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.

As we expected, both mosquito-borne illnesses have been reported in Tarrant County.

West Nile

On July 13, Tarrant County Public Health (TCPH) confirmed the first case of West Nile virus for the 2016 season. The case is from Bedford and is the severe form – West Nile Neuroinvasive Disease. More information is not being released to protect the patient’s identity.

Symptoms of the more severe form of West Nile include neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness and paralysis. This form of the disease can be deadly.

The mild form of the disease is commonly referred to as West Nile Fever. Symptoms include headache, fever, muscle and joint aches, nausea and fatigue. People typically recover on their own, although symptoms may last for several weeks.

“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."

TCPH reminds us that we can protect ourselves from the West Nile virus through prevention and protection.

Reduce mosquito breeding sites:

• Dump mosquito breeding sites:
• Dump standing water
• Overturn containers
• Dispose of trash

Use dunks, bits and briquettes

Protect yourself:

• Use EPA-approved insect repellent
• Wear long sleeved shirts and pants

Zika

Tarrant County Public Health has identified two new imported cases of Zika, raising the total number to 11. There is still no local transmission in Texas.

The chance of a healthy child living in this area becoming ill with either of these viruses, West Nile or Zika, currently is "very, very, low," according to Dr. Whitworth. She said if Zika begins to circulate in local mosquitoes this may change, but it hasn’t yet. She adds that the best thing parents can do is help their children avoid mosquito bites. And if your child becomes ill and you have concerns, seek medical care. 

"Zika Virus is not currently circulating in local mosquitoes and so in this area it only occurs in returning travelers who are infected, their sexual partners, and, sadly sometimes their infants," Dr. Whitworth said. "Until this is circulating in local mosquitoes, the risk of infection here is very close to zero with this virus."

The chance of a healthy child living in this area becoming ill with either of these viruses currently is very, very, low. If Zika begins to circulate in local mosquitoes this may change, but it hasn’t yet. The best thing parents can do is help their children avoid mosquito bites. And if your child becomes ill and you have concerns, seek medical care. “

The first patient had traveled to Jamaica and the second patient to St. Lucia.

Harris County Public Health (HCPH) confirmed the first Zika related microcephaly case in the state of Texas. The mother had traveled from Latin America. The mother received inconclusive test results for Zika. The baby received a definitive positive lab result for Zika, which means the mom most likely carried the virus while pregnant and is thought to have been infected in Latin America.

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.

The Centers for Disease Control and Prevention 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.”

The CDC asks that travelers protect themselves from mosquitoes by using insect repellent, wearing long sleeves and pants, and staying in places with air conditioning or that use window and door screens.

Related links:

• Tarrant County Public Health
• West Nile: What are the symptoms?
• How to fight and win against mosquitoes
• Will Zika affect your family?
• Zika: From nuisance to 'genuine threat to public health'
• Should we be afraid of Zika?
• Guillain-Barré syndrome: Are you at risk?
• 11 facts about the Zika virus
• The deets on DEET

The CDC is monitoring nearly 300 pregnant women with Zika in the U.S. states, territories

Senate Passes Zika Bill That Will Go Nowhere Fast

Every time she sees a new headline about Zika, Mary Suzanne Whitworth, M.D., worries that the public is being inundated with scary news that is unlikely to affect them.

The medical director of Infectious Diseases at Cook Children’s knows that the more Zika stays in the headlines, the more fear will grow in people about the virus. And she expects the concern about the virus to increase during summer as mosquitos become more widespread.

Dr. Whitworth wants people to take the necessary measures to fight against Zika, but cautions parents to balance their fears with a common sense approach to the virus.

“Zika is very rarely found to be fatal,” Dr. Whitworth said. “It often causes a flu-like illness and many people who become infected with the Zika virus won’t even know they have it because they won’t have symptoms.”

Zika is not a bacterial disease that can be spread the same way as an illness such as strep throat. Zika is transmitted through mosquitoes or through sexual transmission.

The illness is usually mild with symptoms lasting for several days to a week. The most common symptoms of Zika are fever, rash, joint pain or red eyes (conjunctivitis). Other symptoms include muscle pain and headache.

So most of us won’t even know we have Zika or if we do, it will basically be the same as having a cold or possibly the flu for a few days.

That’s for the majority of people, but there are serious issues that can go along with some cases of Zika.

Microcephaly has been linked to the Zika virus. Microcephaly is a medical term for an abnormally small head. Between 2001 and 2014, Brazil had, on average, about 163 cases of microcephaly a year, but since 2015 things have taken a dramatic turn for the worse with more than 1,000 cases confirmed.

Zika virus can be spread to pregnant women through the bite of an infected mosquito and through sex. Pregnant women are advised to take precautions to protect themselves from Zika. Click here to learn more.

Guillain-Barré syndrome is a condition that has also been linked to Zika. GBS can affect people of any age, although rare in infants and toddlers. GBS symptoms usually begin with achiness of the muscles or burning or tingling of the feet and legs. GBS can cause the loss of the ability to walk and involve the diaphragm and breathing muscles which can be life threatening.

While microcephaly and GBS are newly linked to Zika, Dr. Whitworth says Cook Children’s has experience recognizing and treating both conditions.

“All of our neurologists are prepared to see patients with microcephaly and Guillain-Barré,” Dr. Whitworth said. “They already see these patients and have experience caring for them.”

Dr. Whitworth understands the fear of the unknown that comes with a new virus. But she says people should be diligent in protecting themselves from mosquito bites and that the CDC is monitoring the situation, as well as Tarrant County Public Health locally.

“The Centers for Disease Control and Prevention (CDC) is keeping up with this on an hourly basis and monitoring this and will keep us informed,” Dr. Whitworth said. “It's important for people to remember that sexual transmission, mother to fetus and blood transfusion are the only person-to-person routes to get Zika. Currently, there's no casual contact transmission that happens person-to-person."

Previous articles on Zika:

• Should we be afraid of Zika?
• Guillain-Barré syndrome: Are you at risk?
• Zika virus confirmed in Tarrant County
• 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.

“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.

Warren Marks, M.D., a neurologist and medical director of the Movement Disorders and Rehabilitation Programs at Cook Children’s, says he sees a dozen or more cases often in clusters.

“Influenza can be a trigger, so flu season often triggers some cases,” Dr. Marks said. “There have been some cases associated with mostly older flu vaccines, however in general, immunizations are safe and should be given as recommended. If you are concerned that your child is having progressive weakness, they should be seen by a physician.”

GBS is a condition that can follow many different infections. The process starts after the infection activates the immune system. Sometimes part of the bacteria or virus can look like our own nerves. If this happens, our immune systems can mistakenly attack those nerves which can lead to weakness or paralysis.

At this time, Dr. Marks is not ready to say there’s a relationship to GBS and the ZIka virus. Although it’s not out of the possibility – “there are literally thousands of potential triggers for Guillian Bare’. It is a nonspecific response to an infection.”

GBS can affect people of virtually any age, although it is rare in infants and toddlers. GBS symptoms usually begin with achiness of the muscles or a burning or tingling of the feet and legs.

“Weakness follows, beginning in the feet and progressing up the body, usually over the course of a few days,” Dr. Marks said. “It can occasionally happen more quickly. GBS can involve the diaphragm and breathing muscles which can be life threatening.”

In the mildest cases, monitoring of progress in the hospital is sufficient. If there is loss of ability to walk 100 feet or the weakness is progressing and breathing is endangered, the treatment is usually a five day course of IVIG (intravenous immunoglobulin). Steroids and plasma exchange are other options.

Related articles:

• Zika virus confirmed in Tarrant County
• 11 facts about the Zika virus
• Zika: From nuisance to genuine threat to public health

About the source

Warren Marks, M.D., is one of the the first two Endowed Chairs at Cook Children’s. Dr. Marks joined Cook Children’s in 1988 and today serves as the medical director for the Movement Disorder and Neurorehabilitation Program. Learn more about Dr. Marks and the contributions he's made to Cook Children's here.

Tarrant County Public Health (TCPH) identified the first imported case of Zika virus in the county, in a positive sample tested in TCPH’s North Texas Regional Laboratory.

TCPH says the patient traveled to a Caribbean country with known local transmission of the disease. No other health information will be released at this time to protect the identity of the patient.

Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s, expressed confidence in the job of Tarrant County Public Health monitoring the situation locally. She said people should know that attention that is being paid to the spread of the Zika virus.

“The Centers for Disease Control and Prevention (CDC) is keeping up with this on an hourly basis and monitoring this and will keep us informed,” Dr. Whitworth said. “It's important for people to remember that sexual transmission, mother to fetus and blood transfusion are the only person-to-person routes to get Zika. Currently, there's no casual contact transmission that happens person-to-person."

TCPH says: “Zika virus is spread to people primarily through the bite of an infected Aedes species mosquito. The most common symptoms of Zika are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is typically mild with symptoms lasting for several days to a week. People usually don’t get sick enough to go to the hospital, and they very rarely die of Zika.”

Sexual transmission of Zika virus can also occur and is of particular concern during pregnancy. TCPH adds: "If a person infected with Zika virus is bit by an Aedes mosquito, that mosquito may later bite another person and spread the virus further."

“The most important thing residents can do is to eliminate mosquito breeding sites around their home,” said TCPH Health Director Vinny Taneja. “When we stop the breeding cycle, we help stop the spread of mosquito-borne diseases.”

Although the beginning of mosquito season is still several weeks away, residents are encouraged to maintain their properties to reduce mosquito breeding sites. Residents should:

• Routinely dump standing water on their property,
• Overturn all small containers,
• Dispose of any trash or debris that can contain small amounts of water.

TCPH has produced a video to help residents Eliminate Mosquito Breeding Sites.

County residents can also call the health department’s Zika Hotline (817-248-6299), if they have questions about this disease. For more information on Zika virus and for other useful tips, click here.

More resources:

Zika virus information from Cook Children's

Zika: From nuisance to 'genuine threat to public health'

How to fight and win against mosquitoes

Centers for Disease Control and Prevention Zika site 

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