West Nile Virus, Part 3

In 2009 Pediatrics published an article about West Nile Virus (WNV). The research showed that median annual incidence of WNND for children was 4 times lower than that reported for younger adults and 13 times lower than that reported for older adults.  For the entire country over the past 8 years, the occurrence  is 0.07 in 100,000 for children under 18.  That is less than 1 in a million.  This seems like a relatively low risk.  But I suppose if there are a lot of cases of WNV in my area then my area would have a higher risk than this.  So what is my area like?

I checked the CDC website and there have been 79 confirmed cases and 3 deaths in my state and 6 cases and 2 deaths (both in elderly people) in my county (800,000 people).  Now, if I lived in Dallas County (2.5 million people) where there have been 293 cases and 15 deaths there would ten times more risk of being exposed to West Nile Virus.  Which may be why they are spraying for mosquitoes in Dallas…which could cause other problems...But the risk in Dallas isn’t high, about 1 in 10,000.   

 (source)

OK, so now I’m wondering what you guys think about the risk of West Nile Virus for kids and the risks of insect repellent.  Which one are you more concerned about?  I would love to hear your thoughts.  Personally, I do not think there is evidence to really worried about either one. But mosquito bites are itchy and uncomfortable.  I want to avoid the baby getting them even if he isn’t at much risk for West Nile Virus.  In fact, at this point, I think my parents are at more risk from West Nile Virus than he is. But I cannot quite bring myself to spray him with DEET. I will probably keep spraying his clothes and and then wipe his exposed skin with an "Avon Skin So Soft Bug Guard plus Picaridin" wipe if the bugs seem to be bothering him.

 

West Nile Virus, Part 2

Previously I presented my husband’s request to start using insect repellent on our baby, who is four months old.  I wanted to do some research on the different insect repellents and their safety before I started to use it on the baby.  I did a review of scientific research that I could access online and have several sites you can look at to see for yourself. 

Last month (8/2012) the American Academy of Pediatrics published tips on preventing West Nile Virus.  It clarified for me that I can use up to 30% DEET on babies over 2 months old, but it should only be applied once a day.  It also should be wiped off at the end of the day.  There have been cases of DEET toxicity but using the lowest effective concentration of DEET on only the areas of exposed skin and wiping it off after returning indoors reduces exposure.

OK, so I could use a DEET insect repellent on the baby, but this talk of toxicity isn’t sounding great to me so I still have more research to do to make my decision. 

The AAP tips page also mentioned Picaridin, which has been available in Europe but only recently has been available in the US.  It does not mention how old babies have to be to use it or possible side effects.

The CDC recommends DEET (N,N-diethyl-m-toluamide), Picaridin, or Oil of lemon eucalyptus as the three most effective insect repellents.  In general, it is wise to use the lowest concentration of the key ingredient that is effective for the amount of time you are going to be outside.

Kidsmeds has a great webpage describing the various insect repellents and how long they are active.  It includes DEET, Picaridin, Eucalyptus, and Citronella.  Citronella is only effective for about thirty minutes, but the other three can last about 6 hours in the stronger concentrations.

Dr. Mark Fradin reviewed the available research on insect repellents in 2001.  He reported that in 50 years there were only 50 significant cases of DEET toxicity.  These cases seemed to have had long-term, excessive, or inappropriate use of DEET repellents but the details of exposure were not well documented.  14 of these were children under age 8 who developed encephalopathy.  Wait, that sounds as bad as West Nile Virus.  But 14 cases in 50 years with millions of uses every year meants it is pretty rare.

He also found few studies on Picaridin, but indicated low concern for toxicity.

A 2008 risk assessments review for the insect repellents DEET and Picaridin had essentially the same conclusions as Dr. Fradin.

Oil of lemon eucalyptus may seem more natural than DEET or Picaridin, but the labeling for oil of lemon eucalyptus says it is not to be used on children under the age of three and Picaridin is derived from pepper.

A final couple of websites for you to look at:

Traditional   http://www.travmed.com/health_guide/ch8.htm

Natural http://www.kitchenstewardship.com/2012/07/31/all-natural-bug-and-insect-repellent-reviews-10-brands/#more-15284

So far for me, it’s toss-up between DEET and Picaridin.  I think they are both safe enough for the baby when used correctly.   DEET is more studied but also has more documented side effects than Picaridin.   Tomorrow I will look at just how big the risk is for West Nile Virus.

West Nile Virus, Part 1

My first two kids were born in 2000 and 2002, shortly after West Nile was first detected in North America in 1999.  This year we are seeing more cases of it, and so it is in the news again.  I had been doing with the baby what I had done with the girls.  Which is basically nothing.

At breakfast today, my husband asked about West Nile Virus and our baby.  In particular he wanted me to be sure to put insect repellent on the baby any time we would be outside for more than 15 minutes. He had read in a newspaper article of a person in our town of 30,000 dying from West Nile virus. He also knew that I haven’t been putting insect repellent on the baby.  

So, I told him that I would look into it.  When I was in PNP (Pediatric Nurse Practitioner) school I was taught that because babies' skin is thin they can absorb chemicals through the skin to get into the blood stream.  I thought I remembered that I wasn’t supposed to put DEET on babies until after they were six months old.  However, I don't remember what the current recommendations are. My mother-in-law had given us some AVON insect wipes with Picaridin, an ingredient that I haven’t ever researched. The packaging didn’t indicate whether it was safe for babies under six months or not.  

When the girls were babies we lived in Dallas and West Nile virus was a very new to the United States.  It seemed quite rare in children. Since it is a virus, the doctor's office I worked for was not very worried about Wile Nile itself. However they were worried if a child had fever over 102F that wouldn't come down, wasn't drinking, or not acting like him or herself. Questions to ask would include:

• Was the child acting ok? 
• Did the fever come down with Tylenol or Motrin?
• Is the child not drinking?
• Did they have symptoms of meningitis or other neurological illness (encephalitis)? (such as, altered level of consciousness, change in ability to walk, not completely wake up, not able to put chin to chest)

So with all of my kids up to this point, I avoided bug spray when they were babies. When we were outside, I just didn’t stay outside when the bugs were biting.  I put them in long pants and long sleeves shirts.  I sprayed their clothes, not their skin.  All of this was done to prevent the discomfort of bug bites as much as to protect against West Nile Virus.

Nowadays I am outside with the baby for the younger daughter's cheerleading practice or just playing outside with the three year old boy. It seems like a good time for a review of the the guidelines and literature out there to decide what I would do with dear baby when we went outside.  

Tomorrow I will post about DEET and Picaridin and other insect repellents. And then what the current scientific research says about children and West Nile Virus.  For now I will leave you with a link to NPmama’s description of West Nile Virus.