2013-01-02 11:14:57
Chikungunya is a viral disease transmitted from human to human through the bite of a mosquito of the species Aedes albopictus. In 2005/2006, a chikungunya epidemic took place in Reunion. After a first episode between March and June 2005, the chikungunya epidemic resumed in Reunion in October 2005, reaching a peak in February 2006. The Health Surveillance Institute (InVS) estimated that around 266,000 people presented with clinical form of the disease and severe forms of this disease were described for the first time. During the period January-December 2006, 246 people were hospitalized in an intensive care unit in Reunion.
In the absence of a vaccine and treatment for this disease, the main way of controlling the chikungunya epidemic has been the fight against the mosquitoes responsible for the transmission of this disease (vectors) and their larvae with a view to to reduce their densities. To be effective, these mosquito control operations also had to be accompanied by individual protection measures aimed at preventing the general population from mosquito bites. Recommendations encouraging the use of mosquito nets or impregnated clothing have been issued by several organizations (Afssaps (now ANSM), InVS, etc.), particularly for the protection of children under 30 months and pregnant women.
As part of the management of the crisis due to the chikungunya epidemic in Reunion, the Director General of Health (Ministry responsible for Health) and the Director of pollution and risk prevention (Ministry responsible for Ecology) contacted the Agency in August 2006 in order to assess the risks linked to the repeated use of insecticide products for impregnating mosquito nets and clothing in the short, medium and long term.
In view of the specific skills necessary to carry out this work, a dedicated group of experts was set up to bring together the skills of toxicologists from the Agency’s CES Biocides, but also entomologists from the Research Institute for Development. (IRD), the World Health Organization (WHO) and the armed forces health services.
The work of the Agency and recommendations
On the basis of the literature and available international recommendations (in particular those of the WHO), the Agency has identified the products available on the market and the associated dangers. Use scenarios were then proposed and the corresponding exposures assessed.
Permethrin and deltamethrin are the two active substances commonly used in fabric impregnation.
Although, initially, the effectiveness of a mosquito net in protecting against attacks by a mosquito active during the day, such as the mosquito responsible for the transmission of chikungunya, may be surprising, the work of the Agency has shown that this use in terms of curbing the transmission of the disease was important.
Isolating patients suspected of being infected with the chikungunya virus under a mosquito net helps prevent mosquitoes coming to feed on their blood from contaminating themselves and infecting other people. Mosquito nets also allow protect vulnerable populations like young children who do not yet walk, bedridden people or even pregnant women.
The Agency therefore recommendedpreferentially use industrially pre-impregnated mosquito nets with a long duration of action the assessment of which has not revealed any particular risk.
Finally, the Agency’s work has shown that the use of impregnated clothing could also provide additional protection, particularly for populations whose activity does not allow them to stay under a mosquito net. This scientific expertise was accompanied by recommendations for use in order to guarantee the safety of users.
These recommendations can apply to epidemic contexts other than that of Reunion Island, when the behavior of the mosquito vector is comparable to that of the mosquito responsible for the transmission of chikungunya.
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