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(Annals of Internal Medicine | 1 June 1998 | Volume 128 Issue 11 | Pages \
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( )Tj
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(This paper is intended to provide the clinician with the detailed and sc\
ientific information needed to )Tj
0 -1.2 TD
(advise patients who seek safe and effective ways of preventing mosquito \
bites. For this review, clinical )Tj
0 -1.2 TD
(and analytical data were selected from peer-reviewed research studies an\
d review articles, case reports, )Tj
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(entomology texts and journals, and government and industry publications.\
Relevant information was )Tj
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(identified through a search of the MEDLINE database, the World Wide Web,\
the Mosquito-L electronic )Tj
0 -1.2 TD
(mailing list, and the Extension Toxicology Network database; selected U.\
S. Army, U.S. Environmental )Tj
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(Protection Agency, and U.S. Department of Agriculture publications were \
also reviewed. )Tj
0 -1.1 TD
( )Tj
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(N,N-diethyl-3-methylbenzamide \(DEET\) is the most effective, and best s\
tudied, insect repellent )Tj
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(currently on the market. This substance has a remarkable safety profile \
after 40 years of worldwide use, )Tj
T*
(but toxic reactions can occur \(usually when the product is misused\). W\
hen DEET-based repellents are )Tj
T*
(applied in combination with permethrin-treated clothing, protection agai\
nst bites of nearly 100% can be )Tj
0 -1.2 TD
(achieved. Plant-based repellents are generally less effective than DEET-\
based products. Ultrasonic )Tj
0 -1.2 TD
(devices, outdoor bug "zappers," and bat houses are not effective against\
mosquitoes. Highly sensitive )Tj
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(persons may want to take oral antihistamines to minimize cutaneous react\
ions to mosquito bites. )Tj
0 -1.1 TD
( )Tj
T*
(The quest to make humans less attractive to mosquitoes has fueled decade\
s of scientific research on )Tj
0 -1.2 TD
(mosquito behavior and control. In the United States, mosquito bites are \
mostly a nuisance. Worldwide, )Tj
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(however, mosquitoes transmit disease to more than 700 000 000 people ann\
ually and will be responsible )Tj
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(for the deaths of 1 of every 17 people currently alive )Tj
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(. Malaria results from infection with a protozoan )Tj
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(carried by mosquitoes and, according to reports from the World Health Or\
ganization, causes as many as )Tj
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(3 000 000 deaths annually )Tj
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(. Mosquitoes transmit the arboviruses responsible for yellow fever, deng\
ue )Tj
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(hemorrhagic fever, epidemic polyarthritis, and several forms of encephal\
itis \(some of which are found in )Tj
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(the United States\). Bancroftian filariasis is caused by a nematode tran\
smitted by mosquito bite. )Tj
0 -1.1 TD
( )Tj
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(Historically, the strategies for reducing the incidence of mosquito-born\
e disease have been two-pronged, )Tj
0 -1.2 TD
(centering around habitat control \(through chemical and biological means\
\) and the use of personal )Tj
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(protection in the form of insect repellents. This paper reviews the scie\
ntific data on chemical \(synthetic\) )Tj
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(and natural \(plant-derived\) insect repellents currently available, deb\
unks some of the popular myths )Tj
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(about alternative repellents, reviews effective techniques for reducing \
mosquito populations in the local )Tj
T*
(environment, and provides the clinician with the practical information n\
eeded to advise patients on how )Tj
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(to safely and effectively reduce their likelihood of being bitten by mos\
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( )Tj
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(Methods)Tj
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( )Tj
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/TT0 1 Tf
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( )Tj
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14 0 0 14 10 733.6679 Tm
(By doing a MEDLINE search with the keywords DEET, insect repellents, mos\
quito, citronella, and )Tj
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(permethrin, pertinent articles published in English-language journals be\
tween 1966 and 1997 were )Tj
T*
(identified and reviewed. The World Wide Web and the Extension Toxicity N\
etwork database were also )Tj
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(searched for toxicology data and other pertinent information. Selection \
from the bibliographies of )Tj
0 -1.2 TD
(relevant articles augmented the database search. Major distributors of n\
atural insect repellents were )Tj
T*
(contacted and asked to provide scientific data, if available, supporting\
the efficacy of their products. )Tj
T*
( )Tj
0 0.6 0.51 rg
/TT0 1 Tf
19.3846 0 0 19.3846 13.5 632.8679 Tm
( )Tj
-0.181 -1.002 Td
( )Tj
/TT1 1 Tf
0 -1.073 TD
(The Mosquito Life Cycle)Tj
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( )Tj
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( )Tj
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14 0 0 14 10 554.0371 Tm
(Mosquitoes are found all over the world, except in Antarctica. These two\
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(order Diptera. Members of the genera )Tj
/T1_1 1 Tf
(Anopheles)Tj
/T1_0 1 Tf
(, )Tj
/T1_1 1 Tf
(Culex)Tj
/T1_0 1 Tf
(, and )Tj
/T1_1 1 Tf
(Aedes)Tj
/T1_0 1 Tf
( are most commonly responsible for )Tj
T*
(bites in humans. There are approximately 170 species of mosquitoes in No\
rth America alone. )Tj
0 -1.1 TD
( )Tj
0 -1.1 TD
(To develop, mosquitoes require an environment of standing water. As a gr\
oup, they have adapted to )Tj
0 -1.2 TD
(complete their life cycle in diverse aquatic habitats, including fresh w\
ater; salt water marshes; brackish )Tj
T*
(water; or water found in containers, old tires, or tree holes. The life \
cycle of the mosquito has four )Tj
0 -1.2 TD
(stages. The female mosquito lays her eggs, up to several hundred at a ti\
me, on the surface of the water or )Tj
T*
(in an area subject to flooding. Unhatched eggs of some species can withs\
tand weeks to months of )Tj
T*
(desiccation, remaining viable until the right conditions for hatching oc\
cur. The eggs of most species )Tj
T*
(hatch in 2 to 3 days, and the larvae feed on organic matter in the water\
for about a week until they )Tj
T*
(change into pupae. The pupae live at the surface of the water for 2 to 3\
days before metamorphosing into )Tj
T*
(adult mosquitoes. )Tj
0 -1.1 TD
( )Tj
T*
(Only female mosquitoes bite. Male mosquitoes feed primarily on flower ne\
ctar, whereas female )Tj
0 -1.2 TD
(mosquitoes require a blood meal to produce eggs. They usually feed every\
3 to 4 days; in a single )Tj
T*
(feeding, a female mosquito typically consumes more than its own weight i\
n blood )Tj
ET
0 0 1 RG
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0 0 1 rg
BT
/T1_0 1 Tf
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([3])Tj
0 0 0 rg
(. Certain species of )Tj
-33.053 -1.343 Td
(mosquitoes prefer to feed at twilight or nighttime; others bite mostly d\
uring the day. )Tj
0 -1.1 TD
( )Tj
T*
(Some mosquito species are zoophilic \(preferring to feed on animals\) an\
d others are anthropophilic )Tj
0 -1.2 TD
(\(showing a preference for human blood\). In some mosquito species, seas\
onal switching of hosts )Tj
T*
(provides a mechanism for transmitting diseases from animal to human. \(I\
t is worth noting, however, that )Tj
T*
(mosquitoes cannot transmit HIV because the virus neither survives nor re\
plicates in mosquitoes and the )Tj
0 -1.2 TD
(blood from the last bitten person is not flushed into the next person du\
ring subsequent feeds. In addition, )Tj
T*
(the circulating viral load of most HIV-infected persons is so low that t\
he theoretical risk that a mosquito )Tj
T*
(bite would transmit HIV is estimated to be less than 1 in 10 000 000 )Tj
ET
395.378 138.32 m
425.702 138.32 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 395.378 140.4371 Tm
([4, 5])Tj
0 0 0 rg
(.\) )Tj
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( )Tj
0 0.6 0.51 rg
/TT0 1 Tf
19.3846 0 0 19.3846 13.5 121.6371 Tm
( )Tj
-0.181 -1.002 Td
( )Tj
/TT1 1 Tf
0 -1.073 TD
(Stimuli That Attract Mosquitoes)Tj
/TT0 1 Tf
( )Tj
0 -1.127 TD
( )Tj
0 0 0 rg
/T1_0 1 Tf
14 0 0 14 10 42.8063 Tm
(The factors involved in attracting mosquitoes to a host are complex and \
are not fully understood )Tj
ET
552.038 40.69 m
587.024 40.69 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 552.038 42.8063 Tm
([6-11])Tj
0 0 0 rg
(. )Tj
ET
EMC
/Artifact <>BDC
Q
BT
/T1_0 1 Tf
9 0 0 9 18 7.17 Tm
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(Mosquitoes and Mosquito Repellents)Tj
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/Article <>BDC
q
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W* n
BT
/T1_0 1 Tf
14 0 0 14 10 753.9756 Tm
(Mosquitoes use visual, thermal, and olfactory stimuli to locate a host. \
Of these, olfactory cues are )Tj
0 -1.2 TD
(probably most important. For mosquitoes that feed during the daytime, mo\
vement of the host and the )Tj
T*
(wearing of dark-colored clothing may initiate orientation toward a perso\
n )Tj
ET
0 0 1 RG
0.706 w 10 M 0 j 0 J []0 d
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462.578 718.259 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 425.254 720.3755 Tm
([3, 12])Tj
0 0 0 rg
(. Visual stimuli seem to )Tj
-29.661 -1.343 Td
(be important for in-flight orientation, particularly over long ranges, w\
hereas olfactory stimuli become )Tj
0 -1.2 TD
(more important as a mosquito nears its host. )Tj
0 -1.1 TD
( )Tj
T*
(It has been estimated that 300 to 400 compounds are released from the bo\
dy as by-products of )Tj
0 -1.2 TD
(metabolism and that more than 100 volatile compounds can be detected in \
human breath )Tj
ET
509.268 635.059 m
525.592 635.059 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 509.268 637.1756 Tm
([9])Tj
0 0 0 rg
(. Of these )Tj
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(odors, only a fraction have been isolated and fully characterized. Carbo\
n dioxide and lactic acid are the )Tj
T*
(two best-studied mosquito attractants. Carbon dioxide, released mainly f\
rom breath but also from skin, )Tj
T*
(serves as a long-range airborne attractant and can be detected by mosqui\
toes at distances of up to 36 )Tj
T*
(meters )Tj
ET
50.824 565.859 m
106.81 565.859 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 50.824 567.9756 Tm
([3, 13-15])Tj
0 0 0 rg
(. Lactic acid, in combination with carbon dioxide, is also an attractant\
. Mosquitoes )Tj
-2.916 -1.343 Td
(have chemoreceptors on their antennae that are stimulated by lactic acid\
. These same receptors may be )Tj
T*
(inhibited by N,N-diethyl-3-methyl-benzamide \(DEET\)-based insect repell\
ents )Tj
ET
451.308 530.259 m
474.632 530.259 l
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0 0 1 rg
BT
/T1_0 1 Tf
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([16])Tj
0 0 0 rg
(. )Tj
-31.522 -1.243 Td
( )Tj
0 -1.1 TD
(At close range, skin temperature and moisture serve as attractants )Tj
ET
380.524 497.459 m
431.848 497.459 l
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0 0 1 rg
BT
/T1_0 1 Tf
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([3, 9, 17])Tj
0 0 0 rg
(. Different species of )Tj
-26.466 -1.343 Td
(mosquitoes may show strong biting preferences for different parts of the\
human body \(such as the head )Tj
0 -1.2 TD
(or feet\), which may be related to local skin temperature and eccrine sw\
eat gland output )Tj
ET
500.658 461.859 m
544.982 461.859 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 500.658 463.9756 Tm
([18, 19])Tj
0 0 0 rg
(. )Tj
-35.047 -1.343 Td
(Anhidrotic persons show markedly decreased attractiveness to mosquitoes \
)Tj
ET
429.93 443.059 m
446.254 443.059 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 429.93 445.1756 Tm
([6])Tj
0 0 0 rg
(. Other volatile )Tj
-29.995 -1.343 Td
(compounds, derived from sebum, eccrine and apocrine sweat, or the cutane\
ous microflora bacterial )Tj
T*
(action on these secretions, may also act as chemoattractants )Tj
ET
347.484 407.459 m
405.808 407.459 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 347.484 409.5756 Tm
([6, 20, 21])Tj
0 0 0 rg
(. Whole-host odors are more )Tj
-24.106 -1.343 Td
(attractive than carbon dioxide and lactic acid alone )Tj
ET
298.484 388.659 m
321.808 388.659 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 298.484 390.7756 Tm
([22])Tj
0 0 0 rg
(. Floral fragrances from perfumes, soaps, lotions, )Tj
-20.606 -1.343 Td
(and hair-care products may also attract mosquitoes )Tj
ET
298.106 369.859 m
321.43 369.859 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 298.106 371.9756 Tm
([23])Tj
0 0 0 rg
(. )Tj
-20.579 -1.243 Td
( )Tj
0 -1.1 TD
(The attractiveness of different persons to the same or different species\
of mosquitoes varies substantially )Tj
ET
10 320.259 m
54.324 320.259 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 10 322.3755 Tm
([17, 24])Tj
0 0 0 rg
(. In general, adults are more likely to be bitten than children )Tj
ET
393.376 320.259 m
437.7 320.259 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 393.376 322.3755 Tm
([17, 25])Tj
0 0 0 rg
(, although adults may )Tj
-27.384 -1.343 Td
(become less attractive to mosquitoes as they age )Tj
ET
284.512 301.459 m
300.836 301.459 l
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0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 284.512 303.5756 Tm
([6])Tj
0 0 0 rg
(. Men are bitten more readily than women )Tj
ET
539.956 301.459 m
577.28 301.459 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 539.956 303.5756 Tm
([3, 26])Tj
0 0 0 rg
(. )Tj
-37.854 -1.343 Td
(Larger persons tend to attract more mosquitoes, perhaps because of their\
greater relative heat or carbon )Tj
0 -1.2 TD
(dioxide output )Tj
ET
94.784 265.859 m
118.108 265.859 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 94.784 267.9756 Tm
([27])Tj
0 0 0 rg
(. )Tj
-6.056 -1.243 Td
( )Tj
0 0.6 0.51 rg
/TT0 1 Tf
19.3846 0 0 19.3846 10 232.5487 Tm
( )Tj
/TT1 1 Tf
0 -1.073 TD
(Insect Repellents)Tj
/TT0 1 Tf
( )Tj
0 -1.127 TD
( )Tj
0 0 0 rg
/T1_0 1 Tf
14 0 0 14 10 173.1448 Tm
(Despite the obvious desirability of finding an effective oral mosquito r\
epellent, no such agent has been )Tj
0 -1.2 TD
(identified )Tj
ET
67.162 154.228 m
111.486 154.228 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 67.162 156.3448 Tm
([28, 29])Tj
0 0 0 rg
(. Thus, the search for the perfect topical insect repellent continues. T\
his ideal agent )Tj
-4.083 -1.343 Td
(would repel multiple species of biting arthropods, remain effective for \
at least 8 hours, cause no )Tj
0 -1.2 TD
(irritation to the skin or mucous membranes, cause no systemic toxicity, \
be resistant to abrasion and rub-)Tj
T*
(off, and be greaseless and odorless. No available insect repellent meets\
all of these criteria. )Tj
0 -1.1 TD
( )Tj
T*
(Efforts to find such a compound have been hampered by the numerous varia\
bles that affect the inherent )Tj
0 -1.2 TD
(repellency of any chemical. Repellents do not all share a single mode of\
action, and surprisingly little is )Tj
ET
EMC
/Artifact <>BDC
Q
BT
/T1_0 1 Tf
9 0 0 9 18 7.17 Tm
(file:///C|/My Documents/! Travel Documents/Mosquitoes_and_Mosquito_Repel\
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/T1_0 1 Tf
14 0 0 14 10 753.9756 Tm
(known about how repellents act on their target insects )Tj
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359.552 751.859 l
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0 0 1 rg
BT
/T1_0 1 Tf
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([30, 31])Tj
0 0 0 rg
(. Moreover, different species of )Tj
-21.802 -1.343 Td
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ET
317.944 733.059 m
341.268 733.059 l
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0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 317.944 735.1756 Tm
([32])Tj
0 0 0 rg
(. )Tj
-21.996 -1.243 Td
( )Tj
0 -1.1 TD
(To be effective, a repellent must show an optimal degree of volatility, \
making it possible for an effective )Tj
0 -1.2 TD
(repellent vapor concentration to be maintained at the skin surface witho\
ut evaporating so quickly that it )Tj
T*
(loses its effectiveness. Many factors play a role in how effective any r\
epellent is, including the )Tj
T*
(frequency and uniformity of application, the number and species of the o\
rganisms attempting to bite, the )Tj
T*
(user's inherent attractiveness to blood-sucking arthropods, and the over\
all activity level of the potential )Tj
0 -1.2 TD
(host )Tj
ET
36.838 616.259 m
60.162 616.259 l
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0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 36.838 618.3755 Tm
([33])Tj
0 0 0 rg
(. Abrasion from clothing, evaporation and absorption from the skin surfa\
ce, wash-off from )Tj
-1.917 -1.343 Td
(sweat or rain, higher temperatures, or a windy environment all decrease \
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ET
543.792 597.459 m
588.116 597.459 l
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0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 543.792 599.5756 Tm
([17, 34-)Tj
ET
10 578.659 m
28.662 578.659 l
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BT
/T1_0 1 Tf
14 0 0 14 10 580.7756 Tm
(37])Tj
0 0 0 rg
(. Each 10\260C increase in temperature can lead to as much as a 50% redu\
ction in protection time )Tj
ET
561.096 578.659 m
584.42 578.659 l
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0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 561.096 580.7756 Tm
([37])Tj
0 0 0 rg
(. )Tj
-39.364 -1.343 Td
(The repellents currently available must be applied to all exposed areas \
of skin; unprotected skin a few )Tj
0 -1.2 TD
(centimeters away from a treated area can be attacked by hungry mosquitoe\
s )Tj
ET
437.658 543.059 m
481.982 543.059 l
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0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 437.658 545.1756 Tm
([33, 35])Tj
0 0 0 rg
(. )Tj
-30.547 -1.343 Td
( )Tj
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/TT0 1 Tf
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( )Tj
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( )Tj
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(Chemical Insect Repellents)Tj
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/T1_1 1 Tf
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( )Tj
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( )Tj
0 -1.1 TD
(N,N-Diethyl-3-Methylbenzamide \(DEET\) )Tj
0 -1.1 TD
( )Tj
/T1_0 1 Tf
14 0 0 14 10 415.2371 Tm
(Previously called N,N-diethyl-m-toluamide, N,N-diethyl-3-methylbenzamide\
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0 -1.2 TD
(standard of currently available insect repellents. This substance was di\
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T*
(scientists at the U.S. Department of Agriculture and was patented by the\
U.S. Army in 1946. It was )Tj
0 -1.2 TD
(subsequently registered for use by the general public in 1957. It is a b\
road-spectrum repellent that is )Tj
0 -1.2 TD
(effective against mosquitoes, biting flies, chiggers, fleas, and ticks. \
Twenty years of empirical testing of )Tj
T*
(more than 20 000 other compounds has not resulted in another marketed ch\
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T*
(duration of protection and broad-spectrum effectiveness of DEET )Tj
ET
381.686 312.32 m
465.672 312.32 l
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0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 381.686 314.4371 Tm
([30, 33, 38-41])Tj
0 0 0 rg
(. The U.S. )Tj
-26.549 -1.343 Td
(Environmental Protection Agency \(EPA\) estimates that more than 38% of \
the U.S. population uses a )Tj
T*
(DEET-based insect repellent every year and that worldwide use exceeds 20\
0 000 000 people annually )Tj
ET
10 259.92 m
33.324 259.92 l
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0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 10 262.0371 Tm
([42])Tj
0 0 0 rg
(.)Tj
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/T1_1 1 Tf
( )Tj
0 -1.243 TD
( )Tj
16.1538 0 0 16.1538 10 227.3872 Tm
(Formulation of Available Products with DEET)Tj
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/T1_0 1 Tf
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( )Tj
-23.046 -1.152 Td
( )Tj
0 -1.1 TD
(In the United States, DEET is available in 5% to 100% concentrations in \
multiple formulations, )Tj
0 -1.2 TD
(including solutions, lotions, creams, gels, aerosol and pump sprays, and\
impregnated towelettes. )Tj
0 -1.1 TD
( )Tj
ET
1.347 w
10 142.361 m
326.809 142.361 l
S
0 0 1 rg
BT
/T1_1 1 Tf
16.1538 0 0 16.1538 10 146.4026 Tm
(View Table 1: Repellents That Contain DEET)Tj
0 0 0 rg
/T1_0 1 Tf
14 0 0 14 326.8092 146.4026 Tm
( )Tj
-22.629 -1.295 Td
( )Tj
0 -1.1 TD
(Until 1989, the standard-issue insect repellent of the U.S. military con\
sisted of 75% DEET in an alcohol )Tj
0 -1.2 TD
(base. Complaints about the aesthetic feel of this product and concerns a\
bout potential toxicity under )Tj
0 -1.2 TD
(long-term daily use led to U.S. Army-sponsored studies to produce new fo\
rmulations. The 3M Company )Tj
T*
(\(St. Paul, Minnesota\) developed a slow-release, polymer-based product \
containing 35% DEET; this has )Tj
T*
(become the repellent provided to all U.S. military personnel. This produ\
ct is available to the general )Tj
ET
EMC
/Artifact <>BDC
Q
BT
/T1_0 1 Tf
9 0 0 9 18 7.17 Tm
(file:///C|/My Documents/! Travel Documents/Mosquitoes_and_Mosquito_Repel\
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/T1_0 1 Tf
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(public exclusively through the Amway Corporation \(New York, New York\) \
under the brand name )Tj
0 -1.2 TD
(HourGuard \(Table 1\). If lower-strength formulations of extended-releas\
e DEET are desired, Minnetonka )Tj
T*
(Brands \(Eden Prairie, Minnesota\) offers products containing 6.5% and 1\
0% DEET \(Table 1\).)Tj
0 0.4 0.353 rg
/T1_1 1 Tf
( )Tj
0 -1.1 TD
( )Tj
16.1538 0 0 16.1538 10 687.7256 Tm
(Efficacy )Tj
T*
( )Tj
0 0 0 rg
/T1_0 1 Tf
14 0 0 14 10 654.0371 Tm
(As a general rule, higher concentrations of DEET provide longer-lasting \
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0 -1.2 TD
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DEET is appropriate for their )Tj
T*
(specific needs. The number of variables that affect a repellent's effect\
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0 -1.2 TD
("insect repellent factor" to individual products. )Tj
0 -1.1 TD
( )Tj
T*
(Mathematical models of the effectiveness and persistence of mosquito rep\
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0 -1.2 TD
(protection offered by a repellent is proportional to the logarithm of th\
e dose \(concentration of the )Tj
T*
(product\). This curve tends to form a plateau at higher repellent concen\
trations, providing relatively less )Tj
0 -1.2 TD
(additional protection for each incremental dose of DEET that exceeds a 5\
0% concentration )Tj
ET
0 0 1 RG
0.706 w 10 M 0 j 0 J []0 d
522.82 520.32 m
567.144 520.32 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 522.82 522.4371 Tm
([43, 44])Tj
0 0 0 rg
(. In )Tj
-36.63 -1.343 Td
(one laboratory study, 50% DEET provided about 4 hours of protection agai\
nst )Tj
/T1_2 1 Tf
(Aedes aegypti)Tj
/T1_0 1 Tf
( )Tj
0 -1.2 TD
(mosquitoes, but increasing the DEET concentration to 100% provided only \
1 additional hour of )Tj
T*
(protection )Tj
ET
70.27 467.92 m
93.594 467.92 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 70.27 470.0371 Tm
([45])Tj
0 0 0 rg
(. In another study, 12.5% DEET provided over 6 hours of protection again\
st )Tj
/T1_2 1 Tf
(Aedes )Tj
-4.305 -1.343 Td
(albopictus)Tj
/T1_0 1 Tf
(; doubling the DEET concentration to 25% increased the protection time o\
nly to about 8 hours )Tj
ET
10 432.32 m
33.324 432.32 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 10 434.4371 Tm
([46])Tj
0 0 0 rg
(. )Tj
0 -1.243 TD
( )Tj
0 -1.1 TD
(Extended-release formulations of DEET have made it possible to reduce th\
e repellent concentration )Tj
0 -1.2 TD
(without sacrificing duration of action. When tested under laboratory and\
several different environmental )Tj
T*
(and climatic field conditions, the 35% DEET polymer formulation by the 3\
M Corporation was as )Tj
T*
(effective as 75% DEET in repelling mosquitoes )Tj
ET
281.012 349.12 m
343.998 349.12 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 281.012 351.2371 Tm
([19, 47-50])Tj
0 0 0 rg
(. The polymer formulation provided up to 12 )Tj
-19.358 -1.343 Td
(hours of more than 95% protection, depending on the environmental condit\
ions and species of mosquito )Tj
T*
(tested )Tj
ET
46.162 313.52 m
132.486 313.52 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 46.162 315.6371 Tm
([46, 48, 49, 51])Tj
0 0 0 rg
(. One study showed that Minnetonka Brands' 6.5% liposphere microdispersi\
on of )Tj
-2.583 -1.343 Td
(DEET was effective for up to 2.5 hours and that their 10% product was ef\
fective for about 1 hour longer )Tj
ET
10 277.92 m
33.324 277.92 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 10 280.0371 Tm
([52])Tj
0 0 0 rg
(.)Tj
0 0.4 0.353 rg
/T1_1 1 Tf
( )Tj
0 -1.243 TD
( )Tj
16.1538 0 0 16.1538 10 245.3872 Tm
(How To Choose and Apply DEET Repellents )Tj
0 -1.1 TD
( )Tj
0 0 0 rg
/T1_0 1 Tf
14 0 0 14 10 211.6986 Tm
(For casual use, a high concentration of DEET is not needed. Products wit\
h 10% to 35% DEET will )Tj
0 -1.2 TD
(provide adequate protection under most conditions. The American Academy \
of Pediatrics recommends )Tj
T*
(that repellents used on children contain no more than 10% DEET )Tj
ET
378.998 175.982 m
423.322 175.982 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 378.998 178.0986 Tm
([53, 54])Tj
0 0 0 rg
(. Products with a DEET )Tj
-26.357 -1.343 Td
(concentration of more than 50% are probably best reserved for circumstan\
ces in which insect biting )Tj
0 -1.2 TD
(pressures are intense and in which other factors, such as high temperatu\
re and humidity, may promote )Tj
T*
(rapid loss of repellent from the skin surface. The EPA issued guidelines\
to consumers about proper )Tj
T*
(application of insect repellents )Tj
ET
184.972 106.782 m
208.296 106.782 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 184.972 108.8986 Tm
([55])Tj
0 0 0 rg
(. )Tj
-12.498 -1.243 Td
( )Tj
ET
1.347 w
10 70.207 m
482.92 70.207 l
S
0 0 1 rg
BT
/T1_1 1 Tf
16.1538 0 0 16.1538 10 74.2487 Tm
(View Table 2: Suggested Guidelines for Safe Use of Insect Repellents)Tj
0 0 0 rg
/T1_0 1 Tf
14 0 0 14 482.92 74.2487 Tm
( )Tj
-33.78 -1.295 Td
( )Tj
0 -1.1 TD
(Repellents may be applied directly to the skin or to clothing, window sc\
reens, mesh insect nets, tents, or )Tj
ET
EMC
/Artifact <>BDC
Q
BT
/T1_0 1 Tf
9 0 0 9 18 7.17 Tm
(file:///C|/My Documents/! Travel Documents/Mosquitoes_and_Mosquito_Repel\
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ET
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0 0 0 rg
0 i
BT
/T1_0 1 Tf
0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 9 0 0 9 18 780.17 Tm
(Mosquitoes and Mosquito Repellents)Tj
ET
EMC
/Article <>BDC
q
0 18 612 756 re
W* n
BT
/T1_0 1 Tf
14 0 0 14 10 753.914 Tm
(sleeping bags. Persons who are particularly concerned about potential to\
xicity from DEET may limit )Tj
0 -1.2 TD
(application of the repellent to their clothes. If DEET-treated garments \
are stored in a plastic bag between )Tj
T*
(wearings, the repellent effect can last for many weeks )Tj
ET
0 0 1 RG
0.706 w 10 M 0 j 0 J []0 d
314.794 718.197 m
338.118 718.197 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 314.794 720.314 Tm
([24])Tj
0 0 0 rg
(. )Tj
-21.771 -1.243 Td
( )Tj
0 -1.1 TD
(Repellents containing DEET must be carefully applied because they can da\
mage plastics \(such as watch )Tj
0 -1.2 TD
(crystals and eyeglasses frames\), rayon, spandex, other synthetic fabric\
s, leather, and painted or )Tj
T*
(varnished surfaces. DEET does not damage natural fibers, such as cotton \
or wool, and has no effect on )Tj
T*
(nylon. The lay literature contains many accounts of the unpleasant odor \
or greasy feel of DEET, but )Tj
T*
(careful testing has shown a full spectrum of aesthetic responses to thes\
e products )Tj
ET
466.862 618.197 m
490.186 618.197 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 466.862 620.314 Tm
([56])Tj
0 0 0 rg
(. )Tj
-32.633 -1.243 Td
( )Tj
0 -1.1 TD
(Consumers who apply both a DEET-based insect repellent and a sunscreen s\
hould be aware that the )Tj
0 -1.2 TD
(repellent may reduce the sunscreen's effectiveness. A limited study in 1\
4 volunteers using the 3M )Tj
T*
(polymer-based 33% DEET repellent and a sunscreen with sun protection fac\
tor 15 revealed a mean )Tj
T*
(decrease in sun protection factor of 33.5% when the two agents were appl\
ied sequentially )Tj
ET
515.05 534.997 m
538.374 534.997 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 515.05 537.114 Tm
([57])Tj
0 0 0 rg
(. )Tj
-36.075 -1.343 Td
(Combination products in which the insect repellent and sunscreen have be\
en formulated together, )Tj
T*
(however, would be expected to provide the sun protection factor stated o\
n the label.)Tj
0 0.4 0.353 rg
/T1_1 1 Tf
( )Tj
0 -1.1 TD
( )Tj
16.1538 0 0 16.1538 10 468.8641 Tm
(Pharmacology )Tj
T*
( )Tj
0 0 0 rg
/T1_0 1 Tf
14 0 0 14 10 435.1756 Tm
(Numerous studies have evaluated the percutaneous absorption, metabolism,\
and rate of excretion of )Tj
0 -1.2 TD
(DEET )Tj
ET
49.27 416.259 m
91.256 416.259 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 49.27 418.3755 Tm
([58-61])Tj
0 0 0 rg
(. Initial data suggested that 9% to 56% of the applied dose was absorbed\
through the skin )Tj
ET
10 397.459 m
33.324 397.459 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 10 399.5756 Tm
([59])Tj
0 0 0 rg
(. A carefully conducted study from 1995 that used human volunteers showe\
d that the average )Tj
0 -1.343 TD
(dermal absorption of 100% DEET was 5.6%; for 15% DEET in ethanol, an ave\
rage of 8.4% of the dose )Tj
0 -1.2 TD
(was absorbed )Tj
ET
89.31 361.859 m
112.634 361.859 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 89.31 363.9756 Tm
([58])Tj
0 0 0 rg
(. Because of its lipophilic nature, DEET was rapidly absorbed within 2 h\
ours after )Tj
-5.665 -1.343 Td
(application; was eliminated from the plasma within 4 hours after being r\
insed off the skin; and was )Tj
T*
(primarily excreted in the urine, mostly within 12 hours. Tape stripping \
revealed that the chemical does )Tj
T*
(not accumulate in the stratum corneum. )Tj
0 -1.1 TD
( )Tj
T*
(Bioavailability experiments conducted with Minnetonka Brands' 10% DEET l\
iposphere formulation )Tj
0 -1.2 TD
(showed that percutaneous absorption was one third of that of a 10% alcoh\
ol-based DEET solution )Tj
ET
562.524 261.859 m
585.848 261.859 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 562.524 263.9756 Tm
([52])Tj
0 0 0 rg
(. )Tj
-39.466 -1.343 Td
(In contrast, U.S. Army studies that used an in vitro pigskin model did n\
ot show any reduced )Tj
T*
(percutaneous absorption \(expressed as a percentage of the applied dose\)\
of the 3M polymer formulation )Tj
T*
(compared with 75% DEET in alcohol )Tj
ET
224.634 209.459 m
247.958 209.459 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 224.634 211.5756 Tm
([62])Tj
0 0 0 rg
(.)Tj
0 0.4 0.353 rg
/T1_1 1 Tf
( )Tj
-15.331 -1.243 Td
( )Tj
16.1538 0 0 16.1538 10 176.9256 Tm
(Toxicity )Tj
0 -1.1 TD
( )Tj
0 0 0 rg
/T1_0 1 Tf
14 0 0 14 10 143.2371 Tm
(Used by millions of people worldwide for 40 years, DEET has a remarkable\
safety profile. As part of the )Tj
0 -1.2 TD
(1980 EPA Reregistration Standard for DEET, more than 30 studies were con\
ducted to assess acute, )Tj
T*
(chronic, and subchronic toxicity; mutagenicity; oncogenicity; and develo\
pmental, reproductive, and )Tj
0 -1.2 TD
(neurologic toxicity \(Table 3\) )Tj
ET
174.864 90.72 m
240.188 90.72 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 174.864 92.8371 Tm
([42, 63, 64])Tj
0 0 0 rg
(. The results of these studies did not require any change to the )Tj
-11.776 -1.343 Td
(product to comply with EPA safety standards, nor did they indicate any n\
ew toxicities with normal use. )Tj
0 -1.2 TD
(Studies of high doses of DEET orally administered to mice and rats did n\
ot reveal any potential in )Tj
T*
(humans for teratogenicity or oncogenicity. )Tj
ET
EMC
/Artifact <>BDC
Q
BT
/T1_0 1 Tf
9 0 0 9 18 7.17 Tm
(file:///C|/My Documents/! Travel Documents/Mosquitoes_and_Mosquito_Repel\
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ET
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/T1_0 1 Tf
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(Mosquitoes and Mosquito Repellents)Tj
ET
EMC
/Article <>BDC
q
0 18 612 756 re
W* n
BT
/T1_0 1 Tf
14 0 0 14 10 755.0371 Tm
( )Tj
ET
0 0 1 RG
1.347 w 10 M 0 j 0 J []0 d
10 733.745 m
575.385 733.745 l
S
0 0 1 rg
BT
/T1_1 1 Tf
16.1538 0 0 16.1538 10 737.7872 Tm
(View Table 3: Studies Done To Support the Reregistration of DEET with th\
e U.S. )Tj
ET
10 712.361 m
245.103 712.361 l
S
BT
/T1_1 1 Tf
16.1538 0 0 16.1538 10 716.4026 Tm
(Environmental Protection Agency)Tj
0 0 0 rg
/T1_0 1 Tf
14 0 0 14 245.1031 716.4026 Tm
( )Tj
-16.793 -1.295 Td
( )Tj
0 -1.1 TD
(Case reports of potential DEET toxicity exist in the medical literature \
and are summarized in Table 4. )Tj
0 -1.2 TD
(The reports of greatest concern involve 14 cases of encephalopathy, 13 o\
f which were in children )Tj
0 -1.2 TD
(younger than 8 years of age )Tj
ET
0.706 w
168.62 647.151 m
252.606 647.151 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 168.62 649.2679 Tm
([63, 66-71, 75])Tj
0 0 0 rg
(. Three of these children died, 1 of whom had an ornithine )Tj
-11.33 -1.343 Td
(carbamoyl transferase deficiency )Tj
ET
198.538 628.351 m
221.862 628.351 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 198.538 630.4679 Tm
([67])Tj
0 0 0 rg
( that might have predisposed her to DEET-induced toxicity )Tj
ET
556.658 628.351 m
579.982 628.351 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 556.658 630.4679 Tm
([66])Tj
0 0 0 rg
(. )Tj
-39.047 -1.343 Td
(The other children recovered without sequelae. Many of these persons had\
a history of long-term, )Tj
T*
(excessive, or inappropriate use of DEET repellents, and the details of e\
xposure are frequently poorly )Tj
T*
(documented. Animal studies in rats and mice have shown that DEET is not \
a selective neurotoxin )Tj
ET
560.214 575.951 m
585.876 575.951 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 560.214 578.0679 Tm
([42, )Tj
ET
10 557.151 m
49.662 557.151 l
S
BT
/T1_0 1 Tf
14 0 0 14 10 559.2679 Tm
(61, 63])Tj
0 0 0 rg
(. )Tj
0 -1.243 TD
( )Tj
ET
1.347 w
10 520.576 m
600.504 520.576 l
S
0 0 1 rg
BT
/T1_1 1 Tf
16.1538 0 0 16.1538 10 524.618 Tm
(View Table 4: Reported Major Signs and Symptoms Attributed to Exposure t\
o DEET)Tj
0 0 0 rg
/T1_0 1 Tf
14 0 0 14 600.5038 524.618 Tm
( )Tj
-42.179 -1.295 Td
( )Tj
0 -1.1 TD
(Toxicology studies in rats and dogs in which sublethal intraperitoneal i\
njections were used revealed that )Tj
0 -1.2 TD
(DEET could induce dose-dependent hypotension and bradycardia; however, t\
hese conditions occurred at )Tj
0 -1.2 TD
(dosages that would be almost impossible to attain with cutaneous applica\
tions of DEET )Tj
ET
0.706 w
505.026 455.366 m
528.35 455.366 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 505.026 457.4832 Tm
([78])Tj
0 0 0 rg
(. Only one )Tj
-35.359 -1.343 Td
(case of bradycardia and hypotension has been documented in the medical l\
iterature )Tj
ET
478.888 436.566 m
502.212 436.566 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 478.888 438.6832 Tm
([79])Tj
0 0 0 rg
(. )Tj
-33.492 -1.243 Td
( )Tj
0 -1.1 TD
(Initial repeat-insult patch tests of 100% technical-grade DEET or 50% DE\
ET in ethanol conducted over )Tj
0 -1.2 TD
(21 consecutive days showed no sign of skin irritation )Tj
ET
311.364 386.966 m
334.688 386.966 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 311.364 389.0833 Tm
([42])Tj
0 0 0 rg
(. Subsequently, 14 cases of contact urticaria )Tj
-21.526 -1.343 Td
(and irritant contact dermatitis \(mostly in soldiers\) have been reporte\
d )Tj
ET
401.16 368.166 m
443.146 368.166 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 401.16 370.2832 Tm
([81-85])Tj
0 0 0 rg
(. The antecubital fossa )Tj
-27.94 -1.343 Td
(seems to be particularly sensitive to developing bullous irritant contac\
t dermatitis if DEET products are )Tj
T*
(allowed to remain on this area overnight )Tj
ET
239.796 332.566 m
263.12 332.566 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 239.796 334.6832 Tm
([86])Tj
0 0 0 rg
(. )Tj
-16.414 -1.243 Td
( )Tj
0 -1.1 TD
(A 1994 study reviewed 9086 cases of DEET exposure reported to 71 poison \
control centers from 1985 )Tj
0 -1.2 TD
(to 1989 )Tj
ET
55.892 282.966 m
79.216 282.966 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 55.892 285.0833 Tm
([76])Tj
0 0 0 rg
(. More than half \(54%\) of the persons involved had no symptoms at the \
time of the call to )Tj
-3.278 -1.343 Td
(the poison control center. The most commonly reported symptoms were rela\
ted to spraying repellent in )Tj
T*
(the eyes \(DEET is a known eye irritant )Tj
ET
231.62 247.366 m
254.944 247.366 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 231.62 249.4832 Tm
([42])Tj
0 0 0 rg
(\) or inhaling it. Symptoms were least likely to occur after )Tj
-15.83 -1.343 Td
(accidental ingestion of small amounts of the repellent. Although most ex\
posures were in children, there )Tj
T*
(was no evidence that children younger than 6 years of age were more like\
ly than older children or adults )Tj
T*
(to develop adverse effects after use of a DEET repellent. No correlation\
was found between the severity )Tj
T*
(of symptoms and age, sex, or concentration of applied DEET. Eighty-eight\
percent of exposed persons )Tj
T*
(did not require treatment at a health care facility. Of the patients who\
were seen, 81% were sent home, )Tj
T*
(and only 5% required hospitalization. Of the patients in whom follow-up \
was available, 99% had no )Tj
T*
(long-term sequelae. )Tj
0 -1.1 TD
( )Tj
T*
(In summary, DEET has had a remarkable safety profile during more than 40\
years of use by millions of )Tj
0 -1.2 TD
(people worldwide. Careful product choice and application of the repellen\
t according to EPA guidelines )Tj
T*
(will greatly reduce the possibility of toxicity. Conservative use of low\
-concentration DEET products is )Tj
T*
(most appropriate for children. )Tj
ET
EMC
/Artifact <>BDC
Q
BT
/T1_0 1 Tf
9 0 0 9 18 7.17 Tm
(file:///C|/My Documents/! Travel Documents/Mosquitoes_and_Mosquito_Repel\
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0 18 612 756 re
W* n
BT
/T1_0 1 Tf
14 0 0 14 10 755.3755 Tm
( )Tj
0 -1.1 TD
(Questions about the safety of DEET may be addressed to the EPA-sponsored\
National Pesticide )Tj
0 -1.2 TD
(Telecommunications Network, available by telephone every day from 6:30 a\
.m. to 4:30 p.m. Pacific )Tj
0 -1.2 TD
(Standard Time at 800-858-7378 or on the World Wide Web at )Tj
ET
0 0 1 RG
0.706 w 10 M 0 j 0 J []0 d
362.66 704.259 m
552.038 704.259 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 362.66 706.3755 Tm
(http://www.ace.orst.edu/info/nptn)Tj
0 0 0 rg
(.)Tj
/T1_1 1 Tf
16.1538 0 0 16.1538 555.538 706.3755 Tm
( )Tj
-33.771 -1.178 Td
( )Tj
0 -1.1 TD
(Skin-So-Soft )Tj
0 -1.1 TD
( )Tj
/T1_0 1 Tf
14 0 0 14 10 635.8833 Tm
(Avon \(New York, New York\) Skin-So-Soft bath oil received considerable \
media attention several years )Tj
0 -1.2 TD
(ago when some consumers reported it to be effective as a mosquito repell\
ent. When tested under )Tj
T*
(laboratory conditions against )Tj
/T1_2 1 Tf
(Aedes aegypti)Tj
/T1_0 1 Tf
( mosquitoes, this product's effective half-life was 30 minutes. )Tj
0 -1.2 TD
(Against )Tj
/T1_2 1 Tf
(Aedes albopictus)Tj
/T1_0 1 Tf
(, Skin-So-Soft oil provided 40 minutes of protection from bites, a durat\
ion 10 )Tj
0 -1.2 TD
(times less than that of 12.5% DEET )Tj
ET
214.54 566.566 m
237.864 566.566 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 214.54 568.6832 Tm
([46])Tj
0 0 0 rg
(. It has been proposed that the limited mosquito repellent effect )Tj
-14.61 -1.343 Td
(of Skin-So-Soft oil could be caused by its fragrance or the presence of \
diisopropyl adipate and )Tj
T*
(benzophenone in the formulation, both of which have some repellent activ\
ity )Tj
ET
444.714 530.966 m
468.038 530.966 l
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0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 444.714 533.0833 Tm
([40])Tj
0 0 0 rg
(. Avon now markets )Tj
-31.051 -1.343 Td
(products under the Skin-So-Soft label that contain an EPA-recognized rep\
ellent. )Tj
0 -1.1 TD
( )Tj
ET
1.347 w
10 477.592 m
571.298 477.592 l
S
0 0 1 rg
BT
/T1_1 1 Tf
16.1538 0 0 16.1538 10 481.6333 Tm
(View Table 5: Plant-Derived Insect Repellents and Permethrin Insecticide\
Sprays)Tj
0 0 0 rg
/T1_0 1 Tf
14 0 0 14 571.2977 481.6333 Tm
( )Tj
-40.093 -1.295 Td
( )Tj
0 -1 TD
( )Tj
0 0.6 0.51 rg
/TT0 1 Tf
19.3846 0 0 19.3846 10 430.0587 Tm
(Plant-Derived Repellents )Tj
0 -1.1 TD
( )Tj
0 0 0 rg
/T1_0 1 Tf
14 0 0 14 10 391.4525 Tm
(Thousands of plants have been tested as potential sources of insect repe\
llents )Tj
ET
0.706 w
444.7 389.336 m
510.024 389.336 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 444.7 391.4525 Tm
([39, 40, 87])Tj
0 0 0 rg
(. None of the )Tj
-31.05 -1.343 Td
(plant-derived chemicals tested to date demonstrate the broad effectivene\
ss and duration of DEET, but a )Tj
0 -1.2 TD
(few show repellent activity. Plants whose essential oils have been repor\
ted to have repellent activity )Tj
T*
(include citronella, cedar, verbena, pennyroyal, geranium, lavender, pine\
, cajeput, cinnamon, rosemary, )Tj
T*
(basil, thyme, allspice, garlic, and peppermint )Tj
ET
265.08 320.136 m
328.066 320.136 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 265.08 322.2525 Tm
([40, 88-91])Tj
0 0 0 rg
(. Unlike synthetic insect repellents, plant-)Tj
-18.22 -1.343 Td
(derived repellents have been relatively poorly studied. When tested, mos\
t of these essential oils tended )Tj
T*
(to give short-lasting protection, usually less than 2 hours. Readily ava\
ilable plant-derived insect )Tj
T*
(repellents are listed in Table 5.)Tj
/T1_1 1 Tf
16.1538 0 0 16.1538 182.634 269.8525 Tm
( )Tj
-10.687 -1.055 Td
( )Tj
0 -1.1 TD
(Citronella )Tj
0 -1.1 TD
( )Tj
/T1_0 1 Tf
14 0 0 14 10 201.3602 Tm
(Citronella is the active ingredient most commonly found in "natural" or \
"herbal" insect repellents )Tj
0 -1.2 TD
(marketed in the United States. It is registered with the EPA as an insec\
t repellent. Citronella oil has a )Tj
T*
(lemony scent and was originally extracted from the grass plant )Tj
/T1_2 1 Tf
(Cymbopogon nardus)Tj
/T1_0 1 Tf
(. Limited data are )Tj
0 -1.2 TD
(available from studies that directly compared the efficacy of citronella\
-based products with that of )Tj
0 -1.2 TD
(DEET-based products. In one study, 0.01 \265mol of DEET per L of air was\
sufficient to prevent 90% of )Tj
T*
(mosquitoes from landing on their targets; a 1000-fold higher concentrati\
on of citronellol \(one of the )Tj
T*
(active chemicals in citronella oil\) was required to achieve a similar e\
ffect )Tj
ET
423.672 98.443 m
446.996 98.443 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 423.672 100.5602 Tm
([31])Tj
0 0 0 rg
(. )Tj
-29.548 -1.243 Td
( )Tj
0 -1.1 TD
(Studies show that citronella can be an effective repellent, but it provi\
des shorter complete protection )Tj
0 -1.2 TD
(time than most DEET-based products. Frequent reapplication of the repell\
ent can partially compensate )Tj
ET
EMC
/Artifact <>BDC
Q
BT
/T1_0 1 Tf
9 0 0 9 18 7.17 Tm
(file:///C|/My Documents/! Travel Documents/Mosquitoes_and_Mosquito_Repel\
lents.htm \(8 of 19\)10/16/2006 5:38:59 PM)Tj
ET
EMC
endstream
endobj
321 0 obj<>stream
/Artifact <>BDC
0 0 0 rg
0 i
BT
/T1_0 1 Tf
0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 9 0 0 9 18 780.17 Tm
(Mosquitoes and Mosquito Repellents)Tj
ET
EMC
/Article <>BDC
q
0 18 612 756 re
W* n
BT
/T1_0 1 Tf
14 0 0 14 10 753.9756 Tm
(for this. The manufacturer of Natrapel \(Tender Corp., Littleton, New Ha\
mpshire\) has laboratory data )Tj
0 -1.2 TD
(showing that their 10% lotion reduced mosquito bites by 84% during a 4-m\
inute test period. In contrast, )Tj
T*
(14% DEET reduced biting by 96% in the same test period. Buzz Away \(Quan\
tum, Inc., Eugene, )Tj
0 -1.2 TD
(Oregon\) with 5% citronella oil provided an average protection time of 1\
.9 hours against )Tj
/T1_1 1 Tf
(Aedes aegypti)Tj
/T1_0 1 Tf
( )Tj
ET
0 0 1 RG
0.706 w 10 M 0 j 0 J []0 d
10 684.659 m
33.324 684.659 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 10 686.7756 Tm
([92])Tj
0 0 0 rg
(. In field testing, Buzz Away Oil provided an average of 88% repellency \
during a 2-hour exposure. )Tj
0 -1.343 TD
(In general, the repellency of Buzz Away was greatest within the first 40\
minutes after application and )Tj
0 -1.2 TD
(decreased over the remainder of the test period )Tj
ET
275.916 649.059 m
299.24 649.059 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 275.916 651.1756 Tm
([93])Tj
0 0 0 rg
(. )Tj
-18.994 -1.243 Td
( )Tj
0 -1.1 TD
(Citronella candles have been promoted as an effective way to repel mosqu\
itoes in the backyard. One )Tj
0 -1.2 TD
(study compared the ability of commercially available 3% citronella candl\
es, 5% citronella incense, and )Tj
T*
(plain candles to prevent bites by )Tj
/T1_1 1 Tf
(Aedes)Tj
/T1_0 1 Tf
( mosquitoes under field conditions )Tj
ET
424.904 582.659 m
448.228 582.659 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 424.904 584.7756 Tm
([94])Tj
0 0 0 rg
(. Persons near the )Tj
-29.636 -1.343 Td
(citronella candles had 42% fewer bites than controls, who had no protect\
ion \(a statistically significant )Tj
T*
(difference\). However, burning ordinary candles reduced the number of bi\
tes by 23%. The efficacy of )Tj
T*
(citronella incense and plain candles did not differ. The ability of plai\
n candles to decrease biting may )Tj
T*
(result from their action as a decoy source of warmth, moisture, and carb\
on dioxide. )Tj
0 -1.1 TD
( )Tj
0 -1.1 TD
(The citrosa plant \()Tj
/T1_1 1 Tf
(Pelargonium citrosum \221van Leenii\222)Tj
/T1_0 1 Tf
(\) has been marketed as being able to repel )Tj
0 -1.2 TD
(mosquitoes through the continuous release of citronella oils. Unfortunat\
ely, when tested, these plants )Tj
T*
(offer no protection against bites )Tj
ET
191.58 449.059 m
235.904 449.059 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 191.58 451.1756 Tm
([95, 96])Tj
0 0 0 rg
(.)Tj
/T1_2 1 Tf
16.1538 0 0 16.1538 239.404 451.1756 Tm
( )Tj
-14.201 -1.178 Td
( )Tj
0 -1.1 TD
(Bite Blocker )Tj
0 -1.1 TD
( )Tj
/T1_0 1 Tf
14 0 0 14 10 380.6832 Tm
(Bite Blocker \(Consep, Inc., Bend, Oregon\) is a plant-based repellent t\
hat was released in the United )Tj
0 -1.2 TD
(States in 1997. Bite Blocker combines soybean oil, geranium oil, and coc\
onut oil in a formulation that )Tj
T*
(has been available in Europe for several years )Tj
ET
270.47 344.966 m
293.794 344.966 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 270.47 347.0833 Tm
([97])Tj
0 0 0 rg
(. Studies conducted at the University of Guelph, )Tj
-18.605 -1.343 Td
(Ontario, Canada, showed that this product gave more than 97% protection \
against )Tj
/T1_1 1 Tf
(Aedes)Tj
/T1_0 1 Tf
( mosquitoes )Tj
0 -1.2 TD
(under field conditions, even 3.5 hours after application. During the sam\
e period, a 6.65% DEET-based )Tj
T*
(spray afforded 86% protection, and Avon Skin-So-Soft citronella-based re\
pellent gave only 40% )Tj
T*
(protection )Tj
ET
70.27 275.766 m
93.594 275.766 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 70.27 277.8833 Tm
([98])Tj
0 0 0 rg
(. A second study showed that Bite Blocker provided a mean \261SD of 200 \
\261 30 minutes of )Tj
-4.305 -1.343 Td
(complete protection from mosquito bites )Tj
ET
241.378 256.966 m
264.702 256.966 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 241.378 259.0833 Tm
([99])Tj
0 0 0 rg
(.)Tj
/T1_2 1 Tf
16.1538 0 0 16.1538 268.202 259.0833 Tm
( )Tj
-15.984 -1.178 Td
( )Tj
0 -1.1 TD
(Permethrin )Tj
0 -1.1 TD
( )Tj
/T1_0 1 Tf
14 0 0 14 10 188.5909 Tm
(Pyrethrum is a powerful, rapidly acting insecticide, originally derived \
from the crushed and dried )Tj
0 -1.2 TD
(flowers of the daisy )Tj
/T1_1 1 Tf
(Chrysanthemum cinerariifolium)Tj
/T1_0 1 Tf
( )Tj
ET
307.864 169.674 m
338.188 169.674 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 307.864 171.7909 Tm
([100])Tj
0 0 0 rg
(. Permethrin is a human-made synthetic )Tj
-21.276 -1.343 Td
(pyrethroid. It does not repel insects but works as a contact insecticide\
, causing nervous system toxicity )Tj
0 -1.2 TD
(that leads to the death or "knockdown" \(out of the air\) of the insect.\
The chemical is effective against )Tj
T*
(mosquitoes, flies, ticks, and chiggers. Permethrin has low toxicity in m\
ammals, is poorly absorbed by )Tj
T*
(the skin, and is rapidly inactivated by ester hydrolysis )Tj
ET
314.864 100.474 m
345.188 100.474 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 314.864 102.5909 Tm
([101])Tj
0 0 0 rg
(. )Tj
-21.776 -1.243 Td
( )Tj
0 -1.1 TD
(Permethrin should be applied directly to clothing or other fabrics \(suc\
h as tent walls )Tj
ET
483.606 67.674 m
513.93 67.674 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 483.606 69.7909 Tm
([102])Tj
0 0 0 rg
( or mosquito )Tj
-33.829 -1.343 Td
(nets )Tj
ET
36.054 48.874 m
66.378 48.874 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 36.054 50.9909 Tm
([103])Tj
0 0 0 rg
(\), not to skin. The spray form is nonstaining, nearly odorless, and res\
istant to degradation by )Tj
ET
EMC
/Artifact <>BDC
Q
BT
/T1_0 1 Tf
9 0 0 9 18 7.17 Tm
(file:///C|/My Documents/! Travel Documents/Mosquitoes_and_Mosquito_Repel\
lents.htm \(9 of 19\)10/16/2006 5:38:59 PM)Tj
ET
EMC
endstream
endobj
322 0 obj<>stream
/Artifact <>BDC
0 0 0 rg
0 i
BT
/T1_0 1 Tf
0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 9 0 0 9 18 780.17 Tm
(Mosquitoes and Mosquito Repellents)Tj
ET
EMC
/Article <>BDC
q
0 18 612 756 re
W* n
BT
/T1_1 1 Tf
12.9231 0 0 12.9231 10 734.6697 Tm
(114.)Tj
/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(Frick TB, Tallamy DW.)Tj
/T1_0 1 Tf
( Density and diversity of non-target insects killed by suburban electric\
insect traps. )Tj
0 -1.2 TD
(Entomological News. 1996; 2:77-82. )Tj
/T1_1 1 Tf
0 -2.67 TD
(115.)Tj
/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(McCormack DR, Salata KF, Hershey JN, Carpenter GB, Engler RJ.)Tj
/T1_0 1 Tf
( Mosquito bite anaphylaxis: )Tj
0 -1.2 TD
(immunotherapy with whole body extracts. Ann Allergy Asthma Immunol. 1995\
; 74:39-44. )Tj
/T1_1 1 Tf
0 -2.67 TD
(116.)Tj
/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(Reunala T, Brummer-Korvenkontio H, Palosuo T.)Tj
/T1_0 1 Tf
( Are we really allergic to mosquito bites? Ann Med. )Tj
0 -1.2 TD
(1994; 26:301-6. )Tj
/T1_1 1 Tf
0 -2.67 TD
(117.)Tj
/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(Reunala T, Brummer-Korvenkontio H, Lappalainen P, Rasanen L, Palosuo T.)Tj
/T1_0 1 Tf
( Immunology and )Tj
0 -1.2 TD
(treatment of mosquito bites. Clin Exp Allergy. 1990; 20 Suppl 4:19-24. )Tj
/T1_1 1 Tf
0 -2.67 TD
(118.)Tj
/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(Reunala T, Lappalainen P, Brummer-Korvenkontio H, Coulie P, Palosuo T.)Tj
/T1_0 1 Tf
( Cutaneous reactivity to )Tj
0 -1.2 TD
(mosquito bites: effect of cetirizine and development of anti-mosquito an\
tibodies. Clin Exp Allergy. 1991; 21:617-)Tj
T*
(22. )Tj
/T1_1 1 Tf
0 -2.67 TD
(119.)Tj
/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(Brummer-Korvenkontio H, Lappalainen P, Reunala T, Palosuo T.)Tj
/T1_0 1 Tf
( Immunization of rabbits with )Tj
0 -1.2 TD
(mosquito bites: immunoblot analysis of IgG antimosquito antibodies in ra\
bbit and man. Int Arch Allergy Appl )Tj
T*
(Immunol. 1990; 93:14-8. )Tj
/T1_1 1 Tf
0 -2.67 TD
(120.)Tj
/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(Peng Z, Yang M, Simons FE.)Tj
/T1_0 1 Tf
( Immunologic mechanisms in mosquito allergy: correlation of skin reactio\
ns )Tj
0 -1.2 TD
(with specific IgE and IgG antibodies and lymphocyte proliferation respon\
se to mosquito antigens. Ann Allergy )Tj
T*
(Asthma Immunol. 1996; 77:238-44. )Tj
/T1_1 1 Tf
0 -2.67 TD
(121.)Tj
/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(Brummer-Korvenkontio H, Palosuo T, Francois G, Reunala T.)Tj
/T1_0 1 Tf
( Characterization of )Tj
/T1_2 1 Tf
(Aedes communis)Tj
/T1_0 1 Tf
(, )Tj
/T1_2 1 Tf
0 -1.2 TD
(Aedes aegypti)Tj
/T1_0 1 Tf
( and )Tj
/T1_2 1 Tf
(Anopheles stephensi)Tj
/T1_0 1 Tf
( mosquito saliva antigens by immunoblotting. Int Arch Allergy Appl )Tj
T*
(Immunol. 1997; 112:169-74. )Tj
/T1_1 1 Tf
0 -2.67 TD
(122.)Tj
/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(Reunala T, Brummer-Korvenkontio H, Karppinen A, Coulie P, Palosuo T.)Tj
/T1_0 1 Tf
( Treatment of mosquito bites )Tj
0 -1.263 TD
(with cetirizine. Clin Exp Allergy. 1993; 23:72-5.)Tj
14 0 0 14 262.3489 256.1909 Tm
( )Tj
ET
EMC
/Artifact <>BDC
Q
BT
/T1_0 1 Tf
9 0 0 9 18 7.17 Tm
(file:///C|/My Documents/! Travel Documents/Mosquitoes_and_Mosquito_Repel\
lents.htm \(19 of 19\)10/16/2006 5:38:59 PM)Tj
ET
EMC
endstream
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323 0 obj<>stream
/Artifact <>BDC
0 0 0 rg
0 i
BT
/T1_0 1 Tf
0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 9 0 0 9 18 780.17 Tm
(Mosquitoes and Mosquito Repellents)Tj
ET
EMC
/Article <>BDC
q
0 18 612 756 re
W* n
BT
/T1_0 1 Tf
14 0 0 14 10 753.9756 Tm
(heat or sun and maintains its potency for at least 2 weeks, even through\
several launderings )Tj
ET
0 0 1 RG
0.706 w 10 M 0 j 0 J []0 d
525.186 751.859 m
583.51 751.859 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 525.186 753.9756 Tm
([104, 105])Tj
0 0 0 rg
(. )Tj
-36.799 -1.343 Td
(The combination of permethrin-treated clothing and skin application of a\
DEET-based repellent creates )Tj
0 -1.2 TD
(a formidable barrier against mosquito bites )Tj
ET
254.188 716.259 m
333.512 716.259 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 254.188 718.3755 Tm
([19, 106, 107])Tj
0 0 0 rg
(. In a field trial conducted in Alaska, persons )Tj
-17.442 -1.343 Td
(wearing permethrin-treated uniforms and a polymer-based 35% DEET product\
had more than 99.9% )Tj
T*
(protection \(1 bite/h\) over 8 hours, even under conditions of intense b\
iting pressures; unprotected persons )Tj
T*
(received an average of 1188 bites/h )Tj
ET
212.16 663.859 m
242.484 663.859 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 212.16 665.9756 Tm
([108])Tj
0 0 0 rg
(. )Tj
-14.44 -1.243 Td
( )Tj
0 -1.1 TD
(Permethrin-based insecticide sprays available in the United States are l\
isted in Table 5. To apply to )Tj
0 -1.2 TD
(clothing, spray each side of the fabric \(outdoors\) for 30 to 45 second\
s, just enough to moisten it. Allow )Tj
T*
(the garment to dry for 2 to 4 hours before wearing it. )Tj
0 -1.1 TD
( )Tj
0 -1 TD
( )Tj
0 0.6 0.51 rg
/TT0 1 Tf
19.3846 0 0 19.3846 10 550.7357 Tm
(Reducing Local Mosquito Populations)Tj
/TT1 1 Tf
( )Tj
0 -1.127 TD
( )Tj
0 0 0 rg
/T1_0 1 Tf
14 0 0 14 10 512.1294 Tm
(Consumers may still find advertisements for small ultrasonic electronic \
devices that are meant to be )Tj
0 -1.2 TD
(carried on the body and purportedly emit sounds that repel mosquitoes. M\
any studies conducted in the )Tj
T*
(field and laboratory show that these devices do not work against mosquit\
oes )Tj
ET
440.836 476.413 m
496.822 476.413 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 440.836 478.5294 Tm
([109-111])Tj
0 0 0 rg
(. Encouraging )Tj
-30.774 -1.343 Td
(natural predation of insects by setting up bird or bat houses in the bac\
kyard has also been unsuccessful )Tj
0 -1.2 TD
(in reducing local mosquito populations )Tj
ET
232.054 440.813 m
262.378 440.813 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 232.054 442.9294 Tm
([112])Tj
0 0 0 rg
(. Likewise, backyard bug "zappers," which lure and )Tj
-15.861 -1.343 Td
(electrocute insects, are ineffective )Tj
ET
203.984 422.013 m
234.308 422.013 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 203.984 424.1294 Tm
([113])Tj
0 0 0 rg
(. Mosquitoes continue to be more attracted to humans than to the )Tj
-13.856 -1.343 Td
(devices. One study conducted in homeowners' backyards showed that of the\
insects killed by these )Tj
T*
(devices, only 0.13% were female mosquitoes )Tj
ET
266.62 386.413 m
296.944 386.413 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 266.62 388.5294 Tm
([114])Tj
0 0 0 rg
(. An estimated 71 billion to 350 billion beneficial )Tj
-18.33 -1.343 Td
(insects may be killed annually in the United States by these electrocuti\
ng devices )Tj
ET
468.444 367.613 m
498.768 367.613 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 468.444 369.7294 Tm
([114])Tj
0 0 0 rg
(. The most )Tj
-32.746 -1.343 Td
(effective way to reduce a local population of mosquitoes is to eliminate\
sources of standing water, such )Tj
T*
(as old discarded tires, clogged gutters, planters, bird baths, or tree s\
tump holes. )Tj
0 -1.1 TD
( )Tj
0 -1 TD
( )Tj
0 0.6 0.51 rg
/TT0 1 Tf
19.3846 0 0 19.3846 10 285.2895 Tm
(Relief from Mosquito Bites)Tj
/TT1 1 Tf
( )Tj
0 -1.127 TD
( )Tj
0 0 0 rg
/T1_0 1 Tf
14 0 0 14 10 246.6832 Tm
(Cutaneous responses to mosquito bites range from common localized wheal-\
and-flare reactions to )Tj
0 -1.2 TD
(delayed bite papules, rare systemic Arthus-type reactions, and anaphylax\
is )Tj
ET
431.078 227.766 m
487.064 227.766 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 431.078 229.8833 Tm
([115-117])Tj
0 0 0 rg
(. Bite reactions are )Tj
-30.077 -1.343 Td
(the result of sensitization to mosquito salivary antigens, which lead to\
the formation of specific IgE and )Tj
0 -1.2 TD
(IgG antibodies )Tj
ET
96.324 192.166 m
152.31 192.166 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 96.324 194.2832 Tm
([118-121])Tj
0 0 0 rg
(. Immediate-type reactions are mediated by IgE and histamine, whereas ce\
ll-)Tj
-6.166 -1.343 Td
(mediated immunity is responsible for the delayed reactions. )Tj
0 -1.1 TD
( )Tj
T*
(Several strategies exist for relieving the itch of mosquito bites. Topic\
al corticosteroids can reduce the )Tj
0 -1.2 TD
(erythema, itching, and induration. Topical diphenhydramine and caine-con\
taining derivatives should be )Tj
T*
(avoided because of concerns about inducing allergic contact sensitivity.\
Oral antihistamines can be )Tj
T*
(effective in reducing the symptoms of mosquito bites. Cetirizine was giv\
en prophylactically in a double-)Tj
0 -1.2 TD
(blind, placebo-controlled, 2-week, crossover trial to 18 persons who had\
previously had dramatic )Tj
T*
(cutaneous reactions to mosquito bites )Tj
ET
223.486 58.566 m
253.81 58.566 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 223.486 60.6832 Tm
([122])Tj
0 0 0 rg
(. Persons who received the active drug had a statistically )Tj
-15.249 -1.343 Td
(significant 40% decrease in the size of the wheal response at 15 minutes\
and the size of the bite papule )Tj
ET
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(at 24 hours. The mean pruritus score, measured 0.25, 1, 12, and 24 hours\
after the mosquito had bitten, )Tj
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(was 67% less than that of the untreated controls. These studies have not\
been done with astemizole, )Tj
T*
(terfenadine, loratadine, or fexofenadine. In highly sensitized persons, \
prophylactic treatment with )Tj
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(nonsedating antihistamines may safely reduce the cutaneous reactions to \
mosquito bites. )Tj
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(Acknowledgments:)Tj
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( The author thanks Donald Baumgartner \(U.S. Environmental Protection Ag\
ency\); Donald )Tj
0 -1.2 TD
(Barnard, PhD \(U.S. Department of Agriculture\); Nigel Hill \(London Sch\
ool of Hygiene and Tropical Medicine\); )Tj
T*
(and Robbin Lindsay, PhD \(Department of Environmental Biology, Universit\
y of Guelph\) for providing data that )Tj
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(were not readily available in the medical literature. The author has rec\
eived no monetary support from any of the )Tj
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(manufacturers whose products are mentioned in this paper. )Tj
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(Requests for Reprints:)Tj
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( Mark S. Fradin, MD, Chapel Hill Dermatology, 891 Willow Drive, Suite 2,\
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( Comparison of the effectiveness of two formulations of deet against )Tj
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( )Tj
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( Caring for Your Baby and Young Child: Birth to Age 5. New York: Bantam \
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( U.S. Environmental Protection Agency, Office of Pesticide Programs. Usi\
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( Some corrections to the record on insect repellents and attractants. J \
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( )Tj
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( Insect repellents and the efficacy of sunscreens. Lancet. )Tj
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( Absorption, metabolism, and excretion )Tj
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(m-toluamide \(DEET\). J Toxicol Environ Health. 1986; 18:503-25. )Tj
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( Absorption, distribution, metabolism, and excretion )Tj
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(Reifenrath W, Hawkins G, Kurtz M, Bernardo E, Dahlberg E, Jesse R.)Tj
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( Controlled Release Personal Use )Tj
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(Arthropod Repellent Formulation: In Vitro Evaluation of Evaporation/Pene\
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(Resistance, and Interaction with CW Agent Analogs. San Francisco: Presid\
io of San Francisco; Division of )Tj
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(Cutaneous Hazards, Letterman Institute of Research; 1986. )Tj
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( Efficacy of Buzz Away Oil against spring )Tj
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( Insect repellents. Med Lett Drugs Ther. 1989; 31:45-7. )Tj
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( Permethrin and dimethyl phthalate as tent fabric treatments against )Tj
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(Control Assoc. 1991; 7:533-5. )Tj
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( )Tj
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(Lines JD, Myamba J, Curtis CF.)Tj
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( Experimental hut trials of permethrin-impregnated mosquito nets and )Tj
0 -1.2 TD
(eave curtains against malaria vectors in Tanzania. Med Vet Entomol. 1987\
; 1:37-51. )Tj
/T1_1 1 Tf
0 -2.67 TD
(104.)Tj
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( )Tj
/T1_1 1 Tf
(Schreck CE, Posey K, Smith D.)Tj
/T1_0 1 Tf
( Durability of permethrin as a potential clothing treatment to protect )Tj
0 -1.2 TD
(against blood-feeding arthropods. J Econ Entomol. 1978; 71:397-400. )Tj
/T1_1 1 Tf
0 -2.67 TD
(105.)Tj
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( )Tj
/T1_1 1 Tf
(Schreck CE, Carlson DA, Weidhass DE, Posey K, Smith D.)Tj
/T1_0 1 Tf
( Wear and aging tests with permethrin-treated )Tj
0 -1.2 TD
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/T1_1 1 Tf
0 -2.67 TD
(106.)Tj
/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(Gupta RK, Sweeney AW, Rutledge LC, Cooper RD, Frances SP, Westrom DR.)Tj
/T1_0 1 Tf
( Effectiveness of )Tj
0 -1.2 TD
(controlled-release personal-use arthropod repellents and permethrin-impr\
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T*
(Mosq Control Assoc. 1987; 3:556-60. )Tj
/T1_1 1 Tf
0 -2.67 TD
(107.)Tj
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( )Tj
/T1_1 1 Tf
(Sholdt LL, Schreck CE, Qureshi A, Mammino S, Aziz A, Iqbal M.)Tj
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( Field bioassays of permethrin-treated )Tj
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(uniforms and a new extended duration repellent against mosquitoes in Pak\
istan. J Am Mosq Control Assoc. )Tj
T*
(1988; 4:233-6. )Tj
/T1_1 1 Tf
0 -2.67 TD
(108.)Tj
/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(Lillie TH, Schreck CE, Rahe AJ.)Tj
/T1_0 1 Tf
( Effectiveness of personal protection against mosquitoes in Alaska. J Me\
d )Tj
0 -1.2 TD
(Entomol. 1988; 25:475-8. )Tj
/T1_1 1 Tf
0 -2.67 TD
(109.)Tj
/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(Belton P.)Tj
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( An acoustic evaluation of electronic mosquito repellers. Mosquito News.\
1981; 41:751-5. )Tj
/T1_1 1 Tf
T*
(110.)Tj
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( )Tj
/T1_1 1 Tf
(Lewis DJ, Fairchild WL, Leprince DJ.)Tj
/T1_0 1 Tf
( Evaluation of an electronic mosquito repeller. Canadian )Tj
0 -1.2 TD
(Entomologist. 1982; 114:699-702. )Tj
/T1_1 1 Tf
0 -2.67 TD
(111.)Tj
/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(Foster WA, Lutes KI.)Tj
/T1_0 1 Tf
( Tests of ultrasonic emissions on mosquito attraction to hosts in a flig\
ht chamber. J )Tj
0 -1.2 TD
(Am Mosq Control Assoc. 1985; 1:199-202. )Tj
/T1_1 1 Tf
0 -2.67 TD
(112.)Tj
/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(Mitchell M.)Tj
/T1_0 1 Tf
( Mythical mosquito control. Wing Beats. 1992; 3:18-20. )Tj
/T1_1 1 Tf
T*
(113.)Tj
/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(Nascl RS, Harris CW, Porter CK.)Tj
/T1_0 1 Tf
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0 -1.2 TD
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(Mosquitoes and Mosquito Repellents: A Clinician's Guide)Tj
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(Annals of Internal Medicine | 1 June 1998 | Volume 128 Issue 11 | Pages \
931-940 )Tj
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( )Tj
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(This paper is intended to provide the clinician with the detailed and sc\
ientific information needed to )Tj
0 -1.2 TD
(advise patients who seek safe and effective ways of preventing mosquito \
bites. For this review, clinical )Tj
0 -1.2 TD
(and analytical data were selected from peer-reviewed research studies an\
d review articles, case reports, )Tj
T*
(entomology texts and journals, and government and industry publications.\
Relevant information was )Tj
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(identified through a search of the MEDLINE database, the World Wide Web,\
the Mosquito-L electronic )Tj
0 -1.2 TD
(mailing list, and the Extension Toxicology Network database; selected U.\
S. Army, U.S. Environmental )Tj
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(Protection Agency, and U.S. Department of Agriculture publications were \
also reviewed. )Tj
0 -1.1 TD
( )Tj
T*
(N,N-diethyl-3-methylbenzamide \(DEET\) is the most effective, and best s\
tudied, insect repellent )Tj
0 -1.2 TD
(currently on the market. This substance has a remarkable safety profile \
after 40 years of worldwide use, )Tj
T*
(but toxic reactions can occur \(usually when the product is misused\). W\
hen DEET-based repellents are )Tj
T*
(applied in combination with permethrin-treated clothing, protection agai\
nst bites of nearly 100% can be )Tj
0 -1.2 TD
(achieved. Plant-based repellents are generally less effective than DEET-\
based products. Ultrasonic )Tj
0 -1.2 TD
(devices, outdoor bug "zappers," and bat houses are not effective against\
mosquitoes. Highly sensitive )Tj
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(persons may want to take oral antihistamines to minimize cutaneous react\
ions to mosquito bites. )Tj
0 -1.1 TD
( )Tj
T*
(The quest to make humans less attractive to mosquitoes has fueled decade\
s of scientific research on )Tj
0 -1.2 TD
(mosquito behavior and control. In the United States, mosquito bites are \
mostly a nuisance. Worldwide, )Tj
T*
(however, mosquitoes transmit disease to more than 700 000 000 people ann\
ually and will be responsible )Tj
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(for the deaths of 1 of every 17 people currently alive )Tj
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(. Malaria results from infection with a protozoan )Tj
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(carried by mosquitoes and, according to reports from the World Health Or\
ganization, causes as many as )Tj
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(3 000 000 deaths annually )Tj
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(. Mosquitoes transmit the arboviruses responsible for yellow fever, deng\
ue )Tj
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(hemorrhagic fever, epidemic polyarthritis, and several forms of encephal\
itis \(some of which are found in )Tj
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(the United States\). Bancroftian filariasis is caused by a nematode tran\
smitted by mosquito bite. )Tj
0 -1.1 TD
( )Tj
T*
(Historically, the strategies for reducing the incidence of mosquito-born\
e disease have been two-pronged, )Tj
0 -1.2 TD
(centering around habitat control \(through chemical and biological means\
\) and the use of personal )Tj
T*
(protection in the form of insect repellents. This paper reviews the scie\
ntific data on chemical \(synthetic\) )Tj
0 -1.2 TD
(and natural \(plant-derived\) insect repellents currently available, deb\
unks some of the popular myths )Tj
T*
(about alternative repellents, reviews effective techniques for reducing \
mosquito populations in the local )Tj
T*
(environment, and provides the clinician with the practical information n\
eeded to advise patients on how )Tj
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(to safely and effectively reduce their likelihood of being bitten by mos\
quitoes. )Tj
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( )Tj
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(By doing a MEDLINE search with the keywords DEET, insect repellents, mos\
quito, citronella, and )Tj
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(permethrin, pertinent articles published in English-language journals be\
tween 1966 and 1997 were )Tj
T*
(identified and reviewed. The World Wide Web and the Extension Toxicity N\
etwork database were also )Tj
0 -1.2 TD
(searched for toxicology data and other pertinent information. Selection \
from the bibliographies of )Tj
0 -1.2 TD
(relevant articles augmented the database search. Major distributors of n\
atural insect repellents were )Tj
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(contacted and asked to provide scientific data, if available, supporting\
the efficacy of their products. )Tj
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(The Mosquito Life Cycle)Tj
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( )Tj
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(Mosquitoes are found all over the world, except in Antarctica. These two\
-winged insects belong to the )Tj
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(order Diptera. Members of the genera )Tj
/T1_1 1 Tf
(Anopheles)Tj
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(, )Tj
/T1_1 1 Tf
(Culex)Tj
/T1_0 1 Tf
(, and )Tj
/T1_1 1 Tf
(Aedes)Tj
/T1_0 1 Tf
( are most commonly responsible for )Tj
T*
(bites in humans. There are approximately 170 species of mosquitoes in No\
rth America alone. )Tj
0 -1.1 TD
( )Tj
0 -1.1 TD
(To develop, mosquitoes require an environment of standing water. As a gr\
oup, they have adapted to )Tj
0 -1.2 TD
(complete their life cycle in diverse aquatic habitats, including fresh w\
ater; salt water marshes; brackish )Tj
T*
(water; or water found in containers, old tires, or tree holes. The life \
cycle of the mosquito has four )Tj
0 -1.2 TD
(stages. The female mosquito lays her eggs, up to several hundred at a ti\
me, on the surface of the water or )Tj
T*
(in an area subject to flooding. Unhatched eggs of some species can withs\
tand weeks to months of )Tj
T*
(desiccation, remaining viable until the right conditions for hatching oc\
cur. The eggs of most species )Tj
T*
(hatch in 2 to 3 days, and the larvae feed on organic matter in the water\
for about a week until they )Tj
T*
(change into pupae. The pupae live at the surface of the water for 2 to 3\
days before metamorphosing into )Tj
T*
(adult mosquitoes. )Tj
0 -1.1 TD
( )Tj
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(Only female mosquitoes bite. Male mosquitoes feed primarily on flower ne\
ctar, whereas female )Tj
0 -1.2 TD
(mosquitoes require a blood meal to produce eggs. They usually feed every\
3 to 4 days; in a single )Tj
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(feeding, a female mosquito typically consumes more than its own weight i\
n blood )Tj
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([3])Tj
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(. Certain species of )Tj
-33.053 -1.343 Td
(mosquitoes prefer to feed at twilight or nighttime; others bite mostly d\
uring the day. )Tj
0 -1.1 TD
( )Tj
T*
(Some mosquito species are zoophilic \(preferring to feed on animals\) an\
d others are anthropophilic )Tj
0 -1.2 TD
(\(showing a preference for human blood\). In some mosquito species, seas\
onal switching of hosts )Tj
T*
(provides a mechanism for transmitting diseases from animal to human. \(I\
t is worth noting, however, that )Tj
T*
(mosquitoes cannot transmit HIV because the virus neither survives nor re\
plicates in mosquitoes and the )Tj
0 -1.2 TD
(blood from the last bitten person is not flushed into the next person du\
ring subsequent feeds. In addition, )Tj
T*
(the circulating viral load of most HIV-infected persons is so low that t\
he theoretical risk that a mosquito )Tj
T*
(bite would transmit HIV is estimated to be less than 1 in 10 000 000 )Tj
ET
395.378 138.32 m
425.702 138.32 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 395.378 140.4371 Tm
([4, 5])Tj
0 0 0 rg
(.\) )Tj
-27.527 -1.343 Td
( )Tj
0 0.6 0.51 rg
/TT0 1 Tf
19.3846 0 0 19.3846 13.5 121.6371 Tm
( )Tj
-0.181 -1.002 Td
( )Tj
/TT1 1 Tf
0 -1.073 TD
(Stimuli That Attract Mosquitoes)Tj
/TT0 1 Tf
( )Tj
0 -1.127 TD
( )Tj
0 0 0 rg
/T1_0 1 Tf
14 0 0 14 10 42.8063 Tm
(The factors involved in attracting mosquitoes to a host are complex and \
are not fully understood )Tj
ET
552.038 40.69 m
587.024 40.69 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 552.038 42.8063 Tm
([6-11])Tj
0 0 0 rg
(. )Tj
ET
EMC
/Artifact <>BDC
Q
0 0 0 rg
0 i
BT
/T1_0 1 Tf
0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 9 0 0 9 18 7.17 Tm
(file:///C|/My Documents/! Travel Documents/Mosquitoes_and_Mosquito_Repel\
lents.htm \(2 of 19\)10/16/2006 5:38:59 PM)Tj
ET
EMC
endstream
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0 0 0 rg
0 i
BT
/T1_0 1 Tf
0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 16.1538 0 0 16.1538 10 732.8457 Tm
(Mosquitoes and Mosquito Repellents: A Clinician's Guide)Tj
/TT0 1 Tf
12.9231 0 0 12.9231 10 697.5555 Tm
(Mark S. Fradin, MD )Tj
0 0.6 0.51 rg
/TT1 1 Tf
0 -1.128 TD
( )Tj
0 -1.1 TD
(Annals of Internal Medicine | 1 June 1998 | Volume 128 Issue 11 | Pages \
931-940 )Tj
T*
( )Tj
0 -1.1 TD
(Source: )Tj
ET
0 0 1 RG
0.62 w 10 M 0 j 0 J []0 d
61.705 638.476 m
360.461 638.476 l
S
0 0 1 rg
BT
/TT1 1 Tf
12.9231 0 0 12.9231 61.7052 640.3366 Tm
(http://www.annals.org/cgi/content/full/128/11/931)Tj
0 0 0 rg
/TT0 1 Tf
14 0 0 14 360.4609 640.3366 Tm
( )Tj
-25.033 -1.241 Td
( )Tj
/T1_1 1 Tf
0 -1.103 TD
(This paper is intended to provide the clinician with the detailed and sc\
ientific information needed to )Tj
0 -1.2 TD
(advise patients who seek safe and effective ways of preventing mosquito \
bites. For this review, clinical )Tj
0 -1.2 TD
(and analytical data were selected from peer-reviewed research studies an\
d review articles, case reports, )Tj
T*
(entomology texts and journals, and government and industry publications.\
Relevant information was )Tj
T*
(identified through a search of the MEDLINE database, the World Wide Web,\
the Mosquito-L electronic )Tj
0 -1.2 TD
(mailing list, and the Extension Toxicology Network database; selected U.\
S. Army, U.S. Environmental )Tj
T*
(Protection Agency, and U.S. Department of Agriculture publications were \
also reviewed. )Tj
0 -1.1 TD
( )Tj
T*
(N,N-diethyl-3-methylbenzamide \(DEET\) is the most effective, and best s\
tudied, insect repellent )Tj
0 -1.2 TD
(currently on the market. This substance has a remarkable safety profile \
after 40 years of worldwide use, )Tj
T*
(but toxic reactions can occur \(usually when the product is misused\). W\
hen DEET-based repellents are )Tj
T*
(applied in combination with permethrin-treated clothing, protection agai\
nst bites of nearly 100% can be )Tj
0 -1.2 TD
(achieved. Plant-based repellents are generally less effective than DEET-\
based products. Ultrasonic )Tj
0 -1.2 TD
(devices, outdoor bug "zappers," and bat houses are not effective against\
mosquitoes. Highly sensitive )Tj
T*
(persons may want to take oral antihistamines to minimize cutaneous react\
ions to mosquito bites. )Tj
0 -1.1 TD
( )Tj
T*
(The quest to make humans less attractive to mosquitoes has fueled decade\
s of scientific research on )Tj
0 -1.2 TD
(mosquito behavior and control. In the United States, mosquito bites are \
mostly a nuisance. Worldwide, )Tj
T*
(however, mosquitoes transmit disease to more than 700 000 000 people ann\
ually and will be responsible )Tj
T*
(for the deaths of 1 of every 17 people currently alive )Tj
ET
0.706 w
308.2 291.797 m
324.524 291.797 l
S
0 0 1 rg
BT
/T1_1 1 Tf
14 0 0 14 308.2 293.914 Tm
([1])Tj
0 0 0 rg
(. Malaria results from infection with a protozoan )Tj
-21.3 -1.343 Td
(carried by mosquitoes and, according to reports from the World Health Or\
ganization, causes as many as )Tj
0 -1.2 TD
(3 000 000 deaths annually )Tj
ET
160.486 256.197 m
176.81 256.197 l
S
0 0 1 rg
BT
/T1_1 1 Tf
14 0 0 14 160.486 258.314 Tm
([2])Tj
0 0 0 rg
(. Mosquitoes transmit the arboviruses responsible for yellow fever, deng\
ue )Tj
-10.749 -1.343 Td
(hemorrhagic fever, epidemic polyarthritis, and several forms of encephal\
itis \(some of which are found in )Tj
T*
(the United States\). Bancroftian filariasis is caused by a nematode tran\
smitted by mosquito bite. )Tj
0 -1.1 TD
( )Tj
T*
(Historically, the strategies for reducing the incidence of mosquito-born\
e disease have been two-pronged, )Tj
0 -1.2 TD
(centering around habitat control \(through chemical and biological means\
\) and the use of personal )Tj
T*
(protection in the form of insect repellents. This paper reviews the scie\
ntific data on chemical \(synthetic\) )Tj
0 -1.2 TD
(and natural \(plant-derived\) insect repellents currently available, deb\
unks some of the popular myths )Tj
T*
(about alternative repellents, reviews effective techniques for reducing \
mosquito populations in the local )Tj
T*
(environment, and provides the clinician with the practical information n\
eeded to advise patients on how )Tj
T*
(to safely and effectively reduce their likelihood of being bitten by mos\
quitoes. )Tj
0 -1.1 TD
( )Tj
0 -1 TD
( )Tj
0 0.6 0.51 rg
/TT1 1 Tf
19.3846 0 0 19.3846 10 42.2741 Tm
(Methods)Tj
/TT0 1 Tf
( )Tj
ET
EMC
/Artifact <>BDC
Q
EMC
endstream
endobj
351 0 obj<>stream
/Artifact <>BDC
EMC
/Article <>BDC
q
0 18 612 756 re
W* n
0 0.6 0.51 rg
0 i
BT
/TT0 1 Tf
0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 19.3846 0 0 19.3846 10 750.4256 Tm
( )Tj
0 0 0 rg
/T1_0 1 Tf
14 0 0 14 10 733.6679 Tm
(By doing a MEDLINE search with the keywords DEET, insect repellents, mos\
quito, citronella, and )Tj
0 -1.2 TD
(permethrin, pertinent articles published in English-language journals be\
tween 1966 and 1997 were )Tj
T*
(identified and reviewed. The World Wide Web and the Extension Toxicity N\
etwork database were also )Tj
0 -1.2 TD
(searched for toxicology data and other pertinent information. Selection \
from the bibliographies of )Tj
0 -1.2 TD
(relevant articles augmented the database search. Major distributors of n\
atural insect repellents were )Tj
T*
(contacted and asked to provide scientific data, if available, supporting\
the efficacy of their products. )Tj
T*
( )Tj
0 0.6 0.51 rg
/TT0 1 Tf
19.3846 0 0 19.3846 13.5 632.8679 Tm
( )Tj
-0.181 -1.002 Td
( )Tj
/TT1 1 Tf
0 -1.073 TD
(The Mosquito Life Cycle)Tj
/TT0 1 Tf
( )Tj
0 -1.127 TD
( )Tj
0 0 0 rg
/T1_0 1 Tf
14 0 0 14 10 554.0371 Tm
(Mosquitoes are found all over the world, except in Antarctica. These two\
-winged insects belong to the )Tj
0 -1.2 TD
(order Diptera. Members of the genera )Tj
/T1_1 1 Tf
(Anopheles)Tj
/T1_0 1 Tf
(, )Tj
/T1_1 1 Tf
(Culex)Tj
/T1_0 1 Tf
(, and )Tj
/T1_1 1 Tf
(Aedes)Tj
/T1_0 1 Tf
( are most commonly responsible for )Tj
T*
(bites in humans. There are approximately 170 species of mosquitoes in No\
rth America alone. )Tj
0 -1.1 TD
( )Tj
0 -1.1 TD
(To develop, mosquitoes require an environment of standing water. As a gr\
oup, they have adapted to )Tj
0 -1.2 TD
(complete their life cycle in diverse aquatic habitats, including fresh w\
ater; salt water marshes; brackish )Tj
T*
(water; or water found in containers, old tires, or tree holes. The life \
cycle of the mosquito has four )Tj
0 -1.2 TD
(stages. The female mosquito lays her eggs, up to several hundred at a ti\
me, on the surface of the water or )Tj
T*
(in an area subject to flooding. Unhatched eggs of some species can withs\
tand weeks to months of )Tj
T*
(desiccation, remaining viable until the right conditions for hatching oc\
cur. The eggs of most species )Tj
T*
(hatch in 2 to 3 days, and the larvae feed on organic matter in the water\
for about a week until they )Tj
T*
(change into pupae. The pupae live at the surface of the water for 2 to 3\
days before metamorphosing into )Tj
T*
(adult mosquitoes. )Tj
0 -1.1 TD
( )Tj
T*
(Only female mosquitoes bite. Male mosquitoes feed primarily on flower ne\
ctar, whereas female )Tj
0 -1.2 TD
(mosquitoes require a blood meal to produce eggs. They usually feed every\
3 to 4 days; in a single )Tj
T*
(feeding, a female mosquito typically consumes more than its own weight i\
n blood )Tj
ET
0 0 1 RG
0.706 w 10 M 0 j 0 J []0 d
472.742 288.72 m
489.066 288.72 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 472.742 290.8371 Tm
([3])Tj
0 0 0 rg
(. Certain species of )Tj
-33.053 -1.343 Td
(mosquitoes prefer to feed at twilight or nighttime; others bite mostly d\
uring the day. )Tj
0 -1.1 TD
( )Tj
T*
(Some mosquito species are zoophilic \(preferring to feed on animals\) an\
d others are anthropophilic )Tj
0 -1.2 TD
(\(showing a preference for human blood\). In some mosquito species, seas\
onal switching of hosts )Tj
T*
(provides a mechanism for transmitting diseases from animal to human. \(I\
t is worth noting, however, that )Tj
T*
(mosquitoes cannot transmit HIV because the virus neither survives nor re\
plicates in mosquitoes and the )Tj
0 -1.2 TD
(blood from the last bitten person is not flushed into the next person du\
ring subsequent feeds. In addition, )Tj
T*
(the circulating viral load of most HIV-infected persons is so low that t\
he theoretical risk that a mosquito )Tj
T*
(bite would transmit HIV is estimated to be less than 1 in 10 000 000 )Tj
ET
395.378 138.32 m
425.702 138.32 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 395.378 140.4371 Tm
([4, 5])Tj
0 0 0 rg
(.\) )Tj
-27.527 -1.343 Td
( )Tj
0 0.6 0.51 rg
/TT0 1 Tf
19.3846 0 0 19.3846 13.5 121.6371 Tm
( )Tj
-0.181 -1.002 Td
( )Tj
/TT1 1 Tf
0 -1.073 TD
(Stimuli That Attract Mosquitoes)Tj
/TT0 1 Tf
( )Tj
0 -1.127 TD
( )Tj
0 0 0 rg
/T1_0 1 Tf
14 0 0 14 10 42.8063 Tm
(The factors involved in attracting mosquitoes to a host are complex and \
are not fully understood )Tj
ET
552.038 40.69 m
587.024 40.69 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 552.038 42.8063 Tm
([6-11])Tj
0 0 0 rg
(. )Tj
ET
EMC
/Artifact <>BDC
Q
EMC
endstream
endobj
352 0 obj<>stream
/Artifact <>BDC
EMC
/Article <>BDC
q
0 18 612 756 re
W* n
0 0 0 rg
0 i
BT
/T1_0 1 Tf
0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 14 0 0 14 10 753.9756 Tm
(Mosquitoes use visual, thermal, and olfactory stimuli to locate a host. \
Of these, olfactory cues are )Tj
0 -1.2 TD
(probably most important. For mosquitoes that feed during the daytime, mo\
vement of the host and the )Tj
T*
(wearing of dark-colored clothing may initiate orientation toward a perso\
n )Tj
ET
0 0 1 RG
0.706 w 10 M 0 j 0 J []0 d
425.254 718.259 m
462.578 718.259 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 425.254 720.3755 Tm
([3, 12])Tj
0 0 0 rg
(. Visual stimuli seem to )Tj
-29.661 -1.343 Td
(be important for in-flight orientation, particularly over long ranges, w\
hereas olfactory stimuli become )Tj
0 -1.2 TD
(more important as a mosquito nears its host. )Tj
0 -1.1 TD
( )Tj
T*
(It has been estimated that 300 to 400 compounds are released from the bo\
dy as by-products of )Tj
0 -1.2 TD
(metabolism and that more than 100 volatile compounds can be detected in \
human breath )Tj
ET
509.268 635.059 m
525.592 635.059 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 509.268 637.1756 Tm
([9])Tj
0 0 0 rg
(. Of these )Tj
-35.662 -1.343 Td
(odors, only a fraction have been isolated and fully characterized. Carbo\
n dioxide and lactic acid are the )Tj
T*
(two best-studied mosquito attractants. Carbon dioxide, released mainly f\
rom breath but also from skin, )Tj
T*
(serves as a long-range airborne attractant and can be detected by mosqui\
toes at distances of up to 36 )Tj
T*
(meters )Tj
ET
50.824 565.859 m
106.81 565.859 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 50.824 567.9756 Tm
([3, 13-15])Tj
0 0 0 rg
(. Lactic acid, in combination with carbon dioxide, is also an attractant\
. Mosquitoes )Tj
-2.916 -1.343 Td
(have chemoreceptors on their antennae that are stimulated by lactic acid\
. These same receptors may be )Tj
T*
(inhibited by N,N-diethyl-3-methyl-benzamide \(DEET\)-based insect repell\
ents )Tj
ET
451.308 530.259 m
474.632 530.259 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 451.308 532.3755 Tm
([16])Tj
0 0 0 rg
(. )Tj
-31.522 -1.243 Td
( )Tj
0 -1.1 TD
(At close range, skin temperature and moisture serve as attractants )Tj
ET
380.524 497.459 m
431.848 497.459 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 380.524 499.5756 Tm
([3, 9, 17])Tj
0 0 0 rg
(. Different species of )Tj
-26.466 -1.343 Td
(mosquitoes may show strong biting preferences for different parts of the\
human body \(such as the head )Tj
0 -1.2 TD
(or feet\), which may be related to local skin temperature and eccrine sw\
eat gland output )Tj
ET
500.658 461.859 m
544.982 461.859 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 500.658 463.9756 Tm
([18, 19])Tj
0 0 0 rg
(. )Tj
-35.047 -1.343 Td
(Anhidrotic persons show markedly decreased attractiveness to mosquitoes \
)Tj
ET
429.93 443.059 m
446.254 443.059 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 429.93 445.1756 Tm
([6])Tj
0 0 0 rg
(. Other volatile )Tj
-29.995 -1.343 Td
(compounds, derived from sebum, eccrine and apocrine sweat, or the cutane\
ous microflora bacterial )Tj
T*
(action on these secretions, may also act as chemoattractants )Tj
ET
347.484 407.459 m
405.808 407.459 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 347.484 409.5756 Tm
([6, 20, 21])Tj
0 0 0 rg
(. Whole-host odors are more )Tj
-24.106 -1.343 Td
(attractive than carbon dioxide and lactic acid alone )Tj
ET
298.484 388.659 m
321.808 388.659 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 298.484 390.7756 Tm
([22])Tj
0 0 0 rg
(. Floral fragrances from perfumes, soaps, lotions, )Tj
-20.606 -1.343 Td
(and hair-care products may also attract mosquitoes )Tj
ET
298.106 369.859 m
321.43 369.859 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 298.106 371.9756 Tm
([23])Tj
0 0 0 rg
(. )Tj
-20.579 -1.243 Td
( )Tj
0 -1.1 TD
(The attractiveness of different persons to the same or different species\
of mosquitoes varies substantially )Tj
ET
10 320.259 m
54.324 320.259 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 10 322.3755 Tm
([17, 24])Tj
0 0 0 rg
(. In general, adults are more likely to be bitten than children )Tj
ET
393.376 320.259 m
437.7 320.259 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 393.376 322.3755 Tm
([17, 25])Tj
0 0 0 rg
(, although adults may )Tj
-27.384 -1.343 Td
(become less attractive to mosquitoes as they age )Tj
ET
284.512 301.459 m
300.836 301.459 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 284.512 303.5756 Tm
([6])Tj
0 0 0 rg
(. Men are bitten more readily than women )Tj
ET
539.956 301.459 m
577.28 301.459 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 539.956 303.5756 Tm
([3, 26])Tj
0 0 0 rg
(. )Tj
-37.854 -1.343 Td
(Larger persons tend to attract more mosquitoes, perhaps because of their\
greater relative heat or carbon )Tj
0 -1.2 TD
(dioxide output )Tj
ET
94.784 265.859 m
118.108 265.859 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 94.784 267.9756 Tm
([27])Tj
0 0 0 rg
(. )Tj
-6.056 -1.243 Td
( )Tj
0 0.6 0.51 rg
/TT0 1 Tf
19.3846 0 0 19.3846 10 232.5487 Tm
( )Tj
/TT1 1 Tf
0 -1.073 TD
(Insect Repellents)Tj
/TT0 1 Tf
( )Tj
0 -1.127 TD
( )Tj
0 0 0 rg
/T1_0 1 Tf
14 0 0 14 10 173.1448 Tm
(Despite the obvious desirability of finding an effective oral mosquito r\
epellent, no such agent has been )Tj
0 -1.2 TD
(identified )Tj
ET
67.162 154.228 m
111.486 154.228 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 67.162 156.3448 Tm
([28, 29])Tj
0 0 0 rg
(. Thus, the search for the perfect topical insect repellent continues. T\
his ideal agent )Tj
-4.083 -1.343 Td
(would repel multiple species of biting arthropods, remain effective for \
at least 8 hours, cause no )Tj
0 -1.2 TD
(irritation to the skin or mucous membranes, cause no systemic toxicity, \
be resistant to abrasion and rub-)Tj
T*
(off, and be greaseless and odorless. No available insect repellent meets\
all of these criteria. )Tj
0 -1.1 TD
( )Tj
T*
(Efforts to find such a compound have been hampered by the numerous varia\
bles that affect the inherent )Tj
0 -1.2 TD
(repellency of any chemical. Repellents do not all share a single mode of\
action, and surprisingly little is )Tj
ET
EMC
/Artifact <>BDC
Q
0 0 0 rg
0 i
BT
/T1_0 1 Tf
0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 9 0 0 9 18 7.17 Tm
(file:///C|/My Documents/! Travel Documents/Mosquitoes_and_Mosquito_Repel\
lents.htm \(3 of 19\)10/16/2006 5:38:59 PM)Tj
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EMC
endstream
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/Article <>BDC
q
0 18 612 756 re
W* n
0 0 0 rg
0 i
BT
/T1_0 1 Tf
0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 14 0 0 14 10 753.9756 Tm
(Mosquitoes use visual, thermal, and olfactory stimuli to locate a host. \
Of these, olfactory cues are )Tj
0 -1.2 TD
(probably most important. For mosquitoes that feed during the daytime, mo\
vement of the host and the )Tj
T*
(wearing of dark-colored clothing may initiate orientation toward a perso\
n )Tj
ET
0 0 1 RG
0.706 w 10 M 0 j 0 J []0 d
425.254 718.259 m
462.578 718.259 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 425.254 720.3755 Tm
([3, 12])Tj
0 0 0 rg
(. Visual stimuli seem to )Tj
-29.661 -1.343 Td
(be important for in-flight orientation, particularly over long ranges, w\
hereas olfactory stimuli become )Tj
0 -1.2 TD
(more important as a mosquito nears its host. )Tj
0 -1.1 TD
( )Tj
T*
(It has been estimated that 300 to 400 compounds are released from the bo\
dy as by-products of )Tj
0 -1.2 TD
(metabolism and that more than 100 volatile compounds can be detected in \
human breath )Tj
ET
509.268 635.059 m
525.592 635.059 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 509.268 637.1756 Tm
([9])Tj
0 0 0 rg
(. Of these )Tj
-35.662 -1.343 Td
(odors, only a fraction have been isolated and fully characterized. Carbo\
n dioxide and lactic acid are the )Tj
T*
(two best-studied mosquito attractants. Carbon dioxide, released mainly f\
rom breath but also from skin, )Tj
T*
(serves as a long-range airborne attractant and can be detected by mosqui\
toes at distances of up to 36 )Tj
T*
(meters )Tj
ET
50.824 565.859 m
106.81 565.859 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 50.824 567.9756 Tm
([3, 13-15])Tj
0 0 0 rg
(. Lactic acid, in combination with carbon dioxide, is also an attractant\
. Mosquitoes )Tj
-2.916 -1.343 Td
(have chemoreceptors on their antennae that are stimulated by lactic acid\
. These same receptors may be )Tj
T*
(inhibited by N,N-diethyl-3-methyl-benzamide \(DEET\)-based insect repell\
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ET
451.308 530.259 m
474.632 530.259 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 451.308 532.3755 Tm
([16])Tj
0 0 0 rg
(. )Tj
-31.522 -1.243 Td
( )Tj
0 -1.1 TD
(At close range, skin temperature and moisture serve as attractants )Tj
ET
380.524 497.459 m
431.848 497.459 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 380.524 499.5756 Tm
([3, 9, 17])Tj
0 0 0 rg
(. Different species of )Tj
-26.466 -1.343 Td
(mosquitoes may show strong biting preferences for different parts of the\
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0 -1.2 TD
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eat gland output )Tj
ET
500.658 461.859 m
544.982 461.859 l
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0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 500.658 463.9756 Tm
([18, 19])Tj
0 0 0 rg
(. )Tj
-35.047 -1.343 Td
(Anhidrotic persons show markedly decreased attractiveness to mosquitoes \
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ET
429.93 443.059 m
446.254 443.059 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 429.93 445.1756 Tm
([6])Tj
0 0 0 rg
(. Other volatile )Tj
-29.995 -1.343 Td
(compounds, derived from sebum, eccrine and apocrine sweat, or the cutane\
ous microflora bacterial )Tj
T*
(action on these secretions, may also act as chemoattractants )Tj
ET
347.484 407.459 m
405.808 407.459 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 347.484 409.5756 Tm
([6, 20, 21])Tj
0 0 0 rg
(. Whole-host odors are more )Tj
-24.106 -1.343 Td
(attractive than carbon dioxide and lactic acid alone )Tj
ET
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321.808 388.659 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 298.484 390.7756 Tm
([22])Tj
0 0 0 rg
(. Floral fragrances from perfumes, soaps, lotions, )Tj
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ET
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321.43 369.859 l
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0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 298.106 371.9756 Tm
([23])Tj
0 0 0 rg
(. )Tj
-20.579 -1.243 Td
( )Tj
0 -1.1 TD
(The attractiveness of different persons to the same or different species\
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ET
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54.324 320.259 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 10 322.3755 Tm
([17, 24])Tj
0 0 0 rg
(. In general, adults are more likely to be bitten than children )Tj
ET
393.376 320.259 m
437.7 320.259 l
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0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 393.376 322.3755 Tm
([17, 25])Tj
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ET
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300.836 301.459 l
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0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 284.512 303.5756 Tm
([6])Tj
0 0 0 rg
(. Men are bitten more readily than women )Tj
ET
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577.28 301.459 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 539.956 303.5756 Tm
([3, 26])Tj
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-37.854 -1.343 Td
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ET
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118.108 265.859 l
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0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 94.784 267.9756 Tm
([27])Tj
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(. )Tj
-6.056 -1.243 Td
( )Tj
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/TT0 1 Tf
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( )Tj
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(Insect Repellents)Tj
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( )Tj
0 -1.127 TD
( )Tj
0 0 0 rg
/T1_0 1 Tf
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0 -1.2 TD
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ET
67.162 154.228 m
111.486 154.228 l
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0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 67.162 156.3448 Tm
([28, 29])Tj
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( )Tj
T*
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0 -1.2 TD
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359.552 751.859 l
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0 0 1 rg
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/T1_0 1 Tf
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([30, 31])Tj
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341.268 733.059 l
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0 0 1 rg
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/T1_0 1 Tf
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( )Tj
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T*
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T*
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T*
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0 -1.2 TD
(host )Tj
ET
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60.162 616.259 l
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0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 36.838 618.3755 Tm
([33])Tj
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588.116 597.459 l
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0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 543.792 599.5756 Tm
([17, 34-)Tj
ET
10 578.659 m
28.662 578.659 l
S
BT
/T1_0 1 Tf
14 0 0 14 10 580.7756 Tm
(37])Tj
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ET
561.096 578.659 m
584.42 578.659 l
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0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 561.096 580.7756 Tm
([37])Tj
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-39.364 -1.343 Td
(The repellents currently available must be applied to all exposed areas \
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0 -1.2 TD
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ET
437.658 543.059 m
481.982 543.059 l
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0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 437.658 545.1756 Tm
([33, 35])Tj
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(. )Tj
-30.547 -1.343 Td
( )Tj
0 0.6 0.51 rg
/TT0 1 Tf
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( )Tj
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( )Tj
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(Chemical Insect Repellents)Tj
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( )Tj
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( )Tj
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(N,N-Diethyl-3-Methylbenzamide \(DEET\) )Tj
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T*
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T*
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0 0 1 rg
BT
/T1_0 1 Tf
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([30, 33, 38-41])Tj
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(Environmental Protection Agency \(EPA\) estimates that more than 38% of \
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T*
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33.324 259.92 l
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0 0 1 rg
BT
/T1_0 1 Tf
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([42])Tj
0 0 0 rg
(.)Tj
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( )Tj
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( )Tj
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(Formulation of Available Products with DEET)Tj
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( )Tj
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326.809 142.361 l
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0 0 1 rg
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/T1_1 1 Tf
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(View Table 1: Repellents That Contain DEET)Tj
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(37])Tj
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0 0 1 rg
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/T1_0 1 Tf
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0 0 1 rg
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0 0 1 rg
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0 -1.2 TD
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( )Tj
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( )Tj
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(Efficacy )Tj
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( )Tj
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( )Tj
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0 0 1 rg
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([43, 44])Tj
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93.594 467.92 l
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0 0 1 rg
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/T1_0 1 Tf
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([45])Tj
0 0 0 rg
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0 0 1 rg
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/T1_0 1 Tf
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([46])Tj
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( )Tj
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/T1_0 1 Tf
0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 14 0 0 14 10 753.914 Tm
(sleeping bags. Persons who are particularly concerned about potential to\
xicity from DEET may limit )Tj
0 -1.2 TD
(application of the repellent to their clothes. If DEET-treated garments \
are stored in a plastic bag between )Tj
T*
(wearings, the repellent effect can last for many weeks )Tj
ET
0 0 1 RG
0.706 w 10 M 0 j 0 J []0 d
314.794 718.197 m
338.118 718.197 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 314.794 720.314 Tm
([24])Tj
0 0 0 rg
(. )Tj
-21.771 -1.243 Td
( )Tj
0 -1.1 TD
(Repellents containing DEET must be carefully applied because they can da\
mage plastics \(such as watch )Tj
0 -1.2 TD
(crystals and eyeglasses frames\), rayon, spandex, other synthetic fabric\
s, leather, and painted or )Tj
T*
(varnished surfaces. DEET does not damage natural fibers, such as cotton \
or wool, and has no effect on )Tj
T*
(nylon. The lay literature contains many accounts of the unpleasant odor \
or greasy feel of DEET, but )Tj
T*
(careful testing has shown a full spectrum of aesthetic responses to thes\
e products )Tj
ET
466.862 618.197 m
490.186 618.197 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 466.862 620.314 Tm
([56])Tj
0 0 0 rg
(. )Tj
-32.633 -1.243 Td
( )Tj
0 -1.1 TD
(Consumers who apply both a DEET-based insect repellent and a sunscreen s\
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0 -1.2 TD
(repellent may reduce the sunscreen's effectiveness. A limited study in 1\
4 volunteers using the 3M )Tj
T*
(polymer-based 33% DEET repellent and a sunscreen with sun protection fac\
tor 15 revealed a mean )Tj
T*
(decrease in sun protection factor of 33.5% when the two agents were appl\
ied sequentially )Tj
ET
515.05 534.997 m
538.374 534.997 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 515.05 537.114 Tm
([57])Tj
0 0 0 rg
(. )Tj
-36.075 -1.343 Td
(Combination products in which the insect repellent and sunscreen have be\
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T*
(however, would be expected to provide the sun protection factor stated o\
n the label.)Tj
0 0.4 0.353 rg
/T1_1 1 Tf
( )Tj
0 -1.1 TD
( )Tj
16.1538 0 0 16.1538 10 468.8641 Tm
(Pharmacology )Tj
T*
( )Tj
0 0 0 rg
/T1_0 1 Tf
14 0 0 14 10 435.1756 Tm
(Numerous studies have evaluated the percutaneous absorption, metabolism,\
and rate of excretion of )Tj
0 -1.2 TD
(DEET )Tj
ET
49.27 416.259 m
91.256 416.259 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 49.27 418.3755 Tm
([58-61])Tj
0 0 0 rg
(. Initial data suggested that 9% to 56% of the applied dose was absorbed\
through the skin )Tj
ET
10 397.459 m
33.324 397.459 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 10 399.5756 Tm
([59])Tj
0 0 0 rg
(. A carefully conducted study from 1995 that used human volunteers showe\
d that the average )Tj
0 -1.343 TD
(dermal absorption of 100% DEET was 5.6%; for 15% DEET in ethanol, an ave\
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0 -1.2 TD
(was absorbed )Tj
ET
89.31 361.859 m
112.634 361.859 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 89.31 363.9756 Tm
([58])Tj
0 0 0 rg
(. Because of its lipophilic nature, DEET was rapidly absorbed within 2 h\
ours after )Tj
-5.665 -1.343 Td
(application; was eliminated from the plasma within 4 hours after being r\
insed off the skin; and was )Tj
T*
(primarily excreted in the urine, mostly within 12 hours. Tape stripping \
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T*
(not accumulate in the stratum corneum. )Tj
0 -1.1 TD
( )Tj
T*
(Bioavailability experiments conducted with Minnetonka Brands' 10% DEET l\
iposphere formulation )Tj
0 -1.2 TD
(showed that percutaneous absorption was one third of that of a 10% alcoh\
ol-based DEET solution )Tj
ET
562.524 261.859 m
585.848 261.859 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 562.524 263.9756 Tm
([52])Tj
0 0 0 rg
(. )Tj
-39.466 -1.343 Td
(In contrast, U.S. Army studies that used an in vitro pigskin model did n\
ot show any reduced )Tj
T*
(percutaneous absorption \(expressed as a percentage of the applied dose\)\
of the 3M polymer formulation )Tj
T*
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ET
224.634 209.459 m
247.958 209.459 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 224.634 211.5756 Tm
([62])Tj
0 0 0 rg
(.)Tj
0 0.4 0.353 rg
/T1_1 1 Tf
( )Tj
-15.331 -1.243 Td
( )Tj
16.1538 0 0 16.1538 10 176.9256 Tm
(Toxicity )Tj
0 -1.1 TD
( )Tj
0 0 0 rg
/T1_0 1 Tf
14 0 0 14 10 143.2371 Tm
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0 -1.2 TD
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T*
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0 -1.2 TD
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ET
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240.188 90.72 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 174.864 92.8371 Tm
([42, 63, 64])Tj
0 0 0 rg
(. The results of these studies did not require any change to the )Tj
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0 -1.2 TD
(Studies of high doses of DEET orally administered to mice and rats did n\
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ET
0 0 1 RG
1.347 w 10 M 0 j 0 J []0 d
10 733.745 m
575.385 733.745 l
S
0 0 1 rg
BT
/T1_1 1 Tf
16.1538 0 0 16.1538 10 737.7872 Tm
(View Table 3: Studies Done To Support the Reregistration of DEET with th\
e U.S. )Tj
ET
10 712.361 m
245.103 712.361 l
S
BT
/T1_1 1 Tf
16.1538 0 0 16.1538 10 716.4026 Tm
(Environmental Protection Agency)Tj
0 0 0 rg
/T1_0 1 Tf
14 0 0 14 245.1031 716.4026 Tm
( )Tj
-16.793 -1.295 Td
( )Tj
0 -1.1 TD
(Case reports of potential DEET toxicity exist in the medical literature \
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0 -1.2 TD
(The reports of greatest concern involve 14 cases of encephalopathy, 13 o\
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0 -1.2 TD
(younger than 8 years of age )Tj
ET
0.706 w
168.62 647.151 m
252.606 647.151 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 168.62 649.2679 Tm
([63, 66-71, 75])Tj
0 0 0 rg
(. Three of these children died, 1 of whom had an ornithine )Tj
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(carbamoyl transferase deficiency )Tj
ET
198.538 628.351 m
221.862 628.351 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 198.538 630.4679 Tm
([67])Tj
0 0 0 rg
( that might have predisposed her to DEET-induced toxicity )Tj
ET
556.658 628.351 m
579.982 628.351 l
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0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 556.658 630.4679 Tm
([66])Tj
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(. )Tj
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T*
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560.214 575.951 m
585.876 575.951 l
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0 0 1 rg
BT
/T1_0 1 Tf
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([42, )Tj
ET
10 557.151 m
49.662 557.151 l
S
BT
/T1_0 1 Tf
14 0 0 14 10 559.2679 Tm
(61, 63])Tj
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(. )Tj
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( )Tj
ET
1.347 w
10 520.576 m
600.504 520.576 l
S
0 0 1 rg
BT
/T1_1 1 Tf
16.1538 0 0 16.1538 10 524.618 Tm
(View Table 4: Reported Major Signs and Symptoms Attributed to Exposure t\
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0 0 0 rg
/T1_0 1 Tf
14 0 0 14 600.5038 524.618 Tm
( )Tj
-42.179 -1.295 Td
( )Tj
0 -1.1 TD
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njections were used revealed that )Tj
0 -1.2 TD
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0 -1.2 TD
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ET
0.706 w
505.026 455.366 m
528.35 455.366 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 505.026 457.4832 Tm
([78])Tj
0 0 0 rg
(. Only one )Tj
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ET
478.888 436.566 m
502.212 436.566 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 478.888 438.6832 Tm
([79])Tj
0 0 0 rg
(. )Tj
-33.492 -1.243 Td
( )Tj
0 -1.1 TD
(Initial repeat-insult patch tests of 100% technical-grade DEET or 50% DE\
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0 -1.2 TD
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ET
311.364 386.966 m
334.688 386.966 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 311.364 389.0833 Tm
([42])Tj
0 0 0 rg
(. Subsequently, 14 cases of contact urticaria )Tj
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ET
401.16 368.166 m
443.146 368.166 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 401.16 370.2832 Tm
([81-85])Tj
0 0 0 rg
(. The antecubital fossa )Tj
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T*
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ET
239.796 332.566 m
263.12 332.566 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 239.796 334.6832 Tm
([86])Tj
0 0 0 rg
(. )Tj
-16.414 -1.243 Td
( )Tj
0 -1.1 TD
(A 1994 study reviewed 9086 cases of DEET exposure reported to 71 poison \
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0 -1.2 TD
(to 1989 )Tj
ET
55.892 282.966 m
79.216 282.966 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 55.892 285.0833 Tm
([76])Tj
0 0 0 rg
(. More than half \(54%\) of the persons involved had no symptoms at the \
time of the call to )Tj
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T*
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ET
231.62 247.366 m
254.944 247.366 l
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0 0 1 rg
BT
/T1_0 1 Tf
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([42])Tj
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T*
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575.385 733.745 l
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0 0 1 rg
BT
/T1_1 1 Tf
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(View Table 3: Studies Done To Support the Reregistration of DEET with th\
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BT
/T1_1 1 Tf
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0 0 1 rg
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0 0 1 rg
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0 0 1 rg
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/T1_0 1 Tf
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600.504 520.576 l
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0 0 1 rg
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/T1_1 1 Tf
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(View Table 4: Reported Major Signs and Symptoms Attributed to Exposure t\
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0 0 1 rg
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( )Tj
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Mosquitoes and Mosquito Repellents
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T*
(plain candles to prevent bites by )Tj
/T1_1 1 Tf
(Aedes)Tj
/T1_0 1 Tf
( mosquitoes under field conditions )Tj
ET
424.904 582.659 m
448.228 582.659 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 424.904 584.7756 Tm
([94])Tj
0 0 0 rg
(. Persons near the )Tj
-29.636 -1.343 Td
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T*
(difference\). However, burning ordinary candles reduced the number of bi\
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T*
(citronella incense and plain candles did not differ. The ability of plai\
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T*
(result from their action as a decoy source of warmth, moisture, and carb\
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0 -1.1 TD
( )Tj
0 -1.1 TD
(The citrosa plant \()Tj
/T1_1 1 Tf
(Pelargonium citrosum \221van Leenii\222)Tj
/T1_0 1 Tf
(\) has been marketed as being able to repel )Tj
0 -1.2 TD
(mosquitoes through the continuous release of citronella oils. Unfortunat\
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T*
(offer no protection against bites )Tj
ET
191.58 449.059 m
235.904 449.059 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 191.58 451.1756 Tm
([95, 96])Tj
0 0 0 rg
(.)Tj
/T1_2 1 Tf
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( )Tj
-14.201 -1.178 Td
( )Tj
0 -1.1 TD
(Bite Blocker )Tj
0 -1.1 TD
( )Tj
/T1_0 1 Tf
14 0 0 14 10 380.6832 Tm
(Bite Blocker \(Consep, Inc., Bend, Oregon\) is a plant-based repellent t\
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0 -1.2 TD
(States in 1997. Bite Blocker combines soybean oil, geranium oil, and coc\
onut oil in a formulation that )Tj
T*
(has been available in Europe for several years )Tj
ET
270.47 344.966 m
293.794 344.966 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 270.47 347.0833 Tm
([97])Tj
0 0 0 rg
(. Studies conducted at the University of Guelph, )Tj
-18.605 -1.343 Td
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against )Tj
/T1_1 1 Tf
(Aedes)Tj
/T1_0 1 Tf
( mosquitoes )Tj
0 -1.2 TD
(under field conditions, even 3.5 hours after application. During the sam\
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T*
(spray afforded 86% protection, and Avon Skin-So-Soft citronella-based re\
pellent gave only 40% )Tj
T*
(protection )Tj
ET
70.27 275.766 m
93.594 275.766 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 70.27 277.8833 Tm
([98])Tj
0 0 0 rg
(. A second study showed that Bite Blocker provided a mean \261SD of 200 \
\261 30 minutes of )Tj
-4.305 -1.343 Td
(complete protection from mosquito bites )Tj
ET
241.378 256.966 m
264.702 256.966 l
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0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 241.378 259.0833 Tm
([99])Tj
0 0 0 rg
(.)Tj
/T1_2 1 Tf
16.1538 0 0 16.1538 268.202 259.0833 Tm
( )Tj
-15.984 -1.178 Td
( )Tj
0 -1.1 TD
(Permethrin )Tj
0 -1.1 TD
( )Tj
/T1_0 1 Tf
14 0 0 14 10 188.5909 Tm
(Pyrethrum is a powerful, rapidly acting insecticide, originally derived \
from the crushed and dried )Tj
0 -1.2 TD
(flowers of the daisy )Tj
/T1_1 1 Tf
(Chrysanthemum cinerariifolium)Tj
/T1_0 1 Tf
( )Tj
ET
307.864 169.674 m
338.188 169.674 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 307.864 171.7909 Tm
([100])Tj
0 0 0 rg
(. Permethrin is a human-made synthetic )Tj
-21.276 -1.343 Td
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, causing nervous system toxicity )Tj
0 -1.2 TD
(that leads to the death or "knockdown" \(out of the air\) of the insect.\
The chemical is effective against )Tj
T*
(mosquitoes, flies, ticks, and chiggers. Permethrin has low toxicity in m\
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T*
(the skin, and is rapidly inactivated by ester hydrolysis )Tj
ET
314.864 100.474 m
345.188 100.474 l
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0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 314.864 102.5909 Tm
([101])Tj
0 0 0 rg
(. )Tj
-21.776 -1.243 Td
( )Tj
0 -1.1 TD
(Permethrin should be applied directly to clothing or other fabrics \(suc\
h as tent walls )Tj
ET
483.606 67.674 m
513.93 67.674 l
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0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 483.606 69.7909 Tm
([102])Tj
0 0 0 rg
( or mosquito )Tj
-33.829 -1.343 Td
(nets )Tj
ET
36.054 48.874 m
66.378 48.874 l
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0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 36.054 50.9909 Tm
([103])Tj
0 0 0 rg
(\), not to skin. The spray form is nonstaining, nearly odorless, and res\
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(heat or sun and maintains its potency for at least 2 weeks, even through\
several launderings )Tj
ET
0 0 1 RG
0.706 w 10 M 0 j 0 J []0 d
525.186 751.859 m
583.51 751.859 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 525.186 753.9756 Tm
([104, 105])Tj
0 0 0 rg
(. )Tj
-36.799 -1.343 Td
(The combination of permethrin-treated clothing and skin application of a\
DEET-based repellent creates )Tj
0 -1.2 TD
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ET
254.188 716.259 m
333.512 716.259 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 254.188 718.3755 Tm
([19, 106, 107])Tj
0 0 0 rg
(. In a field trial conducted in Alaska, persons )Tj
-17.442 -1.343 Td
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had more than 99.9% )Tj
T*
(protection \(1 bite/h\) over 8 hours, even under conditions of intense b\
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T*
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ET
212.16 663.859 m
242.484 663.859 l
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0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 212.16 665.9756 Tm
([108])Tj
0 0 0 rg
(. )Tj
-14.44 -1.243 Td
( )Tj
0 -1.1 TD
(Permethrin-based insecticide sprays available in the United States are l\
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0 -1.2 TD
(clothing, spray each side of the fabric \(outdoors\) for 30 to 45 second\
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T*
(the garment to dry for 2 to 4 hours before wearing it. )Tj
0 -1.1 TD
( )Tj
0 -1 TD
( )Tj
0 0.6 0.51 rg
/TT0 1 Tf
19.3846 0 0 19.3846 10 550.7357 Tm
(Reducing Local Mosquito Populations)Tj
/TT1 1 Tf
( )Tj
0 -1.127 TD
( )Tj
0 0 0 rg
/T1_0 1 Tf
14 0 0 14 10 512.1294 Tm
(Consumers may still find advertisements for small ultrasonic electronic \
devices that are meant to be )Tj
0 -1.2 TD
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any studies conducted in the )Tj
T*
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ET
440.836 476.413 m
496.822 476.413 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 440.836 478.5294 Tm
([109-111])Tj
0 0 0 rg
(. Encouraging )Tj
-30.774 -1.343 Td
(natural predation of insects by setting up bird or bat houses in the bac\
kyard has also been unsuccessful )Tj
0 -1.2 TD
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ET
232.054 440.813 m
262.378 440.813 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 232.054 442.9294 Tm
([112])Tj
0 0 0 rg
(. Likewise, backyard bug "zappers," which lure and )Tj
-15.861 -1.343 Td
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ET
203.984 422.013 m
234.308 422.013 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 203.984 424.1294 Tm
([113])Tj
0 0 0 rg
(. Mosquitoes continue to be more attracted to humans than to the )Tj
-13.856 -1.343 Td
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insects killed by these )Tj
T*
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ET
266.62 386.413 m
296.944 386.413 l
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0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 266.62 388.5294 Tm
([114])Tj
0 0 0 rg
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-18.33 -1.343 Td
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ET
468.444 367.613 m
498.768 367.613 l
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0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 468.444 369.7294 Tm
([114])Tj
0 0 0 rg
(. The most )Tj
-32.746 -1.343 Td
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T*
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tump holes. )Tj
0 -1.1 TD
( )Tj
0 -1 TD
( )Tj
0 0.6 0.51 rg
/TT0 1 Tf
19.3846 0 0 19.3846 10 285.2895 Tm
(Relief from Mosquito Bites)Tj
/TT1 1 Tf
( )Tj
0 -1.127 TD
( )Tj
0 0 0 rg
/T1_0 1 Tf
14 0 0 14 10 246.6832 Tm
(Cutaneous responses to mosquito bites range from common localized wheal-\
and-flare reactions to )Tj
0 -1.2 TD
(delayed bite papules, rare systemic Arthus-type reactions, and anaphylax\
is )Tj
ET
431.078 227.766 m
487.064 227.766 l
S
0 0 1 rg
BT
/T1_0 1 Tf
14 0 0 14 431.078 229.8833 Tm
([115-117])Tj
0 0 0 rg
(. Bite reactions are )Tj
-30.077 -1.343 Td
(the result of sensitization to mosquito salivary antigens, which lead to\
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0 -1.2 TD
(IgG antibodies )Tj
ET
96.324 192.166 m
152.31 192.166 l
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0 0 1 rg
BT
/T1_0 1 Tf
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([118-121])Tj
0 0 0 rg
(. Immediate-type reactions are mediated by IgE and histamine, whereas ce\
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0 -1.1 TD
( )Tj
T*
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0 0 1 rg
BT
/T1_0 1 Tf
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0 0 1 rg
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0 0 1 rg
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T*
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( )Tj
0 -1 TD
( )Tj
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/TT0 1 Tf
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(Reducing Local Mosquito Populations)Tj
/TT1 1 Tf
( )Tj
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( )Tj
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/T1_0 1 Tf
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(Consumers may still find advertisements for small ultrasonic electronic \
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T*
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496.822 476.413 l
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0 0 1 rg
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/T1_0 1 Tf
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([109-111])Tj
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(. Encouraging )Tj
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0 0 1 rg
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(. Likewise, backyard bug "zappers," which lure and )Tj
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0 0 1 rg
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/T1_0 1 Tf
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(. Mosquitoes continue to be more attracted to humans than to the )Tj
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0 0 1 rg
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0 0 1 rg
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/T1_0 1 Tf
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([114])Tj
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(. The most )Tj
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sources of standing water, such )Tj
T*
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0 -1.1 TD
( )Tj
0 -1 TD
( )Tj
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/TT0 1 Tf
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(Relief from Mosquito Bites)Tj
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( )Tj
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( )Tj
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431.078 227.766 m
487.064 227.766 l
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0 0 1 rg
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/T1_0 1 Tf
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([115-117])Tj
0 0 0 rg
(. Bite reactions are )Tj
-30.077 -1.343 Td
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ET
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152.31 192.166 l
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0 0 1 rg
BT
/T1_0 1 Tf
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([118-121])Tj
0 0 0 rg
(. Immediate-type reactions are mediated by IgE and histamine, whereas ce\
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-6.166 -1.343 Td
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( )Tj
T*
(Several strategies exist for relieving the itch of mosquito bites. Topic\
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0 -1.2 TD
(erythema, itching, and induration. Topical diphenhydramine and caine-con\
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T*
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Oral antihistamines can be )Tj
T*
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en prophylactically in a double-)Tj
0 -1.2 TD
(blind, placebo-controlled, 2-week, crossover trial to 18 persons who had\
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T*
(cutaneous reactions to mosquito bites )Tj
ET
223.486 58.566 m
253.81 58.566 l
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0 0 1 rg
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/T1_0 1 Tf
14 0 0 14 223.486 60.6832 Tm
([122])Tj
0 0 0 rg
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(at 24 hours. The mean pruritus score, measured 0.25, 1, 12, and 24 hours\
after the mosquito had bitten, )Tj
0 -1.2 TD
(was 67% less than that of the untreated controls. These studies have not\
been done with astemizole, )Tj
T*
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prophylactic treatment with )Tj
0 -1.2 TD
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mosquito bites. )Tj
0 -1.1 TD
( )Tj
0 -1 TD
( )Tj
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(Author and Article Information )Tj
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( )Tj
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(Acknowledgments:)Tj
/T1_0 1 Tf
( The author thanks Donald Baumgartner \(U.S. Environmental Protection Ag\
ency\); Donald )Tj
0 -1.2 TD
(Barnard, PhD \(U.S. Department of Agriculture\); Nigel Hill \(London Sch\
ool of Hygiene and Tropical Medicine\); )Tj
T*
(and Robbin Lindsay, PhD \(Department of Environmental Biology, Universit\
y of Guelph\) for providing data that )Tj
0 -1.2 TD
(were not readily available in the medical literature. The author has rec\
eived no monetary support from any of the )Tj
0 -1.2 TD
(manufacturers whose products are mentioned in this paper. )Tj
/T1_1 1 Tf
T*
(Requests for Reprints:)Tj
/T1_0 1 Tf
( Mark S. Fradin, MD, Chapel Hill Dermatology, 891 Willow Drive, Suite 2,\
Chapel Hill, )Tj
T*
(NC 27514. )Tj
0 -1.1 TD
( )Tj
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/TT0 1 Tf
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(References)Tj
/TT1 1 Tf
( )Tj
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( )Tj
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(1.)Tj
/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(Taubes G.)Tj
/T1_0 1 Tf
( A mosquito bites back. The New York Times Magazine. 1977; 24 Aug:40-6.)Tj
/T1_1 1 Tf
0 -2.67 TD
(2.)Tj
/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(Shell ER.)Tj
/T1_0 1 Tf
( Resurgence of a deadly disease. The Atlantic Monthly. 1997; Aug:45-60. \
)Tj
/T1_1 1 Tf
T*
(3.)Tj
/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(Clements AN.)Tj
/T1_0 1 Tf
( The Physiology of Mosquitoes. Oxford: Pergamon Pr; 1963. )Tj
/T1_1 1 Tf
T*
(4.)Tj
/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(Miike L.)Tj
/T1_0 1 Tf
( Do insects transmit AIDS? Washington, DC: Office of Technology Assessme\
nt Health Program, U.)Tj
0 -1.2 TD
(S. Congress; 1987. )Tj
/T1_1 1 Tf
0 -2.67 TD
(5.)Tj
/T1_0 1 Tf
( )Tj
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(McHugh CP.)Tj
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(6.)Tj
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( )Tj
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(Maibach HI, Skinner WA, Strauss WG, Khan AA.)Tj
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(10.)Tj
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(Davis EE, Bowen MF.)Tj
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(at 24 hours. The mean pruritus score, measured 0.25, 1, 12, and 24 hours\
after the mosquito had bitten, )Tj
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(was 67% less than that of the untreated controls. These studies have not\
been done with astemizole, )Tj
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(Acknowledgments:)Tj
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( The author thanks Donald Baumgartner \(U.S. Environmental Protection Ag\
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(Barnard, PhD \(U.S. Department of Agriculture\); Nigel Hill \(London Sch\
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(Requests for Reprints:)Tj
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( Mark S. Fradin, MD, Chapel Hill Dermatology, 891 Willow Drive, Suite 2,\
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/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(Taubes G.)Tj
/T1_0 1 Tf
( A mosquito bites back. The New York Times Magazine. 1977; 24 Aug:40-6.)Tj
/T1_1 1 Tf
0 -2.67 TD
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(Shell ER.)Tj
/T1_0 1 Tf
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( The Physiology of Mosquitoes. Oxford: Pergamon Pr; 1963. )Tj
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( )Tj
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/T1_0 1 Tf
( Do insects transmit AIDS? Washington, DC: Office of Technology Assessme\
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0 -1.2 TD
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0 -2.67 TD
(5.)Tj
/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(McHugh CP.)Tj
/T1_0 1 Tf
( Arthropods: vectors of disease agents. Laboratory Medicine. 1994; 25:42\
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/T1_1 1 Tf
T*
(6.)Tj
/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(Maibach HI, Skinner WA, Strauss WG, Khan AA.)Tj
/T1_0 1 Tf
( Factors that attract and repel mosquitoes in human skin. )Tj
0 -1.2 TD
(JAMA. 1966; 196:263-6. )Tj
/T1_1 1 Tf
0 -2.67 TD
(7.)Tj
/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(Curtis CF.)Tj
/T1_0 1 Tf
( Fact and fiction in mosquito attraction and repulsion. Parasitology Tod\
ay. 1986; 2:316-8. )Tj
/T1_1 1 Tf
0 -2.67 TD
(8.)Tj
/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(Keystone JS.)Tj
/T1_0 1 Tf
( Of bites and body odour. Lancet. 1996; 347:1423. )Tj
/T1_1 1 Tf
0 -2.67 TD
(9.)Tj
/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(Bock GR, Cardew G, eds.)Tj
/T1_0 1 Tf
( Olfaction in Mosquito-Host Interactions. New York: J Wiley; 1996. )Tj
/T1_1 1 Tf
T*
(10.)Tj
/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(Bowen MF.)Tj
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(36:139-58. )Tj
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(11.)Tj
/T1_0 1 Tf
( )Tj
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(Davis EE, Bowen MF.)Tj
/T1_0 1 Tf
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(1994; 10\(2 Pt 2\):316-25. )Tj
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(Gjullin CM.)Tj
/T1_1 1 Tf
( Effect of clothing color on the rate of attack of )Tj
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(Aedes)Tj
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(Aedes aegypti)Tj
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(Aedes )Tj
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( )Tj
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(Foster WA, Hancock RG.)Tj
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(Control Assoc. 1994; 10 \(2 Pt 2\):288-96. )Tj
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( )Tj
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(Muirhead-Thomson RC.)Tj
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( )Tj
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(Gilbert IH, Gouck HK, Smith N.)Tj
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( Attractiveness of men and women to )Tj
/T1_2 1 Tf
(Aedes aegypti)Tj
/T1_1 1 Tf
( and relative protection )Tj
0 -1.2 TD
(time obtained with DEET. Florida Entomologist. 1966; 49:53-66. )Tj
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0 -2.67 TD
(27.)Tj
/T1_1 1 Tf
( )Tj
/T1_0 1 Tf
(Port GR, Boreham PFL.)Tj
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(Anopheles gambiae)Tj
/T1_1 1 Tf
( )Tj
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(Giles complex \(Diptera: Culicidae\). Bulletin of Entomological Research\
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( )Tj
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(29.)Tj
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( )Tj
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(Strauss WG, Maibach HI, Khan AA.)Tj
/T1_1 1 Tf
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(Hyg. 1968; 17:461-4. )Tj
/T1_0 1 Tf
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(30.)Tj
/T1_1 1 Tf
( )Tj
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( Insect repellents: concepts of their mode of action relative to potenti\
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0 -1.2 TD
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/T1_0 1 Tf
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(Am Mosq Control Assoc. 1996; 12:69-74. )Tj
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/T1_0 1 Tf
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0 -1.2 TD
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(72.)Tj
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( )Tj
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0 -2.67 TD
(73.)Tj
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( )Tj
/T1_0 1 Tf
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/T1_1 1 Tf
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/T1_0 1 Tf
0 -2.67 TD
(74.)Tj
/T1_1 1 Tf
( Seizures temporally associated with the use of DEET insect repellent-Ne\
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0 -1.2 TD
(Morb Mortal Wkly Rep. 1989; 38:678-80. )Tj
/T1_0 1 Tf
0 -2.67 TD
(75.)Tj
/T1_1 1 Tf
( )Tj
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(Edwards DL, Johnson CE.)Tj
/T1_1 1 Tf
( Insect-repellent-induced toxic encephalopathy in a child. Clin Pharm. 1\
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0 -1.2 TD
(6:496-8. )Tj
/T1_0 1 Tf
0 -2.67 TD
(76.)Tj
/T1_1 1 Tf
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( Retrospective analysis of calls to poison control centers )Tj
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T*
(Toxicol. 1994; 32:1-16. )Tj
/T1_0 1 Tf
0 -2.67 TD
(77.)Tj
/T1_1 1 Tf
( )Tj
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(Tenenbein M.)Tj
/T1_1 1 Tf
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0 -1.2 TD
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( Some cardiovascular effects of the insect repellent N,N-diethyl-m-)Tj
0 -1.2 TD
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( )Tj
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0 -1.2 TD
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/T1_0 1 Tf
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/T1_1 1 Tf
( )Tj
/T1_0 1 Tf
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/T1_1 1 Tf
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/T1_0 1 Tf
T*
(81.)Tj
/T1_1 1 Tf
( )Tj
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(von Mayenburg J, Rakoski J.)Tj
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( Contact urticaria to diethyltoluamide. Contact Dermatitis. 1994; 9:171.\
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/T1_0 1 Tf
T*
(82.)Tj
/T1_1 1 Tf
( )Tj
/T1_0 1 Tf
(Maibach HI, Johnson HL.)Tj
/T1_1 1 Tf
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0 -1.2 TD
(type sensitivity\). Arch Dermatol. 1975; 111:726-30. )Tj
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0 -2.67 TD
(83.)Tj
/T1_1 1 Tf
( )Tj
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0 -1.2 TD
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0 -1.2 TD
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( )Tj
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(Quarles W.)Tj
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. )Tj
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/T1_0 1 Tf
( Natural Insect Repellents for Pets, People and Plants. Austin: The Herb\
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/T1_0 1 Tf
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0 -1.2 TD
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/T1_1 1 Tf
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(93.)Tj
/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(Surgeoner GA.)Tj
/T1_0 1 Tf
( Efficacy of Buzz Away Oil against spring )Tj
/T1_2 1 Tf
(Aedes)Tj
/T1_0 1 Tf
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0 -1.2 TD
(Department of Environmental Biology, University of Guelph; 1995. Sponsor\
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/T1_0 1 Tf
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(Lindsay RL, Surgeoner GA, Heal JD, Gallivan GJ.)Tj
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0 -1.2 TD
(5% citronella incense for protection against field populations of )Tj
/T1_2 1 Tf
(Aedes)Tj
/T1_0 1 Tf
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T*
(1996; 12\(2 Pt 1\):293-4. )Tj
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(95.)Tj
/T1_0 1 Tf
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(" as a repellent against populations of )Tj
/T1_2 1 Tf
(Aedes)Tj
/T1_0 1 Tf
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T*
(Am Mosq Control Assoc. 1996; 12:69-74. )Tj
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0 -2.67 TD
(96.)Tj
/T1_0 1 Tf
( )Tj
/T1_1 1 Tf
(Cilek JE, Schreiber ET.)Tj
/T1_0 1 Tf
( Failure of the "mosquito plant", )Tj
/T1_2 1 Tf
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/T1_0 1 Tf
(, to repel adult )Tj
/T1_2 1 Tf
0 -1.2 TD
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/T1_0 1 Tf
( and )Tj
/T1_2 1 Tf
(Culex quinquefasciatus)Tj
/T1_0 1 Tf
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/T1_1 1 Tf
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( Finally, a safer insect repellent. University of California at Berkeley\
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( )Tj
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(Lindsay RL, Heal JD, Surgeoner GA.)Tj
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( Comparative evaluation of the efficacy of Bite Blocker, Off! )Tj
0 -1.2 TD
(Skintastic, and Avon Skin-So-Soft to protect against )Tj
/T1_2 1 Tf
(Aedes)Tj
/T1_0 1 Tf
( species mosquitoes in Ontario. Guelph, Ontario: )Tj
T*
(Department of Environmental Biology, University of Guelph; 1996. Sponsor\
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/T1_2 1 Tf
(Aedes)Tj
/T1_1 1 Tf
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T*
(Chemfree Environment, Inc. )Tj
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/T1_1 1 Tf
( )Tj
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(Casida JE, Quistad GB.)Tj
/T1_1 1 Tf
( Pyrethrum flowers: production, chemistry, toxicology and uses. Oxford: \
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0 -1.2 TD
(Univ Pr; 1995. )Tj
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0 -2.67 TD
(101.)Tj
/T1_1 1 Tf
( Insect repellents. Med Lett Drugs Ther. 1989; 31:45-7. )Tj
/T1_0 1 Tf
0 -2.67 TD
(102.)Tj
/T1_1 1 Tf
( )Tj
/T1_0 1 Tf
(Schreck CE.)Tj
/T1_1 1 Tf
( Permethrin and dimethyl phthalate as tent fabric treatments against )Tj
/T1_2 1 Tf
(Aedes aegypti)Tj
/T1_1 1 Tf
(. J Am Mosq )Tj
0 -1.2 TD
(Control Assoc. 1991; 7:533-5. )Tj
/T1_0 1 Tf
0 -2.67 TD
(103.)Tj
/T1_1 1 Tf
( )Tj
/T1_0 1 Tf
(Lines JD, Myamba J, Curtis CF.)Tj
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( Experimental hut trials of permethrin-impregnated mosquito nets and )Tj
0 -1.2 TD
(eave curtains against malaria vectors in Tanzania. Med Vet Entomol. 1987\
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/T1_0 1 Tf
0 -2.67 TD
(104.)Tj
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( )Tj
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(Schreck CE, Posey K, Smith D.)Tj
/T1_1 1 Tf
( Durability of permethrin as a potential clothing treatment to protect )Tj
0 -1.2 TD
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/T1_0 1 Tf
0 -2.67 TD
(105.)Tj
/T1_1 1 Tf
( )Tj
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/T1_1 1 Tf
( Wear and aging tests with permethrin-treated )Tj
0 -1.2 TD
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/T1_0 1 Tf
0 -2.67 TD
(106.)Tj
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( )Tj
/T1_0 1 Tf
(Gupta RK, Sweeney AW, Rutledge LC, Cooper RD, Frances SP, Westrom DR.)Tj
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( Effectiveness of )Tj
0 -1.2 TD
(controlled-release personal-use arthropod repellents and permethrin-impr\
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T*
(Mosq Control Assoc. 1987; 3:556-60. )Tj
/T1_0 1 Tf
0 -2.67 TD
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( )Tj
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Mosquitoes and Mosquito Repellents
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