But, driving to work the last few weeks and seeing all the standing water already starts to make my skin itch. Mosquitos are on the way. And I suspect it’s going to be a terrible year.

Mosquitos can cause a variety of problems:

1. Simple itching and discomfort-small bites which can lead to infection when scratched
2. Large local reactions-which can be very itchy, even quite painful (See more at Skeeter Syndrome).
3. Serious systemic illness such as West Nile Virus, Zika virus or Chikungunya.

But our kids don’t have to suffer. There are great options for preventing mosquito bites and warding off some of these miserable consequences.

DEET

N,N-Diethyl-meta-toluamide sounds like a little bit of a scary name for a chemical we can put on babies as young as two months. But DEET has been extensively studied and consistently shown to the safe and effective as a mosquito repellant in children. Recommended concentrations of 10-30% provide great protection with 30% lasting around five hours.

Picardin or Lemon Eucalyptus Oils

Multiple alternatives to DEET have been tried. Studies have shown that these two alteratives can be as effective as 10% DEET and thus last around two hours. Reapplication will be important if there are plans to be outside longer than two hours.

Here are some important facts about applying insect repellant:

1. Spray a thin layer over clothes and exposed skin. Thick layers do not make it more effective.
2. Use your hands to apply repellant to the face rather than directly spraying.
3. Spray in open areas to avoid ongoing inhalation.
4. Assist young children with application to ensure coverage and safety.
5. Avoid combination sunscreen products because reapplication of sunscreen needs to be done more frequently.

Having a healthy and fun summer should include TONS of outdoor play. Keeping your child safe from mosquitos is one part of making sure nothing spoils the fun.

Read more: 

'Skeeter Syndrome': Is My Kid's Bug Bite Infected?

An Infectious Disease Pediatrician Explains Differences and Similarities between West Nile and COVID-19

Everything You Need To Know About DEET and Protecting Your Kids From Mosquitos

Why Do Mosquitoes Bite Me and Not You?

 Chiggers Myths Parents Need To Know

Most people develop some redness and itching after a mosquito bite. Unfortunately, some children will have what’s known as a large local reaction, or “Skeeter syndrome.” This happens due to an allergy to mosquito saliva. These patients develop redness and swelling within hours of a mosquito bite. The swelling can be very large (like an entire arm or leg) and typically worsens over 1-2 days. In the worse reactions there can be bruising and even blistering!

It’s not always easy even for your doctor to tell the difference between “Skeeter syndrome” and a skin infection. One of the big differences is the timeline. Skin infections usually happen several days after a bite or an injury, but “Skeeter syndrome” usually starts within a few hours of a bite. Most often children with a large local reaction will complain about intense itching. Only in the more severe cases are pain and fever seen with allergy. It’s not common, but some even develop severe allergic reactions to mosquito bites that lead to difficulty breathing.

Large local reactions are best treated with oral antihistamines (Benadryl or Zyrtec) and topical over-the-counter steroid cream (hydrocortisone 1 percent). Fingernails need to be trimmed very short, because scratching causes local skin damage that can become infected. Cold compresses several times a day help alleviate some of the discomfort. In patients who have a history of this type of reaction, I recommend daily antihistamines such as Zyrtec during the time of the year when bites are difficult to avoid. This doesn’t totally prevent the reaction, but can help keep the swelling from being as extreme. I don’t recommend topical antihistamines (Benadryl cream) because some people develop a contact allergy that actually worsens the problem

So, when should you come to the doctor? 

Any child with significant eyelid swelling or swelling that is limiting activity or skin blistering deserves an office visit because they require further evaluation and sometimes even need oral steroids or more potent prescription topical steroids. Red/swollen/hot areas of skin that are associated with pain or fever should also be examined to rule out a bacterial infection.

Tick bites don’t usually cause itching like mosquitos, but are more of a concern due to infections they can transmit. Ticks are predicted to be more prevalent this summer due to the winter being relatively warm. Ticks can transmit several infections with Lyme being one that is often discussed.

If you find a tick on your child it should be removed with tweezers by grasping the tick as close to the skin as possible and pulling straight up. Different types of ticks spread different infections. For example, infected deer ticks can spread Lyme after being attached for 36 hours or longer. Certain areas of the country have a much higher rate of local tick infection than others. Texas is not a part of that area, but cases of Lyme do occur every year.

It is best if children bathe after coming in from playing outside to wash off ticks prior to attachment. It’s a good idea to look in hidden areas such as behind the ears and on the scalp. Remove ticks if you find them and watch for a rash. Certainly, a rash that looks like a bull’s eye or a target (erythema migrans) is concerning for Lyme infection and needs to be seen for further testing.

Insect bite avoidance is important (and hard)! The large local reactions are definitely very uncomfortable, but infections transmitted by mosquitos such as West Nile or Lyme from ticks are potentially very dangerous. Using DEET containing insect repellant and wearing long sleeves during peak mosquito times are helpful.

As always, see your pediatrician if you are worried about a bite or rash and we are happy to help.

Related:

• The deets on DEET from a pediatrician
• Protecting Your Child From Ticks

Let’s talk about the satisfaction of avoiding the world’s most annoying bug (and most devastating disease vector).

So…what is the best mosquito repellent out there?

Answer: DEET. (But you’ve got options.)

I’ve said it before and I’ll say it again: DEET may not be the most natural thing on the planet, but you know what is natural? Disease. Like Dengue fever. Malaria. West Nile Virus. Chikungunya. Zika. All carried and passed by mosquitos. Super natural.

Few things I want you to know (all backed by evidence – see my links below if you wanna read more):

1. There is no product out there that is as effective or lasts as long as DEET when it comes to repelling mosquitos, chiggers, fleas, and ticks.
2. DEET comes in all kinds of concentrations – from 10% to over 75%.
3. DEET is safe. This has been proven time and again in numerous studies. It doesn't cause cancer.
4. However - it doesn’t mean that it can’t be sometimes irritating to our skin and airways, and you should be cautious with it. It can cause numb or burning lips, nausea, and headaches. But it causes more problems if ingested than just if on skin. And some people are allergic to DEET.
5. More on safety: There have only been roughly 20 cases in the world of severe DEET reactions, like a seizure or brain encephalopathy. They were due to massive ingestion of DEET (think a small kid drinking a large bottle of it).
6. DEET is safe to use as young as age 2 months. Yes, you read that correctly.
7. If your baby is 2 months or older, spray the DEET spray on your hands, and wipe it onto their body. Don’t put it on their hands or face. Use a DEET concentration somewhere between 10-30%.
8. 10% DEET lasts about 2 hours. 24% lasts about 5 hours. Sweat, rain, wiping, and swimming all make it not last as long.
9. If you need to put on both sunscreen and DEET, apply the sunscreen first, let it soak in for 15 minutes, then spray on the DEET.
10. What do I think you should use if DEET is not an option for you? Picaridin!
11. Picaridin is plant-based and almost as effective as DEET, but you need higher concentrations of it typically and it usually doesn’t last as long. Still though – a good option.
12. DEET is better than Picaridin when it comes to tick protection in particular, but both work.
13. Picaridin is often tolerated a little better by people (and clothing). It’s less stinky and not greasy, and it doesn’t irritate the skin as much.
14. Lemon Eucalyptus oil (PMD) is about one-half as effective as DEET in studies (for example, 30% lemon eucalyptus oil works about as well and as long as 15% DEET). Still more studies needed though. Don’t use this on hands or face of kiddos either; it can irritate the skin and eyes.
15. Citronella is meh.
16. The bracelets just don’t work. Don’t waste your money.
17.  Botanical oils (sandalwood, lemongrass, citronella, geranium, soybean oils) and essential oils are way inferior to DEET, Picaridin, and lemon eucalyptus. They are well tolerated with less irritation, but I don’t think I’d use these until more studies prove they work.
18. There are a lot of theories out there as to why some people get bitten more than others. Those theories include:

• Blood type
• The kinds of bacteria living on our skin
• Pregnancy
• The amount of carbon dioxide we exhale (my husband does think i'm full of hot air....)
• If you’ve recently had a beer (!!)

I use DEET on my kids and don't really think twice about it. I use somewhere between 10-20% and spray it on my hands, and then rub it on them. I avoid the hands and face. And we take a bath once we've come inside (less chance for skin irritation if it's not on the skin all night).

Hope this helps you navigate your fight against these beasts.

Dr. Diane

Below is the evidence I promised: 

• Efficacy of DEET and lemon eucalyptus compared to other products
• Efficacy of DEET
• DEET Safety in Infants and Lactating/Pregnant Women
• Applying DEET to skin does not harm fetuses
• PMD/Lemon Eucalyptus efficacy
• Picaridin efficacy
• Poor Efficacy of Citronella and most wearable bands
• Comprehensive look at plant-based insect repellents

Is it possible that some of us are mosquito magnets, while others seem to naturally repel their attacks?

Is there something about you that mosquitoes particularly prefer over other people? The answer is probably yes, according to Nina M Dacko, MS, Vector Control Supervisor, of the Environmental Health Division for Tarrant County Public Health.

“This question’s answers are not fully understood, but there are many things that make people “more attractive” to mosquitoes,” Dacko said.

Dacko said some of these include:

• Perfumes
• Fragrances
• Scented body lotions
• Sprays - especially those that smell like flowers (mosquitoes do feed on nectar after all)
• Sweat (lactic acid)
• Smelly feet (octanol)
• The smell of someone’s breath

“These vary from person to person since some people sweat more than others and some release more carbon dioxide,” Dacko said. “It even comes down to which bacteria are living on the surface of your skin.”

But it may not be only your smell that makes you a mosquito-magnet. It may also come down to your genetics. It has been suggested O type blood is the most attractive to mosquitoes, though science isn’t sure why.

To stay free of those pesky bites and any diseases that mosquitoes may carry, the Tarrant County Public Health office offers these suggestions:

• Use an EPA approved repellent
• Wear long sleeves and pants
• Avoid being outdoors during dusk and dawn when mosquitoes are the most active

Summer is nearly here! Let's quickly hit some of the most common questions I get around this time of year - about sunscreen, DEET, and life jackets.

1. Sunscreen:

Use it! Even on a cloudy, not-very-hot day! 80% of the sun's rays penetrate clouds! And bounce off sand and snow!

Start using it at age 6 months. Prior to 6 months, do not have your baby in direct sunlight - put them under heavy shade and put a hat on them. If you can't find shade, use sunscreen on small amounts of their skin and try to cover skin with clothing.

Go with SPF 30-50 for your kids. I don't care about brand.

Zinc oxide (the stuff that won't disappear when you rub it in) is the best. It physically blocks the harmful rays. Great for nose, ears, cheeks, tops of shoulders.

Put it on 15-30 min BEFORE YOU GO OUT.

Reapply every 2 HOURS.

PUT ON MORE THAN YOU THINK YOU NEED. 1 teaspoon per limb is about right. 1 tsp for back, 1 tsp for chest. 1/2 tsp for face.

I don't like the sprays. They miss spots and can be inhaled. If you have to use them, spray a ton on your hands and rub it it in good.

More good info about sunscreen here: https://www.checkupnewsroom.com/5-tips-to-protect-your-chi…/

2. DEET:

DON'T BE SCARED OF IT. It is not "DDT"! It is safe down to age 2 months. It is the BEST way to prevent insect bites and this has been proven time and again in medical studies.

Read a ton about this in another article I wrote here:

https://www.checkupnewsroom.com/the-deets-on-deet/

If you absolutely don't want to use DEET, go with Picaridin.

Those wrist bands ain't gonna do anything.

3. Life jackets!

Use only life jackets that are approved by the US Coast Guard.

Here are the types (compliments of the AAP Healthy Children website):

TYPE 1: This jacket floats the best. It is designed to turn most people who are unconscious in the water from the face-down position to an upright and slightly backward position. This jacket helps the person to stay in that position for a long time. It is to be used in open water and oceans. It is available in only 2 sizes: 1 size for adults more than 90 pounds and 1 size for children less than 90 pounds. (Type 1 is the most bulky but has the greatest ability to turn a child "face-up".)

TYPE 2: This jacket can turn a person upright and slightly backward but not as much as the Type 1 jacket. It may not always help an unconscious person to float face up. It is comfortable and comes in many sizes for children. (More comfy but will only turn SOME children "face-up".)

TYPE 3: This jacket is designed for conscious users in calm, inland water. It is very comfortable and comes in many styles. This life jacket is often used for water sports and should be used only when it is expected that the rescue can be done quickly. (Least bulky, most comfortable. Good support for children who have some swimming skills.)

This summer, I will be using Type 1 lifejackets for my kids when we go to the ocean or are at the lake. I will be using Type 2 when we are in the wading pool. My kids are 2 and 4 and I will be within a few feet of them at all times when they are in/around water.

WATCH YOUR CHILDREN AT ALL TIMES WHEN THEY ARE IN OR AROUND WATER. DROWNING IS SILENT.

Let me say that again: DROWNING IS SILENT.

Cook Children's has a great drowning prevention resource page. Click here to learn more.

Hope this helps answer your burning hot summer questions!

Hugs,

Dr. Diane Arnaout

Last year, TCPH reported two associated deaths for the season. 

According to the Centers for Disease Control and Prevention (CDC), in 2016 there were:

• 354 human West Nile Virus cases in Texas
• North Texas accounted for the most WNV cases in the state
• Dallas county had 61 WNV cases, more than any other county in Texas
• Tarrant County had 44, the second largest number of WNV cases in the state
• The number of cases peaked in August

West Nile Virus can affect anyone, although people age 50 and older run a higher risk of developing a severe infection.

About 20 percent of infected people will develop a fever with other symptoms such as headache, body aches, joint pains, vomiting, diarrhea or rash.

Most people with this type of the disease recover completely, but fatigue and weakness can last for weeks or months. Less than 1 percent of infected people develop inflammation of the brain or surrounding tissues. The symptoms of neurologic illness can include headache, high fever, neck stiffness, disorientation, coma, tremors, seizures or paralysis.

“West Nile Virus infection is found in local mosquitoes. It is acquired from mosquito bites and not from infected people," said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children's. "Most children who are infected with this virus do not develop symptoms. It has been circulating in mosquitoes in the United States for many years and is not new."

Precautions to take

With heightened concerns of mosquito-borne illness, Tarrant County Public Health and County officials are asking for help to protect their community from mosquitoes.

The Tarrant County “Be Mosquito Free” campaign hopes to eradicate mosquitoes through taking simple precautions such as:

• Wearing long sleeves and pants
• Dumping standing water
• Using EPA-approved insect repellent
• Keeping vegetation trimmed

TCPH’s video Mosquitoes Love Water has NEW tips to show residents how to take control of their property and help protect their neighbors. You can also view the following videos: Eliminate Mosquito Breeding Sites and Barrier Treatments to Prevent Mosquitoes.

Other resources:

• West Nile Virus Fact Sheet (English)
• My Kid Minute: What You Need To Know About Mosquitoes
• The deets on Deet
• Chikunguna Fact Sheet (English)
• Zika Virus Fact Sheet (English)
• Zika Virus Fact Sheet (Spanish)
• Mosquito Facts (English)
• Mosquito Facts (Spanish)
• Backyard Checklist (English and Spanish)
• Keep Mosquitoes Away (English and Spanish) 
• Skeeter Syndrome


•  

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

The patient lives in Cameron County in the Rio Grande Valley and was confirmed last week by a lab test to be infected. She is not pregnant and reported no recent travel to Mexico or anywhere else with ongoing Zika virus transmission and no other risk factors.

“This is not surprising. We knew this would happen eventually because Texas is so close to Mexico,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “Mosquitoes don’t have borders. The good news is at this time of the year, we should get our first freeze soon and the mosquitoes in the Fort Worth/Dallas area should die out for the winter."

For more information:

• Texas Announces Local Zika Virus Case in Rio Grande Valley
• The deets on DEET from a pediatrician
• Should we be afraid of Zika?
• 11 facts about the Zika virus

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.

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.

Leaders from the Who called Zika a “public health emergency of international concern,” earlier in the week, because how fast the virus is spreading and the continued investigation into its link to babies born with abnormally small heads (microcephaly). Experts are also looking into the possible connection between Zika and a neurological condition called Guillain-Barré syndrome, which can cause paralysis.

No vaccine exists to prevent Zika virus. Mosquitoes that spread Zika virus bit mostly during daytime.

Click here for prevention information from the CDC.

Here's what we know from about the Zika virus from the Centers from Disease Control and Prevention:

1. The Zika virus is spread to people primarily through the bite of an infected Aedes species mosquito, the same mosqutoes that spread dengue and chikungunya.
2. The mosquitoes are aggressive daytime biters, prefer to bite people and live indoors and outdoors near people. Mosquitoes become infected when they feed on a person already infected with the virus. Infected mosquitoes then spread the virus to other people through bites.
3. A mother already infected with the Zika virus can pass on the virus to her newborn around the time of birth, but this is rare.
4. The CDC has not found any reports of the Zika virus spread through breastfeeding.
5. The CDC believes the virus could spread through blood transfusion. At this time, there have been no reports of this happening.
6. There has been one case of the virus spread through sexual contact.
7. The most common symptoms of Zika virus disease are fever, rash, joint pain and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting from several days to a week and severe disease requiring hospitalization is uncommon.
8. However, the Zika virus can be dangerous, especially to babies. Doctors are studying the link to the virus and microcephaly, a birth defect that causes abnormally small heads and brains.
9. There is no vaccine to prevent or medicine to treat Zika.
10. The CDC recommends “that all people, especially pregnant women, who are traveling to Brazil and other areas in Latin America, should take precautions to avoid mosquito bites to reduce their risk of infection with Zika virus and other mosquito-borne viruses such as dengue and chikungunya.”
11. The CDC asks that travelers protect themselves from mosquitoes by using insect repellent, wear long sleeves and pants, and stay in places with air conditioning or that use window and door screens.

“There is still a lot to learn about Zika virus and the potential risk to cause this particular birth defect,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “However, because it could spread to the United States, it is important that doctors and patients are aware of it. Like other diseases that were once thought to be isolated to tropical areas like chikungunya, many patients and doctors forget to think about them.”

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.

Discovered in Uganda in 1947 by scientists who were working to understand mosquito borne illnesses, the Zika virus has never been high on the radar of medical professionals. Transmitted via the bite of an infected Aedes mosquito, Zika was thought to be a “weak” cousin of the more dangerous viruses that caused diseases such as Dengue Fever and Chikungunya. Many people who contracted the virus showed no obvious symptoms. The people who got sick could expect mild to moderate discomfort due to symptoms which include fever, fatigue and a rash. Symptoms often lessened or stopped in a few days and no significant after effects were noted.

In essence an encounter with Zika was considered to be no more distressing than the common cold … until now.

Understanding that the Zika virus was thought to be isolated in the Eastern Hemispheres (Africa and Asia), those in the West had little reason to be aware of this puny, little pathogen. However, all of that changed over the course of 2015 when the country of Brazil noted a sharp spike in the number of newborns being delivered with a unique birth defect: microcephaly.

Microcephaly, is a medical term for an abnormally small head. The causes of microcephaly can vary, but in this instance the small skull was directly related to abnormal fetal brain development. In a normal year, we would expect to see a few hundred children born with microcephaly, but in 2015 over 3,900 children were born with microcephaly in Brazil. This was an astounding tenfold increase in occurrence. Trying to explain the sudden rise in microcephaly, specialists in Belem, Brazil examined the amniotic fluid of pregnant women carrying microcephalic babies. Results demonstrated the presence of the Zika virus in the fluid indicating that is could be a “causative agent.” Subsequently the Centers for Disease Control and Prevention (CDC) solidified the link when it isolated the virus in the brain tissue of microcephalic neonates who had died shortly after birth. All findings seem to indicate that the Zika virus has developed from a nuisance to a genuine threat to public health around the world.

Is it time to be concerned? Sure, but probably the real take home message is to be aware. Zika is in the Western hemisphere and if past history is any indication of future reality, Zika will not stay isolated to Brazil and South America. The virus can be expected to move north through Puerto Rico and South America, winding its way into the southern states. Already cases have been reported in South America, the Caribbean and Polynesia, as well as more than a dozen states in the U.S., including Hawaii, Florida and one in Texas, but these cases do not appear to be native born; rather they arose in mothers who travelled to countries where Zika is in evidence. Any area that contains the appropriate carrier mosquito is at risk.

Is there a vaccine, or antibiotic to manage the disease? Zika is new as a frontline viral threat and as such no vaccines are yet available. Antiviral medication do exist but their efficacy against the Zika virus is not known so the key to staying Zika-free is an avoidance protocol. Remembering that the, the major new alarms surrounding Zika are related to pregnancy, and specifically the neural development in the first trimester, it is newly pregnant women that are at greatest risk. These new mothers-to-be should avoid any areas know to harbor the Zika virus. Wearing long pants and long sleeve shirts creates a protective clothing barrier and in areas where open ventilation is present, mosquito netting has proven very effective in warding off flying pests. Pregnancy safe mosquito repellents are recommended and areas with standing stagnant water should be drained so that mosquito populations can be controlled. Given the newness of the problem, with Zika, an ounce of prevention is the only known “cure.”

Sources:

World Health Organization

Pan American Health Organization

Then you walk inside, feel your arm itching and see the familiar red bumps on your arms. Mosquitoes! In December?

Why are we still seeing mosquitoes three weeks from Christmas?

For the answer, we asked Michael Merchant, Ph.D., a professor and Extension Urban Entomologist at Texas A&M University.

Merchant noticed mosquitoes over the weekend while out in the garden. But he wasn’t too surprised. After all, understanding pest management and insects is something he’s been an expert at for nearly 30 years.

“When the temperature drops below about 55 degrees, mosquitoes stop flying,” Merchant said. “We’ve already seen a major decline in mosquitoes, but we are still seeing a few of the hardier folks persisting.”

Mosquitoes don’t all die off during cold weather, they often just hide in protected spots to avoid freezing.

Mosquitoes are cold-blooded and like temperatures best in the 80s or warmer. Once the temperature drops below 55, they go away – or at least stop moving around as much. Some mosquitoes find holes or places inside to hide in until warmer weather. Others lay their eggs before the freezing weather and then die. The eggs then hatch in warmer winter.

But the risk isn’t over entirely. Merchant said it’s not unusual to see a few West Nile Cases in the Dallas/Fort Worth area into December, and this year’s warm weather has kept the insects around longer than usual.

The last bites of the year may even occur indoors. “A few mosquitoes always make their way indoors, often coming in from your doorways,” Merchant said. “Mosquitoes often hide in protected home entryways to get away from the cold.” From there it’s a short flight inside when the doors open and close.

Merchant suggests sweeping and vacuuming the upper part of your doors and around the doorway, as well as applying insecticides.

“For most of us, the threat of mosquitoes is almost over,” Merchant said. “Hopefully, by next week we will have a blast of cold weather and we won’t see them for a while.

For more information

To learn more on mosquito control around the home, Michael Merchant's website:

• Mosquito Safari Website. Go on a mosquito safari with this interactive AgriLife website. Mosquito Safari takes you on a walk through both urban and semi-rural landscapes to learn more about mosquito risks, biology and control options.
• Mosquito videos. Learn more about practical ways to make your home and landscape safer from mosquitoes, and see mosquito larvae breeding in a backyard setting.

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.