How else can travellers protect themselves?
Ensuring complete protection from mosquito bites when travelling to foreign countries is difficult. Travelling light, sleeping outside, and using public transport can frequently make it even more challenging. However, there are many things that can be done to minimise the chance of being bitten. This step covers some basic guidelines around avoiding mosquito bites.
Insect repellent is the best way to protect yourself from insect bites.1 Selection and appropriate application of a repellent with an appropriate active ingredient was discussed previously. However, there is no guarantee that your destination will have high quality repellents, especially in rural areas, so it is advisable to take your own repellent from a reputable store. Ensure that you pack enough repellent for the duration of your trip. It is also advisable to take an aeroplane-permissible quantity of a good quality repellent in your hand luggage to ensure several days’ worth of protection upon arrival in the event of delays or lost luggage. All travel companions should have their own supply to ensure protection can be maintained.
People travelling to tropical and subtropical countries should stay in hotels and hostels that have flyscreens or sealed window and doorframes installed.2 Damp toilet rooms are often prime breeding or resting sites for mosquitoes. A thorough check for mosquitoes resting in your accommodation should be made before use. Plug-in devices containing insecticides can be used indoors to kill any resting mosquitoes. Using a fan and air conditioning may help deter mosquitoes, but should not be solely relied upon.
Public transport in tropical regions will often be poorly ventilated and may consequently have open windows and doors. When trains and buses are moving the draught created may be adequate to prevent mosquitoes landing easily, but at stations passengers are at high risk of being bitten, particularly at dawn and dusk. Insect repellent should be applied before and during train or bus journeys, and, where possible, a personal mosquito net is advisable on sleeper trains.
It is advisable to sleep fully clothed on public transport, and particularly if you do not have a bed net. This will reduce the areas of skin vulnerable to mosquito bites, allowing repellent to be applied more thoroughly to a smaller surface area, such as the ankles, hands, back of the neck, and face.
Using a bed net
Using a good bed net is particularly important in areas where night biting mosquitoes are present. However, Aedes will readily bite indoors, and if people are not protected by a bed net when sleeping during daylight hours they are at risk. As such, bed nets, along with similar indoor control methods like insecticide treated window/door screens and curtains and nets for hammocks should not be dismissed as control tools for Aedes.
Insecticide-treated nets are more effective than untreated nets as they kill insects on contact and can even repel them.3 Some bed nets come pre-treated, but untreated nets can also be treated by soaking the net in a permethrin solution. This is usually available in travel health clinics and outdoor equipment stores. It is important to remember to check bed nets frequently for tears, as mosquitoes will find a hole if there is one available. However, if it is treated with an insecticide, fewer mosquitoes will enter through holes in the net.
In mosquito prevalent areas, light-coloured and lightweight long sleeves and trousers should be worn. Dark colours are believed to be attractive to several species, including Aedes aegypti and Aedes albopictus,4 and generally it is important for these clothes to be lightweight as countries with mosquito-related issues are often warm. As discussed in Step 3.4, clothing can also be treated with permethrin in the same manner as bed nets and this is available in many outdoor stores or online.2
Seek advice before travel
It is essential that travellers are given expert advice before travelling. For Zika, this is particularly important for women who are pregnant or anybody who is planning to have a child; this includes men and women who are planning to conceive. Advice can be sought from a travel clinic and should be done at least eight weeks before departure. It should be noted that for some regions of the world, prophylaxes, e.g. anti-malarials, and vaccines, e.g. yellow fever and Japanese encephalitis, may be required. Preparation before travel is the key to staying safe when abroad.
Further information around staying safe is available from a number of national and international organisations and can be found in the See Also section.
© London School of Hygiene & Tropical Medicine