Keeping children safe from Dengue

Dengue and children

Dengue remains the biggest cause of worry for parents, both in India and abroad, during mosquito breeding seasons. With outbreaks becoming more frequent and having high mortality rates in children, prevention is the definitely the best cure.
Dengue can be particularly severe in children and infants. A second infection is worse than the first infection in terms of severity. There is no vaccine or specific treatment available for dengue. Hence, if you can protect from dengue, then why risk it.

In a study from North India, mortality rates in children can be upto 3-4%.

Prevention from Dengue or other mosquito borne diseases can be broadly divided into physical and chemical means.

Controlling vector (Mosquito) breeding

This is no doubt the best way of protecting oneself and all from mosquito borne diseases. The dengue mosquito breeds in the clean, stagnant waters. The neglected small water pools in the corners of our homes make the perfect ground for the replication of this mosquito.
The adult lifespan of the Aedes aegypti mosquito can range from two weeks to a month depending on environmental conditions. The average Aedes aegypti mosquito will disperse relatively short distances and travel no more than 500 metres in its lifetime.

Cleaning your neighborhood goes a long way in protecting your family from Dengue. If somebody in your neighborhood has high grade fever, form a neighborhood watch and recheck all potential mosquito breeding sites.

Commonest breeding sites

–    Masonary tanks at construction sites
–    Indoor water containers, like water coolers
–    Flower pots
–    Trays kept for birds
–    Old tyres, discarded bottles
–    Open lid water tanks
–    Check air-conditioner waste water drainage
–    Cover all gully or water traps
–    Tanks that can not be emptied, should be treated by adding a small quantity of medicinal or liquid paraffin or domestic kerosene. The recommended dose of kerosene is 5 mL or one teaspoon for a 1000 liters tank up to 15 mL or 3 teaspoons for a 10,000 liters’ tank. When using paraffin, the dose is double that used for kerosene.

Physical barriers

These are the safest means of protecting against mosquitoes. Most popular one are the mosquito nets while sleeping. These definitely provide best protection at night.
Imp.-Regularly check your net for breach in integrity of net.

However, the mosquito for Dengue bites mostly during daytime, in cold and dark surroundings. Whenever your child sleeps, put up the net, even during daytime.

Second thing is to wear full sleaved clothes with socks. Keep your children covered with full length clothes, preferably shirt tucked inside trousers and trousers tucked inside socks. Light coloured clothes are better in preventing mosquito bites.

Chemical based methods for preventing mosquito borne diseases

There are multiple products available in the market in form of aerosolized sprays, creams, repellant soaked wrist bands, coils etc. One must know the safety profile and efficacy of each product for children.
Synthetic repellants tend to be more effective and longer lasting than Natural repellant products.

DEET(N,N-diethyl-m-toluamide) is the most common constituent of such sprays worldwide. DEET is often sold and used in spray or lotion in concentrations up to 100%. Studies have found a direct correlation between DEET concentration and hours of protection against insect bites. 100% DEET was found to offer up to 12 hours of protection while several lower concentration DEET formulations (20%-34%) offered 3–6 hours of protection. Recent evidence shows that DEET serves as a true repellent in that mosquitoes intensely dislike the smell of the chemical repellent.

Products containing between 10% and 30% DEET have been found by the American Academy of Pediatrics to be safe to use on children, as well as adults, but recommends that DEET not be used on infants less than six months old.

DEET is an irritant. It can cause itching, watering of eyes, redness of skin, watery nose, or in cases, severe skin reactions.  DEET-based products can be used on children between the ages of 2 and 12 only if the concentration of DEET is 10% or less and that repellents be applied no more than 3 times a day, children under 2 should not receive more than 1 application of repellent in a day and DEET-based products of any concentration should not be used on infants under 6 months.

The advantage of using such creams is that they are very effective in protecting children in an outdoor environment, like playing in a park. Common DEET based products available in India include Odomos cream.

DEET remains the standard for comparisons, for testing other repellants.
In April of 2005, the Centers for Disease Control and Prevention (CDC) began recommending two new active ingredients as safe, effective repellents.

The first of these is Picaridin, a synthetic developed by Bayer Corporation in the 1980s. Picaridin is odorless, has a pleasant feel and doesn’t damage certain fabrics and finishes  affected by other repellents.  Studies have shown it to be as fully repellent to mosquitoes as DEET and can also be applied on infants as young as 2 months. Picaridin provides protection upto 3-8 hours depending on the concentration used.

Another registered repellent is oil of lemon-eucalyptus.  The formulation is based on the molecule found in eucalyptus.  It cannot be used on children younger than three years of age.  Like other essential oil products, it can cause skin irritation in higher concentrations.  It has a pleasant scent and feel.
Mosquito coils can also provide some protection. These utilize a synthetic pyrethroid insecticide that has repellent properties.  Important- Most effective in situations of little wind, where the repellent mixture remains in place in the air column surrounding the body.

Prallethrin is a pyrethroid insecticide. Prallethrin 1.6% w/w liquid vaporizer is a repellent insecticide which is generally used for the control of mosquitoes in the household. Marketed as a mosquito repellent by Godrej as “Good Knight Silver Power” and SC Johnson as “All Out” in India. The World Health Organization published in 2004 that “Prallethrin is of low mammalian toxicity, with no evidence of carcinogenicity”. Vaporizers can be used safely in households with children. Trans-allethrin marketed as HIT by Godrej in India is a related compound, which can be both used as an aerosol or coil.

Regarding safety with insect repellent creams/lotions use on children and pregnant women:

•    Read the label and follow all directions and precautions.
•    Children may be at greater risk for adverse reactions to repellents, in part, because their exposure may be greater.
•    Keep repellents out of the reach of children.
•    Do not allow children to apply repellents to themselves.
•    Use only small amounts of repellent on children.
•    Do not apply repellents to the hands of young children because this may result in accidental eye contact or ingestion.
•    Avoid applying repellents to portions of children’s hands that are likely to have contact with eyes or mouth.
•    Wash repellent-treated skin after coming indoors.
•    Use repellent sparingly being sure to cover all exposed skin.  A mosquito can find an unprotected spot the size of a dime. Saturation does not increase efficacy. Protection time provided by repellents is determined by the amount of active ingredient in the formulation.  A 10% DEET-based repellent will typically last 90 minutes or so.  A 30% product will last 5-6 hours.
•    Try to reduce the use of repellents by dressing children in long sleeves and long pants tucked into boots or socks whenever possible. Use netting over strollers, playpens, etc.
•    As with chemical exposures in general, pregnant women should take care to avoid exposures to repellents when practical, as the fetus may be vulnerable.
•    If a suspected reaction to insect repellents occurs, wash treated skin, and call a physician. Keep the repellent container so that you can tell the physician exactly what product you are using. The most commonly reported reaction is stinging when the repellent gets into the eyes.  Flush eyes with cold water immediately if this occurs.  Skin reactions are exceedingly rare and resolve quickly when the product is washed off.  These reactions are not related to the concentration of the active ingredient in the product.

NOTE: The following types of products are not effective repellents:

•    Wristbands soaked in chemical repellents
•    Ultrasonic devices that give off sound waves designed to keep insects away
•    Backyard bug zappers (Insects may actually be attracted to your yard).

Disclaimer: We do not endorse any brand or have received any financial support. Please read the information label completely before using any mosquito repellant product. This article is meant for only general public awareness and education. The text can not substitute expert medical advice. Please consult your doctor if you experience these symptoms.

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