A double-blinded, placebo-controlled trial of garlic as a mosquito repellant: a preliminary study

The oral repellent - science fiction or common sense? Insects, vector-borne diseases, failing strategies, and a bold proposition

Over the last decades, unimaginable amounts of money have gone into research and development of vector control measures, repellents, treatment, and vaccines for vector borne diseases. Technological progress and scientific breakthroughs allowed for ever more sophisticated and futuristic strategies. Yet, each year, millions of people still die or suffer from potentially serious consequences of malaria or dengue to more recent infections, such as zika or chikungunya, or of debilitating consequences of neglected tropical diseases. This does not seem value for money. In addition, all current vector control strategies and personal protection methods have shortcomings, some serious, that are either destructive to non-target species or unsatisfactory in their effectiveness. On the other hand, the rapid decline in insect populations and their predators reflects decades-long aggressive and indiscriminate vector control. This major disruption of biodiversity has an impact on human life not anticipated by the well-meaning killing of invertebrates. The objective of this paper is to re-examine current control methods, their effectiveness, their impact on biodiversity, human and animal health, and to call for scientific courage in the pursuit of fresh ideas. This paper brings together topics that are usually presented in isolation, thereby missing important links that offer potential solutions to long-standing problems in global health. First, it serves as a reminder of the importance of insects to human life and discusses the few that play a role in transmitting disease. Next, it examines critically the many currently employed vector control strategies and personal protection methods. Finally, based on new insights into insect chemo-sensation and attractants, this perspective makes a case for revisiting a previously abandoned idea, the oral repellent, and its use via currently successful methods of mass-application. The call is out for focused research to provide a powerful tool for public health, tropical medicine, and travel medicine.

Differential mosquito attraction to humans is associated with skin-derived carboxylic acid levels

Some people are more attractive to mosquitoes than others, but the mechanistic basis of this phenomenon is poorly understood. We tested mosquito attraction to human skin odor and identified people who are exceptionally attractive or unattractive to mosquitoes. These differences were stable over several years. Chemical analysis revealed that highly attractive people produce significantly more carboxylic acids in their skin emanations. Mutant mosquitoes lacking the chemosensory co-receptors Ir8a, Ir25a, or Ir76b were severely impaired in attraction to human scent, but retained the ability to differentiate highly and weakly attractive people. The link between elevated carboxylic acids in "mosquito-magnet" human skin odor and phenotypes of genetic mutations in carboxylic acid receptors suggests that such compounds contribute to differential mosquito attraction. Understanding why some humans are more attractive than others provides insights into what skin odorants are most important to the mosquito and could inform the development of more effective repellents.

Olfaction in Anopheles mosquitoes

As vectors of disease, mosquitoes are a global threat to human health. The Anopheles mosquito is the deadliest mosquito species as the insect vector of the malaria-causing parasite, which kills hundreds of thousands every year. These mosquitoes are reliant on their sense of smell (olfaction) to guide most of their behaviors, and a better understanding of Anopheles olfaction identifies opportunities for reducing the spread of malaria. This review takes a detailed look at Anopheles olfaction. We explore a range of topics from chemosensory receptors, olfactory neurons, and sensory appendages to behaviors guided by olfaction (including host-seeking, foraging, oviposition, and mating), to vector management strategies that target mosquito olfaction. We identify many research areas that remain to be addressed.

Variability in human attractiveness to mosquitoes

Blood-feeding mosquitoes locate humans spatially by detecting a combination of human-derived chemical signals, including carbon dioxide, lactic acid, and other volatile organic compounds. Mosquitoes use these signals to differentiate humans from other animals. Spatial abiotic factors (e.g. humidity, heat) are also used by mosquitoes to find a host. Mosquitoes cause discomfort and harm to humans, being vectors of many pathogens. However, not all humans suffer from mosquito bites with the same frequency or intensity. Some individuals are more attractive to mosquitoes than others, and this has an important impact on the risk of infection by pathogens transmitted by these vectors, such as arboviruses and malaria parasites. Variability in human attractiveness to mosquitoes is partially due to individual characteristics in the composition and intensity in the release of mosquito attractants. The factors that determine these particularities are diverse, modestly understood and still quite controversial. Thus, this review discusses the role of pregnancy, infection with malaria parasites (Plasmodium spp.), skin microbiota, diet, and genetics in human attractiveness to mosquitoes. In brief, pregnancy and Plasmodium infection increase the host attractiveness to mosquitoes. Skin microbiota and human genetics (especially HLA alleles) modulate the production of mosquito attractants and therefore influence individual susceptibility to these insects. There is evidence pointing to a role of diet on human susceptibility to mosquitoes, with some dietary components having a bigger influence than others. In the last part of the review, other factors affecting human-mosquito interactions are debated, with a special focus on the role of mosquito genetics, pathogens and environmental factors (e.g. wind, environmental disturbances). This work highlights that individual susceptibility to mosquitoes is composed of interactions of different human-associated components, environmental factors, and mosquito characteristics. Understanding the importance of these factors, and how they interact with each other, is essential for the development of better mosquito control strategies and studies focused on infectious disease dynamics.

•

Individual human attractiveness to mosquitoes is highly variable.

•

Mosquito attractants released into the air vary from person to person.

•

Variation in attractiveness to mosquitoes alters the risk of mosquito-borne infections.

•

Pregnancy, malaria infection, skin microbiota and genetic factors alter the release of mosquito attractants.

•

Environment and mosquito-related factors affect human–mosquito interactions.

Efficacy of Active Ingredients From the EPA 25(B) List in Reducing Attraction of Aedes aegypti (Diptera: Culicidae) to Humans

Mosquitoes of the Aedes genus are vectors for dengue, chikungunya, Zika, and yellow fever viruses. Mosquito repellents are an effective way to prevent mosquito bites and reduce the spread of mosquito-borne diseases. In the early 90s, the U.S. Environmental Protection Agency (EPA) published a list of active ingredients that pose minimum risk to human health that can be used as pesticides or repellents without passing the EPA registration process. The present study examined the efficacy of 21 of the active ingredients listed by the EPA 25 (B) exempt list and five commercially available sprays that only contained active ingredients from the EPA 25(B) list in repelling female Aedes aegypti (L.) females. We performed choice bioassays in a controlled laboratory environment, using a Y-tube olfactometer to determine attraction rates of humans to female Ae. aegypti in the presence of one of the 21 active ingredients and five commercially available repellent sprays. We found that cinnamon oil, peppermint oil, spearmint oil, lemongrass oil, and garlic oil reduced mosquito attraction to human odor. Of the five commercial repellent sprays, only one reduced mosquito attraction for up to 30 min in our assay. The EPA 25 (B) list contains active ingredients that under the conditions of our assay repel Ae. aegypti.

Nutrition, malnutrition, and leishmaniasis

Leishmaniasis is a vector-borne infectious disease with a long history of infecting humans and other animals. It is a known emerging or resurging disease. The host nutritional state has an indispensable role in defense against pathogens. The host defense system disorganization as a result of undernutrition is responsible for asymptomatic infections and even severe diseases. Host susceptibility and pathophysiologic severity to infection can be aggravated owing to undernourishment in a number of pathways, and infection also may aggravate preexisting poor nutrition or further increase host susceptibility. This study suggests that there may be some relationship between malnutrition and the endemicity of the parasite. The susceptibility to and severity of leishmanial infection can be altered by the body weight and serum levels of micronutrients. Nutrition not only affects the vulnerability of the host but also may affect the desire of sandfly to bite a specific host. Apart from host defense mechanism, nutritional stress also greatly influences vector competence and host-seeking behavior, especially during larvae development. The host and sandfly vector nutritional states could also influence the evolution of the parasite. It is essential to elucidate the roles that diets and nutrition play in the leishmanial life cycle. The aim of this article is to review the influences of nutrition and diets on the host susceptibility and severity of infection, preemptive and therapeutic strategy feedback, parasite evolution, and vector competence.

Impact of Consumption of Bananas on Attraction of Anopheles stephensi to Humans

Humans vary in attractiveness to mosquitoes, a phenomenon that is largely attributed to differences in physical cues such as heat and volatile odors emanating from breath and skin. Diet can change human odors but whether specific dietary components alter host attractiveness is largely unexplored. We identified bananas as a target for study following a survey of the internet for advice on avoiding mosquito bites. Human attractiveness to Anopheles stephensi Liston was measured using a glass vial bioassay where mosquito contacts were measured before and 1–3 h after ingestion of bananas or grapes. Consumption of grapes had no effect on the number of contacts but banana ingestion resulted in a significant increase in the overall number of contacts in spite of individual variation that included some subjects who showed no effect or decreases in contacts. Further tests with a single volunteer showed that the effect was repeatable and consistent across 15 trials. The magnitude of the increase was not affected by the number of bananas eaten. Increased contact counts after banana ingestion were also observed when A. gambiae Giles was tested. These results support the hypothesis that diet plays an important role in mediating host attractiveness to anopheline mosquitoes.

Taking a bite out of nutrition and arbovirus infection

Nutrition is a key factor in host–pathogen defense. Malnutrition can increase both host susceptibility and severity of infection through a number of pathways, and infection itself can promote nutritional deterioration and further susceptibility. Nutritional status can also strongly influence response to vaccination or therapeutic pharmaceuticals. Arthropod-borne viruses (arboviruses) have a long history of infecting humans, resulting in regular pandemics as well as an increasing frequency of autochthonous transmission. Interestingly, aside from host-related factors, nutrition could also play a role in the competence of vectors required for transmission of these viruses. Nutritional status of the host and vector could even influence viral evolution itself. Therefore, it is vital to understand the role of nutrition in the arbovirus lifecycle. This Review will focus on nutritional factors that could influence susceptibility and severity of infection in the host, response to prophylactic and therapeutic strategies, vector competence, and viral evolution.

As the old adage goes, you are what you eat. Proper nutrition is a cornerstone of health, and malnutrition can seriously impair the function of the immune system, resulting in increased infections or a more severe disease. Imbalanced or inadequate nutrition can also affect responses to vaccines or drugs that are vital for protection and treatment against viruses. A mosquito is also a product of what it eats. Nutrition during development and adult lifecycle can affect the feeding behavior of mosquitoes, thereby affecting transmission of viral diseases. Arthropod-borne viruses (arboviruses) are a major global health concern, especially in areas impacted by malnutrition. Understanding how nutrition can affect both humans and mosquitoes in the context of these viruses is vital to combating these diseases.

Disruption of host-seeking behaviour by the salmon louse, Lepeophtheirus salmonis, using botanically derived repellents

The potential for developing botanically derived natural products as novel feed-through repellents for disrupting settlement of the salmon louse, Lepeophtheirus salmonis (Caligidae) upon farmed Atlantic salmon, Salmo salar, was investigated using an established laboratory vertical Y-tube behavioural bioassay for assessing copepodid behaviour. Responses to artificial sea water conditioned with the odour of salmon, or to the known salmon-derived kairomone component, α-isophorone, in admixture with selected botanical materials previously known to interfere with invertebrate arthropod host location were recorded. Materials included oils extracted from garlic, Allium sativum (Amaryllidaceae), rosemary, Rosmarinus officinalis (Lamiaceae), lavender, Lavandula angustifolia (Lamiaceae), and bog myrtle, Myrica gale (Myricaceae), and individual components (diallyl sulphide and diallyl disulphide from garlic; allyl, propyl, butyl, 4-pentenyl and 2-phenylethyl isothiocyanate from plants in the Brassica genus). Removal of attraction to salmon-conditioned water (SCW) or α-isophorone was observed when listed materials were presented at extremely low parts per trillion (ppt), that is picograms per litre or 10^-12 level. Significant masking of attraction to SCW was observed at a level of 10 ppt for diallyl disulphide and diallyl sulphide, and allyl isothiocyanate and butyl isothiocyanate. The potential of very low concentrations of masking compounds to disrupt Le. salmonis copepodid settlement on a host fish has been demonstrated in vitro.

Chemical and Plant-Based Insect Repellents: Efficacy, Safety, and Toxicity

Most emerging infectious diseases today are arthropod-borne and cannot be prevented by vaccinations. Because insect repellents offer important topical barriers of personal protection from arthropod-borne infectious diseases, the main objectives of this article were to describe the growing threats to public health from emerging arthropod-borne infectious diseases, to define the differences between insect repellents and insecticides, and to compare the efficacies and toxicities of chemical and plant-derived insect repellents. Internet search engines were queried with key words to identify scientific articles on the efficacy, safety, and toxicity of chemical and plant-derived topical insect repellants and insecticides to meet these objectives. Data sources reviewed included case reports; case series; observational, longitudinal, and surveillance studies; and entomological and toxicological studies. Descriptive analysis of the data sources identified the most effective application of insect repellents as a combination of topical chemical repellents, either N-diethyl-3-methylbenzamide (formerly N, N-diethyl-m-toluamide, or DEET) or picaridin, and permethrin-impregnated or other pyrethroid-impregnated clothing over topically treated skin. The insecticide-treated clothing would provide contact-level insecticidal effects and provide better, longer lasting protection against malaria-transmitting mosquitoes and ticks than topical DEET or picaridin alone. In special cases, where environmental exposures to disease-transmitting ticks, biting midges, sandflies, or blackflies are anticipated, topical insect repellents containing IR3535, picaridin, or oil of lemon eucalyptus (p-menthane-3, 8-diol or PMD) would offer better topical protection than topical DEET alone.

Heritability of attractiveness to mosquitoes

Female mosquitoes display preferences for certain individuals over others, which is determined by differences in volatile chemicals produced by the human body and detected by mosquitoes. Body odour can be controlled genetically but the existence of a genetic basis for differential attraction to insects has never been formally demonstrated. This study investigated heritability of attractiveness to mosquitoes by evaluating the response of Aedes aegypti (=Stegomyia aegypti) mosquitoes to odours from the hands of identical and non-identical twins in a dual-choice assay. Volatiles from individuals in an identical twin pair showed a high correlation in attractiveness to mosquitoes, while non-identical twin pairs showed a significantly lower correlation. Overall, there was a strong narrow-sense heritability of 0.62 (SE 0.124) for relative attraction and 0.67 (0.354) for flight activity based on the average of ten measurements. The results demonstrate an underlying genetic component detectable by mosquitoes through olfaction. Understanding the genetic basis for attractiveness could create a more informed approach to repellent development.

A twin study finds that there is a correlation in our attractiveness to mosquitoes by odour and our genetics, providing evidence that the likelihood of getting bitten is heritable.

[Evaluation of the use of repellent against mosquito bite by military personnel in the Amazon Basin]

BACKGROUND

In Brazil, diseases caused by insect bites are frequent. Therefore, it is extremely important that prophylatic measures are adequately carried out, especially in endemic areas such as the Amazon which receives a great number of visitors, for both business and tourism purposes..

OBJECTIVES

To evaluate the use of insect repellents available in the market by military personnel who often go in missions in the middle of the jungle, in the Amazon region.

METHODOLOGY

Fifty - one militaries in the Amazon region were selected and they answered a questionnaire in June/2008.

RESULTS

63,7% of the militaries used products that contained Deet in the maximum concentration of only 15% that has minimum repellent action; 36% reported to combine these products with sun protective products which increased the risk of intoxication; 36,4% used a natural repellent during their missions; two of the militaries participants used vitamin B and considered their repellent action ineffective.

CONCLUSION

The repellents that contain Deet and which were used by the group present concentrations that are lower than the concentrations considered safe for using in the jungle. It was frequent the combination of Deet with sun protective products ,which is a potentially toxic association. Natural repellents that have "andiroba" and" copaíba" as components presented a higher perception of protection from the participants.

To bite or not to bite! A questionnaire-based survey assessing why some people are bitten more than others by midges

Background

The Scottish biting midge, Culicoides impunctatus, responsible for more than 90% of biting attacks on human beings in Scotland, is known to demonstrate a preference for certain human hosts over others.

Methods

In this study we used a questionnaire-based survey to assess the association between people's perception of how badly they get bitten by midges and their demographic, lifestyle and health related characteristics.

Results

Most people (85.8%) reported being bitten sometimes, often or always with only 14.2% reporting never being bitten by midges when in Scotland. There was no association between level of bites received and age, smoking, diet, exercise, medication, eating strongly flavoured foods or alcohol consumption. However, there was a strong association between the probability of being bitten and increasing height (in men) and BMI (in women). A large proportion of participants (33.8%) reported experiencing a bad/severe reaction to midge bites while 53.1% reported a minor reaction and 13.1% no reaction at all. Also, women tend to react more than men to midge bites. Additionally, the results indicated that the susceptibility to being bitten by midges is hereditary.

Conclusions

This study suggests that midges prefer to bite men that are tall and women that have a large BMI, and that the tendency for a child to be bitten or not could be inherited from their parent. The study is questionnaire-based; therefore, the interpretation of the results may be limited by the subjectivity of the answers given by the respondents. Although the results are relevant only to the Scottish biting midge, the approach used here could be useful for investigating human-insect interactions for other insects, particularly those which transmit pathogens that cause disease.

Repelentes de insetos: recomendações para uso em crianças

OBJETIVO: Apresentar uma revisão bibliográfica sobre o uso de repelentes de insetos em crianças, com ênfase especial na proteção contra mosquitos. FONTES DE DADOS: Realizou-se uma pesquisa bibliográfica nas bases de dados Pubmed e Lilacs, cujos artigos incluíam produtos comercialmente disponíveis no Brasil. Foram selecionados artigos publicados nos últimos dez anos em língua inglesa ou portuguesa, referentes a crianças, obtidos com as seguintes palavras-chave: "insect repellents", "children", "mosquitoes", "N,N-dietil-metatoluamida (DEET)". SÍNTESE DOS DADOS: Entre os repelentes tópicos, DEET, icaridina e óleo natural de eucalipto-limão apresentam, em concentrações adequadas, perfil de segurança favorável e são eficazes na prevenção de picadas de mosquitos em crianças e adultos. Em geral, são indicados para crianças acima de dois anos de idade. Medidas físicas são fundamentais para proteger lactentes jovens, especialmente menores de seis meses, com destaque para o uso de telas com permetrina. CONCLUSÕES: Os mosquitos são vetores de doenças infectoparasitárias que acometem, anualmente, milhões de pessoas no mundo e causam milhares de mortes. O combate aos mosquitos inclui medidas ambientais e de proteção individual. O uso de repelentes tópicos para proteção individual da criança exige cuidados específicos e conhecimento quanto ao produto ideal para cada idade, especialmente quando consideradas sua eficácia e segurança.