Expert Review of the Evidence Base for Arthropod Bite Avoidance

Bite avoidance measures are commonly recommended to international travelers to help reduce the risk of various arthropod‐borne diseases. A key strategy is the use of repellents applied topically to skin or clothing which are considered in the first part of this review. Also advised are a variety of methods that employ the use of insecticides and physical barriers such as mosquito nets or oil preparations applied to the skin. In the following document, the authors considered some of the most widely used bite avoidance methods and identified the strength and quality of evidence that determined efficacy. The overall purpose of the review is to provide the available evidence, in a graded format, upon which to base recommendations for the selection of appropriate repellents and other methods of bite avoidance in those traveling overseas. The authors were asked to consider the effectiveness of the most commonly used active ingredients (AIs) in repellent formulations and methods of bite avoidance. The evidence base considered protection against nuisance biting insects, reduction in the incidence of arthropod‐borne diseases, and safety profile. Effectiveness of the repellent related to spectrum of activity against various mosquito species and other arthropods was examined as well as longevity of applied dose. Where possible, efficacy was compared to deet as being the accepted gold standard. All sections employed MEDLINE via PubMed in literature searches augmented by others depending on the subject area investigated. Details of the review process can be found at http://www.istm.org; click on “ISTM Committees” and then “Publications.” ### Major Findings N , N ‐diethyl‐3‐methylbenzamide (deet), (2‐(2‐hydroxyethyl)‐piperidinecarboxylic acid 1‐methyl ester (icaridin), p ‐methane 3, 8‐diol (PMD), and ethyl butylacetylaminopropionate (IR3535)‐based repellents all provide protection against biting arthropods, but volatile oils and other natural products are less reliable. On the strength of available evidence, the first‐line choice for those visiting areas where …