DEET gets a pretty bad rap. In a day and age where people are pushing for the more "natural" approaches to prevention and medical care, DEET seems to be the least natural thing out there, right?

You know what is natural? West Nile virus. Zika virus. Chikungunya virus. Powassan virus. Ugh. All nasty viruses which are passed from human to human thanks to mosquitoes.

Citronella hasn't been proven to last very long and has to be at high concentrations to have any effect. So it has to be used really frequently to make up for its lack in efficacy.

Wristbands have been proven time and again in studies not to work, regardless of ingredients.

Lemon eucalyptus oil actually can help - but studies have shown that it's about half as effective as DEET and hasn't been tested for safety in kids under 3.

"Various botanical oils other than those discussed previously, including sandalwood, geranium, soybean, and others, have been used alone or in combination for repelling mosquitoes and ticks. The majority of studies of these alternative plant-based repellents show that the protection they offer is far inferior to DEET" - straight from a peer-reviewed medical article (UpToDate). I had high hopes for my marigold and lavender plants but I don't think they will work (Insert your own frown emoticon here).

So what do I put on my kids? DEET. Because no other compound (natural or synthetic or otherwise) has been proven to be as effective at keeping away mosquitoes, ticks, fleas, and chiggers.

DEET comes in different percentages - 10 percent to 70 percent. Stick with the 10-30 percent range. Ten percent will get you about two hours. Twenty-four percent gets you about five hours of protection. If your children are older, you can use higher concentrations if you'll be outside longer than five hours. The higher the concentration, the longer the effect will last.

DEET can be used on kids as young as 2 months. I know, I know - the thought of putting a synthetic compound on a sweet baby makes me cringe too. But honestly - it's OK for a few hours at a time. Scary things like neurotoxicity have actually only occurred in giant, massive doses after prolonged exposure, and even then it's super rare. Fewer than 20 cases of this happening have been recorded WORLDWIDE since the beginning of time.

If you have aerosolized spray, do what I do - spray it on your hands, then rub it on their arms, legs, neck, ankles, torso. Don't spray it on them directly , and try to avoid inhalation. Don't put it on their hands (because if they're anything like my kids, their hands are in their mouths nonstop). Avoid the eyes. Give them a bath when you're done with outside time.

DEET really is the best way to keep the bites away. And with such a wet "winter" that we had this year - it sounds like we will all need some.

Hugs,

Dr. Diane

That’s how I remembered this:

Blood, frogs, lice, flies, disease, boils, hail, locusts, darkness, death.

You might ask, why was I learning the order of the plagues? Obviously, for a bible quiz game we used to play in Sunday school. Because I’m ultra-competitive, even when it comes to Sunday school.

The recent weather in North Texas has many questioning if we are witnessing plagues or if the Apocalypse is upon us.

Fortunately, it looks like the worst of the drenching rain (and hopefully the flooding as well) are behind us. As the waters recede, the rising threat will be mosquitoes and mosquito borne illness.

What’s the big deal with standing water?

Standing water is the breeding ground for mosquitoes. There are four stages of life for mosquitoes. The adult flying stage is the only one that does not rely upon water for survival. The eggs, larva and pupal stages must live in standing water.

Any standing water - water in a bird bath, pond or standing water from improper drainage can be a place for mosquitoes to breed.

Why do mosquitoes bite?

Female mosquitoes bite because they need a source of protein before they can produce eggs. Otherwise, like males, they can feed on nectar or sap.

When females bite, their long mouthpart breaks through the skin and gets into the small blood vessels just underneath. They also inject a small amount of saliva into the wound to make entry easier and to keep the blood from clotting.

What harm do bites cause our children?

Local reaction - While not technically an allergy, some kids will have a large local reaction with swelling and redness at the site of mosquito bites. These can be itchy and cause distraction in school or lack of sleep when severe.

Local infection – It’s not uncommon to see local infection in kids who have scratched mosquito bites, leaving a gap in skin, which can lead to infection. If the swelling worsens after the first few days or if there is significant warmth from the site of the bites, you should see your pediatrician to see if antibiotics are necessary.

General infection - Because mosquitoes can carry diseases, bites from mosquitoes can transmit infection that can affect the entire body. Mosquito borne illnesses cause over one million deaths world wide, most commonly from malaria. Two other diseases that we have seen in Texas associated with mosquitos are West Nile Virus and Chikungunya.

Given the amount of rain and the season, mosquitoes will be inevitable this summer season. Read more here about the many different ways you can reduce your child’s risk of discomfort and serious illness: How to fight (and) win against mosquitoes.

“Everything we look at with this virus seems to be a bit scarier than we initially thought,” said Dr. Anne Schuchat, a deputy director at the U.S. Centers for Disease Control and Prevention.

Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s knows that this news conference will increase the fear many already feel about Zika, but she points to a few facts to calm our nerves or at least let us take precautions to be safe:

1. Local transmission of the Zika virus from a mosquito hasn’t been documented in the United States. Zika virus has been reported in travelers returning to the U.S.
2. Pregnant women should consider not traveling to any area where Zika virus transmission is ongoing. Women who are trying to become pregnant should consult with their doctor.
3. Zika can be sexually transmitted. Women who are pregnant should not have sex with their partner if he has Zika. It is unknown how long the virus is present in semen.
4. The virus has been linked to the Guillain-Barré syndrome, which can cause paralysis.

The Zika virus is spread to people primarily through the bite of an infected Aedes species mosquito, the same mosquitoes that spread dengue and chikungunya.

Those mosquitoes have been in the states for years, but we have not seen a massive outbreak in this country.

Dr. Whitworth said the reason why those mosquito-borne illnesses have not spread as much in this country may be as simple as improved mosquito vector control and air conditioning.

With more air conditioned homes, people stay inside more and don’t sleep with the windows open or go outside as much. The other key may be the measures taken to prevent mosquito bites, such as wearing insect repellant and sprays.

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

I remember last year as story after story reported our cities varying counter assaults against West Nile, I looked at my husband and said, “This is really going to freak people out.” My stepson, with his patented perfect timing, walked into the room scratching a red bump on his arm and announced, “Hey something bit me.”

My stomach dropped. While I went in search of an antihistamine in our medicine cabinet, I reminded myself that usually only a small percentage of mosquitos in any area where carrier mosquitos have been found are infected with the West Nile virus. According to the CDC, 80 percent of people bitten by a mosquito infected with West Nile virus never develop symptoms.

Among those who are bitten and infected 1 in 5 develop mild flu-like symptoms such as fever, headache, body aches sometimes skin rash. These symptoms may last for a few days and are easily managed with over the counter medications.

Less than 1 in 100 (that is less than 1 percent) of those infected develop a severe illness with West Nile meningitis or encephalitis (swelling of the brain and surrounding tissue.) Armed with the facts I breathed a sigh of relief and reassured my stepson he would be fine.

What can we do this summer to protect ourselves and our kids? We need to prevent the mosquitoes from biting and make sure we do not have areas around our homes that invite mosquito to breed. We need to use the Four Dʼs: Drain, Dress, Dusk, DEET.

1. Drain all free standing water. Mosquito LOVE free standing water. The murkier the better. It is their favorite breeding ground. Check flower pots, bird baths, swimming pools, gutters, drain pipes. Drain or clean out anywhere water collects.
2. Dress in long sleeves and long pants. Easier said than done in 100 degree Texas heat but the reality is mosquitos only bite skin they can reach. Maybe opt for longer shorts and wear socks and tennis shoes instead of sandals.
3. Dusk (and Dawn) is the mosquito's’ favorite time of day so take extra precautions if the kids go outside during these times of the day.
4. DEET Use insect repellant. DEET has been tested and approved by the Environmental Protection Agency (EPA). Remember you only want to apply repellants to exposed skin or clothing and avoid contact with your eyes and mouth. DEET concentrations vary from product to product from less than 10 to more than 30 percent. The higher the concentration the longer lasting the repellant.

Safety has not been related to concentration. We do not recommend DEET products under 2 months of age. Instead you could try mosquito netting over your infant carrier.

You can also use repellants with picaridin or biopesticide repellants like Oil of Lemon Eucalyptus (ages 3 and up). Regardless of the type of repellant used; remember to wash the product completely off your child’s skin once you are indoors.

If despite your best efforts your child does get a bite you can give him or her an over the counter oral antihistamine or apply topical 1 percent hydrocortisone cream to help relieve the itch. As with all medicines, if you are not sure about the dose check with your pharmacist or pediatrician. If your child develops high fever, body aches or headaches it is time for a visit to your pediatrician.

Remember severe West Nile virus infection is extremely rare and armed with the Four Dʼs we can fight back the terror and, hopefully, take the bite out of this summer.

Tarrant County Public Health (TCPH) confirmed the first imported case of chikungunya as a Mansfield, Texas, resident, who contracted the disease while in the Caribbean and was diagnosed by doctors upon returning home. Additional details are not being released to protect the identity of the patient.

This is the first imported case of chikungunya virus disease reported in Tarrant County – and the 13th in Texas. To date, local spread of the virus has been reported in Florida, but no other states.

Tarrant County Public Health stated that imported cases could make local spread possible because the Aedes mosquitoes that transmit the virus are found in Texas.

Aedes mosquitoes are active and bite during the day the TCPH said, so it’s important for people to protect themselves against mosquitoes at all times.

Because symptoms are similar, TCPH encourages physicians to consider both chikungunya and dengue infection in patients with acute onset of fever and joint pain - and patients who have recently visited areas where at least one of the viruses is present.

Donald Murphey, M.D., medical director of Infectious Disease at Cook Children's, stresses that all cases of chikungunya in the United States have been a result of people traveling outside of the country and returning home. No one has become infected by the virus without leaving U.S. The World Health Organization reports 350,580 suspected cases of the viral infection in the United States.

While infections are rarely fatal, chikungunya can be quite painful; especially for children. Children are impacted more severely.

• Children have a greater chance for rashes and joint pain can be quite painful.
• Babies’ only symptoms may be a rash and fever.
• Older children may complain of aching in their head or joints. Often times, nausea accompanies an infection.

If you notice these symptoms, please contact your pediatrician. A cure for chikungunya doesn’t exist, but a doctor may be help to ease the symptoms.

Symptoms usually begin three to seven days after being bitten by a mosquito. There is no vaccine or treatment for the virus. Most people feel better within a week, though some people may develop longer-term joint pain.

Chikungunya is not transmitted from direct person to person contact. Instead a person with the disease can be the source of the virus for mosquitoes to bite someone else and spread it. To prevent the spread of the disease, people with chikungunya illness should be especially careful to avoid exposure to mosquitoes during the first week of illness.

DSHS encourages people to protect themselves from mosquito bites at home and while traveling. The Aedes mosquitoes that transmit chikungunya are active and bite during the day. Precautions include:

• Use an approved insect repellent every time you go outside, and follow label instructions.
• Drain standing water where mosquitoes can breed.
• Wear long sleeves and pants when outside.
• Use air conditioning or make sure doors and windows are screened to keep mosquitoes outside.

According to the Centers for Disease Control and Prevention, with recent outbreaks in the Caribbean and the Pacific, the number of chikungunya cases among travelers visiting or returning to the United States from affected areas will likely increase. Cases have occurred in Africa, Southern Europe, Southeast Asia, and islands in the Indian and Pacific Oceans.