Protective efficacy of skin-applied arthropod repellents against Chrysops bites in a Loa loa hyperendemic region in Gabon: A placebo-controlled randomised clinical trial of DEET, icaridin, citriodiol, and IR3535

Loa loa - a filarial pathogen causing loiasis -is transmitted by deer fly species Chrysops dimidiata and C. silacea. There are no established control tools available to reduce loiasis transmission in endemic regions. Although the use of repellents has been explored against other arthropods, their protective efficacy against Chrysops bites in humans has not yet been systematically evaluated. The aim of this randomized controlled clinical trial was to assess the efficacy of four commercial skin-applied arthropod repellents against Chrysops bites in a hyperendemic region in Gabon. Volunteers were randomly assigned to apply the skin repellents DEET, icaridin, citriodiol, IR3535 or an inactive control. The primary endpoint was the number of blood meal attempts by Chrysops flies. Secondary outcomes were the frequency and duration of Chrysops landings on clothing and skin. This study is registered with the Pan African Clinical Trials Registry (PACTR202406779622099). Blood meal attempts were significantly reduced by citriodiol (-50%, p=0.04) and DEET (-50%, p<0.001), but not by icaridin (0%, p=0.48) and IR3535 (0%, p=0.69). Concordantly, the time spent by the fly on the skin was significantly shortened by citriodiol (-66%, p=0.02) and DEET (-46%, p<0.001), but not with icaridin (+2%, p=0.35) and IR3535 (0%, p=0.93). Conversely, the number of Chrysops landings on untreated clothing was not reduced by DEET and icaridin, while citriodiol and IR3535 treated individuals experienced a higher number of landings (p=0.005 and p=0.01, respectively). Citriodiol and DEET showed substantial but not complete protective efficacy against the bite of loiasis vectors. Icaridin and IR3535 were ineffective.