title: Long-lasting permethrin-impregnated clothing: protective efficacy against malaria in hyperendemic foci, and laundering, wearing, and weathering effects on residual bioactivity after worst-case use in the rain forests of French Guiana.
abstract: Personal protective measures against hematophagous vectors constitute the first line of defense against arthropod-borne diseases. However, guidelines for the standardized testing and licensing of insecticide-treated clothing are still lacking. The aim of this study was to analyze the preventive effect of long-lasting polymer-coated permethrin-impregnated clothing (PTBDU) against malaria after exposure to high-level disease transmission sites as well as the corresponding loss of permethrin and bioactivity during worst-case field use. Between August 2011 and June 2012, 25 personnel wearing PTBDUs and exposed for 9.5 person-months in hyperendemic malaria foci in the rain forest of French Guiana contracted no cases of malaria, whereas 125 persons wearing untreated uniforms only, exposed for 30.5 person-months, contracted 11 cases of malaria, indicating that PTBDU use significantly (p = 0.0139) protected against malaria infection. In the field, PTBDUs were laundered between 1 and 218 times (mean 25.2 ± 44.8). After field use, the mean remaining permethrin concentration in PTBDU fabric was 732.1 ± 321.1 min varying between 130 and 1270 mg/m2(mean 743.9 ± 304.2 mg/m2) in blouses, and between 95 and 1290 mg/m2(mean 720.2 ± 336.9 mg/m2) in trousers. Corresponding bioactivity, measured according to internal licensing conditions as KD99times against Aedes aegypti mosquitoes, varied between 27.5 and 142.5 min (mean 47.7 ± 22.1 min) for blouses, and between 25.0 and 360 min (mean 60.2 ± 66.1 min) for trousers. We strongly recommend the use of long-lasting permethrin-impregnated clothing for the prevention of mosquito-borne diseases, including chikungunya, dengue, and zika fevers, which are currently resurging globally.
authors.affiliation: Director Department A, Bundeswehr Medical Office, Koblenz, Germany.
authors.forename: Bruno
authors.initials: B
authors.lastname: Most
authors.affiliation: French Armed Forces Center for Epidemiology and Public Health (CESPA), Camp Militaire de Sainte Marthe, Marseille, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Pommier de Santi
authors.affiliation: French Armed Forces Center for Epidemiology and Public Health (CESPA), Camp Militaire de Sainte Marthe, Marseille, France.|Regional Office of the French Institute for Public Health Surveillance (Cire OI, Institut de Veille Sanitaire), Saint-Denis, Réunion, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pagès
authors.affiliation: Institut de Recherche Biomédicale des Armées, Cedex, Brétigny sur Orge, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Mura
authors.affiliation: Bundeswehr Research Institute for Materials, Fuels, and Lubricants, Erding, Germany.
authors.forename: Waltraud M
authors.initials: WM
authors.lastname: Uedelhoven
authors.affiliation: Department of Medical Entomology/Zoology, Central Institute of the Bundeswehr Medical Service, PO Box 7340, 56065, Koblenz, Germany. MichaelFaulde@bundeswehr.org.|Institute of Medical Microbiology, Immunology and Parasitology, University Clinics Bonn, 53105, Bonn, Germany. MichaelFaulde@bundeswehr.org.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Faulde
mesh_terms: D000330:Aedes / Q000187:drug effects*; D000818:Animals; D003715:Dengue / Q000517:prevention & control* / Q000821:virology; D005616:French Guiana; D006801:Humans; D007306:Insecticides / Q000494:pharmacology*; D007846:Laundering; D008288:Malaria / Q000469:parasitology / Q000517:prevention & control*; D026023:Permethrin / Q000494:pharmacology*; D011481:Protective Clothing; D065947:Rainforest; D014887:Weather; D000071244:Zika Virus; D000071243:Zika Virus Infection / Q000517:prevention & control* / Q000821:virology
chemical_list: D007306:Insecticides; D026023:Permethrin
keywords: Laundering resistance; Long-lasting activity; Malaria prevention; Permethrin-impregnated clothing; Personal protection; Weathering effects