Insect Precautions Chikungunya Lyme, Anaplasma, Babesia - PDF document

6/19/2019 Vector types and diseases ▪ Mosquito ▪ Tick • Dengue • Encephalitis, tick ‐ borne Insect Precautions • Chikungunya • Lyme, Anaplasma, Babesia • Encephalitis, Japanese • Rickettsiosis (also fleas, lice, mites for some species) • Filaria, bancroftian Why worry? • Crimean Congo hemorrhagic fever • Malaria • Kyasanur Forest dis, Omsk hemorrhagic fever • Rift Valley fever What works? • West Nile virus • Yellow fever ▪ Bug • Zika • American trypanosomiasis Anne E McCarthy, MD, FRCPC, DTM&H, FASTMH, FISTM ▪ Fly ▪ Flea (rodent) • Loa loa • Plague Director Tropical Medicine and International Health Clinic Ottawa Hospital • Onchocerciasis Professor of Medicine, University of Ottawa • Leishmaniasis • African trypanosomiasis CISTM 2019 1 4 PRESENTER DISCLOSURE Choose the appropriate vector and disease association: A. Aedes mosquitoes and malaria Relationships with commercial interests: ‐ Advisor: Shoreland Inc. B. Phlebotomus sandflies and leishmaniasis C. Triatoma bugs and African trypanosomiasis BIG THANK YOU TO LIN CHEN D. Anopheles mosquitoes and yellow fever 2 5 Objective Choose the appropriate vector and disease association: ▪ Review of vector prevention: • Repellents, permethrin, netting A. Aedes mosquitoes and malaria ▪ Provide and overview of vectors (describe vectors and transmission) B. Phlebotomus sandflies and leishmaniasis C. Triatoma bugs and African trypanosomiasis D. Anopheles mosquitoes and yellow fever 3 6 1

6/19/2019 Diseases and mosquito species ▪ Disease ▪ Mosquito • Malaria • Anopheles • Dengue • Chikungunya • Aedes • Yellow fever (YF ‐ also Haemagogus, Sabethes ) • Zika • RVF (animal blood); Aedes, Culex • Rift Valley fever • Culex • Encephalitis, Japanese • West Nile • various mosquito vectors • Filariasis, lymphatic www.who.int/campaigns/world ‐ health ‐ day/2014/global ‐ brief/en/ 7 10 Global map of dominant malaria vectors What is needed for transmission of vector ‐ Sinka ME et al. Parasit Vectors 2012 borne diseases (VBDs)? ▪ Pathogen presence and amplification ▪ Vector presence and survival ▪ Presence of suitable hosts (reservoirs) ▪ Opportunities for human exposure ▪ Vector competence : can this mosquito transmit this particular virus? • Depends on infection, dissemination, transmission ▪ Vector capacity : how important is this mosquito in transmitting this particular virus? 8 11 Major mosquito species of interest for Anopheles ecology: habitats, feeding travelers ▪ Preferred: clean, unpolluted water. Anopheles gambiae Aedes aegypti (YF mosquito) ▪ Larvae of Anopheles gambiae , the major malaria vector in Africa, can breed in diverse habitats. 3 habitats shown: tire tracks, rice fields, irrigation water. ▪ Feeding patterns: most are crepuscular (dusk/dawn) or nocturnal (night). Aedes albopictus (Asian tiger mosquito) Culex www.cdc.gov/malaria/about/biology/mosquitoes/index.html 9 12 2

6/19/2019 Aedes aegypti are container breeding, adults are indoor dwelling Peak biting ‐ daytime When is the use of repellent most effective to prevent mosquito bites that transmit malaria? www.cdc.gov/Dengue/entomologyEcology/m_habitats.html A. Mid ‐ day and early afternoon B. Early morning and late afternoon C. From dusk to dawn D. From dawn to dusk 13 16 When is the use of repellent most effective to prevent mosquito bites that transmit malaria? A. Mid ‐ day and early afternoon B. Early morning and late afternoon C. From dusk to dawn D. From dawn to dusk 14 17 Aedes mosquitoes : dengue, chikungunya, YF, Culex mosquitoes: JE and West Nile virus Zika West Nile virus Aedes aegypti Aedes albopictus www.cdc.gov/dengue/entomologyEcology/index.html Photo: Ames Gathany at phil.cdc.gov/phil/details.asp Japanese encephalitis virus 15 18 3

6/19/2019 Culex mosquitoes: vector of Japanese A traveler plans to volunteer in a village in Cambodia. encephalitis Which vector ‐ disease pair is a significant risk? ▪ Mosquitoes are infected by feeding on domestic pigs and wild birds, in whom the virus is A. Ixodes ticks and tick ‐ borne encephalitis amplified B. Aedes mosquitoes and Lyme disease ▪ Biting behavior: dusk to dawn C. Culex mosquitoes and Japanese encephalitis ▪ Often outdoors, but sometimes D. Rhipicephalus ticks and chikungunya indoors ▪ Increased risk: • Rural areas, outdoors • Long ‐ term travel 19 22 Ticks Ixodes scapularis: Lyme , Babesia, Anaplasma 20 23 Ticks A traveler plans to volunteer in a village in Cambodia. Which vector ‐ disease pair is a significant risk? ▪ Life: egg 6 ‐ leg larva 8 ‐ leg nymph adult Ixodes scapularis A. Ixodes ticks and tick ‐ borne encephalitis ▪ Diseases: B. Aedes mosquitoes and Lyme disease • Encephalitis, tick ‐ borne C. Culex mosquitoes and Japanese encephalitis • Lyme, anaplasmosis, babesiosis D. Rhipicephalus ticks and chikungunya • Rickettsiosis (esp. ATBF; some can be transmitted by fleas, lice, mites) • Crimean Congo hemorrhagic fever • Kyasanur Forest disease, Omsk hemorrhagic fever 21 24 4

6/19/2019 Bug: American trypanosomiasis ▪ Protozoan: Trypanosoma cruzi ▪ Vector: Triatoma ( reduvid bugs, kissing bugs) ▪ Other transmission modes: transfusion, vertical transmission 25 28 ITNs (insecticide ‐ treated nets) Indoor residual spraying Sandflies: leishmaniasis Outdoor spraying Coils ▪ Protozoan: Leishmania species ▪ Vector: sand flies, Phlebotomus and Lutzomyia Sources: USAID, Roll Back Malaria, WHO Global Brief on VBD 26 29 Summary: vectors and travel Mosquito proofing is effective ▪ Mosquitoes ▪ Tsetse flies Location Intervention Risk ratio after = Anopheles = Glossina intervention (baseline=1) Date = Aedes ▪ Kissing bugs Lahore, India British infantry barracks: wire netting, 0.08 = Culex = Triatoma double doors 1925 ‐ 27 ▪ Sand flies ▪ Ticks = Lutzomyia = Ixodes Honduras Local houses: mosquito proofing 0.23 = Phlebotomus = Amblyomma 1926 = Rhipicephalus Mining communities, Drainage of flooded areas, modification of 0.35 ▪ Black flies northern Zambia river boundaries, vegetation management ▪ Others: = Simulium • Fleas 1930 ‐ 49 ▪ Horse flies/deer flies • Lice = Chrysops • Mites Keiser. Lancet Infect Dis 2005 27 30 5

6/19/2019 Evidence to support methods Repellents ▪ Improve housing design reduced malaria: Product Active ingredient Complete protection time • Modern houses had 47% lower odds of malaria infection/ 45 ‐ 65% lower odds of clinical malaria (mean, minutes) ▪ Insecticide ‐ treated nets/curtains/screen: 77% protective efficacy vs. Deep Woods Off DEET 23.8% 301.5 cutaneous leishmaniasis • High protective efficacy of: Bite Blocker for Kids Soybean oil 2% 94.6 o ITS vs. dengue Skin So Soft Bug Guard Plus IR3535 7.5% 22.9 o ITNs vs. Japanese encephalitis ▪ Larval source management reduced malaria incidence by ¾: Natrapel Citronella 10% 19.7 • 2 cluster ‐ RCTs (Sri Lanka): larviciding abandoned mines, streams, irrigation ditches, rice paddies. Repello Wristband DEET 9.5% 0.2 • 1 trial (India): removal of domestic water containers + weekly larviciding of canals/ stagnant pools. Tusting et al. Malaria J 2015; Wilson et al. PNTD 2014; Tusting et al. Cochrane 2013 Fradin, Day. N Engl J Med 2002 31 34 Insecticide: permethrin, deltamethrin, cypermethrin Consumer Reports 2018: www.consumerreports.org/prod ucts/insect ‐ repellent/ratings ‐ overview/ 32 35 Frequently asked questions Repellents: EPA approved Question Answer Evidence Active ingredient Chemical name Brands Is DEET safe in children? Yes; 2 months and older; adults to apply CDC, AAP N , N ‐ diethyl ‐ m ‐ toluamide or N , N ‐ Off! DEET diethly ‐ 3 ‐ methyl ‐ benzamide Cutter Is DEET safe in pregnancy? Yes; trimesters 2 ‐ 3 use on Thai ‐ Myanmar border McGready et al. Sawyer found no adverse effects on survival, growth, AJTMH 2001. Ultrathon development at birth and 1 year Picaridin 2 ‐ (2 ‐ hydroxyethyl) ‐ 1 ‐ Cutter Advanced piperidinecarboxylic acid 1 ‐ Skin So Soft Bug Guard Plus Is controlled ‐ release DEET Possibly; polymer formulation touted to last Rutledge et al. J methylpropyl ester; Autan more effective? longer Am Mosq KBR 3023, Bayrepel, icaridin Control Assn Oil of lemon eucalyptus* para ‐ menthane ‐ 3,8 ‐ diol; Repel 1996. PMD Sun screen 1 st , then DEET. In what order should one Webb et al. Aust 3 ‐ [ N ‐ butyl ‐ N ‐ acetyl] ‐ Skin so Soft Bug Guard Plus IR3535* apply DEET and sun Limited data suggest reduction of DEET mean N Z J Public aminopropionic acid, ethyl ester Expedition screen? protection time when sun screen applied on top Health 2009. 2 ‐ undecanone methyl nonyl ketone BioUD Is permethrin safe to use Very limited data; no significant, consistent *Biopesticides during pregnancy? association identified 33 36 6