[Prevention with repellent in children]

Use of topical insect repellent is an important component in prophylaxis of arthropod bite vector borne diseases. Topical insect repellent are used in a three part management regimen, along with impregnated clothing and mosquito netting. Parental training for efficacious and secure use of repellents for their children is essential part of a successful strategy to combat Lyme borreliosis, dengue fever, Chikungunya, West Nile virus infection and malaria, amongst children, according to local epidemiological risks. Rational repellent prescription for a child must take into account age, active substance concentration, topical substance tolerance, nature and surface of the skin to protect, number of daily applications, and the length of use in a benefit-risk ratio assessment perspective. The 4 currently repellents recommended by Whopes (Who) for their long lasting efficacy and patient tolerance are: 1) Citriodiol (PMD), 2) DEET, 3) Icaridine (KB3023), and 4) IR3535. In field trials the minimum required concentration of each four of these agents to be effective for 3 hours against most arthropods is 20% (in cream, roll-on or spray vehicle). Described side effects of these agents are mild, being limited to local irritative dermatitis and allergy. The risk of severe side effects has been related to DEET misused and neurotoxicity. The international recommendations concerning utilization of topical repellent amongst children for prophylaxis of arthropod borne diseases is concerning short term usage (several weeks). But the use of repellent is sub chronic or chronic amongst the majority of children living in subtropical regions where these vector borne diseases are endemic. And toxicity of topical repellent when used sub-chronically and chronically is not well studied in pediatric age groups. Taking into account these considerations, the current recommendations of the French Group of Tropical Paediatrics are to teach the parents of children who live in arthropod vector disease endemic regions to use topical insect repellent on their children with the recommended age related frequency in the following way: the use of topical repellent in infants above 6 months, once daily. Only in exceptional circumstances of severe arthropod exposure risk, their brief use in nursing infants as young as 2 months is acceptable, however with never more than 1 application daily. From ages 1 to 12 years, 2 applications daily may be safely used; 3 applications daily after 12 years old through adulthood.