grade was not offered as the vaccine is not currently available for use in the United States.
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Affiliation(s)
- Benjamin M Ho
- Southern Wisconsin Emergency Associates, Janesville, Wisconsin.
| | - Hillary E Davis
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado; Department of Emergency Medicine, University of Tennessee Medical Center, Knoxville, Tennessee
| | | | | | - Taylor Haston
- Department of Emergency Medicine, Medical College of Georgia, Augusta, Georgia
| | - Linda Sanders
- Department of Emergency Medicine, Memorial Hospital, Colorado Springs, Colorado
| | - Mary Caroll Lee
- Department of Emergency Medicine, Virginia Tech-Carilion Clinic, Roanoke, Virginia
| | - Stephanie Lareau
- Department of Emergency Medicine, Virginia Tech-Carilion Clinic, Roanoke, Virginia
| | - Michael Caudell
- Department of Emergency Medicine, Medical College of Georgia, Augusta, Georgia
| | - Christopher B Davis
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado
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12
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Smith GN, Moore KM, Hatchette TF, Nicholson J, Bowie W, Langley JM. Committee Opinion No. 399: Management of Tick Bites and Lyme Disease During Pregnancy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 42:644-653. [PMID: 32414479 DOI: 10.1016/j.jogc.2020.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/06/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Lyme disease is an emerging infection in Canada caused by the bacterium belonging to the Borrelia burgdorferi sensu lato species complex, which is transmitted via the bite of an infected blacklegged tick. Populations of blacklegged ticks continue to expand and are now established in different regions in Canada. It usually takes more than 24 hours of tick attachment to transfer B. burgdorferi to a human. The diagnosis of early localized Lyme disease is made by clinical assessment, as laboratory tests are not reliable at this stage. Most patients with early localized Lyme disease will present with a skin lesion (i.e., erythema migrans) expanding from the tick bite site and/or non-specific "influenza-like" symptoms (e.g., arthralgia, myalgia, and fever). Signs and symptoms may occur from between 3 and 30 days following the tick bite. The care of pregnant patients with a tick bite or suspected Lyme disease should be managed similarly to non-pregnant adults, including the consideration of antibiotics for prophylaxis and treatment. The primary objective of this committee opinion is to inform practitioners about Lyme disease and provide an approach to managing the care of pregnant women who may have been infected via a blacklegged tick bite. INTENDED USERS Health care providers who care for pregnant women or women of reproductive age. TARGET POPULATION Women of reproductive age. EVIDENCE In November 2018, Medline, EMBASE, PubMed, and CENTRAL databases were searched for 2 main categories: (1) Lyme disease and (2) other tick-borne diseases. Because the main focus was Lyme disease, and considering the limited number of the articles, no further filters were applied for publication time or type of study. For other tick-borne diseases, the results were restricted to a publication date within the last 10 years (2008-2018). The search terms were developed using MeSH terms and keywords including Lyme Disease, Pregnancy, Pregnant Women, Pregnancy Complications, Ehrlichiosis, Anaplasmosis, Rocky Mountain Spotted Fever, Babesiosis, Tularemia, Powassan Virus, Encephalitis Viruses, Tick-Borne, Tick-Borne Diseases, Colorado Tick Fever, Q Fever, Relapsing Fever, and Southern Tick-Associated Rash Illness. All articles on Lyme disease and other tick-borne diseases with a target population of pregnant women were included; other groups and populations were excluded. VALIDATION METHODS The content and recommendations of this committee opinion were drafted and agreed upon by the authors. The Board of Directors of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication.
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13
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Shibazaki T, Motoki N, Misawa Y, Ohira S, Inaba Y, Kanai M, Kurita H, Nakazawa Y, Tsukahara T, Nomiyama T. Association between pesticide usage during pregnancy and neonatal hyperbilirubinemia requiring treatment: the Japan Environment and Children's Study. Pediatr Res 2021; 89:1565-1570. [PMID: 32756550 DOI: 10.1038/s41390-020-1100-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 06/26/2020] [Accepted: 07/17/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Maternal exposure to pesticides during pregnancy may cause oxidative hemolysis leading to neonatal hyperbilirubinemia. This investigation examined for associations between maternal use of pesticides or repellents during pregnancy and neonatal hyperbilirubinemia requiring phototherapy. METHODS We used the dataset from the Japan Environment and Children's Study, a large national birth cohort study registered from January 31, 2011 to March 31, 2014. The fixed data of 61,751 live births were used to evaluate the presence of neonatal hyperbilirubinemia and potential confounding factors. We employed multiple logistic regression analysis to identify correlations between the frequency of maternal pesticide or repellent use during pregnancy and clinically relevant neonatal hyperbilirubinemia. RESULTS After controlling for confounding factors, there were significant associations between neonatal hyperbilirubinemia necessitating phototherapy and the frequent use of indoor insecticide spray (OR 1.21, 95% CI 1.05-1.38). For spray- or lotion-type insect repellents, an opposite relationship was observed (more than a few times a week: OR 0.70, 95% CI 0.61-0.81, up to a few times a month: OR 0.84, 95% CI 0.78-0.91). CONCLUSION The frequent use of indoor insecticide spray during pregnancy showed an increased risk of neonatal hyperbilirubinemia requiring phototherapy, which was absent for spray- or lotion-type insect repellents. IMPACT The frequent use of indoor insecticide spray during pregnancy showed an increased risk of neonatal hyperbilirubinemia requiring phototherapy, which was absent for spray- or lotion-type insect repellents. This is the first study examining the effects of maternal exposure to pesticides or repellents on clinically relevant neonatal hyperbilirubinemia using a dataset from a nationwide birth cohort study. This large-scale Japanese cohort study revealed that the frequent use of indoor insecticide spray during pregnancy may increase the risk of neonatal hyperbilirubinemia requiring treatment.
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Affiliation(s)
- Takumi Shibazaki
- Center for Perinatal, Pediatric, and Environmental Epidemiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.,Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Noriko Motoki
- Center for Perinatal, Pediatric, and Environmental Epidemiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yuka Misawa
- Department of Preventive Medicine and Public Health, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Satoshi Ohira
- Center for Perinatal, Pediatric, and Environmental Epidemiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.,Department of Obstetrics and Gynecology, Shinshu University of School of Medicine, Matsumoto, Nagano, Japan
| | - Yuji Inaba
- Center for Perinatal, Pediatric, and Environmental Epidemiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.,Department of Neurology, Nagano Children's Hospital, Azumino, Nagano, Japan
| | - Makoto Kanai
- Center for Perinatal, Pediatric, and Environmental Epidemiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Hiroshi Kurita
- Center for Perinatal, Pediatric, and Environmental Epidemiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yozo Nakazawa
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Teruomi Tsukahara
- Center for Perinatal, Pediatric, and Environmental Epidemiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.,Department of Preventive Medicine and Public Health, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Tetsuo Nomiyama
- Center for Perinatal, Pediatric, and Environmental Epidemiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan. .,Department of Preventive Medicine and Public Health, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
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14
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Lantos PM, Rumbaugh J, Bockenstedt LK, Falck-Ytter YT, Aguero-Rosenfeld ME, Auwaerter PG, Baldwin K, Bannuru RR, Belani KK, Bowie WR, Branda JA, Clifford DB, DiMario FJ, Halperin JJ, Krause PJ, Lavergne V, Liang MH, Meissner HC, Nigrovic LE, Nocton JJJ, Osani MC, Pruitt AA, Rips J, Rosenfeld LE, Savoy ML, Sood SK, Steere AC, Strle F, Sundel R, Tsao J, Vaysbrot EE, Wormser GP, Zemel LS. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease. Clin Infect Dis 2021; 72:e1-e48. [PMID: 33417672 DOI: 10.1093/cid/ciaa1215] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Indexed: 12/13/2022] Open
Abstract
This evidence-based clinical practice guideline for the prevention, diagnosis, and treatment of Lyme disease was developed by a multidisciplinary panel representing the Infectious Diseases Society of America (IDSA), the American Academy of Neurology (AAN), and the American College of Rheumatology (ACR). The scope of this guideline includes prevention of Lyme disease, and the diagnosis and treatment of Lyme disease presenting as erythema migrans, Lyme disease complicated by neurologic, cardiac, and rheumatologic manifestations, Eurasian manifestations of Lyme disease, and Lyme disease complicated by coinfection with other tick-borne pathogens. This guideline does not include comprehensive recommendations for babesiosis and tick-borne rickettsial infections, which are published in separate guidelines. The target audience for this guideline includes primary care physicians and specialists caring for this condition such as infectious diseases specialists, emergency physicians, internists, pediatricians, family physicians, neurologists, rheumatologists, cardiologists and dermatologists in North America.
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Affiliation(s)
- Paul M Lantos
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | | | - Yngve T Falck-Ytter
- Case Western Reserve University, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA
| | | | - Paul G Auwaerter
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly Baldwin
- Geisinger Medical Center, Danville, Pennsylvania, USA
| | | | - Kiran K Belani
- Childrens Hospital and Clinical of Minnesota, Minneapolis, Minnesota, USA
| | - William R Bowie
- University of British Columbia, Vancouver, British Columbia, Canada
| | - John A Branda
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David B Clifford
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | | | - Peter J Krause
- Yale School of Public Health, New Haven, Connecticut, USA
| | | | | | | | | | | | | | - Amy A Pruitt
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jane Rips
- Consumer Representative, Omaha, Nebraska, USA
| | | | | | | | - Allen C Steere
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Franc Strle
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Robert Sundel
- Boston Children's Hospital Boston, Massachusetts, USA
| | - Jean Tsao
- Michigan State University, East Lansing, Michigan, USA
| | | | | | - Lawrence S Zemel
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
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15
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Mbuba E, Odufuwa OG, Tenywa FC, Philipo R, Tambwe MM, Swai JK, Moore JD, Moore SJ. Single blinded semi-field evaluation of MAÏA ® topical repellent ointment compared to unformulated 20% DEET against Anopheles gambiae, Anopheles arabiensis and Aedes aegypti in Tanzania. Malar J 2021; 20:12. [PMID: 33407496 PMCID: PMC7788821 DOI: 10.1186/s12936-020-03461-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND N,N-Diethyl-3-methylbenzamide (DEET) topical mosquito repellents are effective personal protection tools. However, DEET-based repellents tend to have low consumer acceptability because they are cosmetically unappealing. More attractive formulations are needed to encourage regular user compliance. This study evaluated the protective efficacy and protection duration of a new topical repellent ointment containing 15% DEET, MAÏA® compared to 20% DEET in ethanol using malaria and dengue mosquito vectors in Bagamoyo Tanzania. METHODS Fully balanced 3 × 3 Latin square design studies were conducted in large semi-field chambers using laboratory strains of Anopheles gambiae sensu stricto, Anopheles arabiensis and Aedes aegypti. Human volunteers applied either MAÏA® ointment, 20% DEET or ethanol to their lower limbs 6 h before the start of tests. Approximately 100 mosquitoes per strain per replicate were released inside each chamber, with 25 mosquitoes released at regular intervals during the collection period to maintain adequate biting pressure throughout the test. Volunteers recaptured mosquitoes landing on their lower limbs for 6 h over a period of 6 to 12-h post-application of repellents. Data analysis was conducted using mixed-effects logistic regression. RESULTS The protective efficacy of MAÏA® and 20% DEET was not statistically different for each of the mosquito strains: 95.9% vs. 97.4% against An. gambiae (OR = 1.53 [95% CI 0.93-2.51] p = 0.091); 96.8% vs 97.2% against An. arabiensis (OR = 1.08 [95% CI 0.66-1.77] p = 0.757); 93.1% vs 94.6% against Ae. aegypti (OR = 0.76 [95% CI 0.20-2.80] p = 0.675). Average complete protection time (CPT) in minutes of MAÏA® and that of DEET was similar for each of the mosquito strains: 571.6 min (95% CI 558.3-584.8) vs 575.0 min (95% CI 562.1-587.9) against An. gambiae; 585.6 min (95% CI 571.4-599.8) vs 580.9 min (95% CI 571.1-590.7) against An. arabiensis; 444.1 min (95% CI 401.8-486.5) vs 436.9 min (95% CI 405.2-468.5) against Ae. aegypti. CONCLUSIONS MAÏA® repellent ointment provides complete protection for 9 h against both An. gambiae and An. arabiensis, and 7 h against Ae. aegypti similar to 20% DEET (in ethanol). MAÏA® repellent ointment can be recommended as a tool for prevention against outdoor biting mosquitoes in tropical locations where the majority of the people spend an ample time outdoor before going to bed.
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Affiliation(s)
- Emmanuel Mbuba
- Vector Control Product Testing Unit, Department of Environmental Health and Ecological Science, Ifakara Health Institute, P.O. Box 74, Bagamoyo, Tanzania.
- Swiss Tropical & Public Health Institute, Socinstrasse, 57, 4002, Basel, Switzerland.
- University of Basel, St. Petersplatz 1, 4002, Basel, Switzerland.
| | - Olukayode G Odufuwa
- Vector Control Product Testing Unit, Department of Environmental Health and Ecological Science, Ifakara Health Institute, P.O. Box 74, Bagamoyo, Tanzania
- Swiss Tropical & Public Health Institute, Socinstrasse, 57, 4002, Basel, Switzerland
- London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Frank C Tenywa
- Vector Control Product Testing Unit, Department of Environmental Health and Ecological Science, Ifakara Health Institute, P.O. Box 74, Bagamoyo, Tanzania
| | - Rose Philipo
- Vector Control Product Testing Unit, Department of Environmental Health and Ecological Science, Ifakara Health Institute, P.O. Box 74, Bagamoyo, Tanzania
| | - Mgeni M Tambwe
- Vector Control Product Testing Unit, Department of Environmental Health and Ecological Science, Ifakara Health Institute, P.O. Box 74, Bagamoyo, Tanzania
- Swiss Tropical & Public Health Institute, Socinstrasse, 57, 4002, Basel, Switzerland
- University of Basel, St. Petersplatz 1, 4002, Basel, Switzerland
| | - Johnson K Swai
- Vector Control Product Testing Unit, Department of Environmental Health and Ecological Science, Ifakara Health Institute, P.O. Box 74, Bagamoyo, Tanzania
| | - Jason D Moore
- Vector Control Product Testing Unit, Department of Environmental Health and Ecological Science, Ifakara Health Institute, P.O. Box 74, Bagamoyo, Tanzania
- Swiss Tropical & Public Health Institute, Socinstrasse, 57, 4002, Basel, Switzerland
| | - Sarah J Moore
- Vector Control Product Testing Unit, Department of Environmental Health and Ecological Science, Ifakara Health Institute, P.O. Box 74, Bagamoyo, Tanzania
- Swiss Tropical & Public Health Institute, Socinstrasse, 57, 4002, Basel, Switzerland
- University of Basel, St. Petersplatz 1, 4002, Basel, Switzerland
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16
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Arinaitwe E, Mpimbaza A, Nankabirwa JI, Kamya V, Asiimwe A, Kuule JK, Kamya MR, Drakeley C, Dorsey G, Rosenthal PJ, Staedke SG. Malaria Diagnosed in an Urban Setting Strongly Associated with Recent Overnight Travel: A Case-Control Study from Kampala, Uganda. Am J Trop Med Hyg 2020; 103:1517-1524. [PMID: 32840203 DOI: 10.4269/ajtmh.20-0189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Malaria is frequently diagnosed in urban Kampala, despite low transmission intensity. To evaluate the association between recent travel out of Kampala and malaria, we conducted a matched case-control study. Cases were febrile outpatients with a positive malaria test; controls were febrile outpatients with a negative test. For every two cases, five controls were selected, matching on age. Data were collected on recent overnight travel out of Kampala (past 60 days), destination and duration of travel, and behavioral factors, including sleeping under an insecticide-treated net (ITN) during travel. From July to August 2019, 162 cases and 405 controls were enrolled. The locations of residence of cases and controls were similar. More controls were female (62.7% versus 46.3%, P < 0.001). Overall, 158 (27.9%) participants reported recent overnight travel. Travelers were far more likely to be diagnosed with malaria than those who did not travel (80.4% versus 8.6%, OR 58.9, 95% CI: 23.1-150.1, P < 0.001). Among travelers, traveling to a district not receiving indoor residual spraying of insecticide (OR 35.0, 95% CI: 4.80-254.9, P < 0.001), no ITN use (OR 30.1, 95% CI: 6.37-142.7, P < 0.001), engaging in outdoor activities (OR 22.0, 95% CI: 3.42-141.8, P = 0.001), and age < 16 years (OR 8.36, 95% CI: 2.22-56.2, P = 0.03) were associated with increased odds of malaria. Kampala residents who traveled overnight out of the city were at substantially higher risk of malaria than those who did not travel. For these travelers, personal protection measures, including sleeping under an ITN when traveling, should be advocated.
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Affiliation(s)
- Emmanuel Arinaitwe
- Infectious Diseases Research Collaboration, Kampala, Uganda.,London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Arthur Mpimbaza
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda.,Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Joaniter I Nankabirwa
- Department of Medicine, Makerere University, Kampala, Uganda.,Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Victor Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Alan Asiimwe
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Julius K Kuule
- Uganda Malaria Research Centre, Ministry of Health, Kampala, Uganda
| | - Moses R Kamya
- Department of Medicine, Makerere University, Kampala, Uganda.,Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Chris Drakeley
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Grant Dorsey
- Department of Medicine, University of California, San Francisco, California
| | - Philip J Rosenthal
- Department of Medicine, University of California, San Francisco, California
| | - Sarah G Staedke
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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17
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Haleem ZM, Yadav S, Cushion ML, Tanner RJ, Carek PJ, Mainous AG. Exposure to N,N-Diethyl-Meta-Toluamide Insect Repellent and Human Health Markers: Population Based Estimates from the National Health and Nutrition Examination Survey. Am J Trop Med Hyg 2020; 103:812-814. [PMID: 32458781 DOI: 10.4269/ajtmh.20-0226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
N,N-diethyl-meta-toluamide (DEET) is one of the most commonly used insect repellants in the United States, yet the existing literature regarding DEET's potential deleterious impact on humans is mixed and is based mostly on case reports. The primary aim of this study was to address this lack of population-based evidence of the effects of DEET exposure on human health in the United States. Our primary outcome measures were biomarkers related to systemic inflammation (high sensitivity C-reactive protein), immune function (lymphocyte), liver function (aspartate aminotransferase, alanine aminotransferase, and γ-glutamyl transferace), and kidney function (estimated glomerular filtration rate). We analyzed data from the population-based National Health and Nutrition Examination Survey, 2015-2016, and identified 1,205 patients (age 20+ years) who had DEET metabolite levels recorded at or above detection limits. A Pearson correlation was used to assess the relationship between DEET metabolite, and each biomarker found there was no significant correlation. Thus, there is no evidence that DEET exposure has any impact on the biomarkers identified.
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Affiliation(s)
- Zuhair M Haleem
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida
| | - Sandhya Yadav
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida
| | - Minor L Cushion
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida
| | - Rebecca J Tanner
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida
| | - Peter J Carek
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
| | - Arch G Mainous
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida.,Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
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18
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Smith GN, Moore KM, Hatchette TF, Nicholson J, Bowie W, Langley JM. Opinion du comité No 399 : Prise en charge des morsures de tiques et de la maladie de Lyme pendant la grossesse. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:654-664. [DOI: 10.1016/j.jogc.2020.02.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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An investigation into the knowledge, perceptions and role of personal protective technologies in Zika prevention in Colombia. PLoS Negl Trop Dis 2020; 14:e0007970. [PMID: 31961867 PMCID: PMC7010294 DOI: 10.1371/journal.pntd.0007970] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 02/10/2020] [Accepted: 12/05/2019] [Indexed: 01/22/2023] Open
Abstract
Background Arboviruses transmitted by day-biting Aedes mosquitoes are a major public health concern. With the challenges inherent in arbovirus vaccine and therapeutics development, vector control and bite prevention strategies are among the limited options available for immediate intervention. Bite prevention through personal protective technologies (PPT), such as topical mosquito repellents or repellent-impregnated clothing, may help to decrease biting rates and, therefore, the risk of disease in groups most susceptible to adverse outcomes from Zika virus. However, achieving high uptake and compliance with PPT can be challenging. Methodology/Principal findings To gain an insight into the knowledge and concerns of pregnant women surrounding Zika and their opinions regarding PPT, particularly repellent clothing, a focus group study was carried out with pregnant women, women of reproductive age, and semi-structured interviews with their male partners in two cities in Colombia. The discussions revealed shortfalls in basic knowledge of Zika virus, with several pregnant participants reporting being unaware of the potential for Zika-related congenital malformations. Although participants generally considered Zika to be a significant personal threat, most rated it as less of a concern than dengue or diarrheal diseases. Overall, repellent clothing and other forms of PPT were viewed as effective, although some participants expressed concerns over the high costs of repellents, and safety fears of regular contact with repellent chemicals, which they perceived as potentially harmful. Plant-derived repellents were considered to be safer than synthetic chemical repellents. Discussions also highlighted that health centers were the preferred source of information on bite-reduction. Conclusions/Significance Achieving high uptake and compliance with PPT in populations most at risk of adverse outcomes from Zika infection requires engaging key users in open dialogue to identify and address any practical issues regarding PPT use, and concerns over safety. The findings presented here suggest that educational campaigns should strongly emphasize the risks associated with Zika during pregnancy, and discuss safety profiles of approved synthetic repellents and the availability of EPA-approved plant-based repellents. In addition, the economic and political context should be a major consideration when evaluating personal mosquito-repellent strategies. Although mosquito personal protective technologies (PPT), such as topical DEET or permethrin impregnated clothing, show high efficacy in laboratory studies, they frequently achieve poor population uptake. This is likely due to numerous factors, including high costs, dislike of the feel or smell of the product, and safety fears over the repellent chemicals. The targeted use of PPT to those at elevated risk of severe disease, such as pregnant women in Zika endemic regions, may help mitigate adverse outcomes from Zika virus infection. To explore ways of increasing the appeal of PPT, a focus group study was performed with pregnant women and women of reproductive age in two cities in Colombia. Although almost all participants had heard of Zika, not all pregnant women were aware of the potential for Zika-related birth defects. PPT products were generally viewed as effective, although many expressed fears that repeated exposure to chemicals may affect fetal development. There was limited trust over repellent-manufacturer claims of safety, and women from low socioeconomic groups believed PPT products to be unaffordable. Participants identified health centers as trusted sources of bite-prevention education, suggesting health workers should emphasize safety and efficacy of approved repellents.
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20
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Swale DR, Bloomquist JR. Is DEET a dangerous neurotoxicant? PEST MANAGEMENT SCIENCE 2019; 75:2068-2070. [PMID: 31069958 DOI: 10.1002/ps.5476] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/03/2019] [Accepted: 05/03/2019] [Indexed: 06/09/2023]
Abstract
Controversies surrounding the safety of N,N-diethyl-meta-toluamide (DEET) when used as an insect repellent are centered around conflicting findings in the scientific literature and inaccurate reporting in the public media. Lethal cases of DEET poisoning are few, and usually due to deliberate or other overdoses that ignore product label instructions. Deleterious effects of DEET typically involve skin reactions and even when encephalopathies, such as seizures, occur they often abate without sequelae. Recent mode-of-action studies prove it has little direct effect on acetylcholinesterase, and have identified G protein-coupled receptors as a site of action deserving of further investigation. Studies with pregnant women found that DEET had no effect on the developing fetus from proper use and its continued deployment as a repellent is endorsed by both the Centers for Disease Control and Prevention and the Environmental Protection Agency, with specific recommendations of how it should be used on children. © 2019 Society of Chemical Industry.
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Affiliation(s)
- Daniel R Swale
- Department of Entomology, Louisiana State University AgCenter, Baton Rouge, LA, USA
| | - Jeffrey R Bloomquist
- Neurotoxicology Laboratory, Entomology and Nematology Department, Emerging Pathogens Institute, Gainesville, FL, USA
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21
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Gilder ME, Moo P, Hashmi A, Praisaengdet N, Wai K, Pimanpanarak M, Carrara VI, Angkurawaranon C, Jiraporncharoen W, McGready R. "I can't read and don't understand": Health literacy and health messaging about folic acid for neural tube defect prevention in a migrant population on the Myanmar-Thailand border. PLoS One 2019; 14:e0218138. [PMID: 31194796 PMCID: PMC6564004 DOI: 10.1371/journal.pone.0218138] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/25/2019] [Indexed: 11/18/2022] Open
Abstract
Health literacy is increasingly recognized as an important determinant of health outcomes, but definition, measurement tools, and interventions are lacking. Conceptual frameworks must include both individual and health-systems domains which, in combination, determine an individual’s health literacy. Validated tools lack applicability in marginalized populations with very low educational levels, such as migrant worker communities on the Myanmar-Thailand border. We undertake a comprehensive health literacy assessment following a case study of a recent public health campaign promoting preconceptual folic acid uptake in this community. A mixed-methods design utilized quantitative analysis of the prevalence and predictors of low Health literacy, and focus group discussions to gather qualitative data from women about proposed and actual posters used in the campaign. Health literacy was measured with a locally developed tool that has been used in surveys of the population since 1995. Health literacy was low, with 194/525 (37.0%) of tested women demonstrating adequate health literacy, despite 63.1% (331/525) self-reporting being literate. Only one third of women had completed 4th grade or above and reported grade level attained in school was more predictive of health literacy than self-reported literacy. Focus group discussions revealed that low literacy, preconceived associations, and traditional health beliefs (individual domain) interacted with complex images, subtle concepts, and taboo images on posters (health-systems domain) to cause widespread misunderstandings of the visuals used in the campaign. The final poster still required explanation for clarity. Low health literacy is prevalent among pregnant women from this migrant community and barriers to communication are significant and complex. Public health posters need piloting prior to implementation as unanticipated misperceptions are common and difficult to overcome. Verbal communication remains a key method of messaging with individuals of low health literacy and educational system strengthening and audiovisual messaging are critical for improvement of health outcomes.
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Affiliation(s)
- Mary Ellen Gilder
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pru Moo
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Ahmar Hashmi
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Norda Praisaengdet
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Kerry Wai
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Mupawjay Pimanpanarak
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Verena I. Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wichuda Jiraporncharoen
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- * E-mail:
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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22
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Alfhili MA, Nkany MB, Weidner DA, Lee MH. Stimulation of eryptosis by broad-spectrum insect repellent N,N-Diethyl-3-methylbenzamide (DEET). Toxicol Appl Pharmacol 2019; 370:36-43. [DOI: 10.1016/j.taap.2019.03.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/05/2019] [Accepted: 03/12/2019] [Indexed: 01/14/2023]
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23
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Reichert W, Ejercito J, Guda T, Dong X, Wu Q, Ray A, Simon JE. Repellency Assessment of Nepeta cataria Essential Oils and Isolated Nepetalactones on Aedes aegypti. Sci Rep 2019; 9:1524. [PMID: 30728370 PMCID: PMC6365536 DOI: 10.1038/s41598-018-36814-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 11/20/2018] [Indexed: 12/29/2022] Open
Abstract
There is an increased need for improved and affordable insect repellents to reduce transmission of rapidly spreading diseases with high mortality rates. Natural products are often used when DEET cannot be afforded or accessed and when consumers choose not to use a synthetic repellent. The essential oils from two newly bred Nepeta cataria (catnip) plants representing two different chemotypes and their respective isolated nepetalactone isomers were evaluated as mosquito repellents against Aedes aegypti mosquitoes that transmit the Zika and Dengue virus in a one choice landing rate inhibition assay. A dose response curve was generated for each treatment and a time course analysis of repellency was performed over 24 hours with a N. cataria essential oil sample. The results indicate that all essential oil samples and their respective purified nepetalactone isomers were able to achieve greater than 95% repellency. Between two and four hours, the ability to repel more than 95% of the mosquitoes diminished. At the lowest concentrations tested, the nepetalactones and crude essential oil samples were more effective than DEET at reducing the number of mosquito landings.
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Affiliation(s)
- William Reichert
- New Use Agriculture and Natural Plant Products Program, Department of Plant Biology, Rutgers University, New Brunswick, New Jersey, USA
| | - Jadrian Ejercito
- Department of Molecular, Cell and Systems Biology, University of California Riverside, Riverside, California, USA
| | - Tom Guda
- Department of Molecular, Cell and Systems Biology, University of California Riverside, Riverside, California, USA
| | - Xujun Dong
- New Use Agriculture and Natural Plant Products Program, Department of Plant Biology, Rutgers University, New Brunswick, New Jersey, USA.,College of Life Science, Shaanxi Normal University, Xi' an, Shaanxi, China
| | - Qingli Wu
- New Use Agriculture and Natural Plant Products Program, Department of Plant Biology, Rutgers University, New Brunswick, New Jersey, USA.,Department of Medicinal Chemistry, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA
| | - Anandasankar Ray
- Department of Molecular, Cell and Systems Biology, University of California Riverside, Riverside, California, USA
| | - James E Simon
- New Use Agriculture and Natural Plant Products Program, Department of Plant Biology, Rutgers University, New Brunswick, New Jersey, USA. .,Department of Medicinal Chemistry, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA.
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24
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Cartaxo MFS, Silva SMD, Silva JGM, Beltrão EIC, Brayner FA, de Lima Filho JL, Mattos SS, Ceballos AGC, Schettini JAC, Alves LC. Social determinants of health associated with topical repellent use in pregnancy: a cross-sectional study during a Zika outbreak in Brazil. Trans R Soc Trop Med Hyg 2019; 113:65-73. [PMID: 30412231 DOI: 10.1093/trstmh/try114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 10/05/2018] [Indexed: 01/16/2023] Open
Abstract
Background Repellent use during pregnancy was strongly recommended after uncovering Zika virus (ZIKV) involvement with congenital malformations. In this context, Pernambuco, Brazil played a key role since it was the epicentre for the main studies suggesting ZIKV teratogenicity and one of Brazil's most affected states during the 2014-2016 epidemics. Thus we aimed to identify possible associations between social determinants of health and repellent use in pregnancy during the ZIKV outbreak in Pernambuco. Methods We conducted a cross-sectional study (July-December 2016) with 539 pregnant women residing in Pernambuco and estimated the associations by prevalence ratio and multivariable logistic regression. Results Repellents were associated with pregnant women ≥30 y; graduates, employed, health professionals, private health system users and with a monthly income per person greater than two minimum wages. Women whose domiciles favour mosquitoes (ground-floor houses, intermittent water supply from general distribution or water trucks and for ≤6 d/week, cesspools/open wastewater, indoor household water storage) were less likely to use repellents. There was no association for peridomiciles. Conclusions Repellents were not associated with ZIKV in most vulnerable pregnant women, despite all the general recommendations made during the Pernambuco epidemic. This study observed a demand for public policies focused on health, education and sanitation problems related to deprived social groups along with their co-responsibility rather than focusing on individual attitudes against mosquitoes.
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Affiliation(s)
- Marina F S Cartaxo
- Laboratório de Imunopatologia Keizo Asami, Universidade Federal de Pernambuco, Recife, CEP, Brazil
| | - Sophia Maria D Silva
- Laboratório de Imunopatologia Keizo Asami, Universidade Federal de Pernambuco, Recife, CEP, Brazil
| | - Jaiurte G M Silva
- Laboratório de Imunopatologia Keizo Asami, Universidade Federal de Pernambuco, Recife, CEP, Brazil
| | - Eduardo I C Beltrão
- Laboratório de Imunopatologia Keizo Asami, Universidade Federal de Pernambuco, Recife, CEP, Brazil.,Departamento de Bioquímica, Universidade Federal de Pernambuco, Recife, CEP, Brazil
| | - Fábio André Brayner
- Laboratório de Imunopatologia Keizo Asami, Universidade Federal de Pernambuco, Recife, CEP, Brazil.,Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, CEP, Brazil
| | - José Luiz de Lima Filho
- Laboratório de Imunopatologia Keizo Asami, Universidade Federal de Pernambuco, Recife, CEP, Brazil
| | - Sandra S Mattos
- Laboratório de Imunopatologia Keizo Asami, Universidade Federal de Pernambuco, Recife, CEP, Brazil
| | - Albanita G C Ceballos
- Departamento de Medicina Social, Universidade Federal de Pernambuco, Recife, CEP, Brazil
| | - Juliana A C Schettini
- Centro de Ciências Biológicas e Saúde, Universidade Católica de Pernambuco, Recife, CEP, Brazil
| | - Luiz Carlos Alves
- Laboratório de Imunopatologia Keizo Asami, Universidade Federal de Pernambuco, Recife, CEP, Brazil.,Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, CEP, Brazil
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25
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Hasler T, Fehr J, Held U, Schlagenhauf P. Use of repellents by travellers: A randomised, quantitative analysis of applied dosage and an evaluation of knowledge, Attitudes and Practices (KAP). Travel Med Infect Dis 2018; 28:27-33. [PMID: 30578847 DOI: 10.1016/j.tmaid.2018.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/14/2018] [Accepted: 12/18/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Prevention of arthropod-borne infections hinges on bite prevention. We aimed to investigate travellers' use of repellents. METHODS We measured the amount of applied repellent with a spray containing 30% DEET and 20% Icaridin versus a lotion with 20% Icaridin alone. We calculated the concentration of active ingredient reached on the skin and evaluated formulation acceptability. The travellers completed a questionnaire evaluating Knowledge, Attitudes and Practice (KAP) to anti-vectorial protective measures (AVPM). RESULTS Some 200 volunteers travelling to mosquito borne infection endemic areas were recruited. The mean concentration of active substance achieved on the skin of the left arm was 0.52 mg/cm2 of DEET/Icaridin spray versus 0.21 mg/cm2 of Icaridin lotion. These levels are below the recommended protective dose (1 mg/cm2) for each formulation. Women were significantly more likely to apply a higher, protective dose of repellent. Travellers to Africa, women and older participants showed higher projected adherence to AVPM. CONCLUSIONS Only 2.5% of recruited travellers applied the recommended protective dose of repellent. Women and older travellers are the most adherent users of repellents. The pre-travel health consultation should provide more information on the application quantity and correct use of repellents.
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Affiliation(s)
- Thomas Hasler
- University of Zurich Centre for Travel Medicine, WHO Collaborating for Travellers' Health, Department of Public Health, Institute for Epidemiology, Biostatistics and Prevention, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Jan Fehr
- University of Zurich Centre for Travel Medicine, WHO Collaborating for Travellers' Health, Department of Public Health, Institute for Epidemiology, Biostatistics and Prevention, Hirschengraben 84, 8001, Zurich, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrike Held
- Department of Biostatistics, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
| | - Patricia Schlagenhauf
- University of Zurich Centre for Travel Medicine, WHO Collaborating for Travellers' Health, Department of Public Health, Institute for Epidemiology, Biostatistics and Prevention, Hirschengraben 84, 8001, Zurich, Switzerland.
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26
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Gomes GM, Bigon JP, Montoro FE, Lona LMF. Encapsulation of
N,N
‐diethyl‐
meta
‐toluamide (DEET) via miniemulsion polymerization for temperature controlled release. J Appl Polym Sci 2018. [DOI: 10.1002/app.47139] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- G. M. Gomes
- Department of Materials Engineering and Bioprocesses (DEMBio)School of Chemical Engineering, University of Campinas 500 Albert Einstein Avenue, Campinas Sao Paulo 13083‐852 Brazil
| | - J. P. Bigon
- Department of Materials Engineering and Bioprocesses (DEMBio)School of Chemical Engineering, University of Campinas 500 Albert Einstein Avenue, Campinas Sao Paulo 13083‐852 Brazil
| | - F. E. Montoro
- Brazilian Nanotechnology National Laboratory (LNNano)National Center of Energy and Materials Research (CNPEM) 10000 Giuseppe Máximo Scolfaro Street, Campinas Sao Paulo 13083‐970 Brazil
| | - L. M. F. Lona
- Department of Materials Engineering and Bioprocesses (DEMBio)School of Chemical Engineering, University of Campinas 500 Albert Einstein Avenue, Campinas Sao Paulo 13083‐852 Brazil
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27
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Lo WL, Mok KL, Yu Pui Ming SD. Which insect repellents should we choose? Implications from results of local market survey and review of current guidelines. HONG KONG J EMERG ME 2018. [DOI: 10.1177/1024907918773630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Mosquito-borne diseases are global problems. The use of topical insect repellents is a key measure recommended by health authorities to prevent mosquito-borne diseases. Despite more than a hundred commercial products available in the market, there are relatively few active ingredients used across these formulations. The most common active components are diethyltoluamide, picaridin, p-menthane-3,8-diol, ethyl butylacetylaminopropionate (IR3535) and a range of plant-derived products. Research has shown that each of these active ingredients vary in the duration of protection provided against biting mosquitoes. However, the wide spectrum of commercial preparations and various recommendations from different health authorities make it a challenge to pick an effective product for end users as well as healthcare personnel. A local market survey was conducted to assess the mosquito repellent formulae in available products in Hong Kong, and a review of the current recommendations issued by local and overseas authorities on choosing the suitable insect repellents is performed with consideration of recent research and currently available topical repellents in the market.
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Affiliation(s)
- Wai Ling Lo
- Accident and Emergency Department, Ruttonjee Hospital, Wan Chai, Hong Kong
| | - Ka Leung Mok
- Accident and Emergency Department, Ruttonjee Hospital, Wan Chai, Hong Kong
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28
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Prevention of malaria in pregnancy. THE LANCET. INFECTIOUS DISEASES 2018; 18:e119-e132. [PMID: 29395997 DOI: 10.1016/s1473-3099(18)30064-1] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 10/23/2017] [Accepted: 10/27/2017] [Indexed: 12/15/2022]
Abstract
Malaria remains one of the most preventable causes of adverse birth outcomes. Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine is used to prevent malaria, but resistance to this drug combination has decreased its efficacy and new alternatives are needed. In Africa, a meta-analysis showed three-course or monthly IPTp with sulfadoxine-pyrimethamine to be safe and more effective than the original two-course sulfadoxine-pyrimethamine strategy, prompting WHO to update its policy in 2012. Although resistance to sulfadoxine-pyrimethamine reduces the parasitological efficacy of IPTp, this drug combination remains associated with reduced incidence of low birthweight in areas where prevalence of parasites with quintuple Plasmodium falciparum dihydrofolate reductase (Pfdhfr) and dihydropteroate synthetase (Pfdhps) mutations is greater than 90%. Nevertheless, its effectiveness is compromised in women infected with sextuple mutant parasites. Six trials of IPTp showed that neither amodiaquine, mefloquine, nor chloroquine-azithromycin are suitable replacements for sulfadoxine-pyrimethamine because of poor tolerability. Furthermore, four trials showed that intermittent screening and treatment with the current generation of malaria rapid diagnostic tests was not a suitable alternative strategy to IPTp with sulfadoxine-pyrimethamine, even in areas with high prevalence of quintuple mutations. Two trials showed that IPTp with dihydroartemisinin-piperaquine was well tolerated, effective, and acceptable for IPTp, with monthly regimens being the most effective. Coverage of IPTp and insecticide-treated nets continues to lag behind targets. The key barriers to uptake are well documented, and many are open to intervention. Outside of Africa, a single trial suggests a potential role for integrated approaches that combine sulfadoxine-pyrimethamine with azithromycin for IPTp in areas of Papua New Guinea where malaria transmission is high. Modelling analysis suggests the importance of the prevention of malaria early in pregnancy and the need to protect pregnant women declines more slowly than the rate at which transmission declines. Improved funding has led to an increase in the number of prevention trials in the past decade, showing the value of more sustained protection with monthly IPTp regimens. There is a need for confirmatory trials of the safety, efficacy, and feasibility of IPTp with dihydroartemisinin-piperaquine, for studies of intermittent screening and treatment with more sensitive rapid diagnostic tests, for studies of integrated strategies for malaria and other co-infections, and for studies of prevention strategies for malaria in pregnant women who are HIV-positive and living outside of Africa. Additional research is required on how to improve uptake of WHO's updated policy on IPTp with sulfadoxine-pyrimethamine and insecticide-treated nets.
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Abstract
BACKGROUND Malaria is an important cause of illness and death across endemic regions. Considerable success against malaria has been achieved within the past decade mainly through long-lasting insecticide-treated nets (LLINs). However, elimination of the disease is proving difficult as current control methods do not protect against mosquitoes biting outdoors and when people are active. Repellents may provide a personal protection solution during these times. OBJECTIVES To assess the impact of topical repellents, insecticide-treated clothing, and spatial repellents on malaria transmission. SEARCH METHODS We searched the following databases up to 26 June 2017: the Cochrane Infectious Diseases Group Specialized Register; the Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library; MEDLINE; Embase; US AFPMB; CAB Abstracts; and LILACS. We also searched trial registration platforms and conference proceedings; and contacted organizations and companies for ongoing and unpublished trials. SELECTION CRITERIA We included randomized controlled trials (RCTs) and cluster-randomized controlled trials of topical repellents proven to repel mosquitoes; permethrin-treated clothing; and spatial repellents such as mosquito coils. We included trials that investigated the use of repellents with or without LLINs, referred to as insecticide-treated nets. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed trials for inclusion, extracted the data, and assessed the risk of bias. A third review author resolved any discrepancies. We analysed data by conducting meta-analysis and stratified by whether the trials had included LLINs. We combined results from cRCTs with individually RCTs by adjusting for clustering and presented results using forest plots. We used GRADE to assess the certainty of the evidence. MAIN RESULTS Eight cRCTs and two RCTs met the inclusion criteria. Six trials investigated topical repellents, two trials investigated insecticide-treated clothing, and two trials investigated spatial repellents.Topical repellentsSix RCTS, five of them cluster-randomized, investigated topical repellents involving residents of malaria-endemic regions. Four trials used topical repellents in combination with nets, but two trials undertaken in displaced populations used topical repellents alone. It is unclear if topical repellents can prevent clinical malaria (RR 0.65, 95% CI 0.4 to 1.07, very low certainty evidence) or malaria infection (RR 0.84, 95% CI 0.64 to 1.12, low-certainty evidence) caused by P. falciparum. It is also unclear if there is any protection against clinical cases of P. vivax (RR 1.32, 95% CI 0.99 to 1.76, low-certainty evidence) or incidence of infections (RR 1.07, 95% CI 0.80 to 1.41, low-certainty evidence). Subgroup analysis of trials including insecticide-treated nets did not show a protective effect of topical repellents against malaria. Only two studies did not include insecticide-treated nets, and they measured different outcomes; one reported a protective effect against clinical cases of P. falciparum (RR 0.40, 95% CI 0.23 to 0.71); but the other study measured no protective effect against malaria infection incidence caused by either P. falciparum or P. vivax.Insecticide-treated clothingInsecticide-treated clothing were investigated in trials conducted in refugee camps in Pakistan and amongst military based in the Colombian Amazon. Neither study provided participants with insecticide-treated nets. In the absence of nets, treated clothing may reduce the incidence of clinical malaria caused by P. falciparum by approximately 50% (RR 0.49, 95% CI 0.29 to 0.83, low-certainty evidence) and P. vivax (RR 0.64, 95% CI 0.40 to 1.01, low-certainty evidence).Spatial repellentsTwo cluster-randomized RCTs investigated mosquito coils for malaria prevention. We do not know the effect of spatial repellents on malaria prevention (RR 0.24, 95% CI 0.03 to 1.72, very low certainty evidence). There was large heterogeneity between studies and one study had high risk of bias. AUTHORS' CONCLUSIONS There is insufficient evidence to conclude topical or spatial repellents can prevent malaria. There is a need for better designed trials to generate higher certainty of evidence before well-informed recommendations can be made. Adherence to daily compliance remains a major limitation. Insecticide-treated clothing may reduce risk of malaria infection in the absence of insecticide-treated nets; further studies on insecticide-treated clothing in the general population should be done to broaden the applicability of the results.
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Affiliation(s)
- Marta F Maia
- Swiss Tropical and Public Health InstitutePublic Health and EpidemiologySocinstrasse 57BaselSwitzerlandCH‐4051
- Kenya Medical Research Institute ‐ Wellcome Trust ProgrammeDepartment of BiosciencesPO Box 230KilifiKilifiKenya80108
| | - Merav Kliner
- Public Health England North WestHealth Protection Team2nd Floor, 3 Piccadilly PlaceLondon Rd,ManchesterUKM1 3BN
| | - Marty Richardson
- Liverpool School of Tropical MedicineCochrane Infectious Diseases GroupPembroke PlaceLiverpoolUKL3 5QA
| | - Christian Lengeler
- Swiss Tropical and Public Health InstitutePublic Health and EpidemiologySocinstrasse 57BaselSwitzerlandCH‐4051
| | - Sarah J Moore
- Swiss Tropical and Public Health InstitutePublic Health and EpidemiologySocinstrasse 57BaselSwitzerlandCH‐4051
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Charlier C, Beaudoin MC, Couderc T, Lortholary O, Lecuit M. Arboviruses and pregnancy: maternal, fetal, and neonatal effects. THE LANCET CHILD & ADOLESCENT HEALTH 2017; 1:134-146. [PMID: 30169203 DOI: 10.1016/s2352-4642(17)30021-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/27/2017] [Accepted: 06/27/2017] [Indexed: 12/19/2022]
Abstract
Arboviruses are an expanding public health threat, with pregnant women facing unique complications from arbovirus infections. These infections, such as dengue and Crimean-Congo haemorrhagic fever, can be more severe in pregnant women than in the general population. Vertical transmission is reported for many arboviruses and can severely affect pregnancy outcome. Indeed, arboviruses-particularly flaviviruses and alphaviruses-are associated with increased risks of fetal loss and premature birth. Arboviruses can be teratogenic, as is the case for Zika virus and Venezuelan equine encephalitis virus. Finally, intrapartum transmission can result in severe neonatal infections, as is true for chikungunya virus. Although the global burden of arboviruses is well recognised, few studies have provided data on arbovirus infection specifically in the context of maternal and child health. Epidemiological and clinical studies are therefore needed to better assess the burden of arbovirus infections during pregnancy and to improve the prevention and clinical management of these viral infections. In this Review, we analyse the information available and identify gaps in knowledge that require further assessment.
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Affiliation(s)
- Caroline Charlier
- Institut Pasteur, Biology of Infection Unit, Paris, France; Inserm U1117, Paris, France; Paris-Descartes University, Sorbonne Paris Cité, Centre d'Infectiologie Necker-Pasteur, Necker-Enfants Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Marie-Claude Beaudoin
- Paris-Descartes University, Sorbonne Paris Cité, Centre d'Infectiologie Necker-Pasteur, Necker-Enfants Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France; Division of Medical Microbiology and Infectious Diseases, Laval University and CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Thérèse Couderc
- Institut Pasteur, Biology of Infection Unit, Paris, France; Inserm U1117, Paris, France
| | - Olivier Lortholary
- Paris-Descartes University, Sorbonne Paris Cité, Centre d'Infectiologie Necker-Pasteur, Necker-Enfants Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Lecuit
- Institut Pasteur, Biology of Infection Unit, Paris, France; Inserm U1117, Paris, France; Paris-Descartes University, Sorbonne Paris Cité, Centre d'Infectiologie Necker-Pasteur, Necker-Enfants Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France.
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Abstract
Health care providers must be equipped to provide appropriate advice to reproductive-aged patients for protection against the potentially devastating consequences of prenatal Zika virus exposure. The goal of this commentary is to summarize what is known about the safety and toxicity of N,N-diethyl-meta-toluamide (DEET) as a topical insect repellant and the pyrethroid permethrin for treatment of fabric, endorsed in the fight against Zika virus. Reviews assessing the safety and toxicity of DEET conducted by the U.S. Environmental Protection Agency and the Canadian Pest Management Regulatory Agency conclude that DEET has low acute toxicity and does not appear to pose a significant health concern to humans when used as directed. Some experimental animal and limited epidemiologic data suggest that prenatal pyrethroid exposure may adversely affect learning and behavior, but this level of evidence pales in comparison to the known risks of Zika virus to the fetal brain. The available evidence has led to the strong recommendation by the Centers for Disease Control and Prevention for use of these products by pregnant women as personal protection against mosquito bites in the fight against Zika virus infection. This message has been affirmed by our obstetrics and gynecology professional organizations. Because Zika virus is unlikely to be the last disease requiring vector control, those with environmental health expertise must continue to join with infectious disease specialists to communicate the potential vulnerability of our youngest (fetuses, infants, and young children) to vector-borne disease, both to the disease itself and to the strategies employed to mitigate the spread of such disease.
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Kamata K, Birrer RB, Tokuda Y. Travel medicine: Part 2-Special situations. J Gen Fam Med 2017; 18:114-117. [PMID: 29264005 PMCID: PMC5689407 DOI: 10.1002/jgf2.40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 09/07/2016] [Indexed: 11/30/2022] Open
Abstract
Travel should be educational, fun, and safe if the appropriate care is rendered by counseling physicians and travelers take an active role in their health. In the second paper of the 2‐part special articles, we provide a practical summary of up‐to‐date travel medicine about special situations for primary care physicians. We focus on in‐flight emergencies, pregnancy, and specific precautions for injury and infectious disease as special situations. Physicians are frequently called upon to examine patients with in‐flight emergencies, and thus, they should have knowledge and skills for effectively caring patients. Common health problems over the flights include syncope, chest pain, dyspnea, and gastrointestinal symptoms. Cautious and prudent behaviors should be recommended for travelers to prevent injury and infectious disease. Follow‐up after the return home optimizes a positive outcome.
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Affiliation(s)
- Kazuhiro Kamata
- Department of Medicine JCHO Tokyo Joto Hospital Kotoku Tokyo Japan
| | - Richard B Birrer
- Department of Emergency Medicine Cornell University School of Medicine New York NY USA
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Heng S, Sluydts V, Durnez L, Mean V, Polo K, Tho S, Coosemans M, van Griensven J. Safety of a topical insect repellent (picaridin) during community mass use for malaria control in rural Cambodia. PLoS One 2017; 12:e0172566. [PMID: 28339462 PMCID: PMC5365103 DOI: 10.1371/journal.pone.0172566] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 01/31/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND While community distribution of topical repellents has been proposed as an additional malaria control intervention, the safety of this intervention at the population level remains poorly evaluated. We describe the safety of mass distribution of the picaridin repellent during a cluster-randomised trial in rural Cambodia in 2012-2013. METHODS The repellent was distributed among 57 intervention villages with around 25,000 inhabitants by a team of village distributors. Information on individual adverse events, reported by phone by the village distributors, was obtained through home visits. Information on perceived side effects, reported at the family level, was obtained during two-weekly bottle exchange. Adverse events were classified as adverse reactions (events likely linked to the repellent), cases of repellent abuse and events not related to the repellent use, and classified as per Common Terminology Criteria for Adverse Events. FINDINGS Of the 41 adverse events notified by phone by the village distributors, there were 22 adverse reactions, 11 cases of repellent abuse (6 accidental, 5 suicide attempts) and 8 non-related events. All adverse reactions were mild, occurred in the first few months of use, and mainly manifested as skin conditions. Of the 11 cases of abuse, 2 were moderate and 2 life-threatening. All cases with adverse reactions and repellent abuse recovered completely. 20% of families reported perceived side effects, mainly itching, headache, dizziness and bad smell, but few discontinued repellent use. CONCLUSIONS Adverse reactions and abuse during mass use of picaridin were uncommon and generally mild, supporting the safety of the picaridin repellent for malaria control.
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Affiliation(s)
- Somony Heng
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Vincent Sluydts
- Institute of Tropical Medicine, Antwerp, Belgium
- University of Antwerp, Department of Biology, Antwerp, Belgium
| | - Lies Durnez
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Vanna Mean
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Koh Polo
- Banlong Referral Hospital, Ban Lung City, Ratanakiri Province, Cambodia
| | - Sochantha Tho
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Marc Coosemans
- Institute of Tropical Medicine, Antwerp, Belgium
- University of Antwerp, Department of Biomedical Sciences, Antwerp, Belgium
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Patel RV, Shaeer KM, Patel P, Garmaza A, Wiangkham K, Franks RB, Pane O, Carris NW. EPA-Registered Repellents for Mosquitoes Transmitting Emerging Viral Disease. Pharmacotherapy 2016; 36:1272-1280. [PMID: 27779781 DOI: 10.1002/phar.1854] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In many parts of the United States, mosquitoes were previously nuisance pests. However, they now represent a potential threat in the spread of viral diseases. The Aedes aegypti, Aedes albopictus, and Culex species mosquitoes are endemic to the United States and together may transmit a variety of viral diseases of growing concern, including West Nile virus, chikungunya, dengue fever, and Zika virus. The Centers for Disease Control and Prevention and the Environmental Protection Agency (EPA) recommend N,N-diethyl-meta-toluamide (DEET) as a first-line mosquito repellent, but for patients refusing to use DEET or other conventional repellents, guidance is limited to any EPA-registered product. Therefore, we conducted a systematic review of the literature to identify which EPA-registered personal mosquito repellent provides the best protection from A. aegypti, A. albopictus, and Culex spp. mosquitoes. We abstracted data from 62 published reports of EPA-registered mosquito repellents. The conventional repellent picaridin has the strongest data to support its use as a second-line agent, while IR3535 and oil of lemon eucalyptus are reasonably effective natural products. Citronella, catnip, and 2-undecanone offer limited protection or have limited data. These results can be used by pharmacists and other health care professionals to advise patients on the selection of an EPA-registered mosquito repellent. Regardless of the repellent chosen, it is vital for patients to follow all instructions/precautions in the product labeling to ensure safe and effective use.
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Affiliation(s)
- Radha V Patel
- Department of Pharmacotherapeutics and Clinical Research, University of South Florida College of Pharmacy, Tampa, Florida.,Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Kristy M Shaeer
- Department of Pharmacotherapeutics and Clinical Research, University of South Florida College of Pharmacy, Tampa, Florida.,Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Pooja Patel
- Department of Pharmacotherapeutics and Clinical Research, University of South Florida College of Pharmacy, Tampa, Florida.,Department of Family Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Aleksey Garmaza
- Department of Pharmacotherapeutics and Clinical Research, University of South Florida College of Pharmacy, Tampa, Florida
| | - Kornwalee Wiangkham
- Department of Pharmacotherapeutics and Clinical Research, University of South Florida College of Pharmacy, Tampa, Florida
| | - Rachel B Franks
- Department of Pharmacotherapeutics and Clinical Research, University of South Florida College of Pharmacy, Tampa, Florida.,Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Olivia Pane
- Department of Pharmacotherapeutics and Clinical Research, University of South Florida College of Pharmacy, Tampa, Florida.,Department of Family Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Nicholas W Carris
- Department of Pharmacotherapeutics and Clinical Research, University of South Florida College of Pharmacy, Tampa, Florida.,Department of Family Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida
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Cruz RDSBLC, Batista Filho M, Caminha MDFC, Souza EDS. Protocols on prenatal care for pregnant women with Zika infection and children with microcephaly: nutritional approach. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2016. [DOI: 10.1590/1806-9304201600s100008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract This summary aimed to synthesize the protocol guidelines of Pernambuco, the Ministry of Health and the Centers for Disease Control and Prevention which deal with health care related to Zika virus infection during pregnancy and the preliminary procedures for surveillance on microcephaly cases including nutritional care. With the increase of number of cases on this event since August, 2015, it was necessary to reorganize the prenatal care which is offered to pregnant women, including the protocols in order to reduce the chances of a possible contamination of the virus, to detect previously suspected cases as well as perform follow up on confirmed cases. The gaps in the knowledge of this morbidity, it should be noted that the information and recommendations are subject to revision due to possible incorporation of new knowledge and other evidence, as well as the need for adequacy of surveillance actions in new epidemiological scenarios. It is known that cases of nutritional deficiencies are capable of producing malformation of the Central Nervous System, including microcephaly. In the analysis of the protocols, there were no changes as to the nutritional recommendations already established for the low-risk pregnant women. The authors presented a hypothesis and conceptually, as a prevention measurement, the inclusion of prenatal care to prevent and control isolated or multiple deficiencies associated to microcephaly, such as protein, vitamin A, iodine, folate, B12, vitamin D, biotin, zinc and selenium.
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van Eijk AM, Ramanathapuram L, Sutton PL, Peddy N, Choubey S, Mohanty S, Asokan A, Ravishankaran S, Priya GSL, Johnson JA, Velayutham S, Kanagaraj D, Patel A, Desai N, Tandel N, Sullivan SA, Wassmer SC, Singh R, Pradhan K, Carlton JM, Srivasatava HC, Eapen A, Sharma SK. The use of mosquito repellents at three sites in India with declining malaria transmission: surveys in the community and clinic. Parasit Vectors 2016; 9:418. [PMID: 27465199 PMCID: PMC4963934 DOI: 10.1186/s13071-016-1709-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 07/18/2016] [Indexed: 12/01/2022] Open
Abstract
Background Repellents such as coils, vaporizers, mats and creams can be used to reduce the risk of malaria and other infectious diseases. Although evidence for their effectiveness is limited, they are advertised as providing an additional approach to mosquito control in combination with other strategies, e.g. insecticide-treated nets. We examined the use of repellents in India in an urban setting in Chennai (mainly Plasmodium vivax malaria), a peri-urban setting in Nadiad (both P. vivax and P. falciparum malaria), and a more rural setting in Raurkela (mainly P. falciparum malaria). Methods The use of repellents was examined at the household level during a census, and at the individual level in cross-sectional surveys and among patients visiting a clinic with fever or other symptoms. Factors associated with their use were examined in a multivariate analysis, and the association between malaria and the use of repellents was assessed among survey- and clinic participants. Results Characteristics of participants differed by region, with more people of higher education present in Chennai. Use of repellents varied between 56–77 % at the household level and between 32–78 % at the individual level. Vaporizers were the main repellents used in Chennai, whereas coils were more common in Nadiad and Raurkela. In Chennai and Nadiad, vaporizers were more likely to be used in households with young male children. Vaporizer use was associated with higher socio-economic status (SES) in households in Chennai and Nadiad, whereas use of coils was greater in the lower SES strata. In Raurkela, there was a higher use of coils among the higher SES strata. Education was associated with the use of a repellent among survey participants in Chennai and clinic study participants in Chennai and Nadiad. Repellent use was associated with less malaria in the clinic study in Chennai and Raurkela, but not in the surveys, with the exception of the use of coils in Nadiad. Conclusions Repellents are widely used in India. Their use is influenced by the level of education and SES. Information on effectiveness and guidance on choices may improve rational use. Electronic supplementary material The online version of this article (doi:10.1186/s13071-016-1709-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Maria van Eijk
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, 10003, USA.
| | - Lalitha Ramanathapuram
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, 10003, USA
| | - Patrick L Sutton
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, 10003, USA.,Acsel Health, 500 5th Ave, Suite 2760, New York, NY, 10110, USA
| | - Nandini Peddy
- Jigyansha, International Center of Excellence for Malaria Research, Sector 1, Raurkela, Odisha, India
| | - Sandhya Choubey
- Jigyansha, International Center of Excellence for Malaria Research, Sector 1, Raurkela, Odisha, India
| | - Stuti Mohanty
- Jigyansha, International Center of Excellence for Malaria Research, Sector 1, Raurkela, Odisha, India
| | - Aswin Asokan
- National Institute of Malaria Research Field Unit, Indian Council of Medical Research, National Institute of Epidemiology Campus, Ayapakkam, Chennai, Tamil Nadu, India
| | - Sangamithra Ravishankaran
- National Institute of Malaria Research Field Unit, Indian Council of Medical Research, National Institute of Epidemiology Campus, Ayapakkam, Chennai, Tamil Nadu, India
| | - G Sri Lakshmi Priya
- National Institute of Malaria Research Field Unit, Indian Council of Medical Research, National Institute of Epidemiology Campus, Ayapakkam, Chennai, Tamil Nadu, India
| | - Justin Amala Johnson
- National Institute of Malaria Research Field Unit, Indian Council of Medical Research, National Institute of Epidemiology Campus, Ayapakkam, Chennai, Tamil Nadu, India
| | - Sangeetha Velayutham
- National Institute of Malaria Research Field Unit, Indian Council of Medical Research, National Institute of Epidemiology Campus, Ayapakkam, Chennai, Tamil Nadu, India
| | - Deena Kanagaraj
- National Institute of Malaria Research Field Unit, Indian Council of Medical Research, National Institute of Epidemiology Campus, Ayapakkam, Chennai, Tamil Nadu, India
| | - Ankita Patel
- National Institute of Malaria Research Field Unit, Civil Hospital, Nadiad, Gujarat, India
| | - Nisha Desai
- National Institute of Malaria Research Field Unit, Civil Hospital, Nadiad, Gujarat, India
| | - Nikunj Tandel
- National Institute of Malaria Research Field Unit, Civil Hospital, Nadiad, Gujarat, India
| | - Steven A Sullivan
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, 10003, USA
| | - Samuel C Wassmer
- London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Ranveer Singh
- National Institute of Malaria Research Field Unit, Civil Hospital, Nadiad, Gujarat, India
| | - K Pradhan
- Jigyansha, International Center of Excellence for Malaria Research, Sector 1, Raurkela, Odisha, India
| | - Jane M Carlton
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, 10003, USA
| | - H C Srivasatava
- National Institute of Malaria Research Field Unit, Civil Hospital, Nadiad, Gujarat, India
| | - Alex Eapen
- National Institute of Malaria Research Field Unit, Indian Council of Medical Research, National Institute of Epidemiology Campus, Ayapakkam, Chennai, Tamil Nadu, India
| | - S K Sharma
- National Institute of Malaria Research, Indian Council of Medical Research, Dwarka Sector 8, New Delhi, India
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Panchaud A, Stojanov M, Ammerdorffer A, Vouga M, Baud D. Emerging Role of Zika Virus in Adverse Fetal and Neonatal Outcomes. Clin Microbiol Rev 2016; 29:659-94. [PMID: 27281741 PMCID: PMC4978612 DOI: 10.1128/cmr.00014-16] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The rapid spread of the Zika virus (ZIKV) in the Americas and its potential association with thousands of suspected cases of microcephaly in Brazil and higher rates of Guillain-Barré syndrome meet the conditions for a Public Health Emergency of International Concern, as stated by the World Health Organization in February 2016. Two months later, the Centers for Disease Control and Prevention (CDC) announced that the current available evidence supports the existence of a causal relationship between prenatal Zika virus infection and microcephaly and other serious brain anomalies. Microcephaly can be caused by several factors, and its clinical course and prognosis are difficult to predict. Other pathogens with proven teratogenicity have been identified long before the current ZIKV epidemic. Despite the growing number of cases with maternal signs of infection and/or presence of ZIKV in tissues of affected newborns or fetuses, it is currently difficult to assess the magnitude of increase of microcephaly prevalence in Brazil, as well as the role of other factors in the development of congenital neurological conditions. Meanwhile, health agencies and medical organizations have issued cautious guidelines advising health care practitioners and expectant couples traveling to, returning from, or living in affected areas. Analogous to dengue virus (DENV) epidemics, ZIKV has the potential to become endemic in all countries infested by Aedes mosquitoes, while new mutations could impact viral replication in humans, leading to increased virulence and consequently heightened chances of viral transmission to additional naive mosquito vectors. Studies are urgently needed to answer the questions surrounding ZIKV and its role in congenital neurological conditions.
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Affiliation(s)
- Alice Panchaud
- School of Pharmaceutical Sciences, University of Geneva and University of Lausanne, Geneva, Switzerland Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA Swiss Teratogen Information Service and Division of Clinical Pharmacology, University of Lausanne and University Hospital, Lausanne, Switzerland
| | - Miloš Stojanov
- Institute of Microbiology, Faculty of Biology and Medicine, University of Lausanne and University Hospital, Lausanne, Switzerland Materno-fetal and Obstetrics Research Unit, Department Femme-Mère-Enfant, University of Lausanne and University Hospital, Lausanne, Switzerland
| | - Anne Ammerdorffer
- Institute of Microbiology, Faculty of Biology and Medicine, University of Lausanne and University Hospital, Lausanne, Switzerland Materno-fetal and Obstetrics Research Unit, Department Femme-Mère-Enfant, University of Lausanne and University Hospital, Lausanne, Switzerland
| | - Manon Vouga
- Institute of Microbiology, Faculty of Biology and Medicine, University of Lausanne and University Hospital, Lausanne, Switzerland Materno-fetal and Obstetrics Research Unit, Department Femme-Mère-Enfant, University of Lausanne and University Hospital, Lausanne, Switzerland
| | - David Baud
- Institute of Microbiology, Faculty of Biology and Medicine, University of Lausanne and University Hospital, Lausanne, Switzerland Materno-fetal and Obstetrics Research Unit, Department Femme-Mère-Enfant, University of Lausanne and University Hospital, Lausanne, Switzerland
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Patel D, Field V, Schlagenhauf P. Countdown to the 2016 Olympic Games: A travel medicine checklist. Travel Med Infect Dis 2016; 14:173-6. [DOI: 10.1016/j.tmaid.2016.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022]
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Wong SSY, Poon RWS, Wong SCY. Zika virus infection-the next wave after dengue? J Formos Med Assoc 2016; 115:226-42. [PMID: 26965962 DOI: 10.1016/j.jfma.2016.02.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 02/17/2016] [Indexed: 01/10/2023] Open
Abstract
Zika virus was initially discovered in east Africa about 70 years ago and remained a neglected arboviral disease in Africa and Southeast Asia. The virus first came into the limelight in 2007 when it caused an outbreak in Micronesia. In the ensuing decade, it spread widely in other Pacific islands, after which its incursion into Brazil in 2015 led to a widespread epidemic in Latin America. In most infected patients the disease is relatively benign. Serious complications include Guillain-Barré syndrome and congenital infection which may lead to microcephaly and maculopathy. Aedes mosquitoes are the main vectors, in particular, Ae. aegypti. Ae. albopictus is another potential vector. Since the competent mosquito vectors are highly prevalent in most tropical and subtropical countries, introduction of the virus to these areas could readily result in endemic transmission of the disease. The priorities of control include reinforcing education of travellers to and residents of endemic areas, preventing further local transmission by vectors, and an integrated vector management programme. The container habitats of Ae. aegypti and Ae. albopictus means engagement of the community and citizens is of utmost importance to the success of vector control.
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Affiliation(s)
- Samson Sai-Yin Wong
- Department of Microbiology, Research Centre for Infection and Immunology, Faculty of Medicine, The University of Hong Kong, Hong Kong.
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Alpern JD, Dunlop SJ, Dolan BJ, Stauffer WM, Boulware DR. Personal Protection Measures Against Mosquitoes, Ticks, and Other Arthropods. Med Clin North Am 2016; 100:303-16. [PMID: 26900115 DOI: 10.1016/j.mcna.2015.08.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Arthropod-associated diseases are a major cause of morbidity among travelers. Obtaining a detailed travel itinerary and understanding traveler-specific and destination-specific risk factors can help mitigate the risk of vector-borne diseases. DEET, picaridin, PMD, and IR3535 are insect repellents that offer sufficient protection against arthropod bites. IR3535 does not provide adequate protection against Anopheles mosquitoes, and should be avoided in malaria-endemic regions. General protective measures, such as bite avoidance, protective clothing, insecticide-treated bed nets, and insecticide-treated clothing, should be recommended, especially in malaria-endemic areas. Spatial repellents may prevent nuisance biting, but have not been shown to prevent against vector-borne disease.
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Affiliation(s)
- Jonathan D Alpern
- Division of Infectious Disease & International Medicine, University of Minnesota, 420 Delaware Street SE, MMC 250 Mayo, Minneapolis, MN 55455, USA.
| | - Stephen J Dunlop
- Department of Emergency Medicine, Hennepin County Medical Center, University of Minnesota, 701 Park Avenue, Minneapolis, MN 55415, USA
| | - Benjamin J Dolan
- Department of Emergency Medicine, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN 55415, USA
| | - William M Stauffer
- Division of Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, 420 Delaware Street Southeast, 133 Variety Club Research Center, MMC 284, Minneapolis, MN 55455, USA
| | - David R Boulware
- Infectious Disease & International Medicine, Department of Medicine, University of Minnesota, MTRF 3-222, 2001 6th Street Southeast, Minneapolis, MN 55455, USA
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Diaz JH. Chemical and Plant-Based Insect Repellents: Efficacy, Safety, and Toxicity. Wilderness Environ Med 2016; 27:153-63. [PMID: 26827259 DOI: 10.1016/j.wem.2015.11.007] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/17/2015] [Accepted: 11/18/2015] [Indexed: 12/22/2022]
Abstract
Most emerging infectious diseases today are arthropod-borne and cannot be prevented by vaccinations. Because insect repellents offer important topical barriers of personal protection from arthropod-borne infectious diseases, the main objectives of this article were to describe the growing threats to public health from emerging arthropod-borne infectious diseases, to define the differences between insect repellents and insecticides, and to compare the efficacies and toxicities of chemical and plant-derived insect repellents. Internet search engines were queried with key words to identify scientific articles on the efficacy, safety, and toxicity of chemical and plant-derived topical insect repellants and insecticides to meet these objectives. Data sources reviewed included case reports; case series; observational, longitudinal, and surveillance studies; and entomological and toxicological studies. Descriptive analysis of the data sources identified the most effective application of insect repellents as a combination of topical chemical repellents, either N-diethyl-3-methylbenzamide (formerly N, N-diethyl-m-toluamide, or DEET) or picaridin, and permethrin-impregnated or other pyrethroid-impregnated clothing over topically treated skin. The insecticide-treated clothing would provide contact-level insecticidal effects and provide better, longer lasting protection against malaria-transmitting mosquitoes and ticks than topical DEET or picaridin alone. In special cases, where environmental exposures to disease-transmitting ticks, biting midges, sandflies, or blackflies are anticipated, topical insect repellents containing IR3535, picaridin, or oil of lemon eucalyptus (p-menthane-3, 8-diol or PMD) would offer better topical protection than topical DEET alone.
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Affiliation(s)
- James H Diaz
- Schools of Public Health and Medicine, Louisiana State University, Health Sciences Center, New Orleans, LA.
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Wilson ME, Schlagenhauf P. Aedes and the triple threat of DENV, CHIKV, ZIKV – Arboviral risks and prevention at the 2016 Rio Olympic games. Travel Med Infect Dis 2016; 14:1-4. [DOI: 10.1016/j.tmaid.2016.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 01/27/2016] [Indexed: 10/22/2022]
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Martinez E, Vélez SM, Mayo M, Sastre MP. Acute toxicity assessment of N,N-diethyl-m-toluamide (DEET) on the oxygen flux of the dinoflagellate Gymnodinium instriatum. ECOTOXICOLOGY (LONDON, ENGLAND) 2016; 25:248-252. [PMID: 26467804 DOI: 10.1007/s10646-015-1564-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/02/2015] [Indexed: 06/05/2023]
Abstract
Despite the ubiquitous occurrence of N,N-diethyl-m-toluamide (DEET) in aquatic systems, assessments evaluating the toxicity of DEET on phytoplankton species are summed to a single study on a unicellular green alga. In particular, the toxicological effects of DEET in dinoflagellates are unknown. In this study, we employed the mixotrophic dinoflagellate Gymnodinium instriatum as a study system to evaluate acute effects of DEET on the oxygen flux of laboratory cultures. This study reports an inhibitory reaction model of DEET described by the equation y = 4.99x(0.54), where y represents the percent inhibition of oxygen flux and x represents DEET concentration in mg L(−1) (r(2) = 0.98). Based on this model, the effective concentration of DEET needed to reduce O2 flux by 50% (EC50) for this species was found to be at 72.9 mg L(−1). The reported EC50 is more than five times lower than the EC50 reported previously for the unicellular green algae Chlorella protothecoides. This study raises the question of the potential toxicological effects of DEET in dinoflagellates, in particular those populations inhabiting systems characterized by low water circulation such as enclosed bays and lagoons.
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Joy E, Van Baak K, Dec KL, Semakula B, Cardin AD, Lemery J, Wortley GC, Yaron M, Madden C. Wilderness Preparticipation Evaluation and Considerations for Special Populations. Wilderness Environ Med 2015; 26:S76-91. [PMID: 26617382 DOI: 10.1016/j.wem.2015.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Children, older adults, disabled and special needs athletes, and female athletes who participate in outdoor and wilderness sports and activities each face unique risks. For children and adolescents traveling to high altitude, the preparticipation physical evaluation should focus on risk assessment, prevention strategies, early recognition of altitude-related symptoms, management plans, and appropriate follow-up. As the risk and prevalence of chronic disease increases with age, both older patients and providers need to be aware of disease and medication-specific risks relative to wilderness sport and activity participation. Disabled and special needs athletes benefit from careful pre-event planning for the potential medical issues and equipment modifications that may affect their health in wilderness environments. Issues that demand special consideration for female adventurers include pregnancy, contraceptive use, menses, and ferritin levels at altitude. A careful preparticipation evaluation that factors in unique, population- specific risks will help special populations stay healthy and safe on wilderness adventures. The PubMed and SportDiscus databases were searched in 2014 using both MeSH terms and text words and include peer-reviewed English language articles from 1977 to 2014. Additional information was accessed from Web-based sources to produce this narrative review on preparticipation evaluation for special populations undertaking wilderness adventures. Key words include children, adolescent, pediatric, seniors, elderly, disabled, special needs, female, athlete, preparticipiation examination, wilderness medicine, and sports.
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Affiliation(s)
- Elizabeth Joy
- Clinical Outcomes Research, Intermountain Healthcare, Salt Lake City, Utah (Dr Joy).
| | - Karin Van Baak
- Department of Family Medicine, University of Colorado, Denver, Colorado (Dr Van Baak)
| | | | - Barbara Semakula
- Anne Arundel Medical Center, Orthopedic and Sports Medicine Center, Annapolis, Maryland (Dr Semakula)
| | - Ashlea D Cardin
- Missouri State University, Springfield, Missouri (Dr Cardin)
| | - Jay Lemery
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado (Drs Lemery and Yaron)
| | - George C Wortley
- Big Island Family Medicine Center, Lynchburg, Virginia (Dr Wortley)
| | - Michael Yaron
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado (Drs Lemery and Yaron)
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Abstract
Children, older adults, disabled and special needs athletes, and female athletes who participate in outdoor and wilderness sports and activities each face unique risks. For children and adolescents traveling to high altitude, the preparticipation physical evaluation should focus on risk assessment, prevention strategies, early recognition of altitude-related symptoms, management plans, and appropriate follow-up. As the risk and prevalence of chronic disease increases with age, both older patients and providers need to be aware of disease and medication-specific risks relative to wilderness sport and activity participation. Disabled and special needs athletes benefit from careful pre-event planning for the potential medical issues and equipment modifications that may affect their health in wilderness environments. Issues that demand special consideration for female adventurers include pregnancy, contraceptive use, menses, and ferritin levels at altitude. A careful preparticipation evaluation that factors in unique, population-specific risks will help special populations stay healthy and safe on wilderness adventures. The PubMed and SportDiscus databases were searched in 2014 using both MeSH terms and text words and include peer-reviewed English language articles from 1977 to 2014. Additional information was accessed from Web-based sources to produce this narrative review on preparticipation evaluation for special populations undertaking wilderness adventures. Key words include children, adolescent, pediatric, seniors, elderly, disabled, special needs, female, athlete, preparticipiation examination, wilderness medicine, and sports.
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Käser AK, Arguin PM, Chiodini PL, Smith V, Delmont J, Jiménez BC, Färnert A, Kimura M, Ramharter M, Grobusch MP, Schlagenhauf P. Imported malaria in pregnant women: A retrospective pooled analysis. Travel Med Infect Dis 2015; 13:300-10. [PMID: 26227740 PMCID: PMC4627431 DOI: 10.1016/j.tmaid.2015.06.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/26/2015] [Accepted: 06/26/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Data on imported malaria in pregnant women are scarce. METHOD A retrospective, descriptive study of pooled data on imported malaria in pregnancy was done using data from 1991 to 2014 from 8 different collaborators in Europe, the United States and Japan. National malaria reference centres as well as specialists on this topic were asked to search their archives for cases of imported malaria in pregnancy. A total of 631 cases were collated, providing information on Plasmodium species, region of acquisition, nationality, country of residence, reason for travel, age, gestational age, prophylactic measures and treatment used, as well as on complications and outcomes in mother and child. RESULTS Datasets from some sources were incomplete. The predominant Plasmodium species was P. falciparum (78.5% of cases). Among the 542 cases where information on the use of chemoprophylaxis was known, 464 (85.6%) did not use chemoprophylaxis. The main reason for travelling was "visiting friends and relatives" VFR (57.8%) and overall, most cases of malaria were imported from West Africa (57.4%). Severe anaemia was the most frequent complication in the mother. Data on offspring outcome were limited, but spontaneous abortion was a frequently reported foetal outcome (n = 14). A total of 50 different variants of malaria treatment regimens were reported. CONCLUSIONS Imported cases of malaria in pregnancy are mainly P. falciparum acquired in sub-Saharan Africa. Malaria prevention and treatment in pregnant travellers is a challenge for travel medicine due to few data on medication safety and maternal and foetal outcomes. International, collaborative efforts are needed to capture standardized data on imported malaria cases in pregnant women.
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Affiliation(s)
- Annina K Käser
- University of Zürich Travel Clinic, Infectious Diseases, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Paul M Arguin
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Peter L Chiodini
- Public Health England, Malaria Reference Laboratory, London School of Hygiene & Tropical Medicine, London, UK; Department of Clinical Parasitology, Hospital for Tropical Diseases, University College London Hospitals, NHS Foundation Trust, London, UK
| | - Valerie Smith
- Public Health England, Malaria Reference Laboratory, London School of Hygiene & Tropical Medicine, London, UK
| | - Jean Delmont
- University Hospital Institute for Infectious and Tropical Diseases, Hospital Nord, AP-HM, Marseille, France
| | - Beatriz C Jiménez
- Department of Internal Medicine, University Hospital Fuenlabrada, Madrid, Spain
| | - Anna Färnert
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Mikio Kimura
- Department of Internal Medicine, Shin-Yamanote Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Michael Ramharter
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria; Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Martin P Grobusch
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - Patricia Schlagenhauf
- University of Zürich Travel Clinic, Infectious Diseases, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland.
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48
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Abstract
Arthropod-borne bacterial diseases affect more than 25,000 Americans every year and thousands more around the world. These infections present a diagnostic dilemma for clinicians because they mimic many other pathologic conditions and are often low on or absent from the differential diagnosis list. Diagnosis is particularly challenging during pregnancy, as these infections may mimic common pregnancy-specific conditions, such as typical and atypical preeclampsia, or symptoms of pregnancy itself. Concerns regarding the safety in pregnancy of some indicated antibiotics add a therapeutic challenge for the prescriber, requiring knowledge of alternative therapeutic options for many arthropod-borne bacterial diseases. Physicians, especially those in endemic areas, must keep this class of infections in mind, particularly when the presentation does not appear classic for more commonly seen conditions. This article discusses presentation, diagnosis, and treatment of the most common of these arthropod-borne bacterial diseases, including Lyme disease, Rocky Mountain spotted fever, tick-borne relapsing fever, typhus, plague, cat-scratch disease, and Carrión disease.
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49
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Radeva‐Petrova D, Kayentao K, ter Kuile FO, Sinclair D, Garner P. Drugs for preventing malaria in pregnant women in endemic areas: any drug regimen versus placebo or no treatment. Cochrane Database Syst Rev 2014; 2014:CD000169. [PMID: 25300703 PMCID: PMC4498495 DOI: 10.1002/14651858.cd000169.pub3] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pregnancy increases the risk of malaria and this is associated with poor health outcomes for both the mother and the infant, especially during the first or second pregnancy. To reduce these effects, the World Health Organization recommends that pregnant women living in malaria endemic areas sleep under insecticide-treated bednets, are treated for malaria illness and anaemia, and receive chemoprevention with an effective antimalarial drug during the second and third trimesters. OBJECTIVES To assess the effects of malaria chemoprevention given to pregnant women living in malaria endemic areas on substantive maternal and infant health outcomes. We also summarised the effects of intermittent preventive treatment with sulfadoxine-pyrimethamine (SP) alone, and preventive regimens for Plasmodium vivax. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS, and reference lists up to 1 June 2014. SELECTION CRITERIA Randomized controlled trials (RCTs) and quasi-RCTs of any antimalarial drug regimen for preventing malaria in pregnant women living in malaria-endemic areas compared to placebo or no intervention. In the mother, we sought outcomes that included mortality, severe anaemia, and severe malaria; anaemia, haemoglobin values, and malaria episodes; indicators of malaria infection, and adverse events. In the baby, we sought foetal loss, perinatal, neonatal and infant mortality; preterm birth and birthweight measures; and indicators of malaria infection. We included regimens that were known to be effective against the malaria parasite at the time but may no longer be used because of parasite drug resistance. DATA COLLECTION AND ANALYSIS Two review authors applied inclusion criteria, assessed risk of bias and extracted data. Dichotomous outcomes were compared using risk ratios (RR), and continuous outcomes using mean differences (MD); both are presented with 95% confidence intervals (CI). We assessed the quality of evidence using the GRADE approach. MAIN RESULTS Seventeen trials enrolling 14,481 pregnant women met our inclusion criteria. These trials were conducted between 1957 and 2008, in Nigeria (three trials), The Gambia (three trials), Kenya (three trials), Mozambique (two trials), Uganda (two trials), Cameroon (one trial), Burkina Faso (one trial), and Thailand (two trials). Six different antimalarials were evaluated against placebo or no intervention; chloroquine (given weekly), pyrimethamine (weekly or monthly), proguanil (daily), pyrimethamine-dapsone (weekly or fortnightly), and mefloquine (weekly), or intermittent preventive therapy with SP (given twice, three times or monthly). Trials recruited women in their first or second pregnancy (eight trials); only multigravid women (one trial); or all women (eight trials). Only six trials had adequate allocation concealment.For women in their first or second pregnancy, malaria chemoprevention reduces the risk of moderate to severe anaemia by around 40% (RR 0.60, 95% CI 0.47 to 0.75; three trials, 2503 participants, high quality evidence), and the risk of any anaemia by around 17% (RR 0.83, 95% CI 0.74 to 0.93; five trials,, 3662 participants, high quality evidence). Malaria chemoprevention reduces the risk of antenatal parasitaemia by around 61% (RR 0.39, 95% CI 0.26 to 0.58; seven trials, 3663 participants, high quality evidence), and two trials reported a reduction in febrile illness (low quality evidence). There were only 16 maternal deaths and these trials were underpowered to detect an effect on maternal mortality (very low quality evidence).For infants of women in their first and second pregnancies, malaria chemoprevention probably increases mean birthweight by around 93 g (MD 92.72 g, 95% CI 62.05 to 123.39; nine trials, 3936 participants, moderate quality evidence), reduces low birthweight by around 27% (RR 0.73, 95% CI 0.61 to 0.87; eight trials, 3619 participants, moderate quality evidence), and reduces placental parasitaemia by around 46% (RR 0.54, 95% CI 0.43 to 0.69; seven trials, 2830 participants, high quality evidence). Fewer trials evaluated spontaneous abortions, still births, perinatal deaths, or neonatal deaths, and these analyses were underpowered to detect clinically important differences.In multigravid women, chemoprevention has similar effects on antenatal parasitaemia (RR 0.38, 95% CI 0.28 to 0.50; three trials, 977 participants, high quality evidence)but there are too few trials to evaluate effects on other outcomes.In trials giving chemoprevention to all pregnant women irrespective of parity, the average effects of chemoprevention measured in all women indicated it may prevent severe anaemia (defined by authors, but at least < 8 g/L: RR 0.19, 95% CI 0.05 to 0.75; two trials, 1327 participants, low quality evidence), but consistent benefits have not been shown for other outcomes.In an analysis confined only to intermittent preventive therapy with SP, the estimates of effect and the quality of the evidence were similar.A summary of a single trial in Thailand of prophylaxis against P. vivax showed chloroquine prevented vivax infection (RR 0.01, 95% CI 0.00 to 0.20; one trial, 942 participants). AUTHORS' CONCLUSIONS Routine chemoprevention to prevent malaria and its consequences has been extensively tested in RCTs, with clinically important benefits on anaemia and parasitaemia in the mother, and on birthweight in infants.
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Affiliation(s)
- Denitsa Radeva‐Petrova
- Liverpool School of Tropical MedicineChild & Reproductive Health GroupPembroke PlaceLiverpoolUKL3 5QA
| | - Kassoum Kayentao
- Liverpool School of Tropical MedicineChild & Reproductive Health GroupPembroke PlaceLiverpoolUKL3 5QA
- University of Sciences, Techniques, and Technologies of BamakoBamakoMali
| | - Feiko O ter Kuile
- Liverpool School of Tropical MedicineChild & Reproductive Health GroupPembroke PlaceLiverpoolUKL3 5QA
| | - David Sinclair
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesPembroke PlaceLiverpoolUKL3 5QA
| | - Paul Garner
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesPembroke PlaceLiverpoolUKL3 5QA
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50
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Friedman EE, Dallah F, Harville EW, Myers L, Buekens P, Breart G, Carles G. Symptomatic Dengue infection during pregnancy and infant outcomes: a retrospective cohort study. PLoS Negl Trop Dis 2014; 8:e3226. [PMID: 25299383 PMCID: PMC4191958 DOI: 10.1371/journal.pntd.0003226] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 08/27/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Dengue is a mosquito-borne disease that is common in many tropical and subtropical areas. Dengue infections can occur at any age and time in the lifespan, including during pregnancy. Few large scale studies have been conducted to determine the risk of preterm birth (PTB) and low birthweight (LBW) for infants born to women who had symptomatic dengue infection during pregnancy. METHODOLOGY/PRINCIPAL FINDINGS This study is a retrospective cohort study using medical records from 1992-2010 from pregnant women who attended a public regional referral hospital in western French Guiana. Exposed pregnancies were those with laboratory confirmed cases of dengue fever during pregnancy. Each of the 86 exposed infants was matched to the three unexposed births that immediately followed them to form a stratum. Conditional logistic regression was used to analyze these matched strata. Three groups were examined: all infants regardless of gestational age, only infants> = 17 weeks of gestational age and their strata, and only infants> = 22 weeks of age and their strata. Odds ratios were adjusted (aOR) for maternal age, maternal ethnicity, maternal gravidity, interpregnancy interval and maternal anemia. There was an increased risk of PTB among women with symptomatic dengue; (aOR all infants: 3.34 (1.13, 9.89), aOR 17 weeks: 1.89 (0.61, 5.87), aOR 22 weeks: 1.41 (0.39, 5.20)) but this risk was only statistically significant when all infants were examined (p value = 0.03). Adjusted results for LBW were similar, with an increased risk in the exposed group (aOR All infants: 2.23 (1.01, 4.90), aOR 17 weeks: 1.67 (0.71, 3.93), aOR 22 weeks: 1.43 (0.56, 3.70)) which was only statistically significant when all infants were examined (p value = 0.05). CONCLUSIONS/SIGNIFICANCE Symptomatic dengue infection during pregnancy may increase the risk of PTB and LBW for infants. More research is needed to confirm these results and to examine the role of dengue fever in miscarriage.
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Affiliation(s)
- Eleanor E. Friedman
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
| | - Fadi Dallah
- Franck Joly Hospital, St. Laurent du Maroni, French Guiana, France
| | - Emily W. Harville
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
| | - Leann Myers
- Department of Biostatistics and Bioinformatics, Tulane School of Public Health and Tropical Medicine, New Orleans Louisiana, United States of America
| | - Pierre Buekens
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
| | | | - Gabriel Carles
- Franck Joly Hospital, St. Laurent du Maroni, French Guiana, France
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