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Bite prevention

For many diseases spread by insects, avoiding bites is the best if not the only way to prevent them. Places like jungles and swamps may be highly infested with biting insects, while bed bugs are found in sleeping accommodation. It is almost impossible to completely avoid bites, but by reducing the number of times you are bitten, you will reduce your risk of being infected.


Mosquitoes
Mosquitoes bite at any time of day but most bites occur in the evening. They cause much inconvenience because of localised reactions to the bites themselves and from the infections they transmit. Mosquitoes spread malaria, yellow fever, dengue and Japanese encephalitis. Mosquitoes are also more prevalent in jungle and swampy areas, so these should be avoided as far as possible, or the traveller should take additional precautions.

Sleeping
Well air-conditioned accommodation, and to a lesser extent mesh screening on doors and windows, helps reduce the number of insects in your room. It is also recommended that you must sleep under an intact bed net, otherwise known as a mosquito net. These are often impregnated with an insecticide but all nets need to be soaked again after six months. Carry a sewing kit and tape to repair any holes or tears. Plug-in devices (vaporisers) release an insecticide mist.

Clothing
It is recommended to wear light coloured, loose fitting clothes (insects can reach skin through tight clothing) that cover as much of the body as possible, particularly wrists and feet. Mosquitoes can also bite through thin clothing, so it is recommended to spray an insecticide or insect repellent on them. Do not use insecticide directly on skin. Malaria mosquitoes are most active after dark, so it’s important to cover up in the evenings in malaria risk regions.

Insect repellents and insecticides 
Insect repellents should also be used on exposed skin. Insect repellents made with a chemical called DEET (N, N-diethyl-m-toluamide) are the most effective. They come in several strengths and are available as creams, lotions and sprays. Most repellents can be used on children over 2 months old and are usually marked with any age restriction. Higher DEET concentrations provide longer protection up to 50%, though 30% or lower DEET should be used for children aged 2 months plus and not at all in babies younger than 2 months [76].  Alternative recommended insect repellents are those containing Picaridin 20%. Oil of lemon, eucalyptus-based repellent (OLE) is also available however this repellent only lasts as long as 15% DEET and so needs applying more frequently. OLE should not be used for children under 3 years old [76]. Citronella based repellents provide even shorter protection. If you are also using sunscreen, apply sunscreen first and insect repellent second [77]. Avoid putting repellent on children's hands as they often put them in their mouths [76]. Insecticide coils, also known as mosquito coils, are circles of solid insecticide (pyrethroid) which can be burnt outside, but they are considered a fire hazard indoors.

Ticks
To reduce the risk of tick bites, and the risk of the disease they carry, travellers should avoid wooded and brushy areas with high grass, brush, and leaves [77]. The best form of prevention is avoiding being bitten, by protecting the skin with clothing, tucking long trousers into socks using, insect repellents and avoiding undergrowth by using designated pathways. Once back indoors, shower as soon as possible and check your entire body for ticks. Ticks should be removed carefully and entirely using a pair of tweezers. The tick should not be squeezed as that will simply inject (more) infection into the body. Parents should check their children, pets and belongings for ticks. If any signs of illness occur within 28 days of a tick bite, advice should be promptly sought from a medical practitioner.

Bed bugs
Although bed bugs do not carry disease, they are unpleasant and their bites are an annoyance. They are more common in lower quality accommodation, and so mattresses, bedding and furniture should be inspected for signs of bed bugs. Clothes should be kept in your suitcase when you are not wearing them and inspect and shake out clothes before putting them back in your suitcase. Suitcases should be kept closed and done up when not in use and kept off the floor where possible [77].

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