Recommendations		EBM rating (10)
Avoiding arthropods:
1. Avoid travelling to risk areas during the season(s) when transmission of AAD is most likely.		BIII
2. Reduce exposure by avoiding times or places when/where vectors are known to be active (e.g., by staying indoors during peak activity periods, minimizing exposure in rural areas or other habitats associated with specific vectors).		CIII
Physical barriers:
1. Use screening on doors and windows, close eaves, eliminate holes in roofs and walls and close other gaps to protect work and accommodation areas against vectors.		BI
2. Wear appropriate clothing (e.g., full length, loose fitting and light-coloured garments).		BIII
Chemical barriers:
1. Use topical repellents that are registered in Canada on exposed areas of skin to prevent arthropod bites and to reduce the risk of AAD.		AI
i. Repellents that contain DEET (20-30%) or icaridin (20%) should be the first choice for adults.		AII
ii. Repellents that contain icaridin (20%) should be the first choice for children aged six months to twelve years. Repellents containing age-appropriate concentrations of DEET should be considered as a second choice for children aged six months to twelve years.		AII
iii. Repellents that contain p-menthane-3,8-diol should be considered second-choice topical repellents for adults and children aged three years or older.		AII
iv. Other active ingredients currently registered in Canada (e.g., citronella, soybean oil) are not widely available and/or do not provide sufficiently long protection times against bites, and are not recommended for use to protect travellers against the bites of vectors.		EII
v. For travel outside of Canada to endemic/epidemic areas, the risk for arthropod-associated diseases (AAD) likely outweighs the risk of an adverse reaction to DEET or icaridin. In such situations and if vectors cannot be otherwise excluded (e.g., through use of insecticide-treated netting), use of up to 10% DEET or 10% icaridin should be considered for infants under six months of age.		BIII
vi. If biting is noted before the re-application interval indicated on the label has expired, reapply repellent.		BII
vii. Where there is interest in minimizing the amount of repellent used, apply at times of the day where vectors are most active and exposure is more likely (e.g., when leaving a bed net in the morning and in the late afternoon).		CIII
viii. Where possible, choose PPM to suit each traveller’s needs (e.g., a cream, spray or liquid topical repellent, to enhance the likelihood of product use).	CIII
ix. Do not use repellent and sunscreen combination products.	EII
x. It is preferable to apply sunscreen first and allow it to penetrate the skin before applying repellent. Where this is not possible, apply both products even if such is done contemporaneously.	CIII
Insecticide barriers:
1. For long-term travellers, expatriates, persons spending significant time in rural areas of risk, etc., a preference for accommodations or areas that are subject to indoor residual spraying is reasonable.	CIII
Bed nets:
1. Use insecticide-treated nets (ITN) for protection against arthropod bites and related diseases.	AI
i. While ITN and related products (portable insecticide-treated netting) are typically deployed at night, they should be used whenever and wherever appropriate, including when resting indoors during the daytime or to protect children in cribs and strollers.	AI
ii. Where possible, bed nets should be selected based on a PMRA or EPA registration and a full or interim recommendation from the World Health Organization Pesticide Evaluation Scheme (WHOPES).	AII
iii. Use products manufactured where there is greater assurance of quality (e.g., in western countries or where the supplier/manufacturer can provide documentation to assure that WHOPES specifications have been met).	CIII
iv. Some products are marketed as LN without having been so designated by WHOPES. CATMAT cannot evaluate the veracity of such claims, and hence recommends that these products not be used or marketed as long-lasting ITN (LN).	DIII
v.To minimize exposure to pesticides that might occur through spills or improper treatment of nets, use pre-treated nets rather than nets that you treat yourself.	DIII
vi. Where travel is frequent and/or is expected to be for a long period (e.g., six months or greater) use LN.	CIII
vii. Use ITN to reduce the bites from nuisance arthropods and to protect against snake bites.	BII
Clothing treatments:
1. Use insecticide-treated clothing (ITC) to protect against the bites of vectors and nuisance arthropods.	BII
i. To optimize protection against bites, ITC should be used in combination with an appropriate repellent product, preferably long-lasting, such that skin is near to completely protected, i.e. apply topical repellent to exposed skin that is not covered by ITC.	AII
ii. Until such time as ITC are registered in Canada for civilian use, use ITC that have been registered by the United States Environmental Protection Agency (US EPA).	AII
Other insecticide products:
1. CATMAT recommends against use of/reliance on other insecticide-based approaches such as insecticide coils that are burned, insecticide vaporizers, aerosols and space sprays, and insecticide-treated sheets.	CIII
2. CATMAT recommends against use of insect personal protection measures that are ineffective, or that have not been convincingly shown to be efficacious against arthropod vectors and related diseases. They include: Electronic (ultrasonic) devices Wristbands, neckbands, and ankle bands impregnated with repellents Electrocuting devices (“bug zappers”) Odour-baited mosquito traps Citrosa plant (geranium houseplant) Orally administered vitamin B1 Skin moisturizers that do not contain an approved repellent active ingredient.	EII