Deployed US Army soldiers' knowledge and use of personal protection measures to prevent arthropod-related casualties

The recommendation to use personal protection measures (PPMs) to prevent arthropod-related diseases and nuisance bites is a common element of travel medicine consultation.1-3 Prevention of arthropod-related casualties is especially important to the military, given the often intense exposure of service members to biting arthropods and the threat of personnel losses to mission success. In the 1980s, 75% deet (N,N-diethyl-m-toluamide) was the US military-issue insect repellent for use on skin and clothing. Collaboration between military and civilian researchers led to the implementation in 1991 of the current US military system of PPMs which has three components: topical application of 33% extended-duration deet, treatment of field uniforms with permethrin, and proper wearing of field uniforms.4-6 Compared to military-issue 75% topical deet, 33% extended-duration deet prevents bites up to three times longer (as long as 12 hours), is less greasy, and has lower plasticizing properties. Field uniforms treated with the contact toxicant, permethrin, are also necessary to minimize bites from crawling arthropods such as ticks and chiggers. Implementation of all three components of this system is a safe and effective means of reducing the threat posed by biting arthropods.7 We conducted a questionnaire survey to assess the degree of deployed soldiers' knowledge of the US military's system of PPMs and use of PPMs in general. Survey results may promote the development of better ways to advise and teach military and civilian travelers about the proper use of PPMs given the multitude of available products and practices.