Wilderness Medicine, First Aid, and Outdoor Skills
Mosquito Information

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Spider Bites
 - Brown Recluse Bites
Sunburn Pictures
Tendon Ruptures
US Army First Aid Manual
Fundamental Criteria for First Aid
Basic Measures for First Aid
First Aid for Special Wounds
First Aid for Fractures
First Aid for Climatic Injuries
First Aid for Bites and Stings
First Aid in Toxic Environments
First Aid for Psychological Reactions
Appendix A: First Aid Case and Kits, Dressings, and Bandages
Appendix B: Rescue and Transportation Procedures
Appendix C: Common Problems/Conditions
Appendix D: Digital Pressure
Appendix E: Decontamination Procedures
Appendix F: Glossary


Mosquito Table of Contents

Introduction

When my son was a small boy at age 7, he asked me, “Why did God create mosquitoes?” A difficult question, my only response was to say “They help feed the birds, in fact we probably wouldn’t have dragonflies since that is their main source of food.” There are more mosquito related deaths than AIDS. 1 out of 17 people die from a mosquito related death. (Taubes G., “A Mosquito Bites Back”, The New York Times, 1997).

Mosquito Facts

Mosquitoes are found all over the world except for Antarctica. Malaria which is transmitted via the mosquito is responsible for 300 to 500 million deaths per year. Only the female mosquito bites, the male feeds on plant juices. The female feeds every 3 to 4 days eating their own body weight each time. Mosquitoes find their host by visual, thermal, and olfactory stimuli i.e. By sight, heat, and recognition of carbon dioxide excreted from our skin.

Dark colored clothing is an attractant as opposed to light colored clothing. Carbon dioxide can be recognized by a mosquito up to 155 feet away. Soaps, cologne, and lotions can also attract mosquitoes.

It appears when reviewing the data that men are bitten more than women. This could be due to men being in the outdoors more and/or men have large body mass and excrete more carbon dioxide. We do know that heavier individuals are bitten more than thin.

Mosquitoes are more active early in the morning and at dusk. They will also bite throughout the night. They need a very small amount of water to breed, in fact a soda bottle cap turned upside down is enough to breed many mosquito larvae.

Pathophysiology

When the mosquitoes sword like mouth pierces our skin we rarely feel pain. The mosquito uses an anesthetic in its saliva that is injected in the tissue. This can cause a local reaction usually of redness, and a wheel with intense itching.

Rarely do mosquito bite reactions occur in children less than 1 year old due to their levels of antibodies. The bite itself is our bodies response to antibody complexes and histamine. The bite will go away in a few days. In rare situations it may last for a couple of months.

Mosquito Bite Symptoms

Symptoms are usually the typical redness and wheel with associated itching. There are situations that arise where an individual has an intense local allergic reaction. These individuals are usually fair skinned, and also could have a history of allergies such as allergic asthma, and many have a history of psoriasis or eczema. These reactions are sudden and progressive. This author has seen mosquito bites as large as the top of a coffee cup with redness measuring 8 to 10 inches in diameter. In these situations if the mosquito bite is on the face, eyes can actually swell shut. Although these symptoms are dramatic and rare, they do occur. They are easily treated and resolve in 1 to 2 days.

Mosquito Bite Treatment and Prevention

Avoiding the outdoors is the obvious prevention, however this is not practical and not the mission of Survive Outdoors. One can avoid early morning outings and evening treks.

Prevention Tips:

  • Light colored are helpful as opposed to dark.
  • Avoid cologne, perfume, scented soaps and lotion.
  • Use mosquito repellents such as products with DEET and the new product PICARIDIN. (Please see our section on Mosquito Repellents)
  • Skin so Soft by Avon is NOT very effective. Survive Outdoors has tried this product in very infected areas and we cannot recommend it.
  • Citronelle products do work but are very short lived.
  • Permethrin is very effective to treat clothing and tents. Products Permethrin need to be sprayed on clothing or fabric for 30 seconds and allowed to dry for up to 2 hours before wearing them.
  • At your campsite or home, it is helpful after a rain to walk around and empty such items as hollow logs, empty pots, and attempt to drain all standing water. Each step can be helpful to not only you and your family, but the neighborhood as well. A conscious effort needs to be implemented for this to work.

Healthcare Provider - Medical Treatment
For the vast majority of mosquito bites, a topical steroid is effective to reduce itching and redness. A very small amount can be applied 2 times a day will usually resolve the bite in 2 to 3 days.

It is advised to educate the patient on what to look for in case of a secondary infection. A wound care sheet should be given to the patient to show them what to look for in case the bite worsens.

  • Increasing redness moving up an extremity.
  • Fever
  • Pain
  • Drainage of pus
  • Tender lymph nodes

Antihistamines are helpful with local itching and oral steroids are rarely needed, only in severe reactions would they be necessary.

Mosquito Repellent

Over the years repellents have been experimented with to come up with an effective and safe product. Repellents are big business and caution needs to be used as a consumer in terms of safety as well as price. Companies will not always have a consumer’s safety in mind with their primary goal being to sell the most product compared to competitors.

We must remember, with the increase in West Nile Virus, and the panic associated with it, companies are scrambling to do whatever it takes to satisfy consumer demands - from mosquito foggers to Mosquito Deleto TM machines, to new formulations that may irritate our skin. Survive Outdoors will attempt to educate you on what is safe, and what is effective.

DEET (N1 N - diethyl-3-methylbenzamide)

DEET is the most actively used ingredient in today’s repellents. However, Survive Outdoors predicts it will shortly become the no. 2 player in repellents. DEET was approved for the general public in 1957.

DEET should be applied directly to the skin. It is not as effective when applied on clothing, and is worthless when applied to tents. DEET can damage plastic, erode tents, and rain gear, as well as eye-glass frames.

The concentration of DEET in repellents ranges from 5% to 99%. Survive Outdoors recommends NO MORE than 30% DEET, and it should be reapplied to the skin every 4 to 6 hours depending on temperature, perspiration, and activity. We do not recommend spraying or applying DEET before sleeping, and we strongly encourage mesh shelters or tents when in the outdoors. So why does Survive Outdoors recommend no DEET at bedtime? A good but old research study in 1969 had 77 volunteers applying 75% DEET to the antecubital fossa at bedtime on their arms. It was found that 50% of the volunteers developed blisters and scaring at the application site. It is speculated that while sleeping, the arm was bent occluded. The area could not be exposed to air. The DEET could not evaporate and caused a severe reaction.

Another report reconfirms this in an Israeli study. One day after the same application with 50% DEET, 50% of the Israeli soldiers had ulcerations and scaring.

The American Academy of Pediatricians recommends DEET applied to children should be no more than 10%. There have been rare situations of neurotoxicity in children. In 1989, 2 deaths of children were reported to be contributed by DEET. These cases were due to prolonged use and high concentrations. It boggles this author’s mind that some companies can still promote their product with 99% DEET.

So how does DEET work? It basically masks the carbon dioxide being excreted from your body, making us invisible to the pests. Survive Outdoors still uses DEET products, but never anything over 30% for adults, and not over 10% for children.

Lemon Eucalyptus Oil (p-menthane-3, 8-diol) or PMD

In reviewing the literature, it is interesting how little is discussed about a natural product as eucalyptus oil. It lacks the unpleasant odor of DEET and appears to be effective and safe, however it needs to be applied frequently. The application the should be about every 2 hours. In field trials, it should good comparison to 50% DEET.

Skin-So-Soft TM (by Avon)

Survive Outdoors has personally used Skin-So-Soft with less than adequate results. It appears to be effective against no-see-ums, which are biting midges which are very common in northern climates. We feel it is not effective against mosquitoes and cannot be recommended.

Citronella

Oil of citronella approved by the EPA in 1948 has been tested as a good repellent. It appears to be effective for the first hour, then decreases over time. In one study, citronella candles resulted in 42% fewer bites than the control group. Interesting though, another group that used non-scented candles resulted in 24% fewer bites. It appears that candles act as a decoy and mosquitoes will seek out the warmth and carbon dioxide emitted by the candles.

Picaridin

Well here it is, the newest attack against mosquitoes. Picaridin has been used in Australia commercially since 2000. It does not dissolve plastic, it is dramatically less irritating than DEET, and the odor is almost non existent. In head to head studies with DEET, it lasted 2 hours longer and a more favorable response from participants.

The CDC endorses Picaridin, and in May, 2005, a press release was issued that stated Picaridin was approved by the CDC as a repellent for the West Nile mosquito.

Picaridin formulations are available by the company Cutter. You cannot miss their blue bottle with an orange cap, and it clearly states “Cutter Advanced”. It has 7% Picaridin, and comes in an environmentally safe pump spray.

Summary

As with most interventions, it is best to use a combination approach. Survive Outdoors recommends Cutter Advanced, with 7% Picaridin, light-colored clothes, and avoiding extended time in the dawn and dusk hours. Candles around the campsite, and mesh or netting over hammocks and tents are also recommended. It is also advisable to tuck pants into socks. With all these precautions, one can still enjoy the outdoors and minimize the risk of the all to familiar mosquito.

 

References

1. Paul S. Auerbach, Wilderness Medicine
2. Judith Tintanelli, Emergency Medicine: A Comprehensive Study Guide
3. Kettle, DS. Medical and Veterinary Entomology, New York, 1982.
4. Keystone JS: Of Bites and Body Odor, Lancet, 347:1423, 1996
5. Foster WA, Hancock RF: Nectar-related Olfactory and Visual Attractants for Mosquitoes. Journal of American Mosquito Control Associations. 10:288 1994.
6. Lamberg SI, Mulrennan Jr. JA. Bullous reaction to diethyl toluamide (deet) resembling a blistering insect eruption. Arch Dermatol 1969; 100:582-586
7. Reuveni H, Yagupsky P. Diethyltoluamide-containing insect repellent. Adverse effects in worldwide use. Arch Dermatol 1982; 118: 582-583
8. Maibach HI, Johnson HL. Contact urticaria syndrome. Arch Dermatol 1975; 111: 726-730.
9. ADF Health: Personal protection measures against mosquitoes. http://Defense.gov.au





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