Biting Realities: Navigating The Pestilent Presence Of Mosquitoes In Afghanistan

Afghanistan is home to mosquitoes that can spread a number of diseases, including malaria. The Centers for Disease Control and Prevention (CDC) recommends that travellers going to certain areas of Afghanistan take prescription medicine to prevent malaria.

Preventing mosquito bites in Afghanistan

Mosquitoes are a common problem in Afghanistan, especially during the warmer months. These insects can carry diseases such as malaria, yellow fever, Zika, dengue, chikungunya, and Lyme. While some of these diseases are mild, others can be severe and have lasting consequences. To avoid mosquito bites, you can take several precautions, including:

• Using insect repellents: Look for repellents that contain DEET, picaridin, oil of lemon eucalyptus (OLE), or para-menthane-diol (PMD). When applying repellent, follow the instructions on the product label. Apply it to all exposed skin, and reapply regularly, especially if you are sweating or swimming. Do not apply repellents under your clothes or directly to your face—instead, spray it on your hands and rub it on your face, avoiding your eyes and mouth.
• Wearing protective clothing: Cover your skin by wearing long-sleeved shirts, long pants, socks, and hats. Choose light-colored, tightly woven fabrics, as mosquitoes have a harder time penetrating tight weaves, and light colors make it harder for them to find you.
• Using mosquito nets: If you are sleeping outdoors or in a room without screens or air conditioning, use a mosquito net. Nets that have been pre-treated with insecticides are even more effective.
• Keeping your property dry: Mosquitoes lay their eggs in standing water, so eliminate any sources of standing water on your property, such as flowerpots, water buckets, and kiddie pools.
• Using fans: A breeze of any kind can make it difficult for mosquitoes to fly, so consider placing fans around your living and sleeping areas, or choosing to spend time outdoors on breezy days.
• Avoiding peak mosquito hours: Mosquitoes are most active at dusk and dawn, so try to stay inside during these times if possible.
• Avoiding scented products: Mosquitoes are attracted to scents, so avoid wearing perfumes, colognes, or scented lotions, and opt for unscented soaps and detergents.
• Keeping windows closed or screened: Install screens on your windows and doors to keep mosquitoes out while letting in fresh air. If that's not possible, keep the windows closed and consider turning on the air conditioning.
• Treating clothing with permethrin: Permethrin is an insecticide that kills mosquitoes. You can treat your clothing, gear, and bedding with permethrin, or purchase pre-treated items. Just be sure to follow the product instructions carefully and do not apply permethrin directly to your skin.

Insect repellent to prevent mosquito bites

Mosquitoes are a common problem in Afghanistan, and they can carry dangerous diseases such as malaria, Zika, and dengue fever. To prevent mosquito bites, it is recommended to use insect repellent and take other preventive measures. Here are some detailed, direct, and focused instructions on how to use insect repellent to prevent mosquito bites:

• Use Environmental Protection Agency (EPA)-registered insect repellents with active ingredients such as picaridin (known as KBR 3023 or icaridin outside the US), oil of lemon eucalyptus (OLE), or para-menthane-diol (PMD). These repellents are safe and effective, even for pregnant and breastfeeding women, when used as directed.
• When choosing an insect repellent, consider the length of protection needed. For example, DEET provides protection for up to six hours, while picaridin and oil of lemon eucalyptus offer protection for up to six to eight hours.
• Always follow the label instructions when using insect repellent. Pay close attention to any precautions and directions for application.
• If you are also using sunscreen, apply it first, followed by the insect repellent.
• Avoid applying insect repellent under your clothes or directly onto your face. Instead, spray it onto your hands and then apply it to your face, avoiding the eyes and mouth.
• Do not apply insect repellent to irritated or broken skin, and wash your hands after application.
• For babies and young children, dress them in long-sleeved clothing and cover strollers and baby carriers with mosquito netting.
• Do not use products containing OLE or PMD on children under three years old.
• Treat clothing and gear, such as boots, pants, socks, and tents, with 0.5% permethrin. Alternatively, purchase pre-treated clothing and gear. Do not apply permethrin products directly to the skin.
• Stay in air-conditioned or well-screened rooms when possible, especially if there is a mosquito-borne disease warning.
• Use mosquito nets if sleeping outdoors or in rooms without proper screening. Choose a net that is compact, white, rectangular, with 156 holes per square inch, and long enough to tuck under the mattress.
• To further reduce mosquito bites, remove potential mosquito habitats by eliminating standing water, such as in rain gutters, buckets, and flower pots.

Vaccines and medicines for mosquitoes

Vaccines and medicines are essential tools in the fight against mosquito-borne diseases, which cause significant mortality and morbidity worldwide. While most mosquito bites are harmless, some mosquitoes carry pathogens, such as bacteria and viruses, that can lead to deadly illnesses. Here is an overview of the current landscape of vaccines and medicines for mosquitoes:

Vaccines:

• Japanese Encephalitis Vaccine: This vaccine has been successful in reducing mortality and morbidity associated with the disease. It is recommended for individuals living in endemic areas and travellers spending a substantial amount of time in these regions.
• Yellow Fever Vaccine: This is one of the success stories in the fight against mosquito-borne diseases. The 17D vaccine is the only commercially available option and is highly effective. It is recommended for individuals travelling to or living in areas where yellow fever is present.
• Malaria Vaccine: The RTS,S/AS01 vaccine, also known as Mosquirix, has completed Phase 3 trials and received a positive regulatory assessment. It is designed to protect against Plasmodium falciparum malaria and is particularly effective for children aged 5-17 months.
• Dengue Vaccine: Dengvaxia (CYD-TDV) is the first licensed dengue vaccine, initially registered in Mexico in 2015. It is a live recombinant vaccine containing four live attenuated recombinant viruses representing the different dengue serotypes. The World Health Organization (WHO) recommends its introduction in countries with a high burden of dengue.
• Zika Virus Vaccine: While there is currently no licensed vaccine, the National Institute of Allergy and Infectious Diseases (NIAID) has initiated a clinical trial for a vaccine candidate. Preclinical trials using various technologies, such as inactivated virus, live-attenuated viruses, and DNA vaccines, are also underway.
• Chikungunya Virus Vaccine: There are currently no licensed vaccines for chikungunya, but several candidates are in the clinical and preclinical stages. These include a recombinant live attenuated vaccine, purified inactivated vaccines (PIVs), and viral vectored vaccines.
• Universal Mosquito Vaccine: A recent Phase 1 trial tested a vaccine (AGS-v) designed to induce an immune response against mosquito saliva, rather than specific pathogens. The results showed that the vaccine is safe and elicited a strong immune response in healthy volunteers. Further research is needed to test its efficacy against individual diseases.

Medicines:

• Dengue: There are currently no antiviral treatments for dengue. The focus is on treating symptoms with fluids and medications for pain and fever management, such as acetaminophen.
• Zika: While there is no specific treatment for Zika, mosquito control, blood supply protection, and contraception methods are used to prevent the spread of the virus.
• Chikungunya: There is currently no specific treatment available for chikungunya.

Malaria prevention in Afghanistan

Afghanistan has the world's third-highest malaria burden. The country accounts for 11% of cases in the WHO Eastern Mediterranean region. In Afghanistan, 5% of malaria cases are attributed to Plasmodium falciparum (P.f.) and 95% to Plasmodium vivax (P.v.). Over 76% of Afghans live in at-risk areas.

• Insecticide-treated bed nets (ITNs): While 26% of households own at least one ITN, only 3% of households have enough nets to cover all household members. Few children under five years of age and pregnant women – the most at-risk groups – slept under an ITN.
• Long-lasting insecticidal nets (LLINs): In 2008, free distribution of LLINs was adopted to attain universal coverage in high-risk populations.
• Insect repellent: The CDC recommends using a repellent that contains 20% or more DEET for protection that lasts up to several hours.
• Permethrin-treated clothing and gear: The CDC recommends the use of permethrin-treated clothing and gear (such as boots, pants, socks, and tents).
• Accommodation: The CDC recommends staying and sleeping in air-conditioned or screened rooms.
• Bed nets: The CDC recommends the use of a bed net if the sleeping area is exposed to the outdoors.
• Clothing: The CDC recommends covering exposed skin by wearing long-sleeved shirts, long pants, and hats.
• Malaria prophylaxis: The CDC recommends that travellers going to certain areas of Afghanistan take prescription medicine to prevent malaria.

Mosquito-borne diseases in Afghanistan

Afghanistan is battling a severe health crisis, with a high prevalence of infectious diseases, including tuberculosis, malaria, HIV, and the added strain of the COVID-19 pandemic. The nation's healthcare system is fragile and faces many challenges. Mosquito-borne diseases are spread by the bite of an infected mosquito. Diseases spread by mosquitoes include Zika virus, West Nile virus, Chikungunya virus, dengue fever, and malaria. Dengue fever is a mosquito-borne disease that can severely impact public health.

In Afghanistan, the CDC recommends that travellers going to certain areas take prescription medicine to prevent malaria. Dengue fever is transmitted by Aedes mosquitoes and can cause severe flu-like symptoms, including high fever, shaking chills, and body aches. There is no specific treatment for dengue fever, so the best way to combat the disease is through prevention measures such as proper waste disposal, appropriate use of insecticides, increased community awareness, and careful clinical detection and management of patients.

Malaria is another mosquito-borne disease that poses a grave threat to Afghanistan's healthcare system. The disease is caused by the transmission of parasites through the bites of infected mosquitoes and can be life-threatening if left untreated. The most common types of malaria parasites in Afghanistan are Plasmodium falciparum and P. vivax, which thrive in lowland areas bordering Pakistan. In 2019, the country recorded more than 150,000 malaria cases, with the majority of cases concentrated in the province of Nangarhar.

To prevent mosquito-borne diseases, it is essential to take precautions such as wearing long-sleeved shirts and pants, using insect repellent, and sleeping in screened or air-conditioned rooms. Additionally, removing standing water and improving sanitation can help reduce the mosquito population and lower the risk of disease transmission.

Frequently asked questions