Southern City Colleges

SENIOR HIGH SCHOOL

Pilar Street, Zamboanga City, Philippines

"Lemon: A homemade lemon repellent to prevent dengue virus”

Researchers:

Alim Nisha

Ammali Almina

Asiri Naida

Baiser Shermina

Baja Zainab

Bilao Monera

Handang Radzma

Gapor Arsalyn

Farhana, Jalil

Luna Dessa

Ulod Aziema

12-Stem-A-am
 CHAPTER I

INTRODUCTION

Objectives of the Study

1. To seek an early prevention for dengue cases.

2. To ensure effectiveness in the output to be created.

3. To reduce incident rate of dengue cases using homemade lemon repellent.

4. To provide an alternative repellent to reduce dengue cases.

5. To have an economic and chemical-free product.

6. To supply safety mosquitoes repellent that can be used in any ages.

7. To contribute for the uprising problems of our community.

8. To have a budget-wised product.

9. To educate people about the benefits of lemon.

10. To let people know the procedure on how to make homemade lemon repellent.
Background of the Study

Dengue fever is a mosquito-borne tropical disease caused by the dengue virus.

This study focuses on preventing dengue cases by the use of home-made lemon
repellent. Lemon repellent is an effective way of repelling the mosquitoes from biting the
skin. Many people would rather use a natural substance than a chemical on their skin
while warding off mosquitoes. The extract of lemon repels mosquitoes because they
hate the smell or the aroma of it. The use of this repellent is very essential in areas at
home.

According to Amer & Mehlhorn Amer A, Mehlhorn H. lemons (and citrus fruit at
large) have seen some discussion as a natural mosquito deterrent in folk medicine
circles for some time, likely as a correlation between the strong odors produced by
lemons and their potential ability to fool a mosquito’s highly sensitive olfactory organs.
While this falls in line with modern understandings of how mosquitoes identify their prey,
lemons have not been shown to be productive at accomplishing this desired task.

Definition

Dengue is a mosquito-borne viral infection causing a severe flu-like illness and,

sometimes causing a potentially lethal complication called severe dengue. It is fast
emerging pandemic prone viral disease in many parts of the world. Dengue flourishes in
urban poor areas, suburbs and the countryside but also affects more affluent
neighborhoods in tropical and subtropical countries.
The dengue virus comprises four distinct stereotypes (DEN-1, DEN-2, DEN-3, DEN-4)
which belong to genus Flavivirus, family flaviviride. Distinct genotypes have been
identified within each stereotype, highlighting the extensive genetic variability of the
dengue stereotypes. Among them, "ASIAN" genotypes of DEN-2 and DEN-3 are
frequently associated with severe disease accompanying secondary dengue infections.
 The Aedes aegypti mosquito is the main vector that transmits the viruses that
cause dengue. The viruses are passed on to humans through the bites of an infective
female Aedes mosquito, which mainly acquires the virus while feeding on the blood of
an infected person. The vector-borne dengue virus infection spreads via the bite of a
striped Aedes aegypti and Aedes Albopictus mosquito that has previously bitten an
infected person. The mosquito flourishes during rainy seasons but can breed in water-
filled flowerpots, plastic bags, and cans year-round. One mosquito bite can cause the
disease.

Once infected, humans become the main carriers and multipliers of the virus,
serving as the source of the virus for uninfected mosquitoes. The virus circulates in the
blood of an infected for 2-7 days, at approximately the same time that the person
develops a fever. Patients who are already infected with the dengue virus can transmit
the infection via Aedes mosquitoes after the first symptoms appear (during 4-5 days;
maximumb12).The virus is not contagious and cannot spread directly from person to
person. It is mosquito-borne, so there must be a person-to-mosquito-to-another-person
pathway. A mosquito bites a dengue-infected person and becomes infected with
dengue. That mosquito then bites another person and passes the dengue virus infection
to that person. The full life cycle of the virus involves the Aedes mosquito as the vector
(transmitter) and the human as the source of infection.
But the researcher’s think of some idea that can lessen the chance of having the
dengue virus, which is the lemon repellant spray. Avoiding mosquitos is important to
avoid contracting dengue fever. In dengue-endemic tropical and sub-tropical areas, you
should wear light-colored long-sleeved shirts and long pants or trousers, use insect
repellant, stay or sleep indoors in air conditioning when possible and use mosquito
netting over the bed if available.

Dengue is not a tick-borne illness. Only the bite of an infected mosquito can
transmit dengue. Lemon is a yellow, oval citrus fruit wirh thick skin and acidic juice. We
use lemon as our main ingredient because we have research that infected mosquitoes
doesn't like the smell of lemon. That’s why we come up with an idea of making the
lemon as a spray repellant for mosquitoes.

Cause and effect

As we all know dengue is a mosquito-borne viral infection and this dengue are
carrying diseases and it can affects our health, Sometimes it may lead to death. There
are some effects of dengue on our health like hair fall, joint pain, muscular pain, etc.
Dengue can lead to a dengue fever and the dengue fever affects our body by causing a
high fever and flu like symptoms. When the virus infects our blood and it causes a
migraine- like headache, rash, achenesgreasiness, tiredness and fever. It can affect our
blood and causing mild bleeding of the gums and you may bruise easily. We need to be
careful to avoid the dengue. When a person's was bitten by a dengue and that dengue
has a virus it infects more cells, including those in the lymph nodes and bone marrow,
macrophages in both the spleen and liver and monocytes in the blood. The virus spread
and increased and may results in viremia- it is a condition in which there is a high level
of dengue virus in the blood stream.

According to Susan M.Paskewitz,One animal professional claim that lemons help

repel mosquitoes from dogs, though. Many people would rather use a natural substance
than a chemical on their skin while warding off mosquitoes on a camping trip or even in
the backyard. As we all know the dengue hates the smell of lemon, as a researcher we
find a ways where in the mosquitoes hated most, we come up with the study of lemon
repellent. Lemon repellent is effective when using because the mosquitoes hated it.
Mosquitoes hates the smell of lemon and orange peels, with the use of lemon repellent
it lessen the people who are infected by the dengue, There's a reason why most insects
repellents have a lemon scent and that's because for some reason mosquitoes don't
like it, adding a bit of lemon juice to water can help to avoid attracting mosquitoes.
 According to mayoclinic.com dengue fever is caused by any of four types of
dengue viruses spread by mosquitoes that thrive in and near human lodgings. When a
mosquito bites a person who has a dengue virus, it will carry the malaria virus. This
mosquito that carries the virus could cause multiple diseases in a form of dengue fever.

According to AT Bäck and Lundkvist A., dengue virus causes the most common
anthropod-borne viral disease in man with 50-100 million infections per year. Dengue is
an acute febrile disease caused by the mosquito-borne dengue virus consisting of four
serotypes.

According to Halstead S. and Thomas S. (2018) the four types of dengue virus
are DENV-1, DENV-2, DENV-3 and DENV-4 which are members of the flavirus group of
the virus family flaviridae. These four types of dengue virus has one cause which is the
Aedes Aegypti or yellow fever type of mosquito.

Historical Background

Dengue viruses have been on the march for more than 100 years and it is
originated in monkeys and spilled over into humans as long as 800 years ago. The word
dengue is Spanish for "affection", "careful", or "fastidious". The term probably described
the cautious, stiff movement of patients suffering from the muscle, bone, and joint pain
caused by dengue fever.

The first recorded of a case of probable dengue fever is in a Chinese medical

encyclopedia from the Him Dynasty (265-420 AD) which referred to a "water poison"
associated with flying insects. The primary vector, (A. aegypty) A. aegypti, spread out of
Africa in the 15th to 19th centuries due in part to increased globalization secondary to
the slave trade. There have been descriptions of epidemics in the 17th century, but the
most plausible early reports of dengue epidemics are from 1779 and 1780, when all
epidemics swept across Asia, Africa and North America. From that time until 1940,
epidemics were infrequent.

The first confirmed case report dates from 1789 and is by Benjamin Rush, who
coined the term "break bone fever" because of the symptoms of myalgia and arthralgia.
Nowadays, about 2.5 billion people, or 40% of the world's population, live in areas
where there is a risk of dengue transmission. Dengue spread to more than 100
countries in Asia, the pacific the America, Africa, and the Caribbean.

In early 1960s, dengue reappeared in the Caribbean and spread through the
islands and then into tropical and sub subtropical mainland countries of the Americas,
becoming a significant public health problem starting in the early 1980s. The America
controlling virtually eliminated dengue fever. In 1906, transmission by the Aedes
mosquitos was confirmed, and in 1907 dengue was the second disease (after yellow
fever) that was shown to be caused by a virus. Further investigation by John Burten
Cleland and Joseph Franklin Siler, completed the basic understanding of dengue
transmission.

The marked spread of dengue during and after the Second World War has been
attributed to ecologic disruption. The same trends also led to the spread of different
serotypes of the disease to new areas, and to the emergence of dengue hemorrhagic
fever. This severe form of the disease was first reported in the Philippines in 1953 by
the 1970s; it had become a major cause of child morality and had emerged in the pacific
and the Americans.

The first substantial cultivation of lemons in Europe began in Genoa in the middle
of the 15th century. The lemon was later introduced to the Americas in 1493 when
Christopher Colombo’s brought lemon seeds to Hispaniola on his voyages. Spanish
conquest throughout the new world helped spread lemon seeds. It was mainly used as
an ornamental plant and for medicine. In the 19th century, lemons were increasingly
planted in Florida and California.
 In 1747, James Lind’s experiment on seamen suffering from scurvy involved
adding lemon juice to their diet; through vitamin C was not yet known as an important
dietary ingredient. The origin of the lemon is known, through lemons are through to
have first grown in Assam (a region in northeast India), northern Burma or china. A
genomic study of the lemon indicated it was a hybrid between bitter orange (sour
orange) and citron.

Problem and Issues

The dengue can get of course in dirty environment. to avoid this kind of problem
we should maintain the cleanliness of our environment in our generation some people
just throw their garbage everywhere they do not think of what will happen to our society
if everyone will do the same thing unlike before all of them unite to clean their area but
now everything changed no one cares to their community we should clean our
environment to have a better society .Mostly people nowadays continuing doing their
hobby such as not cleaning their own area that's why the community or surrounding
immediately effected and mostly effected in this issue are the children or youth. That
why our group decide find the Solution to prevent the dengue issue that is making a
herbal medicine which is lemon repellant. According to entomologist Susan M.
Paskewitz, a number of essential oils can be effective mosquito repellants, including
peppermint, clove, cinnamon and many others, but lemon oil isn't on her list. Hearing
that the combination of citric acid in limes and the fragrance of cloves combine to
effectively repel mosquitoes, Natalia de Cuba Romero put the idea to the test. It didn't
work; she was driven from her patio by the marauding scavengers. The fact that few
researchers even mention lemons in regards to mosquito control is powerful evidence
against their efficacy. Nevertheless, animal professional Karen Rosenthal claims that
lemons can be used as a topical application and ingested treatment to keep mosquitos
away. Lemon it can also repel dengue mosquitoes.Dr. Manuel Mapue department of
health (DOH) Regional medical dengue coordinator for metro Manila during the
ovicidal /lauvicidal (OL) mosquito trap orientation held in Caloocan city on May 28,
2012.
Lemons (and citrus fruit at large) have seen some discussion as a natural mosquito
deterrent in folk medicine circles for some time, likely as a correlation between the
strong odors produced by lemons and their potential ability to fool a mosquito’s highly
sensitive olfactory organs. While this falls in line with modern understandings of how
mosquitoes identify their prey, lemons have not been shown to be productive at
accomplishing this desired task.
The Dengue fever a global problem
-During epidemics of dengue, infection rates among those who have not been
previously exposed to the virus are often 40% to50% but can reach 80% to 90%.
- An estimated 500000 people with DHF require hospitalization each year, a very large
proportion of who are children about 2.5% of those affected die.
- Without proper treatment. DHF fatality rates can exceed 20%.
- Wider access to medical care from health providers with knowledge about DHF.
Physicians and nurses who recognize its symptoms and know how to treats its effects
can reduce deaths rates to less than 1%.
- Dengue can occasionally affect several other body systems either in isolation or along
with the classic dengue symptoms. A decreased level of consciousness occurs in 0.5%-
6% of severe cases, which is attributable either to inflammation of the brain by the virus
or indirectly as a result of impairment of vital organs, for example the liver.
- Dengue fever is cause by any one of four types of dengue viruses spread by
mosquitoes that thrive in and near human lodgings, When a mosquitoes bites a person
infected with dengue virus, the virus enters the mosquito. When the infected mosquito
then bites another person, the virus enters that person's bloodstream.
- Other neurological disorder has been reported in the context of dengue such as
transverse myelitis and Guillian-barré syndrome. Infection of the heart and acute liver
failure are among the rarer complications.

However, the serious problem can develop. These include dengue hemorrhage fever, a
rare complication characterized by high fever, damage to lymph and blood vessels,
bleeding from the nose and gums, enlargement of the liver and failure of circulatory
system.

And we as a researchers know that we can't cure this kind of illness but we're going to
try our best to help other people who is infected with this dengue viruses to prevent or
avoid the dengue cases through lemon repellant.
Mosquito control is a gnarly problem, no matter which part of the world in which you live.
Researchers have evaluated a large number of repellants and insecticides, and it's
difficult to find any hard evidence for the efficacy of lemon juice, lemon oil or citric acid
as a mosquito deterrent. One animal professional claim that lemons help repel
mosquitoes from dogs, though, and lemon oil is sometimes recommended as a folk
remedy for mosquitoes. You can't hurt yourself by experimenting, but you may suffer a
few mosquito bites in the process.
Another way to use lemons is to combine them with olive oil and apply the mixture
topically to your skin or things you wear, such as belts or bracelets. Rosenthal
recommends putting the oil on your pet's collar to repel mosquitoes. To make the oil,
peel two lemons, immerse them in 1 cup of olive oil and boil the mixture on low heat for
20 minutes.

Comparison and Contrast

Similarities between natural repellent and synthetic repellent.

- The most ingredient in these formulas is DEET. DEET was created in 1946 by the
United States Army, which wanted to create a product to repel insects as soldiers fought
in the jungles during World War II. DEET has introduced into civilian use by 1957 and is
still commonly used today.

- Natural insects’ repellents have active ingredients from the oils of various plants and
are considered perfectly safe to use. In fact, although the EPA requires registration of
skin-applied insect repellents, repellents that use natural ingredients such as citronella,
cedar, geranium, peppermint and soybean oils are exempt from registration because
they have been learn to be minimum risk.

- On the other hand, insect repellents with synthetic ingredients must be evaluated first
for safety and effectiveness in order to be registered by the EPA. In registering them the
EPA is giving a stamp of approval based on their safety/efficacy profile.

- Overall, the research shows that natural insect repellents and synthetic are both safe
and effective for keeping bugs away. Given the questionable safety profile DEET and
other synthetic insect repellents, many people today choose natural insect repellents as
a safe alternative.

- DEET (Chemical name, N,N -diethyl -meta -tow amide) is the active ingredient in many
repellent products. It is widely used to repel biting pests such as mosquitoes. DEET is
designed for direct application to people's skin to repel insects. Rather that killing them,
DEET works by making it hard for these biting bugs to smell us.
There are two kinds of repellent. Which are synthetic and natural repellent? Lemon is
belong to the natural repellent while the synthetic or chemical insect repellent. Natural
insect repellent natural ingredients such as essential oil and other plant-based element.
This includes oils from lemon eucalyptus, lemongrass, and citronella. Non-natural insect
repellent use synthetic or manmade ingredients. The best repellent used to prevent
dengue is the natural repellent because it came from plants that are good to our health.
Other synthetic or chemical repellent is not good to our health because of its smell or
the ingredients that is not good to your skin. Oil of lemon eucalyptus is an oil extracted
from the gum eucalyptus tree and it is distilled product contains several botanical
substances including citronella.

The Picaridin molecule is synthetic because it is made in a laboratory and other

experts agreed that Picaridin is also safe even for use in infants. If it’s misapplied
Picaridin can imitate your skin and eyes. The similarities of oil of lemon eucalyptus and
Picaridin is that they are safe to use and if misapplied can cause eye injury. In contrast,
Picaridin is safe even in an infant while the oil of lemon eucalyptus hasn’t been well-
tested on children and centers for disease Control and prevention and consumer report.
The other natural repellent are not registered with the EPA because it doesn’t consider
the chemicals they contain to pose any serious safety risks like botanical product
induced lemongrass, citronella, peppermint. They are safe but not because the
chemicals in that product are likely to cause you any serious harm themselves, though
they do contain known allergens, often at much higher concentrations that other natural
products.
The most common mistake people make when choosing a repellent is thinking that the
"strength" of the repellent determines how many mosquitoes it will protect from them.
This is untrue. The strength, or concentration of active ingredients, such as DEET,
determines the length of time the repellent will protect you. The main difference
between natural and non-natural insect repellents is in the active ingredient they use to
repel insect. Natural insect repellents use natural ingredients such essential oils and
other plant-based elements. This includes oils from lemon eucalyptus, spearmint,
geranium, cedar, peppermint, soybean, citronella and lemongrass.
According to the Korean food and drug Administration (KFDA) these guidelines were
used to test the efficacy and complete protection times (CPTs) of three representative
mosquito repellents: N, N-diethyl-3-methylbenzamide (DEET), citronella, and fennel oil.
The repellency of citronella oil decreased over time, from 97.9% at 0 h to 71.4% at 1 h
and57.7%, at 2 h, as did the repellency of fennel oil, from 88.6% at 0 h to 61.2% at 1 h
and 47.4% at 2 h. In contrast, the repellency of DEET remained over 90% for 6 h. The
CPT of DEET (360 min) I was much longer than the cpt's of citronella (010.5 min) and
fennel oil (8.4 min). These results did not differ significantly from previous findings, and
hence confirm that the KFDA guidelines are applicable for testing the efficacy of
mosquito repellents.
 Advantages and Disadvantages

Disadvantages of lemon repellent:

*Natural product gives 30 to 60 minutes 100% repellent.

* Natural product has also been use but generally have shorter lived repellent effect.

* The repellent won't kill the mosquitos.

* The repellent make mosquito faint when the repellent order is very high.

* Pure lemon eucalyptus oil shouldn't be applied directly to the skin or used in larger
amounts than recommended (the oil are absorbed through the skin and using too much
can be toxic)

* Certain ingredients in lemon eucalyptus oil production may trigger allergic reaction.
* Lemon eucalyptus oil should never be ingested as it may cause seizures on death.
1. Easy to make, you can do it with complete materials<br>
2. The lemon repellents are used to prevent dengue fever or different kinds of
symptoms. <br>
3. These lemon repellent products are also likely to be less toxic to human and to the
environment and safer to used<br>
4. Our lemon repellent does not contain any DEET (DEET is well known abbreviation for
chemical) <br>
5. Lemon repellent are important because it protects an individual from acquiring certain
diseases that insect can transmit to our body. <br>
6. A natural repellent products claimed that these products are safer to the skin than
synthetic ones. Most of the synthetic repellent are the chemical DEET, while lemon and
eucalyptus are popular among natural based products. <br>
7. We also have studied that any lemon repellent works perfectly because of its benefits
that lemon eucalyptus oil can give us protection from mosquitoes based on other
researchers from 2014 medical researchers Med. INC found that a formula containing
95% protection from mosquitoes for 3 hours.<br>
8. These lemon repellents are highly effective and in expensive ways to stay away from
disease.

Scientific Problem

 The population of being infected by dengue virus.

 The treatment for dengue virus

Scientific Question

 What might be the cause of dengue virus?

 What is the possible treatment since it has no cure?
 What are the effects of dengue virus?

Hypothesis

Dengue virus is not a new disease, but recently because of its serious emerging
health threats, coupled with possible dire consequences including death. Dengue
viruses cause of dengue illness are members of the Flaviviridae family, the main vector
of dengue virus transmission is Aedes Aegypti species of mosquito. Dengue fever is
transmitted by bite of an Aedes mosquito infected with dengue virus. The mosquito
becomes infector when it bites a person with dengue virus in their blood. It cant be
spread directly from one person to another person.
Scope and Limitation

The researchers aim to focus in providing home-made repellent wherein the

researchers will use lemon oil and lemon juice. These repellent contains citronella oil
which repels mosquitoes. The focus of this study is to somehow prevent dengue cases
in the chosen community by creating an innovative and easy-to-use mosquito repellent.
These lemon repellent will help the community to lessen the dengue cases. According
to WHO, 50-100 million cases of dengue are reported worldwide every year. The
statistical data given will be the basis or objective to minimize. This study covers the
procedure or the process of making a home-made repellent, the benefits of lemon and
the uniqueness of this lemon repellent compared to other chemical products.

Significance of the Study

The result of this study will be beneficial to the following;

The barangay officials - they can use this study for them to give advices to the
residents of the barangay on how to prevent or avoid the dengue cases through
lemon repellent.
The residents of barangay- they will know that there's a treatment in preventing
dengue and it will be easy for them because the treatment can be done at home.
The future researchers - they can use this study as their guide and they will know if
this study is really effective or not
The researchers- this serves as their steppingstone in their upcoming research
projects or paper, this documents or study can serve as their avenue of information.

Definition of Terms
Dengue virus- is the cause of dengue fever. It is a mosquito-borne, single positive-
stranded RNA virus of the family Flaviviridae; genus Flavivirus. Five serotypes of the
virus have been found, all of which can cause the full spectrum of disease.

Lemon- is a species of small evergreen tree in the flowering plant family Rutaceae,
native to South Asia, primarily North Eastern India. Its fruits are round in shape.

DEET- is the most common active ingredients in insect repellents. It is slightly yellow oil
intended to be applied to the skin or to clothing and provides protection against
mosquitoes, ticks, fleas, chiggers, leeches and many biting insects.

Aedes Aegypti- the yellow fever mosquito, is a mosquito that can spread dengue fever,
chikungunya, Zika fever, Mayaro and yellow fever viruses, and other disease agents.
The mosquito can be recognized by white markings on its legs and a marking in the
form of a lyre on the upper surface on its thorax.

Aedes Albopictus- also known as tiger mosquito or forest mosquito, is a mosquito

native to the tropical and subtropical areas of Southeast Asia; however, in the past few
decades, this species has spread to many countries through the transport of goods and
international travel.

Picaridin- is an insect repellent which can be used directly on skin or clothing. It has
broad efficacy against various insects and ticks and is almost colorless and odorless

Citronella oil- is an essential oil obtained from the leaves and stem of different species
of cymbopogon (lemongrass). The oil is used extensively as a source of perfumery
chemicals such as citronella, citronellol, and geranoil.

Eucalyptus- is a genus of over seven hundred species of flowering trees, shrubs or

mallees in the myrtle family, myrtaceae. Along with other genera in the tribe
Eucalypteae, they are commonly known as eucalyptus.

Scientific Related Literature

According to Jimmy Antony Background: Dengue fever is a serious public health
problem in terms of its morbidity and mortality. It reports from almost all countries and it
is endemic in the tropical countries. Aim: The present hospital study aims to describe
the frequency, distribution and case fatality of dengue fever based on the variables such
as age, sex and year. There are four serotypes of dengue: DEN-1, DEN-2, DEN-3, and
DEN-4. No cross-protection is seen among the serotypes, so dengue can develop after
infection with another serotype. Infection with a second serotype places the individual at
risk for the development of hemorrhagic fever. Gert J Venter, Karien Labuschagne,
Solomon NB Boikanyo, Liesl Morey The use of insecct repellents to reduce the attack
rate of Culicoides species (Diptera: Ceratopogonidae) should form part of an integrated
control programmed to combat African horse sickness and other diseases transmitted
by these blood-feeding midges. In the present study the repellent effects of a
commercially available mosquito repellent, a combination of citronella and lemon
eucalyptus oils, on Culicids midges was determined. The number of midges collected
with two 220 V Onderstepoort traps fitted with 8 W 23 cm white light tubes and baited
with peel-stick patches, each containing 40 mg of active ingredient, was compared with
that of two unbaited traps. Two trials were conducted and in each trial the four traps
were rotated in two replicates of a 4 x 4 randomized Latin square design. Although more
midges were collected in the baited traps, the mean number in the baited and unbaited
traps was not significantly different. This mosquito repellent did not influence either the
species composition or the physiological groups of Culicoides imicola Kieffer. The
higher mean numbers in the baited traps, although not statistically significant, may
indicate that this mosquito repellent might even attract Culicoides. Plant-based
repellents have been used for generations in traditional practice as a personal
protection measure against host-seeking mosquitoes. Knowledge on traditional
repellent plants obtained through ethno botanical studies is a valuable resource for the
development of new natural products. Recently, commercial repellent products
containing plant-based ingredients have gained increasing popularity among
consumers, as these are commonly perceived as “safe” in comparison to long-
established synthetic repellents although this is sometimes a misconception. To date
insufficient studies have followed standard WHO Pesticide Evaluation Scheme
guidelines for repellent testing Lemon eucalyptus essential oil, comprising 85%
citronellal, is used by cosmetic industries due to its fresh smell. However, it was
discovered that the waste distillate remaining after hydro-distillation of the essential oil
was far more effective at repelling mosquitoes than the essential oil itself. Many plant
extracts and oils repel mosquitoes, with their effect lasting from several minutes to
several hours. Their active ingredients tend to be highly volatile, so although they are
effective repellents for a short period after application, they rapidly evaporate leaving
the user unprotected. The exception to this is para-menthane 3, 8 diol, which has a
lower vapor pressure than volatile monoterpines found in most plant oils and provides
very high protection from a broad range of insect vectors over several hours, whereas
the essential oil is repellent for around one hour. PMD is the only plant-based repellent
that has been advocated for use in disease endemic areas by the CDC (Centres for
Disease Control), due to its proven clinical efficacy to prevent malaria and is considered
to pose no risk to human health. It should be noted that the essential oil of lemon
eucalyptus does not have EPA (Environmental Protection Agency) registration for use
as an insect repellent. Dr. Frost is an Epidemiologist at the R. Stuart Dickson Institute
for Health Studies, Carolinas HealthCare System, Charlotte, NC; she reports no
consultant, stockholder, speaker’s bureau, research, or other financial relationships with
companies having ties to this field of study. Before synthetic repellents were developed
in 1929, people routinely used natural compounds to protect against insect bites. During
World War II, however, the United States government began testing more than 20,000
mosquito repellents to protect troops traveling to tropical areas. As a result, a highly
effective synthetic repellent (N,N-diethyl-m-toluamide or DEET) was developed in 1953
and arrived on the market in 1956.1 Currently, DEET is the most popular commercial
insect repellent, with close to 250 formulations sold worldwide. Despite its effectiveness,
many consumers are reluctant to apply synthetic chemicals to their skin and seek
natural alternatives to synthetic repellents. This desire has been exacerbated by reports
that DEET is dangerous for children, possibly inducing encephalitis. These cases are
extremely rare (17 suspected cases worldwide reported to date)2 and occurred in
children that orally ingested DEET or were repeatedly exposed to high concentrations.3
Nonetheless, many would rather err on the side of caution. Commercially available
insect repellents fall into one of two classes: synthetic chemicals or plant-derived
essential oils.4 Currently, there are only five active ingredients registered for topical use
in the United States: two are synthetic (DEET and IR3535) and three are plant-derived
(picaridin [KBR 3023], citronella, and p-menthane-3, 8-diol [PMD]).1 One plant-derived
alternative that has sparked particular attention of late is oil of lemon eucalyptus. In fact,
the Centers for Disease Control and Prevention (CDC) recently reported that oil of
lemon eucalyptus (PMD is the active ingredient) is one of only three products (DEET,
picaridin, and PMD) recommended to protect against West Nile virus, a serious virus
spread by mosquitoes that can cause neurological disease or even death.5 The
Environmental Protection Agency (EPA) lists PMD as effective against mosquitoes,
biting flies, and gnats.6 Botany and Pharmacology Eucalyptus ssp. is a genus of trees
and shrubs in the family Myrtaceae that originated in Australia, but now commonly
grows in almost all tropical and subtropical areas. Eucalyptus trees are characterized by
vertically hanging; white, leathery leaves and ragged bark.7 there are close to 600
species of eucalyptus, one of which is Eucalyptus citriodora Hook. E. citriodora is also
known as citron-scented gum, lemon eucalyptus, lemon-scented gum, Corymbia
citriodora, and spotted gum. E. citriodora has been credited with anti-inflammatory,
antibacterial, and antifungal activity; and, recently has gained popularity as an insect
repellent.8 E. citriodora leaves contain many compounds with pesticide activity
including: aromadendrene, citronellal, citronellic acid, citronellol, citronellyl acetate, p-
cymene, limonene, linalool, alpha-pinene, PMD, tannin, terpinene, terpinolene, and
ursolic acid.8 PMD has been identified as the compound that provides the strongest
insect protection in this plant. Of note, E. citriodora also contains citronellol, which is the
active ingredient in oil of citronella products. Oil of citronella, however, is not obtained
from E. citriodora, rather from perennial grasses indigenous to tropical Asia (C. nardus
and C. winterianus).9 Oil of citronella is reported to have considerably shorter repellent
times than DEET and PMD alternatives, with complete protection times averaging only
about 20 minutes at concentrations of 10%.4 Research Studies In the late 1980s, a
worldwide survey was conducted by the U.S. military to identify repellents not produced
in the United States. Of the 65 formulations not produced in the United States, 33
contained DEET and the remainder contained natural oils or undisclosed ingredients.
One of the natural formulas identified was quwenling. This formula sparked the interest
of researchers because it had become China’s repellent of choice.10 Quwenling was
made from the waste distillate after extraction of lemon eucalyptus oil; the main
ingredient in this distillate was PMD.11 Quwenling has been a popular insect repellent
in China for more than two decades. As mentioned previously, PMD is the main
ingredient in quwenling; however, products containing PMD are relatively new to the
U.S. market. There is a paucity of information on the efficacy of these products in peer-
reviewed literature. This will likely change over time as PMD is more widely used and
evaluated in

he United States. Results of studies from the current literature are discussed in the next
several paragraphs. Schreck et al studied the effectiveness of quwenling through a
series of tests that involved application of quwenling (30% active ingredients, or AI) on
the forearm of a volunteer, from the wrist to the elbow.9 After 15 minutes, the
volunteer’s arm (a protective glove covered the hand) was exposed sequentially for
three minutes in four cages, each containing 200 blood-hungry female mosquitoes of
four different species (Aedes aegypti, Aedes albopictus, Anopheles quadrimaculatus,
and Anopheles albinmanus). Volunteers were also taken to the Everglades National
Park to test the repellent in an authentic environment. Treated arms were exposed
continuously to the natural environment to calculate time until first bite. The same tests
were done with a DEET standard (15% AI) and the two repellents were then compared.
Collectively, the results from these series of tests suggested that quwenling was not as
effective as DEET in terms of duration of protection: The mean number of hours until
the first bite by Aedes aegypti was 1.1 hours with quwenling and 4.8 hours with DEET.
Fradin et al compared several different insect repellents on the national market by using
arm-in-cage studies with variable protocols depending on the time at first bite.4 This
study reported that 11 of 12 non-DEET repellents had mean protection times from
Aedes aegypti mosquitoes of less than 23 minutes, whereas DEET topical formulas
provided mean protection times ranging from 88 minutes (4.75% DEET) to 301 minutes
(23.8% DEET). After the study was started, a new botanical product was introduced in
the United States under the trade names of Repel Lemon Eucalyptus Insect Repellent
(Wilson Pharmaceutical Company) and Fite Bite Plant Based Insect Repellent (Travel
Medicine). The authors evaluated this product using the same method that they used for
the products originally specified in the study using six test subjects. The lemon
eucalyptus repellent had a mean protection time of 120 minutes, which made it the most
effective of all non-DEET repellents tested in this study and more effective than low-
concentration DEET products (6.65% and lower); however, the concentration of lemon
eucalyptus or PMD was not stated in the study. Another important point from this study
was that wristband repellents were not effective, regardless of the formula.4 In 2002,
Barnard et al tested IR3535, KBR 3023, PMD repellent (40% PMD), and DEET (25%)
against Ochlerotatus taeniorhynchus in the Everglades National Park.12 During seven,
three-minute observation periods over six hours, bites were surveyed on test subjects.
The PMD repellent had a mean complete protection time of 3.7 hours (compared to 5.6
hours with DEET) and an overall mean percent repellency of 89%. Authors stated that
all three non-DEET repellents were effective insect repellents for human use. In 2004,
Barnard and Xue tested 12 commercially available synthetic and botanical insect
repellents against Aedes albopictis, Culex nigripalpus, and Ochlerotatus triseriatus by
exposing treated forearms to three-minute cage exposures every 30 minutes until the
subject received two or more mosquito bites in the same observation period or one bite
in two consecutive observation periods.11 When estimated mean time of protection was
averaged over the three species, Repel Lemon Eucalyptus Insect Repellent (26% oil of
lemon eucalyptus or 65% PMD) provided more than seven hours of protection from
mosquitoes of these species. Repel’s protection time was comparable to the 15% DEET
formula in the study. Similarly, Govere et al reported that 0.574 g of quwenling
(Mosiguard towelettes) was comparable to 15% DEET for protection against Anopheles
arabiensis mosquitoes in their arm-in-cage study.13 Both formulas protected against
this species of mosquitoes for 5-6 hours of one-minute, hourly cage exposures. Trigg
also found spray, gel, and stick formulations of 50% PMD effective against An. gambiae
and An. funestus mosquitoes in the field in Tanzania.14 Their results, however, are
misleading: They reported six hours and 42 minutes average time until first bite when
the first five hours were spent unexposed to mosquitoes before the trial began at 10 pm.
Once they went into the field where the experiment tool place, it took an average of one
hour and 42 minutes using PMD spray compared to one hour and 55 minutes using
DEET spray until the first bite was received. Hadis et al reported comparable efficacy of
DEET and PMD (greater than 90% for both) in terms of mean number of bites and
average percent protection at concentrations of 40% and 75%, respectively, against
Mansonia mosquitoes.15 They did not compare time until first bite for the different
repellents, but rather the overall effectiveness during the test period (from 7:00 to 7:30
pm) in Pugnudo, Ethiopia. John Staughton (BASc, BFA) last updated - February 08,
2018 ✓ Evidence Based Ask your question Lemon eucalyptus essential oil boasts a
number of health benefits, such as strengthening the immune system, preventing
respiratory infections, repelling disease-bearing insects, relieving pain, soothing
inflammation, healing wounds, improving digestive health and treating fungal infections,
among others. Some of the side effects of lemon eucalyptus oil include serious stomach
upset when ingested, as well as topical skin irritation and complications for people with
certain medical conditions or prescriptions. This powerful essential oil is derived from a
lemon-scented gum eucalyptus plant, which goes by the scientific name Eucalyptus
citriodora. The pleasant smell of this essential oil, combined with its insect repellent
properties, made it a standard in traditional medical uses, but it has now reached the
global mainstream for its other apparent health benefits. You will find this essential oil in
everything from aromatherapy treatments and insect repellents to massage oils and
essential oil diffusers, thanks to its wide range of effects. Native to northern Australia,
the lemon eucalyptus plant is highly sought after due to its high concentration of
citronellal, limonene, linalool and other antioxidants, as well as various nutrients and
active compounds. Lemon Eucalyptus Oil Benefits and Uses The impressive essential
oil of lemon eucalyptus is very popular with people suffering from chronic pain,
inflammatory conditions, indigestion, fungal and bacterial infections, cough, cold, flu,
fever, body odor, arthritis, bronchitis, poor circulation and sinus infections, as well as
people in areas with mosquito- and insect-borne diseases. Effective Insect Repellent
The most common use of lemon eucalyptus essential oil is for repelling insects; the
significant content of citronellal is extremely effective for driving away insects, including
those that bear diseases, for up to 8 hours after application. In fact, lemon eucalyptus
essential oil has been praised as a viable replacement for DEET and other dangerous
insecticides and has proven to be just as effective.
According to Cathy Wong N. Fogoros,MD Lemon eucalyptus oil is an oil extracted from
the leaves of a tree native to Australia ( Eucalyptus citriodora ) that is used as a natural
insect repellant . The oil contains a compound called para-menthane-3, 8-diol (PMD)
that makes it harder for mosquitoes and other insects to pick up on your skin odor. Most
commercially available insect repellents contain processed lemon eucalyptus oil that
intensifies its concentration of PMD and, in turn, increase its power and duration as a
repellent. The Environmental Protection Agency (EPA) classifies synthetic PMD as a
“biochemical pesticide,” which is a type of naturally occurring substance that controls
pests by non-toxic mechanisms. Health Benefits Mosquitoes in the U.S. can carry
diseases like Zika, dengue, and chikungunya , according to the Centers for Disease
Control and Prevention (CDC). Other insects also carry diseases, such as ticks and
Lyme disease. Used as an insect repellent, lemon eucalyptus oil can protect against
bites that can lead to disease. Lemon eucalyptus oil is sometimes used as an
alternative to DEET, which is the active ingredient in many popular insect repellents.
While DEET is highly effective when it comes to warding off disease- carrying insects,
some individuals are concerned about its possible side effects, such as irritation of the
eyes and skin. According to the CDC, EPA-registered products made from synthesized
lemon eucalyptus oil appear to provide reasonably long-lasting repellent activity. The
CDC includes EPA-registered products containing synthesized lemon eucalyptus oil and
PMD in its list of repellents that can help reduce the bites of disease- carrying
mosquitoes. Products containing DEET, picaridin, and IR3535 are also included on the
CDC’s list. Beyond Zika: What to Know About Mosquito- Borne Diseases Other Uses
Although lemon eucalyptus oil is most commonly used as a mosquito repellent, it’s also
said to stave off Lyme disease by preventing deer tick bites . In addition, lemon
eucalyptus oil has long been used to soothe muscle spasms and alleviate osteoarthritis
pain. However, there is a lack of scientific support for these uses of lemon eucalyptus
oil.

Reducing the number of host-vector interactions is an effective way to reduce the

spread of vector-borne diseases. Repellents are widely used to protect humans from a
variety of protozoans, viruses, and nematodes. DEET (N, N-Diethyl-meta-toluamide), a
safe and effective repellent, was developed during World War II. Fear of possible side
effects of DEET has created a large market for “natural” DEET-free repellents with a
variety of active ingredients. We present a comparative study on the efficacy of eight
commercially available products, two fragrances, and a vitamin B patch. The products
were tested using a human hand as attractant in a Y-tube olfactometer setup
with Aedes aegypti (Linnaeus) and Aedes albopictus (Skuse), both major human
disease vectors. We found that Ae. albopictus were generally less attracted to the test
subject’s hand compared with Ae, aegypti . Repellents with DEET as active ingredient
had a prominent repellency effect over longer times and on both species. Repellents
containing p-menthane-3,8-diol produced comparable results but for shorter time
periods. Some of the DEET-free products containing citronella or geraniol did not have
any significant repellency effect. Interestingly, the perfume we tested had a modest
repellency effect early after application, and the vitamin B patch had no effect on either
species. This study shows that the different active ingredients in commercially available
mosquito repellent products are not equivalent in terms of duration and strength of
repellency. Our results suggest that products containing DEET or p-menthane-3,8-diol
have long-lasting repellent effects and therefore provide good protection from mosquito-
borne diseases.

Mosquitoes are hosts for an array of different protozoan parasites, nematodes, and
viruses ( Marquardt 2004 , Enserink 2007 , Murray et al. 2010 ). Controlling mosquito
populations is an effective tool for the fight against such pathogens. Several different
methods for mosquito control have been developed, e.g., source reduction, physical
exclusion (nets, screens, etc.), pesticide application, biological control methods, sterile
insect technique, and release of genetically modified mosquitoes ( Rose 2001 , Phuc
et al. 2007 , Alphey et al. 2010 ). Unfortunately and for a variety of reasons, these
approaches can be difficult to implement in many locations ( Peter et al. 2005 ).
Widespread insecticide resistance in disease-carrying mosquito populations also poses
a significant problem.

On an individual level, mosquito repellents are widely used to avoid disease exposure
( Barnard 2000 , Barnard and Xue 2004 ). Repellents, even though they can never
guarantee complete protection, can significantly lessen the chance of contracting
vector-borne diseases ( Kahn et al. 1975 , Barnard et al. 1998 , Barnard and Xue
2004 , Rowland et al. 2004 , Hill et al. 2007 ). They are especially useful when used
where human activity coincides with the diurnal activity patterns of mosquitoes, e.g.,
outdoor activities that take place at dusk and dawn, e.g., hunting and fishing.

The sense of smell is one of the most important senses that mosquitoes use for long
range host seeking ( Potter 2014 ). Insect olfaction has been extensively studied leading
to the identification of the key proteins involved: odorant receptors, odorant receptor co-
receptors, gustatory receptors, and odorant binding proteins ( Kaupp 2010 , Suh et al.
2014 ). The processing of olfactory information in different regions of the insect brain
has also attracted a lot of research interest ( Galizia 2014 ). Various mosquito
attractants and repellents have been identified, many of which are produced by human
metabolism or the bacterial degradation of sweat components. Lactic acid and 1-octen-
3-ol are two components that act as strong mosquito attractants ( Zwiebel and Takken
2004 ). Carbon dioxide from breath is another strong attractant that sensitizes
mosquitoes to other odorants ( Dekker et al. 2005 ). Studies have shown that different
insect repellents use a similar mode-of-action. Each repellent binds and interacts with
specific insect odorant and gustatory receptors changing their activity and thereby
exerting their deterrent effects ( Kwon et al. 2010 , Dickens and Bohbot 2013 , Xu et al.
2014 ). The most widely used insect repellent, DEET (N,N-diethyl-m-toluamide), has
been in use for about 70 yr. DEET is considered a very safe repellent ( Osimitz and
Grothaus 1995 , Koren et al. 2003 , Sudakin and Trevathan 2003 ). Nevertheless, fear
of possible side effects of DEET and general chemophobia has resulted in the
development of a multitude of “DEET-free” mosquito repellents with a variety of active
ingredients. Plant-based repellents usually contain essential plant oils as active
ingredients.

There are several approaches for evaluating the efficacy of insect repellents. Some of
the bioassays that have been used include spatial repellency assay, host attraction-
inhibition assay, landing inhibition assay, effective dose and duration assays, taxis cage
assays, etc. ( Lorenz et al. 2013 , Afify et al. 2014 , Menger et al. 2014 ). Olfactometers
are useful tools used in attraction-inhibition assays to test repellent efficacy. They allow
the experimenter to perform the tests under very controlled conditions, thereby
eliminating many variables that may alter experimental results in more open systems
( McIndoo 1926 ).

Here, we report experiments performed with a Y-tube olfactometer that was constructed
according to a blueprint published by the World Health Organization in its publication
“Guidelines for efficacy testing of spatial repellents” ( World Health Organization [WHO]
2013 ). We performed host attraction-inhibition assays and tested the efficacy of eight
commercially available mosquito repellent products, a perfume, a bath oil, and a vitamin
B patch.

Ae . aegypti UGAL strain and Ae. albopictus F10 strain were acquired from the Malaria
Research and Reference Reagent Resource Center (ATCC 2015). Mosquito culture
was executed as described in Marquardt (2004), using chicken for a blood meal source.
Larvae were reared in 13” by 20” pans filled with 2 liters of deionized water held at
27°C. Larvae were given five dry cat food pellets (Special Kitty-Wal-Mart Stores, Inc.
Bentonville, AR) every 3 d; water was changed after 5 d. The mosquitoes were allowed
to mature for 5 d in a BugDorm-1 Insect Rearing Cage (30 by 30 by 30 cm, BugDorm
Store, Taichung, Taiwan) before the experiment commenced. The adult mosquitoes
were maintained on 20% sucrose solution, ad libitum, up to 24 h before the experiment
began. The cages were placed in an incubation room that was maintained at 80%
humidity and 27°C with a photoperiod of 14:10 (L:D) h. Mosquitoes were starved 24 h
before each Y-tube assay.

Repellents were purchased locally in Las Cruces, NM, or ordered online via
Amazon. Table 1 lists the products tested, active ingredients, manufacturer and
location, and the manufacturer’s estimated protection times. The Mosquito Skin Patch
was applied 2 h before the start of the experiment.

osquitoes are among the most deadly disease vectors in the world. The Zika virus,
currently making headlines in Central and South America due to its potential for causing
severe birth defects if pregnant women are infected, is just the latest in a long roster of
mosquito-borne diseases, such as chikungunya, dengue, West Nile, Japanese
encephalitis, and yellow fever. Worst of all is malaria, which kills over a million people
every year.

To avoid these debilitating illnesses, most conventional mosquito-prevention advice

guides people toward DEET, a powerful chemical repellent. However, research
suggests that natural solutions can be even more powerful. A pair of studies found that
lemon eucalyptus essential oil can be equally or even more effective at warding off
mosquitoes than DEET.

In one study, published in the Journal of the American Mosquito Control Association,

researchers tested the effectiveness of three different types of eucalyptus-based
repellent against Anopheles gambiae and Anopheles funestus mosquitoes, two of the
breeds that carry the deadly malaria parasite in Sub-Saharan African. Subjects put the
product on their legs and feet and found that it protected them completely from
mosquito bites for 6 to 7.75 hours, matching the performance of DEET.

Another study, conducted by the London School of Hygiene and Tropical Medicine,

tested a mix of 30 percent lemon eucalyptus essential oil against two other natural
repellents in addition to DEET. The various mixtures were put on trial
against Anopheles darlingi, the mosquito that is the primary vector of malaria in Bolivia.
Two of the natural repellents, one made from the Neem tree and another from a mix of
essential oils, were found to be ineffective at preventing mosquito bites. A 15 percent
DEET compound performed better, providing about 85 percent protection from bites.
However, the lemon eucalyptus oil was the best repellent of the bunch, resulting in 97
percent protection over four hours.

Lemon eucalyptus oil is believed to work because its main active ingredient, p-
menthane-3,8-diol or PMD, blocks mosquitoes from sensing human presence, masking
signals like carbon dioxide and lactic acid. If you purchase repellent that is labeled
PMD, it could indicate it contains the natural essential oil itself, or a synthetic mimic of
the same chemical. PMD can cause irritation if it gets in the eyes but is rated in the
“least-toxic” category by ChemicalWatch.
That’s welcome news for people who would rather avoid DEET, which can cause skin
irritation and in rare instances has been implicated in seizures. Other research has
suggested that extended exposure to the repellent could be a factor in insomnia, mood
disturbances and impaired cognitive function. It has also been linked to neurological
damage in children.

The next time someone turns their nose up at eucalyptus oil and insists that DEET is
the only way to prevent bug bites, tell them that the natural solution actually
outperformed the chemical in a scientific study. If you are heading to a tropical country
and need to protect yourself from disease, or simply want to avoid pesky bites during
picnics and barbeques this summer, there’s good reason to consider trying out some
lemon eucalyptus essential oil and discover its impressive mosquito repellent qualities
for yourself.

Many people would rather use a natural substance than a chemical on their skin while
warding off mosquitoes on a camping trip or even in the backyard. Unfortunately, lemon
juice has no effect as a mosquito repellent.

Lemon juice is not the most effective repellent for mosquitoes.

You may see mosquito products listing lemon eucalyptus oil or lemongrass oil. While
these two oils are effective for warding off mosquitoes, neither of them contains lemon
juice.

Thai lemongrass contains citronella, a substance that has a lemony scent and repels
mosquitoes. Many all-natural mosquito repellents contain citronella as well as lemon
eucalyptus oil, but no lemon juice.

Although ineffective against mosquitoes, lemon juice and lemon peel can ward off other
unwanted insects. Ants, fleas and moths dislike lemon juice and will stay away from it.

Citronella is a well-known mosquito repellent. In a dose by dose comparison, citronella

is initially as effective as DEET. However, citronella oil evaporates quickly, meaning that
it is only effective for a short time. Also, high concentrations of citronella can cause skin
irritation.
Research has shown that the topical application of 100% citronella can provide
complete protection against three types of mosquito for up to 120 minutes in a
laboratory setting.

People traveling to areas where mosquitoes carry diseases may wish to use a more
effective synthetic repellent than citronella.

People can purchase citronella candles or essential oil online or in some stores.

2. Lemon eucalyptus

Lemon eucalyptus essential oil contains 85% citronellal. It is a popular product in the

cleaning and cosmetics industries due to its fresh scent.

The findings of both field and laboratory studies show that lemon eucalyptus oil can
effectively protect against several species of malaria-carrying mosquito as well as
the yellow fever mosquito.

A 2014 study found that a formula containing 32% lemon eucalyptus oil provided at
least 95% protection from mosquitoes for 3 hours. However, it has a shorter protection
time than DEET as it evaporates more quickly.

3. Clove

Many people use cloves either alongside cinnamon in baking or as an aromatic addition

to drinks with lemon and sugar. However, cloves may also help prevent bothersome
mosquito bites.

In a 2013 study, researchers mixed clove essential oil with bases of olive and coconut
oil, which volunteers then applied topically to their skin.

The clove oil mixtures protected against yellow fever mosquitoes for up to 96 minutes.

Other research suggests that a component of cloves called methyl eugenol could be a

carcinogen, but these claims require further research.
4. Peppermint

Using peppermint may be another natural way to repel mosquitoes. The authors of
a 2011 review concluded that high concentrations of peppermint essential oil are
effective, but they could not find any research on lower concentrations.

A study in 2011 found that peppermint essential oil was effective against mosquito
larvae and provided 100% protection against bites from adult yellow fever mosquitoes
for up to 150 minutes.

5. Lemongrass

Share on Pinterest Lemongrass essential oil is a good option for a natural mosquito
repellent.

Lemongrass is an herb with a subtle citrus flavor. It is a popular ingredient in tea and
several Asian cuisines.

In a 2015 study, researchers found that a combination of lemongrass essential oil and
olive oil provided 98.8% protection against the southern house mosquito.

Other research found that topical application of lemongrass essential oil provided 74–

95% protection for 2.5 hours against two types of mosquito during a field study.
Scientific Related Studies

According to World Health Organization Dengue is fast emerging pandemic-prone viral

disease in many parts of the world. Dengue flourishes in urban poor areas, suburbs and
the countryside but also affects more affluent neighborhoods in tropical and subtropical
countries. Dengue is a mosquito-borne viral infection causing a severe flu-like illness
and, sometimes causing a potentially lethal complication called severe dengue. The
incidence of dengue has increased 30-fold over the last 50 years. Up to 50-100 million
infections are now estimated to occur annually in over 100 endemic countries, putting
almost half of the world’s population at risk. Severe dengue (previously known as
dengue hemorrhagic fever) was first recognized in the 1950s during dengue epidemics
in the Philippines and Thailand. Today it affects Asian and Latin American countries and
has become a leading cause of hospitalization and death among children and adults in
these regions. The full life cycle of dengue fever virus involves the role of mosquito as a
transmitter (or vector) and humans as the main victim and source of infection. The virus
the dengue virus (DEN) comprises four distinct serotypes (DEN-1, DEN-2, DEN-3 and
DEN-4) which belong to the genus Flavivirus, family Flaviviridae. Distinct genotypes
have been identified within each serotype, highlighting the extensive genetic variability
of the dengue serotypes. Among them, “Asian” genotypes of DEN-2 and DEN-3 are
frequently associated with severe disease accompanying secondary dengue infections.
The mosquito The Aedes aegypti mosquito is the main vector that transmits the viruses
that cause dengue. The viruses are passed on to humans through the bites of an
infective female Aedes mosquito, which mainly acquires the virus while feeding on the
blood of an infected person. Learn more on the mosquito The human Once infected,
humans become the main carriers and multipliers of the virus, serving as a source of
the virus for uninfected mosquitoes. The virus circulates in the blood of an infected
person for 2-7 days, at approximately the same time that the person develops a fever.
Patients who are already infected with the dengue virus can transmit the infection via
Aedes mosquitoes after the first symptoms appear (during 4-5 days; maximum 12). In
humans recovery from infection by one dengue virus provides lifelong immunity against
that particular virus serotype. However, this immunity confers only partial and transient
protection against subsequent infection by the other three serotypes of the virus.
Evidence points to the fact that sequential infection increases the risk of developing
severe dengue. The time interval between infections and the particular viral sequence of
infections may also be of importance.

Natural mosquito repellant everybody’s innovating so we want to introduce you to a

natural mosquito repellant! Some plants like citronella, lemongrass, cedar, verbena,
geranium lavender, peppermint, tea tree oil, rosemary and garlic have repellant
properties. Dengue mosquitoes do not like the smell of these plants but the repelling
action last only for 2 hours. Now, there is an effective and safe insect repellant called
Oilganics Andiroba Herbal Lotion. Unlike the existing insect repellant lotion in the
market, with its chemical and pesticide properties, this lotion is an all natural herbal
repellant that can also cure bruises and open wounds because it has antiseptic and
anti-inflammatory properties. Oilganics Andiroba Herbal Lotion contains Andiroba from
Andiroba Plant or Brazilian Mahogany. It can be found growing wild in the Amazon
rainforest and well known in Brazil and widely used as a natural insect repellent. Aside
from treating insect bites, here are more of its benefits: Treats skin problems like
psoriasis, dermatitis, heat rashes and skin fungi It has analgesic (pain reliever), anti-
bacterial, antiparasitic and anti-inflammatory properties It is a rich source of essential
fatty acids including oleic, palmitic, stearic and linoleic acid It has limonoids and
andirobin that gives the oil its insect repellent and anti-inflammatory properties To apply,
just put a generous amount to your body especially to exposed parts like arms and legs
and ankles twice a day.

Dengue is a mosquito-borne, acute febrile illness that is an important public health

problem in tropical countries. In the early 1950’s, the disease was described in the
Philippines as hemorrhagic fever or infectious acute thrombocytopenic purpura. Dengue
continues to cause considerable concern in the country because of its widespread
endemicity, the minimal success of vector control strategies, the possibility of severe
disease caused by sequential infection by a different serotype, the potential for fatal
outcomes and the consequent social and economic burden. The four dengue virus
serotypes circulate in the country where the disease is predominantly reported among
children.

Findings from dengue studies could provide policy-makers with information needed for
rational decision-making regarding dengue preventive and control efforts. The focus of
dengue research may vary widely. This could include basic laboratory research, the
estimation of dengue seroprevalence and incidence; the assessment of risk factors for
severe disease; the quantification of its economic burden; the elucidation of local
transmission and epidemiology; the development of improved diagnostic tests or the
evaluation of interventions.

We reviewed published studies on dengue research in the Philippines during the past
60 years. The objective of the review is to better understand the trends in dengue
research and the findings from these studies. The results of the review could provide an
impression of local capacity and infrastructure for dengue research and help determine
important knowledge gaps. These gaps need to be identified since research interest
and support for funding can only be achieved if scientists, decision makers and other
stakeholders are able to understand developments related to the disease and recognize
areas where more information is needed.

The Philippines is an archipelago of 7,107 islands and is located in the western Pacific
Ocean in Southeastern Asia. The population of the Philippines in 2015 was
100,981,437. Philippine health status indicators show that the country lags behind most
of Southeast and North Asia in terms of health outcomes. Communicable diseases
continue to be major causes of morbidity and mortality in the country. Health care in the
Philippines is provided through a mixed public-private system.

This systematic review was conducted according to the Preferred Reporting Items for
Systematic Review and Meta-Analyses (PRISMA) guidelines. In June 2018, we
searched articles on PubMed, the Cochrane Library, Science Direct and the Health
Research and Development Information Network (HERDIN) from 1 January 1958 to 31
December 2017 combining Mesh and free-text terms for the following: dengue, “dengue
fever”, “hemorrhagic fever”, “dengue hemorrhagic fever”, “dengue shock syndrome”,
DF, DHF, DSS and Philippines without any language or age restrictions. The search on
HERDIN, an electronic database of health research in the Philippines, was done to
ensure that articles from local journals not indexed on international databases are
included. The completed PRISMA checklist is shown in the Supporting information.
There is no protocol for this systematic review.

The articles were compiled in Endnote (Thomson Reuters, San Francisco, CA, USA).
Titles and abstracts were screened for eligibility. Published articles on dengue research
in the Philippines and on Filipinos that reported objectives, methods and results or
descriptive epidemiologic and case reports were included.

We excluded unpublished articles, studies that were not focused on dengue or not
focused on the Philippines, those reporting aggregated results from various countries or
analysis of a global or regional collection of viral isolates and specimens from which
findings specific to the Philippines could not be retrieved, those reporting the same data
from another publication (duplicates), reviews and updates (not original research),
meeting or news reports, program descriptions, commentaries, guidelines on dengue
(prevention, treatment or diagnosis) and studies on expatriates and non-Filipinos.
Towards the goal of assessing the broad picture of dengue research in the Philippines,
we included studies that met the basic standard requirements and did not exclude
studies based on methodology or risk of bias or selective reporting.

The relevant full papers were downloaded and reviewed in detail. Information from each
eligible paper was extracted and entered into an Excel spread sheet (Microsoft Office
2007, Seattle, WA, USA). These included the study title, the year of publication, the
journal, the study site primary location, type of study, brief methods and study findings.
The summary measures were descriptive.

We compared the annual number of Philippine-related dengue publications with other

markers. As a measure of economic growth in the country, we assessed the Philippine
Gross Domestic Product (GDP) per capita (in current US dollars) in 1960 (the earliest
year data was available) and in 2017. For comparison, we also obtained the annual
number of publications worldwide on PubMed combining the terms: dengue, “dengue
fever”, “hemorrhagic fever”, “dengue hemorrhagic fever”, “dengue shock syndrome”,
DF, DHF, DSS, from 1958 to 2017, without location, language or age restrictions.
To confirm that Korean Food and Drug Administration (KFDA) guidelines are applicable
to test the efficacy of mosquito repellents, these guidelines were used to test the
efficacy and complete protection times (CPTs) of three representative mosquito
repellents: N,N-diethyl-3-methylbenzamide (DEET), citronella, and fennel oil. The
repellency of citronella oil decreased over time, from 97.9% at 0 h to 71.4% at 1 h and
57.7% at 2 h, as did the repellency of fennel oil, from 88.6% at 0 h to 61.2% at 1 h and
47.4% at 2 h. In contrast, the repellency of DEET remained over 90% for 6 h. The CPT
of DEET (360 min) was much longer than the CPTs of citronella (10.5 min) and fennel
oil (8.4 min). These results did not differ significantly from previous findings, and hence
confirm that the KFDA guidelines are applicable for testing the efficacy of mosquito
repellents.

Insect-borne diseases are a worldwide health problem, especially in tropical and

subtropical climates. Mosquitoes transmit many diseases, including yellow fever,
dengue hemorrhagic fever, malaria, several forms of encephalitis, and filariasis. For
example, malaria has been estimated to kill 3 million persons per year, including over 1
million children. Mosquito repellents may effectively protect humans from vector-borne
diseases as well as other problems caused by mosquitoes.

N, N-Diethyl-m-toluamide (DEET) is a readily available and frequently used mosquito

repellent. However, adverse effects of DEET have been reported, with some being
severe enough to cause sensory disturbances and affect motor capacity, memory, and
learning ability. In addition, DEET is not recommended for children, because high
concentrations of DEET can cause encephalopathy and other side effects.

Botanical mosquito repellents, which cause little risk to the environment or human
health, may be feasible alternatives to synthetic chemical repellents such as DEET.
Thus, many people prefer to use natural repellents extracted from plants, such as
citronella oil from Cymbopogon nardus, p-menthane-3,8-diol (PMD) from Eucalyptus
maculata citriodora, and fennel oil from Foeniculum vulgare . Little information is
available, however, about the mosquito repellent activities of these natural and herbal-
based substances. This study evaluated the repellency of commercially available
natural mosquito repellents using the Korean FDA guidelines and compared their
activities with that of 24% DEET.

Aedes albopictus (Skuse) mosquitoes were used for repellent testing. Mosquito larvae
were obtained from the Division of Medical Entomology of Korea Centers for Disease
Control and Prevention (KCDC). The larvae were reared at 27°C and 70% relative
humidity at a dedicated facility of Konkuk University. Adult mosquitoes were fed and
maintained on a 10% sucrose solution, as described previously.

The repellent tests followed KFDA guidelines modified from WHOPES and EPA
methods. Two hundred female mosquitoes (age 5–10 days), which had never received
a blood meal, were placed into each test cage and starved of their sugar diet for 12 h
before the test.

The arms of each volunteer were washed with unscented soap, rinsed with water, and
dried for 5 min. A 1.5 mL aliquot of each repellent solution was applied evenly on the
right forearm between the wrist and elbow using a pipette and allowed to dry for
approximately 5 min. The

Repellent-treated right arms were placed into the test cage for 3 min at 1 h intervals,
DEET-treated arms for 6 h, and arms treated with fennel or citronella oil for 2 h. The
number of mosquitoes that landed on or bit that arm was recorded every hour.

Repellency () was calculated using the formula where is the number of mosquito bites
on the control arm and the number of bites on the treated arm.

The complete protection time (CPT) was defined as the time the first mosquito landed
on or bit a treated arm. To determine the CPT of mosquito repellents, the treated right
arm of each volunteer was inserted into the test cage for 3 min. If there were no bites,
that arm was reinserted at 10 min intervals until the first bite occurred.

The repellency of the control and treated arms was compared using -tests, with
a value< 0.05 considered statistically significant. SPSS was used for statistical analysis.
The CPT of DEET repellent was replaced with a Kaplan-Meier survival function, since
there were no bites over 6 h.
The study protocol was approved by the IRB of Konkuk University Hospital (Approval
number KUH 1120025). Forty-three volunteers were enrolled, all of whom provided
written informed consent.

To evaluate the effectiveness of repellent activity against mosquito, we performed

preparatory experiments with widespread kinds of mosquitoes, Culex pipiens, Aedes
togoi, and Aedes albopictus. Culex pipiens, common house mosquito, however, is not
ideal for the repellency test in the laboratory setting because it fed on human only at
night time due to its nocturnal characteristic. On the other hand, Aedes togoi showed
much less biting activity compared to Aedes albopictus throughout the experiment
setting, which is not optimal to quantify the biting rate to assess the effect of repellants.
Thus, Aedes albopictus was chosen to evaluate the effect of repellant activities clearly
in the experimental setting.

DEET, citronella, and fennel oil were tested on 10, 20, and 13 volunteers, respectively.
Initial skin tests on volunteers’ forearms were performed to assess their allergic
responses to the three repellents. As determined by a dermatologist, none of the
volunteers had allergic reactions at 48 h and 96 h (data not shown).

As hazards by mosquitoes have gradually increased, many kinds of mosquito repellents

have been manufactured to protect humans against mosquito bites. Because mosquito
repellents have played an important role in protecting humans from vector-borne
diseases caused by mosquitoes, standardized guidelines are needed to evaluate the
efficacy of these repellents.

In the United States, for example, repellents are tested against mosquitoes and other
pests according to the guidelines of the Environmental Protection Agency (US EPA;)
and the American Society for Testing and Materials (ASTM). Although European
guidelines have not been developed, the efficacy of these repellents has been tested
according to the guidelines of the World Health Organization Pesticide Evaluation
Scheme (WHOPES ;) and the US EPA, which are considered the international standard
testing guidelines.
In Korea, the standardized guideline to test the efficacy of mosquito repellents has been
established by modifying the existing EPA and WHOPES methods in 2012. In this
study, we applied a laboratory test and the semifield test (data not shown) to the
efficacy of DEET according to Yoon et al. and botanical mosquito repellents such as
citronella and fennel oils according to the KFDA guideline.

“Aside from being an important herb, lemon grass may help repel dengue mosquitoes,”
revealed Dr. Manuel Mapue, Department of Health (DOH) Regional Medical Dengue
Coordinator for Metro Manila during the Ovicidal/Larvicidal (OL) Mosquito Trap
Orientation held in Caloocan City on 28 May 2012. Lemon grass (Cybopogon citrates) is
a perennial herb widely used in Asian cuisine. It is commonly used for teas, soups and
curries. In the Philippines lemon grass is called “tanglad” commonly used to sav our
Filipino delicacies. In a study Evaluation of Herbal Essential oil against Mosquitoes by
the Department of Plant Production Technology and Faculty of Agricultural Technology
in Bangkok Thailand affirmed that lemon grass indeed contains organic repellents
against mosquitoes. In a laboratory experiment, volunteers were instructed to apply oil
extracts from different target crops including lemon grass on one of their arms, while the
other was untreated (control). Both hands were inserted in a cage containing 250
nulliparous female mosquitoes ageing 5-7 day old. Mosquitoes were observed in terms
movements and behaviours. Results showed that oil extracts from lemon grass,
peppermint, eucalyptus, citronella, and cloves were effective to repel both dengue and
malaria mosquitoes. However, the repellent effects of these oil extracts do not last
longer compare to synthetic chemicals, thus, further study to improve its formulation and
efficacy is needed. Another study on “The Effectiveness of Lemon Grass as a Natural
Mosquito Repellent” by the University of Southern California (USC), comparing the
repellent efficacy of lemon grass extract to the DEET (N,N-diethyl-m-toluamide) based
repellents or the leading commercial brands for insect repellents has found that lemon
grass extract could be used as an alternative to chemical insect repellent. Also
read:Commercial mosquito repellent lotion may induce allergies, study says According
to the study DEET-based repellents has 81% efficacy compare to 51% efficacy of lemon
grass extract. However, the study concluded that although lemon grass has lower
efficacy, many people are too sensitive to the DEET chemical used in repellent.
According to Dr. Marilyn Patricio, professor from the Central Luzon State University,
lemon grass is being used to repel pests in organic farming as part of the integrated
pest management (IPM) strategy in agriculture. “Planting lemon grass as border crop is
very effective to prevent the entry of insect pests in the farm. In fact, aside from lemon
grass, we also plant peppermint and other aromatic herbs to detract insect pests from
destroying the crop,” said Dr. Patricio. Like farm pests, Dr. Patricio believes that dengue
mosquitoes are detracted with the pungent aroma of lemon grass. She also
recommends planting lemon grass on backyard, especially near doors and windows to
shoo dengue mosquitoes in entering the home. On the other hand, in an interview with
Mr. Ferdinand Salazar, Supervising Science Research Specialist from the Department
of Medical Entomology, Research Institute of Tropical Medicine, Department of Health
(RITM-DOH) said that, planting lemon grass on backyards could help repel mosquito,
however it will not guarantee protection because people are moving around. “Though
there is no perfect single approach to control mosquitoes, adding all these plus our
eagerness to maintain cleanliness in our surroundings will surely control dengue
mosquitoes. Because after all cleanliness will not only spare us from dengue but to
other infectious diseases as well..

Adnan I Qureshi, in Ebola Virus Disease, 2016 Dengue fever in Asia and South America
Dengue fever is a mosquito-borne virus disease that has rapidly spread to several
regions in recent times. Dengue fever presents with high-grade fever, headache, mouth
nose bleeding, muscle joint pains, vomiting, rash, diarrhea, gastrointestinal bleeding,
altered consciousness, seizures, and itching. The disease spread throughout the tropics
with local variations, influenced by rainfall, unplanned rapid urbanization, and
temperature. In 1950s, during dengue epidemic in the Philippines and Thailand, a
severe form, known as dengue hemorrhagic fever, was first recognized, and has
become a leading cause of death among children in Asian and Latin American
countries. Unlike the Ebola virus infection, which causes a depletion of coagulation
proteins by affecting the liver, dengue fever causes hemorrhages by depleting the
platelets within the circulation. About 500,000 dengue fever cases require
hospitalization worldwide each year with large proportion of who are children. Close to
2.5% of those affected with dengue fever will die from the disease. There are four
serotypes of dengue fever virus. Recovery from one serotype does not provide
complete immunity against other serotypes. A subsequent infection by the other
serotype increases the risk of developing dengue hemorrhagic fever. Damon P.
Coppola, in Introduction to International Disaster Management (Second Edition) , 2011
Dengue fever is caused by four closely related “flavoviruses”: DEN-1, DEN-2, DEN-3,
and DEN-4. When people are infected with one of these viruses, they gain lifetime
immunity if they survive the illness. However, they will not have cross-protective
immunity, and people living in dengue-endemic areas can actually have four dengue
infections during their lifetime. Dengue fever occurs predominantly in the tropics, and is
spread through a cycle of infection between humans and the Aedes aegypti mosquito.
Stanley J. Naides, in Goldman's Cecil Medicine (Twenty Fourth Edition), 2012 Definition
Dengue is an acute febrile illness characterized by severe muscle and joint pain, rash,
malaise, and lymphadenopathy. The severity of the musculoskeletal complaints gave
rise to the sobriquet breakbone fever. Dengue occurs in the tropical and subtropical
climes of the Caribbean, Central and South America, Asia, and Africa. The mosquito
range extends into the southeastern part of the United States, where dengue
reemerged in the 1980s. After World War II, a spreading global pandemic has been
associated with erosion of mosquito control programs, human populations that have
spread into rural settings, accelerated population movement as a result of travel by
airplane, and large areas that have experienced deterioration in public health
infrastructure. Approximately 40% of the world's population lives in endemic areas; tens
of millions of individuals are infected annually. The Pathogen Dengue virus is a member
of the Flaviviridae family, which consists of single-stranded RNA viruses with a lipid
envelope approximately 50 nm in diameter. There are four serotypes of dengue: DEN-1,
DEN-2, DEN-3, and DEN-4. No cross-protection is seen among the serotypes, so
dengue can develop after infection with another serotype. Infection with a second
serotype places the individual at risk for the development of hemorrhagic fever.

During past five decades, dengue fever (DF) has increased rapidly up to 30-fold,
making it a global public health concern in the world. It has been reported that 128
countries all over the world are endemic for DF, including Sri Lanka. Dengue has
reached the worst ever epidemic status in Sri Lanka recording the highest ever number
of 186,101 cases in the year 2017. Ministry of Health recently declared 12 districts in
the island as heavily affected areas. Among them over 50% of the total cases have
been reported from the Western province of Sri Lanka, more specifically form Colombo
and Gampaha districts indicating the first and second highest dengue cases,
respectively.

Despite clinical progress towards the development of a vaccine against dengue virus
(DENV), there are no proven vaccines available to be used in disease control.
Therefore, vector control efforts that aim to limit populations of the vector and prevent
their invasion of other regions are considered as the only promising option at the
moment. Hence, vector controlling authorities in Sri Lanka have vigilantly focused on
source reduction and elimination of breeding habitats in the endemic regions.

The mosquito Aedes aegypti is the primary vector of DF, while Aedes

albopictus remains as the secondary vector. Being hydrophilic mosquitoes, they prefer
artificial containers for oviposition. Until recently, they were believed to oviposit in clear
and clean water. However, some recent findings evidence that they can breed not only
in clean and clear water bodies, but also in water with high organic matter content, low
dissolved oxygen levels, and high salinity conditions.

Several studies have claimed that the majority of dengue infections occur per
domestically, and therefore vector control has been embattled at residential areas.
However, a recent study conducted in the city of Colombo, Sri Lanka, highlights the fact
that, out of all identified breeding containers, about 11.9% residential premises, 66.7%
schools, and 21.2% work or public sites had at least one container positive for larvae
and or pupae. The highest breeding rate has been observed at school premises.

Children spend a considerable amount of time in the school environment, which can
facilitate the transmission of certain illnesses. As such, schools can serve as key
locations for health promotion and disease prevention activities. Health education and
personal sanitation are necessary initial steps in modern control of mosquito borne
diseases, as it involves removal of possible breeding sites of larvae. For dengue control,
public awareness and health education regarding the habitat and life cycle of the
mosquito vector, as well as its physical control, are important in maintaining the vector
population below risk levels. It is acceptable that there is severe lacking in the
awareness as well as health education about dengue and its transmission among
school communities. Therefore, the objective of the present study was to determine the
existing level of awareness of dengue infection and assess the effectiveness of dengue
awareness programmers on school children to improve the existing knowledge and
preventive practices on dengue. Hence, the study of this nature would be useful to
reduce dengue incidence by public awareness and encouraged community
participation.

During past five decades, dengue fever (DF) has increased rapidly up to 30-fold,
making it a global public health concern in the world. It has been reported that 128
countries all over the world are endemic for DF, including Sri Lanka. Dengue has
reached the worst ever epidemic status in Sri Lanka recording the highest ever number
of 186,101 cases in the year 2017. Ministry of Health recently declared 12 districts in
the island as heavily affected areas. Among them over 50% of the total cases have
been reported from the Western province of Sri Lanka, more specifically form Colombo
and Gampaha districts indicating the first and second highest dengue cases,
respectively. Despite clinical progress towards the development of a vaccine against
dengue virus (DENV), there are no proven vaccines available to be used in disease
control. Therefore, vector control efforts that aim to limit populations of the vector and
prevent their invasion of other regions are considered as the only promising option at
the moment [8, 9]. Hence, vector controlling authorities in Sri Lanka have vigilantly
focused on source reduction and elimination of breeding habitats in the endemic
regions. The mosquito Aedes aegypti is the primary vector of DF, while Aedes
albopictus remains as the secondary vector. Being hydrophilic mosquitoes, they prefer
artificial containers for oviposition. Until recently, they were believed to oviposit in clear
and clean water. However, some recent findings evidence that they can breed not only
in clean and clear water bodies, but also in water with high organic matter content, low
dissolved oxygen levels, and high salinity conditions. Several studies have claimed that
the majority of dengue infections occur peridomestically , and therefore vector control
has been embattled at residential areas. However, a recent study conducted in the city
of Colombo, Sri Lanka, highlights the fact that, out of all identified breeding containers,
about 11.9% residential premises, 66.7% schools, and 21.2% work or public sites had
at least one container positive for larvae and or pupae [14]. The highest breeding rate
has been observed at school premises. Children spend a considerable amount of time
in the school environment, which can facilitate the transmission of certain illnesses. As
such, schools can serve as key locations for health promotion and disease prevention
activities . Health education and personal sanitation are necessary initial steps in
modern control of mosquito borne diseases, as it involves removal of possible breeding
sites of larvae. For dengue control, public awareness and health education regarding
the habitat and life cycle of the mosquito vector, as well as its physical control, are
important in maintaining the vector population below risk levels. It is acceptable that
there is severe lacking in the awareness as well as health education about dengue and
its transmission among school communities . Therefore, the objective of the present
study was to determine the existing level of awareness of dengue infection and assess
the effectiveness of dengue awareness programmers on school children to improve the
existing knowledge and preventive practices on dengue. Hence, the study of this nature
would be useful to reduce dengue incidence by public awareness and encouraged
community participation.

Trends in dengue research in the Philippines: A systematic review Kristal An Agrupis,

Data curation, Writing – review & editing, Michelle Ylade, Writing – review & editing, [...],
and Jacqueline Deen, Conceptualization, Data curation, Formal analysis, Supervision,
Writing – original draft, Writing – review & editing Additional article information
Associated Data Supplementary Materials Data Availability Statement Abstract Dengue
is an important public health problem in the Philippines. We sought to describe the
trends in dengue research in the country. We searched four databases and identified
published studies on dengue research in the Philippines during the past 60 years. We
reviewed 135 eligible studies, of which 33% were descriptive epidemiologic studies or
case series, 16% were entomologic or vector control studies, 12% were studies on
dengue virology and serologic response, 10% were socio-behavioral and economics
studies, 8% were clinical trials, 7% were on burden of disease, 7% were investigations
on markers of disease severity, 5% were on dengue diagnostics, and 2% were
modeling studies. During the last decade, dengue research in the Philippines has
increased and evolved from simple descriptive studies to those with more complex and
diverse designs. We identified several key topics where more research would be useful.
Author summary Dengue is a disease caused by four separate but related viruses
transmitted by mosquitos. In this systematic review, we aimed to describe dengue
research in the Philippines, where the disease is of great concern, to better understand
the types of dengue research and the main findings and important gaps. We identified
135 studies that described dengue research in the Philippines during the past 60 years.
Our review showed that in the early years, dengue studies were mainly simple
descriptive studies and case reports. Recently the types of investigations have become
more complex and diverse, reflecting advancement in local research capacity and
infrastructure but more research activity would be beneficial in several areas.
Introduction Dengue is a mosquito-borne, acute febrile illness that is an important public
health problem in tropical countries. In the early 1950’s, the disease was described in
the Philippines as hemorrhagic fever or infectious acute thrombocytopenic purpura [1,
2]. Dengue continues to cause considerable concern in the country because of its
widespread endemicity, the minimal success of vector control strategies, the possibility
of severe disease caused by sequential infection by a different serotype, the potential
for fatal outcomes and the consequent social and economic burden. The four dengue
virus serotypes circulate in the country where the disease is predominantly reported
among children [3]. Findings from dengue studies could provide policy-makers with
information needed for rational decision-making regarding dengue preventive and
control efforts. The focus of dengue research may vary widely. This could include basic
laboratory research, the estimation of dengue seroprevalence and incidence; the
assessment of risk factors for severe disease; the quantification of its economic burden;
the elucidation of local transmission and epidemiology; the development of improved
diagnostic tests or the evaluation of interventions. We reviewed published studies on
dengue research in the Philippines during the past 60 years. The objective of the review
is to better understand the trends in dengue research and the findings from these
studies. The results of the review could provide an impression of local capacity and
infrastructure for dengue research and help determine important knowledge gaps.
These gaps need to be identified since research interest and support for funding can
only be achieved if scientists, decision makers and other stakeholders are able to
understand developments related to the disease and recognize areas where more
information is needed.

Lemon Eucalyptus Oil More Effective than DEET Mosquito Repellent MARCH 23, 2016
BY AARON KASE 2 COMMENTS Mosquitoes are among the most deadly disease
vectors in the world. The Zika virus, currently making headlines in Central and South
America due to its potential for causing severe birth defects if pregnant women are
infected, is just the latest in a long roster of mosquito-borne diseases, such as
chikungunya, dengue, West Nile, Japanese encephalitis, and yellow fever. Worst of all
is malaria, which kills over a million people every year. To avoid these debilitating
illnesses, most conventional mosquito-prevention advice guides people toward DEET, a
powerful chemical repellent. However, research suggests that natural solutions can be
even more powerful. A pair of studies found that lemon eucalyptus essential oil can be
equally or even more effective at warding off mosquitoes than DEET. The lemon
eucalyptus tree (Corymbia citriodora) is native to north eastern Australia. Via: alybaba |
Shutterstock. The lemon eucalyptus tree (Corymbia citriodora) is native to north eastern
Australia. Via: alybaba | Shutterstock. In one study, published in the Journal of the
American Mosquito Control Association, researchers tested the effectiveness of three
different types of eucalyptus-based repellent against Anopheles gambiae and
Anopheles funestus mosquitoes, two of the breeds that carry the deadly malaria
parasite in Sub-Saharan African. Subjects put the product on their legs and feet and
found that it protected them completely from mosquito bites for 6 to 7.75 hours,
matching the performance of DEET. Another study, conducted by the London School of
Hygiene and Tropical Medicine, tested a mix of 30 percent lemon eucalyptus essential
oil against two other natural repellents in addition to DEET. The various mixtures were
put on trial against Anopheles darlingi, the mosquito that is the primary vector of malaria
in Bolivia. Two of the natural repellents, one made from the Neem tree and another from
a mix of essential oils, were found to be ineffective at preventing mosquito bites. A 15
percent DEET compound performed better, providing about 85 percent protection from
bites. However, the lemon eucalyptus oil was the best repellent of the bunch, resulting
in 97 percent protection over four hours. Lemon eucalyptus oil is believed to work
because its main active ingredient, p-menthane-3,8-diol or PMD, blocks mosquitoes
from sensing human presence, masking signals like carbon dioxide and lactic acid. If
you purchase repellent that is labeled PMD, it could indicate it contains the natural
essential oil itself, or a synthetic mimic of the same chemical. PMD can cause irritation if
it gets in the eyes but is rated in the “least-toxic” category by ChemicalWatch. That’s
welcome news for people who would rather avoid DEET, which can cause skin irritation
and in rare instances has been implicated in seizures. Other research has suggested
that extended exposure to the repellent could be a factor in insomnia, mood
disturbances and impaired cognitive function. It has also been linked to neurological
damage in children. The next time someone turns their nose up at eucalyptus oil and
insists that DEET is the only way to prevent bug bites, tell them that the natural solution
actually outperformed the chemical in a scientific study. If you are heading to a tropical
country and need to protect yourself from disease, or simply want to avoid pesky bites
during picnics and barbeques this summer, there’s good reason to consider trying out
some lemon eucalyptus essential oil and discover its impressive mosquito repellent
qualities for you.

The Philippines is an archipelago of 7,107 islands with a population of about 101 million.
The country lags behind most of Southeast and North Asia in terms of health outcomes.
Dengue was first detected in the Philippines in the 1950s and remains a concern
because of widespread endemicity, minimal success of vector control measures, the
possibility of sequential infection by different serotypes and the risk for severe disease.
In the new work, Jacqueline Deen, of the University of the Philippines -- Manila, and
colleagues used four databases -- PubMed, the Cochrane Library, Science Direct, and
the Health Research and Development Information Network. They searched each for
articles dating 1958 through 2017 that included keywords related to dengue as well as
the Philippines. The team identified and reviewed 135 eligible studies on dengue in the
Philippines; 33% were descriptive epidemiological studies or case series, 16% were
entomologic or vector control studies, 12% were studies on dengue virology, 10% were
socio-behavioral and economic studies, 8% were clinical trials, 7% were on burden of
disease, 7% were on markers of disease severity, 5% were on diagnostics, and 2%
were modeling. In recent years, the number of dengue publications increased, and
types of investigations became more complex and diverse, the review noted. However,
they also identified several knowledge gaps: long-term comparative analysis of
epidemiological patterns by site and year, studies on newer intervention measures as
they become available, and more basic laboratory research are needed. "Studies such
as this can help raise awareness on the significance of the disease and the need for
better treatment and preventive strategies," the researchers say.

Trends in dengue research in the Philippines: A systematic review Kristal An Agrupis,

Michelle Ylade, Josephine Aldaba, Anna Lena Lopez, Jacqueline Deen Abstract
Dengue is an important public health problem in the Philippines. We sought to describe
the trends in dengue research in the country. We searched four databases and
identified published studies on dengue research in the Philippines during the past 60
years. We reviewed 135 eligible studies, of which 33% were descriptive epidemiologic
studies or case series, 16% were entomologic or vector control studies, 12% were
studies on dengue virology and serologic response, 10% were socio-behavioral and
economics studies, 8% were clinical trials, 7% were on burden of disease, 7% were
investigations on markers of disease severity, 5% were on dengue diagnostics, and 2%
were modeling studies. During the last decade, dengue research in the Philippines has
increased and evolved from simple descriptive studies to those with more complex and
diverse designs. We identified several key topics where more research would be useful.
Author summary Dengue is a disease caused by four separate but related viruses
transmitted by mosquitos. In this systematic review, we aimed to describe dengue
research in the Philippines, where the disease is of great concern, to better understand
the types of dengue research and the main findings and important gaps. We identified
135 studies that described dengue research in the Philippines during the past 60 years.
Our review showed that in the early years, dengue studies were mainly simple
descriptive studies and case reports. Recently the types of investigations have become
more complex and diverse, reflecting advancement in local research capacity and
infrastructure but more research activity would be beneficial in several areas. This is an
open access article distributed under the terms of the Creative Commons Attribution
License , which permits unrestricted use, distribution, and reproduction in any medium,
provided the original author and source are credited. Data Availability: All relevant data
are within the manuscript and its Supporting Information files. Funding: The author(s)
received no specific funding for this work. Competing interests: No authors have
competing interests. Introduction Dengue is a mosquito-borne, acute febrile illness that
is an important public health problem in tropical countries. In the early 1950’s, the
disease was described in the Philippines as hemorrhagic fever or infectious acute
thrombocytopenic purpura [ 1 , 2 ]. Dengue continues to cause considerable concern in
the country because of its widespread endemicity, the minimal success of vector control
strategies, the possibility of severe disease caused by sequential infection by a different
serotype, the potential for fatal outcomes and the consequent social and economic
burden. The four dengue virus serotypes circulate in the country where the disease is
predominantly reported among children [ 3 ]. Findings from dengue studies could
provide policy-makers with information needed for rational decision-making regarding
dengue preventive and control efforts. The focus of dengue research may vary widely.
This could include basic laboratory research, the estimation of dengue seroprevalence
and incidence; the assessment of risk factors for severe disease; the quantification of its
economic burden; the elucidation of local transmission and epidemiology; the
development of improved diagnostic tests or the evaluation of interventions. We
reviewed published studies on dengue research in the Philippines during the past 60
years. The objective of the review is to better understand the trends in dengue research
and the findings from these studies. The results of the review could provide an
impression of local capacity and infrastructure for dengue research and help determine
important knowledge gaps. These gaps need to be identified since research interest
and support for funding can only be achieved if scientists, decision makers and other
stakeholders are able to understand developments related to the disease and recognize
areas where more information is needed.

Humans are infected with dengue viruses by the bite of an infective mosquito (37). A.
aegypti, the principal vector, is a small, black-and-white, highly domesticated tropical
mosquito that prefers to lay its eggs in artificial containers commonly found in and
around homes, for example, flower vases, old automobile tires, buckets that collect
rainwater, and trash in general. Containers used for water storage, such as 55-gallon
drums, cement cisterns, and even septic tanks, are important in producing large
numbers of adult mosquitoes in close proximity to human dwellings. The adult
mosquitoes prefer to rest indoors, are unobtrusive, and prefer to feed on humans during
daylight hours. There are two peaks of biting activity, early morning for 2 to 3 h after
daybreak and in the afternoon for several hours before dark. However, these
mosquitoes will feed all day indoors and on overcast days. The female mosquitoes are
very nervous feeders, disrupting the feeding process at the slightest movement, only to
return to the same or a different person to continue feeding moments later. Because of
this behavior, A. aegypti females will often feed on several persons during a single
blood meal and, if infective, may transmit dengue virus to multiple persons in a short
time, even if they only probe without taking blood (46, 112, 114,135). It is not
uncommon to see several members of the same household become ill with dengue
fever within a 24- to 36-h time frame, suggesting that all of them were infected by a
single infective mosquito (43). It is this behavior that makes A. aegypti such an efficient
epidemic vector. Inhabitants of dwellings in the tropics are rarely aware of the presence
of this mosquito, making its control difficult. After a person is bitten by an infective
mosquito, the virus undergoes an incubation period of 3 to 14 days (average, 4 to 7
days), after which the person may experience acute onset of fever accompanied by a
variety of nonspecific signs and symptoms (136). During this acute febrile period, which
may be as short as 2 days and as long as 10 days, dengue viruses may circulate in the
peripheral blood (51). If other A. aegypti mosquitoes bite the ill person during this febrile
viremic stage, those mosquitoes may become infected and subsequently transmit the
virus to other uninfected persons, after an extrinsic incubation period of 8 to 12 days
(37, 46).

Dengue Fever Classic dengue fever is primarily a disease of older children and adults. It
is characterized by the sudden onset of fever and a variety of nonspecific signs and
symptoms, including frontal headache, retro-orbital pain, body aches, nausea and
vomiting, joint pains, weakness, and rash (1, 71, 131, 136, 149). Patients may be
anorexic, have altered taste sensation, and have a mild sore throat. Constipation is
occasionally reported; diarrhea and respiratory symptoms are infrequently reported and
may be due to concurrent infections. The initial temperature may rise to 102 to 105°F,
and fever may last for 2 to 7 days. The fever may drop after a few days, only to rebound
12 to 24 h later (saddleback). A relative bradycardia may be noted despite the fever.
The conjunctivae may be injected, and the pharynx may be inflamed. Lymphadenopathy
is common. Rash is variable but occurs in up to 50% of patients as either early or late
eruptions. Facial flushing or erythematous mottling may occur coincident with or slightly
before onset of fever and disappears 1 to 2 days after onset of symptoms. A second
rash, varying in form from scarlatiniform to maculopapular, may appear between days 2
and 6 of illness. The rash usually begins on the trunk and spreads to the face and
extremities. In some cases, an intense erythematous pattern with islands of normal skin
is observed. The average duration of the second rash is 2 to 3 days. Toward the end of
the febrile phase of illness or after the temperature falls to or below normal, petechiae
may appear; these may be scattered or confluent. Intense pruritus followed by
desquamation on the palms of the hands and soles of the feet may occur. Hemorrhagic
manifestations in dengue fever patients are not uncommon and range from mild to
severe. Skin hemorrhages, including petechiae and purpura, are the most common,
along with gum bleeding, epistaxis, menorrhagia, and gastrointestinal (GI) hemorrhage.
Hematuria occurs infrequently, and jaundice is rare. Clinical laboratory findings
associated with dengue fever include a neutropenia followed by a lymphocytosis, often
marked by atypical lymphocytes. Liver enzyme levels in the serum may be elevated; the
elevation is usually mild, but in some patients, almandine aminotransferase and
aspartame aminotransferase levels reach 500 to 1,000 U/liter. In one epidemic of DEN-
4, 54% of confirmed patients with data reported on liver enzymes had elevated levels
(32). Thrombocytopenia is also common in dengue fever; in the above epidemic, 34% of
patients with confirmed dengue fever who were tested had platelet counts of less than
100,000/mm3 (32). Dengue fever is generally self-limiting and is rarely fatal. The acute
phase of illness lasts for 3 to 7 days, but the convalescent phase may be prolonged for
weeks and may be associated with weakness and depression, especially in adults. No
permanent sequelae are known to be associated with this infection.

According to the World Health Organization, 50 to 100 million cases of dengue are
reported worldwide every year. Dengue fever can affect anyone—infants and young
children included. That’s why every year, especially during rainy season, the public is
advised to take precautionary measures to prevent dengue-carrying mosquitoes from
multiplying. According to the Pan American Health Organiza-tion, a case of DHF must
fulfill all of the following cri-terrier: fever (or recent history of acute fever), any Lhe in o r r
h a g i c manifest at i o n , t hro in b o c y t o p en i a (5100,000/mm’), and objective
evidence of increased cap-illary permeability (e.g., hemoconcentration [hemat-ocrit
increased by L20%], pleural effusion [by chest radiography or other imaging method], or
hypopro-teinemia).’ A case of dengue shock syndrome (DSS) must meet all these
criteria plus hypotension or narrow Pulse pressure (520 mmHg).*The fatality rate for
patients with DSS may be high (12%44%).’ There are also less common, but well
recognized, unusual manifestations of dengue fever that may produce high
1ethality.These are dengue fever with severe hem-orrhage, encephalopathy, hepatic
damage, up and myocar-diopathy.’-13 According to (Shamimul Hasan ) Dengue is an
acute viral illness caused by RNA virus of the family Flaviviridae and spread by Aedes
mosquitoes. Presenting features may range from asymptomatic fever to dreaded
complications such as hemorrhagic fever and shock. A cute-onset high fever, muscle
and joint pain, myalgia, cutaneous rash, hemorrhagic episodes, and circulatory shock
are the commonly seen symptoms. Oral manifestations are rare in dengue infection;
however, some cases may have oral features as the only presenting manifestation.
Early and accurate diagnosis is critical to reduce mortality. Although dengue virus
infections are usually self-limiting, dengue infection has come up as a public health
challenge in the tropical and subtropical nations. This article provide a detailed overview
on dengue virus infections, varied clinical manifestations, diagnosis, differential
diagnosis, and prevention and treatment

ed by biologists at the University of California San Diego, the research team describes
details of the achievement in Aedes aegypti mosquitoes, the insects that spread dengue
in humans, on January 16 in the journal PLOS Pathogens.

Researchers in UC San Diego Associate Professor Omar Akbari's lab worked with
colleagues at Vanderbilt University Medical Center in identifying a broad spectrum
human antibody for dengue suppression. The development marks the first engineered
approach in mosquitoes that targets the four known types of dengue, improving upon
previous designs that addressed single strains.

They then designed the antibody "cargo" to be synthetically expressed in female A.

aegypti mosquitoes, which spread the dengue virus.

"Once the female mosquito takes in blood, the antibody is activated and expressed --
that's the trigger," said Akbari, of the Division of Biological Sciences and a member of
the Tata Institute for Genetics and Society. "The antibody is able to hinder the
replication of the virus and prevent its dissemination throughout the mosquito, which
then prevents its transmission to humans. It's a powerful approach."

Akbari said the engineered mosquitoes could easily be paired with a dissemination
system, such as a gene drive based on CRISPR/CAS-9 technology, capable of
spreading the antibody throughout wild disease-transmitting mosquito populations.

"It is fascinating that we now can transfer genes from the human immune system to
confer immunity to mosquitoes. This work opens up a whole new field of biotechnology
possibilities to interrupt mosquito-borne diseases of man," said coauthor James Crowe,
Jr., M.D., director of the Vanderbilt Vaccine Center at Vanderbilt University Medical
Center in Nashville, Tenn.

According to the World Health Organization, dengue virus threatens millions of people
in tropical and sub-tropical climates. Severe dengue is a leading cause of serious illness
and death among children in many Asian and Latin American countries. The Pan
American Health Organization recently reported the highest number of dengue cases
ever recorded in the Americas. Infecting those with compromised immune systems,
dengue victims suffer flu-like symptoms, including severe fevers and rashes. Serious
cases can include life-threatening bleeding. Currently no specific treatment exists and
thus prevention and control depend on measures that stop the spread of the virus.

"This development means that in the foreseeable future there may be viable genetic
approaches to controlling dengue virus in the field, which could limit human suffering
and mortality," said Akbari, whose lab is now in the early stages of testing methods to
simultaneously neutralize mosquitoes against dengue and a suite of other viruses such
as Zika, yellow fever and chikungunya.

"Mosquitoes have been given the bad rap of being the deadliest killers on the planet
because they are the messengers that transmit diseases like malaria, dengue,
chikungunya, Zika and yellow fever that collectively put 6.5 billion people at risk
globally," said Suresh Subramani, professor emeritus of molecular biology at UC San
Diego and global director of the Tata Institute for Genetics and Society (TIGS). "Until
recently, the world has focused on shooting (killing) this messenger. Work from the
Akbari lab and at TIGS is aimed at disarming the mosquito instead by preventing it from
transmitting diseases, without killing the messenger. This paper shows that it is possible
to immunize mosquitoes and prevent their ability to transmit dengue virus, and
potentially other mosquito-borne pathogens."

Coauthors of the research include: UC San Diego graduate student Stephanie Gamez;
Anna Buchman and Ming Li of the Section of Cell and Developmental Biology, Division
of Biological Sciences, UC San Diego; Igor Antoshechkin of the California Institute of
Technology, Shin-Hang Lee, Shin-Wei Wang and Chun-Hong Chen of the National
Health Research Institutes (Taiwan); and Melissa Klein, Jean-Bernard Duchemin and
Prasad Paradkar of CSIRO Health and Biosecurity.

The Philippines is an archipelago of 7,107 islands with a population of about 101 million.
The country lags behind most of Southeast and North Asia in terms of health outcomes.
Dengue was first detected in the Philippines in the 1950s and remains a concern
because of widespread endemicity, minimal success of vector control measures, the
possibility of sequential infection by different serotypes and the risk for severe disease.

In the new work, Jacqueline Deen, of the University of the Philippines -- Manila, and
colleagues used four databases -- PubMed, the Cochrane Library, Science Direct, and
the Health Research and Development Information Network. They searched each for
articles dating 1958 through 2017 that included keywords related to dengue as well as
the Philippines.

The team identified and reviewed 135 eligible studies on dengue in the Philippines; 33%
were descriptive epidemiological studies or case series, 16% were entomologic or
vector control studies, 12% were studies on dengue virology, 10% were socio-
behavioral and economic studies, 8% were clinical trials, 7% were on burden of
disease, 7% were on markers of disease severity, 5% were on diagnostics, and 2%
were modeling. In recent years, the number of dengue publications increased, and
types of investigations became more complex and diverse, the review noted. However,
they also identified several knowledge gaps: long-term comparative analysis of
epidemiological patterns by site and year, studies on newer intervention measures as
they become available, and more basic laboratory research are needed.

"Studies such as this can help raise awareness on the significance of the disease and
the need for better treatment and preventive strategies," the researchers say.

Dengue has become a serious health problem worldwide, and scientists are focusing
their attention on understanding how the dengue virus causes disease. As they learn
more about how dengue affects the body, researchers hope to diagnose and treat
dengue better. Current dengue research also aims to provide better surveillance to limit
the effect of dengue epidemics.

Basic Research on Dengue

What does basic dengue research involve? Basic research includes a wide range of
studies focused on learning how the dengue virus is transmitted and how it infects cells
and causes disease. This type of research investigates many aspects of dengue viral
biology, including exploration of the interactions between the virus and humans and
studies of how the dengue virus replicates itself.

One important field of basic research is dengue pathogenesis, the study of the process
and mechanisms of dengue in humans. Scientists want to understand how the dengue
virus causes damage to the human body and how the immune system responds to a
dengue infection so that they can develop new treatments for the disease. For example,
researchers want to understand why bleeding and vascular leakage occur in patients
with severe dengue illnesses. Knowledge of the disease pathway may help doctors and
clinicians diagnose dengue at earlier stages. Researchers want to find out whether
there are genetic factors that result in an increased or decreased risk of infection for
individuals. Some people may be genetically susceptible to develop more severe
symptoms than other people.

Scientists are also studying the dengue viruses to understand which factors are
responsible for transmitting the virus to humans. Researchers are investigating how the
dengue virus replicates itself and the structure of the viral components, such as the
capsid, membrane, and envelope proteins. Scientists also want to know — how do the
dengue viruses manage to avoid detection by the immune system? Because viruses
can evolve and gain mutations over time, researchers are examining dengue viral
genetics and evolution to investigate changes in viral genomes over time. These
variations may help the virus hide from the immune system. Scientists know that
particular viral sequences are associated with more severe dengue symptoms. In
addition, certain dengue sequence variations may produce more deadly viruses with a
greater potential for causing epidemics. This kind of information can help scientists
monitor the regional spread of particularly dangerous dengue strains to help
communities prevent or prepare for dengue outbreaks.

Other dengue research focuses on vector biology. What is vector biology? This field of
dengue research studies the disease vector, Aedes mosquitoes. Vector biology studies
mosquito ecology, population biology, genetics, and behaviors to understand how
mosquitoes transmit the dengue viruses. Researchers can also study dengue
transmission patterns. As one example, researchers studied dengue infections in
children living in Nicaragua and saw that patterns of dengue transmission depended on
changes in climate and changes in the dengue serotypes in the area. Large-scale
studies of patterns in dengue transmission can provide essential information to resist
the disease, identify and diagnose dengue cases, and implement mosquito-control
efforts.

Diagnostics

Patients with severe dengue illnesses can be treated successfully if they are diagnosed
as early as possible. Scientists are working on improving dengue diagnostics so that
patients infected with dengue can be treated quickly. What would the ideal diagnostic
test for dengue do? The ideal diagnostic test would be able to distinguish dengue from
other diseases with similar symptoms and distinguish one dengue serotype from
another. An ideal diagnostic test would be highly sensitive during the acute stage of the
infection, quick and easy to use, and affordable.

How is dengue diagnosed? A number of laboratory methods are used to diagnose

dengue, including detection of the dengue virus, viral RNA, viral antigens, and
antibodies against the virus in the patient's blood or tissues (Figure 1). The virus can be
detected in the blood for only four to five days after the onset of symptoms. During this
early stage of the disease, isolation of the virus, viral RNA, and viral protein can be used
to diagnose dengue.

The detection of antibodies (IgM and IgG) in the blood of an infected individual is an
indirect method to diagnose dengue. This method is commonly used to diagnose
dengue in the later stage of the disease, after the viral levels have decreased.
Antibodies against dengue can be detected in most patients five days after the onset of
symptoms, and IgG can be detected for many months and even years after an infection
(Figure 2). During a primary (first) dengue infection, IgM levels are very high, but during
a secondary infection, IgM levels are lower. The levels of IgG actually increase during a
secondary infection. Therefore, clinicians can measure the amounts of IgM and IgG to
decide whether a patient has a primary or a secondary dengue infection. This test can
be useful because patients with secondary infections are more likely to have severe
dengue than those who have not had a previous infection. Because dengue can be
mistaken for other diseases such as yellow fever, measles, and influenza, it is best to
confirm a diagnosis of dengue by detecting the antibody response and testing for direct
evidence of the virus.
Have researchers developed any new diagnostic tests to diagnose dengue? Recently,
scientists developed a rapid, one-step test to detect and distinguish all four dengue
serotypes. This test is based on reverse transcription polymerase chain reaction
amplification of the viral RNA, and it is a sensitive, rapid, and cost-effective tool to
diagnose patients with dengue. A second approach involves diagnosing dengue
infections by detecting NS1, one of the seven nonstructural dengue proteins. NS1 is
produced in large quantities during dengue viral replication, and it can be detected as
early as the first day the patient experiences a fever.

Is there a way to know which patients might develop severe dengue? Scientists want to
find ways to quickly identify patients who are the most likely to develop severe dengue
illnesses. To identify these patients, researchers must first discover predictive factors for
severe dengue. One way researchers can discover these factors is to monitor the
progression of the disease and look for factors that predict severe illness by taking
frequent blood samples and ultrasound images from patients with dengue. Ultrasound
can measure indicators of severe dengue, including the thickening of the gall bladder
wall and excess fluids around the tissues and organs in the abdomen and chest cavity.
Knowledge of additional predictive factors could help researchers design more effective
diagnostic tests. Another strategy involves applying decision-making computer models
to diagnose patients with dengue and predict their prognoses by using clinical data,
such as the patient's platelet count and the presence of preexisting IgG antibodies
against dengue in the blood.

What can other fields of research do to prevent and control dengue? In addition to
performing basic research and improving diagnostics, improving dengue surveillance is
an essential way to prevent and control dengue transmission. The World Health
Organization — in partnership with ministries of health, research centers, and
laboratories around the world — has developed a dengue surveillance system called
DengueNet, a database that can be continuously updated to share current and historical
data on dengue cases. The goals of DengueNet are to standardize reporting of dengue
cases and to improve the preparedness of public health officials by providing early
warnings prior to epidemics, which can help reduce fatality rates.

Monitoring mosquito populations is a first line of defense against dengue. Vector

surveillance allows for a prompt response to control mosquito populations and limit
dengue transmission. Studying vector competence, the ability of Aedes mosquitoes to
acquire and transmit the dengue virus, can provide important information about
variations in the transmission of the different dengue serotypes. Researchers have
shown that delayed mosquito-control responses can lead to an exponential increase in
both the number of infected people and health costs. Public health officials can prevent
large dengue outbreaks by using surveillance information to plan mosquito-control
efforts and interventions and to provide resources to affected areas. Vector surveillance
is crucial for public health officials so that they can provide a prompt and preventative
response to dengue.

Dengue is an important public health problem in the Philippines. We sought to describe

the trends in dengue research in the country. We searched four databases and
identified published studies on dengue research in the Philippines during the past 60
years. We reviewed 135 eligible studies, of which 33% were descriptive epidemiologic
studies or case series, 16% were entomologic or vector control studies, 12% were
studies on dengue virology and serologic response, 10% were socio-behavioral and
economics studies, 8% were clinical trials, 7% were on burden of disease, 7% were
investigations on markers of disease severity, 5% were on dengue diagnostics, and 2%
were modeling studies. During the last decade, dengue research in the Philippines has
increased and evolved from simple descriptive studies to those with more complex and
diverse designs. We identified several key topics where more research would be useful.

Dengue is a disease caused by four separate but related viruses transmitted by

mosquitos. In this systematic review, we aimed to describe dengue research in the
Philippines, where the disease is of great concern, to better understand the types of
dengue research and the main findings and important gaps. We identified 135 studies
that described dengue research in the Philippines during the past 60 years. Our review
showed that in the early years, dengue studies were mainly simple descriptive studies
and case reports. Recently the types of investigations have become more complex and
diverse, reflecting advancement in local research capacity and infrastructure but more
research activity would be beneficial in several areas.

Dengue is a mosquito-borne, acute febrile illness that is an important public health

problem in tropical countries. In the early 1950’s, the disease was described in the
Philippines as hemorrhagic fever or infectious acute thrombocytopenic purpura. Dengue
continues to cause considerable concern in the country because of its widespread
endemicity, the minimal success of vector control strategies, the possibility of severe
disease caused by sequential infection by a different serotype, the potential for fatal
outcomes and the consequent social and economic burden. The four dengue virus
serotypes circulate in the country where the disease is predominantly reported among
children.

Findings from dengue studies could provide policy-makers with information needed for
rational decision-making regarding dengue preventive and control efforts. The focus of
dengue research may vary widely. This could include basic laboratory research, the
estimation of dengue seroprevalence and incidence; the assessment of risk factors for
severe disease; the quantification of its economic burden; the elucidation of local
transmission and epidemiology; the development of improved diagnostic tests or the
evaluation of interventions.

We reviewed published studies on dengue research in the Philippines during the past
60 years. The objective of the review is to better understand the trends in dengue
research and the findings from these studies. The results of the review could provide an
impression of local capacity and infrastructure for dengue research and help determine
important knowledge gaps. These gaps need to be identified since research interest
and support for funding can only be achieved if scientists, decision makers and other
stakeholders are able to understand developments related to the disease and recognize
areas where more information is needed.
The Philippines is an archipelago of 7,107 islands and is located in the western Pacific
Ocean in Southeastern Asia. The population of the Philippines in 2015 was
100,981,437. Philippine health status indicators show that the country lags behind most
of Southeast and North Asia in terms of health outcomes. Communicable diseases
continue to be major causes of morbidity and mortality in the country. Health care in the
Philippines is provided through a mixed public-private system.

This systematic review was conducted according to the Preferred Reporting Items for
Systematic Review and Meta-Analyses (PRISMA) guidelines. In June 2018, we
searched articles on PubMed, the Cochrane Library, ScienceDirect and the Health
Research and Development Information Network (HERDIN) from 1 January 1958 to 31
December 2017 combining MeSH and free-text terms for the following: dengue,
“dengue fever”, “hemorrhagic fever”, “dengue hemorrhagic fever”, “dengue shock
syndrome”, DF, DHF, DSS and Philippines without any language or age restrictions.
The search on HERDIN, an electronic database of health research in the Philippines,
was done to ensure that articles from local journals not indexed on international
databases are included. The completed PRISMA checklist is shown in the Supporting
information. There is no protocol for this systematic review.

The articles were compiled in Endnote (Thomson Reuters, San Francisco, CA, USA).
Titles and abstracts were screened for eligibility. Published articles on dengue research
in the Philippines and on Filipinos that reported objectives, methods and results or
descriptive epidemiologic and case reports were included.

We excluded unpublished articles, studies that were not focused on dengue or not
focused on the Philippines, those reporting aggregated results from various countries or
analysis of a global or regional collection of viral isolates and specimens from which
findings specific to the Philippines could not be retrieved, those reporting the same data
from another publication (duplicates), reviews and updates (not original research),
meeting or news reports, program descriptions, commentaries, guidelines on dengue
(prevention, treatment or diagnosis) and studies on expatriates and non-Filipinos.
Towards the goal of assessing the broad picture of dengue research in the Philippines,
we included studies that met the basic standard requirements and did not exclude
studies based on methodology or risk of bias or selective reporting.

The relevant full papers were downloaded and reviewed in detail. Information from each
eligible paper was extracted and entered into an Excel spread sheet (Microsoft Office
2007, Seattle, WA, USA). These included the study title, the year of publication, the
journal, the study site primary location, type of study, brief methods and study findings.
The summary measures were descriptive.

We compared the annual number of Philippine-related dengue publications with other

markers. As a measure of economic growth in the country, we assessed the Philippine
Gross Domestic Product (GDP) per capita (in current US dollars) in 1960 (the earliest
year data was available) and in 2017 . For comparison, we also obtained the annual
number of publications worldwide on PubMed combining the terms: dengue, “dengue
fever”, “hemorrhagic fever”, “dengue hemorrhagic fever”, “dengue shock syndrome”,
DF, DHF, DSS, from 1958 to 2017, without location, language or age restrictions.

According to Maia M. and Moore S. plant-based repellents have been used for
generations in traditional practice as a personal protection measure against host-
seeking mosquitoes. These. A study conducted by Phasomkusolsil S. and Soonwera M.
investigated insect bite protection and length of the protection with 30 repellents which
were divided into 3 categories: plant oil, essential oil and essential oil with ethyl alcohol
and was tested against three mosquito species. Essential oil from citronella grass
exhibited protection against biting from all three mosquito species. It means that
citronella oil is one of the effective element used in repellents to avoid attracting
mosquitoes. These compound is used by many Another study was conducted by
Trongtokit Y. and Rongsriyam Y. (2005). The mosquito repellent activity of 38 essential
oils from plants at three concentrations was screened against the mosquito Aedes
aegypti under laboratory conditions using human subjects. When the tested oils were
applied, none of them prevented mosquito bites for as long as 2 hours, but the undiluted
oils of citronella effected. The study shows that citronella oil is effective than any other
type of oils in preventing attraction of mosquitoes in the skin. 
Some plants like citronella, lemongrass, cedar, verbena, geranium lavender,
peppermint, tea tree oil, rosemary and garlic have repellant properties. Dengue
mosquitoes do not like the smell of these plants but the repelling action last only for 2
hours. 

Now, there is an effective and safe insect repellant called Oilganics Andiroba Herbal
Lotion. Unlike the existing insect repellant lotion in the market, with its chemical and
pesticide properties, this lotion is an all-natural herbal repellant that can also cure
bruises and open wounds because it has antiseptic and anti-inflammatory properties

Oilganics Andiroba Herbal Lotion contains Andiroba from Andiroba Plant or Brazilian

Mahogany. It can be found growing wild in the Amazon rainforest and well known in
Brazil and widely used as a natural insect repellent. Aside from treating insect bites,
here are more of its It has analgesic (pain reliever), anti-bacterial, antiparasitic and anti-
inflammatory properties. 
Theoretical Framework

According to Eva Harris (far right) has led a dengue study in Nicaragua that for more
than 12 years has regularly taken blood samples from children. ALEJANDRO
BELLI/PLOS PATHOGENS New evidence that dengue antibodies trigger life-
threatening infections By Jon CohenNov. 2, 2017 , 2:10 PM It’s a disease theory fit for a
spy novel: Protective antibodies can turn double agent, teaming up with the dengue
virus to make an infection more severe, even life-threatening. First proposed more than
40 years ago, antibody-dependent enhancement (ADE) has won over many doubters
but still has impassioned skeptics. Now, a finding from a large, long-term study in
Nicaraguan children adds compelling evidence that ADE is real, occurring when people
previously infected with dengue—and with the right level and type of dengue antibodies
still in their blood—become infected again. “It wasn’t my life mission to prove or
disapprove ADE,” says molecular biologist Eva Harris of the University of California,
Berkeley, who started the study to better understand dengue epidemiology and
pathology. “We kind of stumbled into it. And I never was really convinced until these
data.” Dengue, spread by mosquitoes, sickens up to 100 million people each year,
mostly in tropical regions of the world. The virus has four “serotypes,” each of which
triggers a unique antibody response. Someone infected for the first time with any of the
serotypes typically has a mild, flulike disease that causes fever and muscle pains but
does not require hospitalization. But those who become infected with a second serotype
later are at risk of dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS),
which can cause massive fluid loss, organ failure, and death.

organ failure, and death. SIGN UP FOR OUR DAILY NEWSLETTER Get more great
content like this delivered right to you! What is unclear is how, exactly, the first infection
makes the second one more severe. “That’s where the field has been stuck for
decades,” Harris says. ADE advocates say the pre-existing antibodies are to blame, but
others contend that T cells, innate immunity, and genetics also play important roles. The
ADE hypothesis, backed by test tube and animal data, builds on the fact that an
antibody to the first dengue serotype can bind to the virus, but not strongly enough to
“neutralize” it. This binding antibody/virus complex more easily enters host cells,
allowing the virus to copy itself at even higher levels. The intensified infection leads the
immune system to storm the body with chemical messengers called cytokines,
ultimately increasing the likelihood of blood vessels leaking, causing hemorrhage and
shock. ADE doesn’t always occur when people are infected with an additional dengue
serotype, say the theory’s supporters, because the mechanism is complex. Exposure to
dengue virus triggers a mix of binding and neutralizing antibodies—and ADE requires
the mix to be just right. If a person’s pre-existing dengue antibodies are low, there aren’t
enough binding antibodies to help the virus enter host cells. And if a person’s antibody
levels are high, they’ll have enough neutralizing ones that can “cross-react” to the
second infection and slow it down. The same thing happens if a person has been
infected with two or more serotypes. But people enter the ADE “danger zone” when
their levels are somewhere in the middle, Harris says. To do the study, Harris and her
team enrolled more than 8000 children between the ages of 2 and 14 in Managua and
analyzed dengue antibodies found in their blood samples repeatedly taken over a 12-
year period. Participants were asked to come to the study clinic if they had a fever;
those kids were bled again and referred to a hospital if necessary. More than 600
children came down with symptomatic dengue, and 44 of them developed DHF/DSS.
An analysis of 41,302 blood samples taken from the entire study at different time points
found that a child who had an intermediate antibody level and became infected again
had a 7.64 times higher risk of being in the small group that developed DHS/DSS,
researchers report today in Science. “[The study is] truly impressive and a good
example of how investments in long-term studies pay off,” says Aravinda de Silva, a
virologist who studies dengue at the University of North Carolina School of Medicine in
Chapel Hill. “I think this paper will put to rest whether antibodies can enhance dengue.”
It hasn’t, however. Timothy Endy, a dengue researcher at the State University of New
York Upstate Medical University in Syracuse, notes that the assay Harris’s group used
did not distinguish between binding and neutralizing antibodies—or even the different
serotypes. “This study falls short,” says Endy, who says it’s “simplistic” and “overstated”
to link ADE to specific levels of pre-existing dengue antibodies. “ADE is still a theory
that invites rigorous science and investigation.” Harris agrees that more work needs to
be done to characterize the specific antibodies behind the phenomenon. “This paper is
about a seroepidemiological finding,” she says. “It has the potential to be taken to next
step that has a finer resolution of exactly what kind of antibodies are being measured,
and that’s where we want to take it.” Even the father of the dengue-ADE hypothesis,
Scott Halstead of the Uniformed Services University of the Health Sciences in
Bethesda, Maryland, says the new work doesn’t offer definitive proof of ADE. “If you’re
going to say enhanced infection is occurring, you need direct evidence that infection
was enhanced,” Halstead says. One way of doing that, he suggests, is by showing
increased levels of virus in children infected for the second time. Still, Halstead says
he’s “delighted” to see the new data that support ADE. Alternative theories are
“fantasies” that have wasted research money, he says. Whether the new finding has a
practical application remains unclear. Halstead, Harris, and many other researchers
have raised concerns that a dengue vaccine produced by Sanofi Pasteur may, in fact,
be triggering ADE in some recipients. Clinical trials showed increased hospitalization
from dengue in young children who received the shot, which is now licensed in at least
11 affected countries. The World Health Organization recommends that it only be used
in kids over the age of 9, and only in areas where dengue incidence is high. Halstead
insists the increased hospitalization rate is due to ADE—which Sanofi Pasteur disputes
—and says the vaccine should not be given to people who test negative for dengue
antibodies. Harris agrees. And knowing that intermediate antibody levels increase the
risk of DHF/DSS could prove useful in the testing of future

vaccines by showing who might be in what she calls the danger zone. That, not
surprisingly, is debated, too.

 Studied were 35 male and female ages 1 to 30. Based on the study, the dermatologist
concluded that Oilganics Andiroba Herbal Lotion is significantly effective as a mosquito
repellant after 8 and 24 hours of exposure.

Mosquitoes are also attracted to those who have high cholesterol and high uric acid in
their sweat. Pregnant women who exhale double amounts of carbon dioxide are also
susceptible to getting bitten. According to research, those with blood “type o” are also
prone to bites because among all the blood types, this has the strongest smell attractive
to mosquitoes. 
Lemon Balm Mosquito Repellent, and Other Uses for Lemon Balm Lemon balm is a
valuable, easy-to-grow ally against biting insects, as well as a gentle curative. Use it to
repel mosquitoes naturally, and for much more. By Stephanie Bloyd August/September
2007 Lemon balm, the International Herb Association’s 2007 Herb of the Year, is an
ancient antidote to modern-day stress. This versatile herb can be used to calm nerves,
promote restful sleep, and reduce digestive distress — plus it could be your new best
friend in the great outdoors. Not only do its leaves have a rich, zippy, lemon smell, but
they also contain compounds that can repel mosquitoes. “Some northern European
forms of lemon balm are high in citronellal, a compound which mimics the well-known
herbal repellent citronella oil,” says Arthur Tucker, an ethnobotanist at Delaware State
University. He notes that some forms of lemon balm (Melissa officinalis) are nearly 38
percent citronellal. A variety called ‘Quedlinburger Niederliegende’ with this higher
content of essential oil is available from Johnny’s Selected Seeds and Richters. For a
quick mosquito repellent, simply crush a handful of lemon balm leaves in your hand and
rub them on your exposed skin. Grow the plants near your backdoor or in your garden,
where the leaves will be handy when you need them. Lemon Balm to the Rescue In
addition to keeping biting bugs at bay, lemon balm has a long history of medicinal use.
Cultivated in the Mediterranean region for the past 2,000 years, this perennial herb was
prized for its catchall curative properties. During the Middle Ages, King Charles V of
France was said to drink lemon balm tea daily for his health. Paracelsus, a Swiss
Renaissance physician, called lemon balm the “elixir of life.” And in the 17th century, the
French Carmelite nuns made their famous Carmelite Water with lemon balm and other
herbs to treat nervous headaches and neuralgia. Today, lemon balm is gaining
acceptance as a useful herb for modern stress-related maladies.

Dr. Frost is an Epidemiologist at the R. Stuart Dickson Institute for Health Studies,
Carolinas HealthCare System, Charlotte, NC; she reports no consultant, stockholder,
speaker’s bureau, research, or other financial relationships with companies having ties
to this field of study. Before synthetic repellents were developed in 1929, people
routinely used natural compounds to protect against insect bites. During World War II,
however, the United States government began testing more than 20,000 mosquito
repellents to protect troops traveling to tropical areas. As a result, a highly effective
synthetic repellent (N,N-diethyl-m-toluamide or DEET) was developed in 1953 and
arrived on the market in 1956.1 Currently, DEET is the most popular commercial insect
repellent, with close to 250 formulations sold worldwide. Despite its effectiveness, many
consumers are reluctant to apply synthetic chemicals to their skin and seek natural
alternatives to synthetic repellents. This desire has been exacerbated by reports that
DEET is dangerous for children, possibly inducing encephalitis. These cases are
extremely rare (17 suspected cases worldwide reported to date)2 and occurred in
children that orally ingested DEET or were repeatedly exposed to high concentrations.3
Nonetheless, many would rather err on the side of caution. Commercially available
insect repellents fall into one of two classes: synthetic chemicals or plant-derived
essential oils.4 Currently, there are only five active ingredients registered for topical use
in the United States: two are synthetic (DEET and IR3535) and three are plant-derived
(picaridin [KBR 3023], citronella, and p-menthane-3,8-diol [PMD]).1 One plant-derived
alternative that has sparked particular attention of late is oil of lemon eucalyptus. In fact,
the Centers for Disease Control and Prevention (CDC) recently reported that oil of
lemon eucalyptus (PMD is the active ingredient) is one of only three products (DEET,
picaridin, and PMD) recommended to protect against West Nile virus, a serious virus
spread by mosquitoes that can cause neurological disease or even death.5 The
Environmental Protection Agency (EPA) lists PMD as effective against mosquitoes,
biting flies, and gnats.

Melissa M. Remy Dengue fever is a mosquito-borne viral disease infecting several

hundred million people in tropical and subtropical areas every year. Its clinical
manifestations range from mild fever to severe life-threatening shock syndrom. No
therapeutics or licensed vaccines are available yet and with half of the world's
population already at risk, it represents a major public health concern. The co-existence
of four different Dengue virus serotypes renders difficult the obtaining of full protective
immunity against each one of them. On the contrary, these serotypes trigger significant
cross-reactivities of antibodies and T cells, both of which may lead to disease
enhancement when reactivated in the context of reinfection with a heterologous
serotype. Several immunological concepts have been developed to explain disease
enhancement, and the uncertainty around the topic has consequently slowed down the
development of Dengue vaccines. Recent advances however have shed light on key
aspects of both the immunoprotective and immunopathological mechanisms. In
particular the responses of specific antibodies and T cells have been a focus of many
studies. These immunological players are thought to directly influence a cytokine
dysbalance that eventually leads to severe disease and vascular leakage. In this review
I outline current concepts and ongoing debates on the above topics. A better
understanding of Dengue virus immunopathogenesis is critically needed to optimize
candidate vaccines including those currently under development. In particular, the
results from large-scale human efficacy trials will offer outstanding opportunities to
refine correlates of protection and design even more effective vaccines.

CDC lists oil of lemon eucalyptus as comparable to DEET for mosquitoes Melissa
Breyer Melissa Breyer MelissaBreyer June 29, 2018 Oil of lemon eualyptus Public
Domain pxhere Even the CDC recommends this botanical ingredient as comparable to
DEET for repelling disease-carrying insects. Oh the dichotomies of DEET. While DEET
is the gold standard of insect repellents, it is also a strong synthetic chemical with a
tarnished reputation. Known to the chemistry set as N,N-Diethyl-meta-toluamide, DEET
was potentially linked to 14 cases of brain damage in the 1980s and 90s, inciting a flood
of fear amongst consumers that has yet to recede. Other reports of ill effects from the
ingredients haven’t helped its cause. Scientific American describes one study, among
others: "A study conducted in the late 1980s on Everglades National Park employees to
determine the effects of DEET found that a full one-quarter of the subjects studied
experienced negative health effects that they blamed on exposure to the chemical.
Effects included rashes, skin irritation, numb or burning lips, nausea, headaches,
dizziness and difficulty concentrating." Meanwhile, in 2014 the EPA reported that after
an interim review of DEET, they were unable to identify any risks of concern to “human
health, non-target species or the environment.” So it's a bit of a mixed bag. A lot of
times we are left weighing relative risks. What’s more important: Using the strongest
weapons we can against disease-bearing insects, or staying away from synthetic
chemicals that have been associated with health problems? If you trust the EPA (this
writer may question some of their findings, just sayin') then repel to your heart’s content
with DEET, following the instructions, of course. BUT, there’s an alternative. Behold oil
of lemon eucalyptus (OLE), the plant-based active ingredient derived from eucalyptus
leaves and approved for efficacy by the CDC. The agency notes: "CDC has evaluated
information published in peer-reviewed scientific literature and data available from EPA
to identify several types of EPA-registered products that provide repellent activity
sufficient to help people reduce the bites of disease-carrying mosquitoes. Products
containing the following active ingredients typically provide reasonably long-lasting
protection." They list DEET, picaridin, IR3535, 2-undecanone, and oil of lemon
eucalyptus. They describe it as such: "Oil of lemon eucalyptus (OLE) or PMD (chemical
name: para-menthane-3,8-diol), the synthesized version of OLE. Products containing
OLE and PMD include, but are not limited to, Repel and Off! Botanicals. This
recommendation refers to EPA-registered products containing the active ingredient OLE
(or PMD). “Pure” oil of lemon eucalyptus (essential oil not formulated as a repellent) is
not recommended; it has not undergone similar, validated testing for safety and efficacy
and is not registered with EPA as an insect repellent." I know that some people shy
away from botanicals when they’ve got manmade alternatives to take care of the job,
but plants are powerful! There’s a reason why so many of our modern pharmaceuticals
are synthesized plant ingredients. Interestingly, a study published in Malaria Journal (if
anyone knows about mosquito protection …) explains how plants have been used for
millennia to repel insects. The use of plant-based oil formulations applied to the skin or
clothes were first recorded in writings by ancient Greek, Roman and Indian scholars. So
how effective is it? Consumer Reports looked at plant-oil based repellents and found
that one “product in our insect repellent ratings that contained 30 percent oil of lemon
eucalyptus (OLE) did well in our tests, warding off mosquitoes and ticks for at least 7
hours.” They add that other products with plant oils – including cedar, cinnamon,
citronella, clove, geranium, lemongrass, rosemary, and peppermint – “provided little
protection, often failing in our tests within a half-hour.” (Bonus: That one product that did
so well in the Consumer Reports ratings? Repel Plant-Based Lemon Eucalyptus Insect
Repellent. But be warned, as one Amazon reviewer put it, "omg does this stuff have a
strong smell to it. it not only repels mosquitoes but I'm sure it could work on mother in
laws, ex's, lawyers, cops, etc. I mean my wife was sent away in tears so imagine what it
must do to the bugs. it even says flammable on it?! this stuff is awesome!) So there you
have it. Even the decidedly-not-crunchy CDC finds this botanical alternative to DEET
good enough to recommend as one of the five ingredients to use against disease-
carrying pests. And Consumer Reports seconds the opinion in their meticulous testing.
That's good enough for me. The world already has enough synthetic chemicals being
sprayed about, it's time to let the plants do some heavy lifting. Note: Just because OLE
comes from trees, it's still strong stuff. Be sure to read and follow product instructions
closely.

In the eye-opening study from the London School of Hygiene and Tropical Medicine,
United Kingdom, four mosquito repellents were put to the test. One was a mixture of
several essential oils believed to have repellant properties. Another repellent was based
in Noem essential oil, a natural plant compound. They also tested a repellent containing
15 percent of the controversial DEET chemical. The final product was a lemon
eucalyptus-based repellent containing 30% p-methane-diol, a natural compound all
repellents were applied at the same dose. Both the Neem and the compound essential
oil mixture did not provide significant protection from the Anopheles mosquitoes. DEET
however gave 84.81 percent protection in a four hour period. In the same amount of
time the lemon eucalyptus-based repellent provided 96.89% protection. This study
debunks the theory lemon eucalyptus is effective in repelling mosquito. In another
study, researchers found similar results. Lemon eucalyptus essential oil was just as
effective as DEET in repelling Anopheles gambiae and Anopheles Funestus mosquitoes
for atleast six hours. These studies prove that botanical mosquito repellents can be
used with confidence. According to R.H Wright (Head, Division of Chemistry, British
Columbia Research Council Vancouver, Canada), to produce an odor sensation, a
substance must be volatile and its molecules must come into contact with the olfactory
end organ which may require some measure of lipoid solubility. This much is generally
agreed, but beyond this, there has been no accepted theom of the triggering process by
which the odorous molecule initiates discharge of the olfactory nerve. In part, this
ignorance has been due to the lack of any secure correlation between the odors of
substances and the chemical constitution or reactivity of the odorous molecules, on their
physical shapes or electrical properties. A correlation of odor with molecular vibrational
modes would be consistent with most of the facts of olfactory chemistry, but this
hypothesis has failed to win general acceptance until because, (1) there has been no
direct evidence of a correlation between odor and vibrational frequency, and (2) there
has been no suggestion of a mechanism whereby a molecular vibration could trigger a
nervous discharge. Some evidence bearing on both these objections has recently been
brought forward which is of considerable interest in relation to the problem of insect
attractancy and repellency. Theory of Olfaction and the Action of Mosquito Repellents.
Lemon Balm is a natural repellent, it is a member of the mint family and looks quite
similar with soft, grooved, slightly “fury leaves”. But rather than having a minty fresh
scent. It has a strong lemony aroma, somewhat similar to lemon verbena and citronella.
It is less desirable bugs and mosquito don’t feel quite fresh scent. It has a strong
lemony aroma, somewhat similar to lemon verbena and citronella. It is less desirable for
bugs and mosquito don’t feel quite so favorably about it. It contains high levels of a
compound called citronellal, which gives it its lemony aroma and flavor that bugs and
mosquitoes find so unpleasant. Researchers found out that lemon balm has a long
history medicinal use. Cultivated in the Mediterranean region for the past 2000 years,
this perennial herb was price for its catchall curative properties. According to James
Dulce “weedy lemon balm, which any old brown thumb can grow, would be one of the
herbs you should try before resorting to pharmaceuticals. On the other hand lemon
balm and rubbing them on the skin is confirmed to be effective on repelling mosquitoes.
The lemony scent of this plant has the same scent on native lemons, regarding the
lemon’s acidity, it would be an additional element that would repel or eliminate
mosquitoes at once.

In the eye-opening study from the London School of Hygiene and Tropical Medicine,
United Kingdom, four mosquito repellents were put to the test. One was a mixture of
several essential oils believed to have repellant properties. Another repellent was based
in Noem essential oil, a natural plant compound. They also tested a repellent containing
15 percent of the controversial DEET chemical. The final product was a lemon
eucalyptus-based repellent containing 30% p-methane-diol, a natural compound all
repellents were applied at the same dose. Both the Neem and the compound essential
oil mixture did not provide significant protection from the Anopheles mosquitoes. DEET
however gave 84.81 percent protection in a four hour period. In the same amount of
time the lemon eucalyptus-based repellent provided 96.89% protection. This study
debunks the theory lemon eucalyptus is effective in repelling mosquito. In another
study, researchers found similar results. Lemon eucalyptus essential oil was just as
effective as DEET in repelling Anopheles gambiae and Anopheles Funestus mosquitoes
for atleast six hours. These studies prove that botanical mosquito repellents can be
used with confidence. According to R.H Wright (Head, Division of Chemistry, British
Columbia Research Council Vancouver, Canada), to produce an odor sensation, a
substance must be volatile and its molecules must come into contact with the olfactory
end organ which may require some measure of lipoid solubility. This much is generally
agreed, but beyond this, there has been no accepted theom of the triggering process by
which the odorous molecule initiates discharge of the olfactory nerve. In part, this
ignorance has been due to the lack of any secure correlation between the odors of
substances and the chemical constitution or reactivity of the odorous molecules, on their
physical shapes or electrical properties. A correlation of odor with molecular vibrational
modes would be consistent with most of the facts of olfactory chemistry, but this
hypothesis has failed to win general acceptance until because, (1) there has been no
direct evidence of a correlation between odor and vibrational frequency, and (2) there
has been no suggestion of a mechanism whereby a molecular vibration could trigger a
nervous discharge. Some evidence bearing on both these objections has recently been
brought forward which is of considerable interest in relation to the problem of insect
attractancy and repellency. Theory of Olfaction and the Action of Mosquito Repellents.
Lemon Balm is a natural repellent, it is a member of the mint family and looks quite
similar with soft, grooved, slightly “fury leaves”. But rather than having a minty fresh
scent. It has a strong lemony aroma, somewhat similar to lemon verbena and citronella.
It is less desirable bugs and mosquito doesn’t feel quite fresh scent. It has a strong
lemony aroma, somewhat similar to lemon verbena and citronella. It is less desirable for
bugs and mosquito don’t feel quite so favorably about it. It contains high levels of a
compound called citronellal, which gives it its lemony aroma and flavor that bugs and
mosquitoes find so unpleasant. Researchers found out that lemon balm has a long
history medicinal use. Cultivated in the Mediterranean region for the past 2000 years,
this perennial herb was price for its catchall curative properties. According to James
Dulce “weedy lemon balm, which any old brown thumb can grow, would be one of the
herbs you should try before resorting to pharmaceuticals. On the other hand lemon
balm and rubbing them on the skin is confirmed to be effective on repelling mosquitoes.
The lemony scent of this plant has the same scent on native lemons, regarding the
lemon’s acidity, it would be an additional element that would repeal or eliminate
mosquitoes at once

Sue Pace It’s now well into the season of spring–almost summer– and once again,
we’re dealing with the emergence of pesky insects. Two of the most bothersome bugs
found in the United States are the mosquito and the tick. Today’s blog focuses on the
mosquito, and ticks will be discussed in an upcoming series, the first of which will be
published on the Tisserand Institute.
Mosquitos are one of the world’s leading causes of disease and death. The World
Health Organization says about mosquitoes “…their ability to carry and spread disease
to humans causes millions of deaths every year. In 2015 malaria alone caused 438,000
deaths” [1]. While malaria is a serious health concern worldwide, it’s not the only
mosquito-borne disease that can cause debilitating illness. Others include dengue fever,
chikungunya, yellow fever, West Nile virus, Zika, and Eastern Equine Encephalitis [Ibid].
However, for the majority of people in the U.S. mosquitos are an annoyance and
nothing more.
When discussing the subject of naturally-derived mosquito repellents, a 2011 article
which appeared on the ‘green’ website treehugger.com caused confusion in
aromatherapy circles, which continues today. The article’s headline declared that the
U.S. Centers for Disease Control (CDC) confirmed lemon eucalyptus oil to be just as
effective a mosquito repellent as the commercial repellent DEET [2]. This has led to
repeated questions on aromatherapy sites where people ask “how do I make a
mosquito spray using lemon eucalyptus oil?”
I admit that I was pretty excited when the article first came to my attention. That
excitement rapidly deflated when it became clear the CDC wasn’t talking about lemon
eucalyptus essential oil. Instead, the product they were referring to was oil of lemon
eucalyptus.
Oil of lemon eucalyptus contains a substance called para-Menthane-3,8-diol (PMD), a
naturally occurring compound obtained from the spent distillation of leaves of the
Corymbia citriodora tree (also known as Eucalyptus citriodora or lemon eucalyptus.

A 2011 article from Malaria Journal stated that “PMD is the only plant-based repellent
that has been advocated for use in disease endemic areas by the CDC due to its
proven clinical efficacy to prevent malaria and is considered to pose no risk to human
health. It should be noted that the essential oil of lemon eucalyptus does not have EPA
(Environmental Protection Agency)
Oil of lemon eucalyptus (PMD) has been included in clinical studies and has been
registered by the EPA as an effective plant based mosquito repellent, whereas lemon
eucalyptus essential oil has not. Though they may be derived from the same source, the
two are separate.
One of the primary limitations of using essential oils as insect repellents is their volatile
nature; that is, they tend to evaporate quickly and need to be reapplied frequently
[Ibid,4]. Also, in an oil of lemon eucalyptus formulation the level of PMD is standardized.
Many commercially available PMD repellents contain a level of 30% oil of lemon
eucalyptus, containing 65% PMD. Lemon eucalyptus essential oil has a very high
concentration of the aldehyde citronellal using it at anywhere near the same
concentration as oil of lemon eucalyptus would very likely cause skin concerns (or
worse).
So if you prefer using a naturally derived insect repellent product when mosquitoes
arrive at your garden party, you can ‘disinvite’ them by using a product containing PMD.
While you certainly can still use lemon eucalyptus essential oil as part of a homemade
insect blend, you cannot expect the same level of protection as a product containing oil
of lemon eucalyptus.

According to Cathy Wong, Medically reviewed by Richard N. Fogoros. Lemon

eucalyptus oil is an oil extracted from the leaves of a tree native to Australia (Eucalyptus
citriodora ) that is used as a natural insect repellant. The oil contains a compound called
para-menthane-3,8-diol (PMD) that makes it harder for mosquitoes and other insects to
pick up on your skin odor. Most commercially available insect repellents contain a
processed lemon eucalyptus oil that intensifies its concentration of PMD and, in turn,
increase its power and duration as a repellent. The Environmental Protection Agency
(EPA) classifies synthetic PMD as a “biochemical pesticide,” which is a type of naturally
occurring substance that controls pests by non-toxic mechanisms. Mosquitoes in the
U.S. can carry diseases like Zika, dengue, and chikungunya.according to the Centers
for Disease Control and Prevention (CDC). Other insects also carry diseases, such as
ticks and Lyme disease . Used as an insect repellent, lemon eucalyptus oil can protect
against bites that can lead to disease. Lemon eucalyptus oil is sometimes used as an
alternative to DEET, which is the active ingredient in many popular insect repellents.
While DEET is highly effective when it comes to warding off disease-carrying insects,
some individuals are concerned about its possible side effects, such as irritation of the
eyes and skin. Although lemon eucalyptus oil is most commonly used as a mosquito
repellent, it’s also said to stave off Lyme disease by preventing deer tick bites. In
addition, lemon eucalyptus oil has long been used to soothe muscle spasms and
alleviate osteoarthritis pain. However, there is a lack of scientific support for these uses
of lemon eucalyptus oil.

One might expect that the scientist who came up with the theory in the first place would
also cheer the publication. Dr. Scott Halstead has insisted for decades that dengue
antibodies were responsible when people who’ve had the virus develop severe — and
sometimes fatal — infections the second time around. But, he said, he does not see this
paper as the first in vivo proof of ADE.Halstead, a former U.S. Army scientist who is
now semi-retired, told STAT that evidence was arrived at a couple of decades ago
through studies conducted in Thailand. He acknowledged, however, that this is the
largest study to show the effect.And the fact that the paper was published by Science —
one of the highest-impact journals in the world — suggests its editors, too, felt this
research adds something significant to the scientific literature.In the study, researchers
followed a cohort of nearly 6,700 children between the ages of 2 to 14. They monitored
them for 12 years — and continue to follow them — drawing blood for testing every
year. And any time one of the children developed an illness with fever, which is a
hallmark symptom of dengue infection, they were assessed medically.Senior author Eva
Harris, a professor of infectious diseases and immunology at the University of
California, Berkeley, said the team analyzed the more than 41,000 blood samples they
had accumulated over the years, looking for a pattern that could explain why some
children develop severe disease — dengue hemorrhagic fever or dengue shock
syndrome — on their second dengue infection.They used three different statistical
approaches to explore the question, and “all roads led to Rome,” Harris said.“Amazingly
not only do we find that there is a specific titer of antibody that is predictive of severe
disease, but all the three methods came to the exact same range of titers,” she said.

Dengue fever is an acute, mosquito-transmitted viral disease characterized by fever,

headache, arthralgia, myalgia, rash, nausea, and vomiting. Infections are caused by any
of four virus serotypes (DEN-1, DEN-2, DEN-3, and DEN-4). The incidence of dengue is
increasing in most tropical areas throughout the world (Fig. l).Although dengue is not
endemic in the continental United States, Hawaii, or Alaska, more than 500 laboratory-
positive cases of introduced dengue were reported from 1977 through 1994 in U.S.
residents who visited dengueendemic areas throughout the world.’4 In addition, two
competent mosquito vectors (Aedes aegypti and Aedes albopictus) are found in the
southeastern United States, and both could possibly transmit an introduced virus. In
Hawaii, Ae. albopictus is the dominant mosquito on all islands; Ae. aegypti has only
focal distribution on Molokai and the Kona coast of Hawaii. Economic, political,
technologic, ecologic, and demographic changes have brought about the emergence of
new microbial diseases, as well as an increase in the incidence of previously known
infections. The increase in dengue activity in Asia,Africa, and the Americas represents a
pandemic that is being facilitate by increased air travel; global urbanization; population
growth; greater abundance of disposable, nondegradable containers that can serve as
Aedes production sites; and lack of effective mosquito control program^.^,^ This report
summarizes information about risk factors for severe disease, recent dengue outbreaks
throughout the world, and cases of dengue virus infection in travelers who have been
diagnosed on return to the United States. A clinical diagnosis of dengue fever is
reasonable in an acute febrile illness with two or more of the typical manifestations
(headache, retro-orbital pain, myalgia, arthralgia, rash, hemorrhagic manifestations,
nausea or vomiting) in a person who has recently lived in, or had recent travel to, a
tropical area. Most dengue infections result in relatively mild illness, but many will also
result in biochemical evidence of hepatocellular damage, and some can produce
dengue hemorrhagic fever (DHF). Although DHF/DSS can occur in primary infections
with certain strains of dengue virus, there is a higher risk for DHF in locations with two
or more virus serotypes circulating simultaneously. For individuals, there appears to be
a higher risk of DHF with a second infection (i.e., with a heterologous serotype). The
most widely accepted hypothesis for the pathogenesis of DHF in secondary infections is
immune enhancement. Antibody-dependent enhancement (ADE) of dengue viruses, as
suggested by in vitro studies, is a process in which the infecting virus is complexed with
non-neutralizing From 1986 through 1994, CDC’s Dengue Branch processed serum
samples from 937 residents of 48 states and the District of Columbia to confirm clinical
suspicion of dengue fever acquired during travel to tropical areas (Table 1). Of the 937
residents, 204 dengue cases (21.8%) were diagnosed serologically or virologically. The
mean number of reports per year was 104, and the mean number of laboratory-
diagnosed cases was 23 (Table Z).Virus serotype was identified in 20 of these cases
(9.8%): seven DEN-1, six DEN-2, four DEN-3, and three DEN-4. Most plants contain
compounds that they use in preventing attack from phytophagous (plant eating) insects.
These chemicals fall into several categories, including repellents, feeding deterrents,
toxins, and growth regulators. Most can be grouped into five major chemical categories:
(1) nitrogen compounds (primarily alkaloids), (2) terpenoids, (3) phenolics, (4)
proteinase inhibitors, and (5) growth regulators. Although the primary function of these
compounds is defence against phytophagous insects, many are also effective against
mosquitoes and other biting Diptera, especially those volatile components released as a
consequence of herbivory. The fact that several of these compounds are repellent to
haematophagous insects could be an evolutionary relict from a plant-feeding ancestor,
as many of these compounds evolved as repellents to phytophagous insects, and this
repellent response to potentially toxic compounds is well conserved in the lineage of
Diptera (True Flies). Insects detect odours when that volatile odour binds to odorant
receptor (OR) proteins displayed on ciliated dendrites of specialized odour receptor
neurons (ORNs) that are exposed to the external environment, often on the antennae
and maxillary palps of the insect, and some ORNs, such as OR83b that is important in
olfaction and blocked by the gold-standard synthetic repellent DEET (N, N-diethyl-3-
methylbenzamide), are highly conserved across insect species. Plants commonly
produce volatile “green leaf volatiles” when leaves are damaged in order to deter
herbivores, and several authors have shown strong responses of mosquito odour
receptors to this class of volatiles including geranyl acetate and citronellal , 6-methyl-5-
hepten-2-one and geranylacetone. Interestingly, the same odour receptors that respond
to DEET also respond to thujone eucalyptol and linalool in Culex quinquefasciatus.
In Anopheles gambiae, the DEET receptor OR83b is stimulated by citronellal, but is also
modulated by the TRPA1 cation channel. However, it is most likely that many plant
volatiles are deterrent or repellent because they have high vapour toxicity to insects.
This repellency of plant material has been exploited for thousands of years by man,
most simply by hanging bruised plants in houses, a practice that is still in wide use
throughout the developing countries. Plants have also been used for centuries in the
form of crude fumigants where plants were burnt to drive away nuisance mosquitoes
and later as oil formulations applied to the skin or clothes which was first recorded in
writings by ancient Greek, Roman and Indian scholars. Plant-based repellents are still
extensively used in this traditional way throughout rural communities in the tropics
because for many of the poorest communities the only means of protection from
mosquito bites that are available, and indeed for some of these communities , as in the
Europe and North America “natural” smelling repellents are preferred because plants
are perceived as a safe and trusted means of mosquito bite prevention.

This study investigated insect bite protection and length of the protection with 30
repellents which were divided into 3 categories: plant oil, essential oil and essential oil
with ethyl alcohol, tested against three mosquito species, Aedes aegypti, Anopheles
minimus and Culex quinquefasciatus, under laboratory conditions. The plant oil group
was comprised of Phlai (Zingiber cassumunar) and Sweet basil (Ocimum basilicum).
Both substances were effective as repellents and feeding deterrents against An.
minimus (205 minutes protection time and a biting rate of 0.9%), Cx. quinquefasciatus
(165 minutes protection time and 0.9% biting rate) and Ae. aegypti (90 minutes
protection time and 0.8% biting rate). Essential oil from citronella grass (Cymbopogon
nardus) exhibited protection against biting from all 3 mosquito species: for An. minimus,
Cx. quinquefasciatus and Ae. aegypti, the results were 130 minutes and 0.9%, 140
minutes and 0.8%, and 115 minutes and 0.8%, respectively. The period of protection
time against Ae. aegypti for all repellent candidates tested was lower than the Thai
Industrial Standards Institute (TISI) determined time of greater than 2 hours.

The mosquito repellent activity of 38 essential oils from plants at three concentrations
was screened against the mosquito Aedes aegypti under laboratory conditions using
human subjects. On a volunteer's forearm, 0.1 mL of oil was applied per 30 cm 2 of
exposed skin. When the tested oils were applied at a 10% or 50% concentration, none
of them prevented mosquito bites for as long as 2 h, but the undiluted oils
of Cymbopogon nardus (citronella), Pogostemon cablin (patchuli), Syzygium
aromaticum (clove) and Zanthoxylum limonella (Thai name: makaen) were the most
effective and provided 2 h of complete repellency.

From these initial results, three concentrations (10%, 50% and undiluted) of citronella,
patchouli, clove and makaen were selected for repellency tests against Culex
quinquefasciatus and Anopheles dirus. As expected, the undiluted oil showed the
highest protection in each case. Clove oil gave the longest duration of 100% repellency
(2–4 h) against all three species of mosquito

Dengue fever is endemic in Malaysia, contributing to significant economic and health

burden in the country. Aedes aegypti and Ae. albopictus are the main vectors of the
dengue virus (DENV), which circulates in sylvatic and human transmission cycles and
has been present in Malaysia for decades. The study investigated the presence and
distribution of DENV in urban localities in the Klang Valley, Peninsular Malaysia. A total
of 364 Ae. aegypti and 1,025 Ae. albopictus larvae, and 10 Ae. aegypti and
42 Ae. albopictus adult mosquitoes were screened for the presence of DENV. In total,
31 (2.2%) samples were positive, of which 2 Ae. albopictus larvae were co-infected with
two serotypes, one with DENV-2 and DENV-3 and the other with DENV-3 and DENV-4.
Phylogenetic analysis determined that the isolates belonged to DENV-1 genotype I
(1 Ae. aegypti adult), DENV-2 (1 Ae. albopictus larva), DENV-3 genotype V
(3 Ae. aegypti larvae and 10 Ae. albopictus larvae) and DENV-4 genotype IV
(6 Ae. aegypti larvae and 12 Ae. albopictus larvae), a sylvatic strain of DENV-4 which
was most closely related with sylvatic strains isolated from arboreal mosquitoes and
sentinel monkeys in Peninsular Malaysia in the 1970s. All four DENV serotypes were
co-circulating throughout the study period. The detection of a sylvatic strain of DENV-4
in Ae. aegypti and Ae. albopictus mosquitoes in urban areas in Peninsular Malaysia
highlights the susceptibility of these vectors to infection with sylvatic DENV. The
infectivity and vector competence of these urban mosquitoes to this strain of the virus
needs further investigation, as well as the possibility of the emergence of sylvatic virus
into the human transmission cycle.

Dengue is a mosquito-borne disease that has re-emerged as a major public health

problem in the 21st Century. The four serotypes of dengue virus are capable of infecting
humans with a range of symptoms and clinical outcomes, with the change in
predominating serotypes often responsible for new dengue outbreaks. In this study, we
surveyed urban sites in the Klang Valley, Malaysia, for Aedes aegypti and Aedes
albopictus mosquito vectors and confirmed the presence of all four serotypes of the
virus. We detected the presence of genotype V of dengue serotype 3, which has
previously not been reported in the country, as well as a sylvatic strain of dengue
serotype 4 that was closely related to strains obtained from forest-dwelling mosquito
vectors and sentinel monkeys in Malaysia. The detection of a sylvatic strain of dengue
virus in urban vectors raises questions over the risk of virus transmission to humans,
especially with recent reports of severe clinical cases as a result of infection with
sylvatic dengue virus serotypes. Further studies will be needed to determine the source
and origins of these strains as well as the severity of dengue disease upon infection,
especially with the development of new dengue vaccines.

Dengue disease surveillance and vector surveillance are presumed to detect dengue
outbreaks at an early stage and to save – through early response activities – resources,
and reduce the social and economic impact of outbreaks on individuals, health systems
and economies. The aim of this study is to unveil evidence on the cost of dengue
outbreaks.
Economic evidence on dengue outbreaks was gathered by conducting a literature
review and collecting information on the costs of recent dengue outbreaks in 4
countries: Peru, Dominican Republic, Vietnam, and Indonesia. The literature review
distinguished between costs of dengue illness including cost of dengue outbreaks, cost
of interventions and cost-effectiveness of interventions.

Seventeen publications on cost of dengue showed a large range of costs from 0.2
Million US$ in Venezuela to 135.2 Million US$ in Brazil. However, these figures were
not standardized to make them comparable. Furthermore, dengue outbreak costs are
calculated differently across the publications, and cost of dengue illness is used
interchangeably with cost of dengue outbreaks. Only one paper from Australia analysed
the resources saved through active dengue surveillance. Costs of vector control
interventions have been reported in 4 studies, indicating that the costs of such
interventions are lower than those of actual outbreaks. Nine papers focussed on the
cost-effectiveness of dengue vaccines or dengue vector control; they do not provide any
direct information on cost of dengue outbreaks, but their modelling methodologies could
guide future research on cost-effectiveness of national surveillance systems.

The country case studies – conducted in very different geographic and health system
settings - unveiled rough estimates for 2011 outbreak costs of: 12 million US$ in
Vietnam, 6.75 million US$ in Indonesia, 4.5 million US$ in Peru and 2.8 million US$ in
Dominican Republic (all in 2012 US$). The proportions of the different cost components
(vector control; surveillance; information, education and communication; direct medical
and indirect costs), as percentage of total costs, differed across the respective
countries. Resources used for dengue disease control and treatment were country
specific.

Dengue is geographically a fast-spreading disease (WHO 2012) . Outbreaks hit the

economy and health systems of endemic countries with variable epidemiologic
magnitude. Resources used for the prevention and treatment of dengue are not
available for alternative uses in health systems or in the economy as a whole. Dengue
is in competition with other diseases for the limited resources available, especially in
endemic countries with dengue-outbreaks, where too there are efforts to bring the costs
of dengue interventions within the reach of less wealthy populations. Health
technologies available to reduce the consumption of resources used to prevent and
treat dengue are therefore of high interest, since resources saved can be allocated to
other diseases and sectors of the economy. Investigations on the efficacy of health
technologies to combat dengue are nowadays always supplemented by health
economic analyses.

As a first step, this paper reviews available literature on cost of dengue outbreaks
worldwide. As a second step, country case studies are used to gather first-hand
evidence on the direct costs of dengue outbreaks in 2011 in four selected countries: two
countries in the Americas (Peru and Dominican Republic) and two countries in South
East Asia (Vietnam and Indonesia). The ultimate aim, which is not part of this technical
report, is to appraise the efficiency of improved surveillance.

The rationale of this research is to provide ministries or official institutions in dengue-

endemic countries with evidence on the costs of dengue outbreaks, so as to guide them
on the expected returns on their investments in surveillance systems tailored to identify,
respond to and stop potential dengue outbreaks at an early stage. The underlying
assumption was that by showing the costs of a dengue outbreak, governments would
be more inclined to put resources into outbreak prevention, early outbreak detection and
response.

Besides the practical difficulties in ascertaining costs of dengue outbreaks in the field,
the costing of dengue outbreaks is problematic in several other respects: i) the health
systems and the economy of countries are very different in terms of their health
systems’ structures and the resources deployed to combat dengue. ii) there is no
unique worldwide dengue outbreak definition the measurement of how much of an
outbreak could be avoided by certain interventions might be ethically and practically
impossible to conduct in a prospective field study.

However, the aim of the literature review is to study the publications on costs of dengue,
with respect to: A) how these dengue costs have been measured and B) what were the
findings in terms of cost of dengue.
The literature review was conducted in the following databases: the United States
National Library of Medicine and the National Institutes of Health Medical Database
(PubMed) (1966–2012); the Cochrane Database of Systematic Reviews (CDSR); the
World Health Organisation (WHO) library database (WHOLIS) and the Latin American
and Caribbean Health Sciences Database (Lilacs) (1967–2012); Econlit; and the library
of the Pan American Health Organization (PAHO). The free text search terms “cost” and
“dengue” were used. All citations up to April 1st 2012 were included, irrespective of
language or publication year.

We identified 220 citations out of which we selected 56 eligible abstracts according to

the following criteria: A) analysed cost; B) provided detailed methods; C) included data
analysis. Out of these selected abstracts we identified 12 duplicates and 3 papers that
were not accessible to us. Finally, 41 citations were selected for full text review. Dengue
cost studies were defined as analyses identifying, quantifying and valuing in monetary
terms those resources used (direct medical, direct non-medical, and indirect) at any
stage of dengue disease prevention or control, on any geographical level (region,
country, continent, world) from any perspective (patient, relatives, government, provider
or societal) at any level of intervention (vector, cases) and disease severity, including or
excluding assessments of effectiveness of health technologies. The rationale was to
collect as much information as possible from different publications, wherever costs were
analysed in the context of dengue, with the aim of compiling dengue outbreak costs.
 Conceptual Framework

Barangay Sta. Catalina

Zamboanga City

 Personal protection  Using lemon as home-

Lemon: A home-made
 Checking and made repellent
repellent in preventing  Throw away standing
removing stagnant dengue water
water from container
 Avoid strong fragrances
 Natural treatment  Applied lemon
 Healthy and having a eucalyptus oil to your
strong immune system skin
will protect against  Add lemon juice to the
dengue water to avoid attracting
mosquitoes

 To lessen the  Effective in treating and

infected of mosquito.  Get rid of the dengue preventing acne
virus breakouts
 Having a good
health.  Helping against  Helping the people
fever, flu, colds and away from the illness.
 Lemon is a good
Source of vitamin C. etc.  Prevent the mosquito.
 Improves your skin  Lemons may aid  Reduce your risk of
quality. weight loss heart disease and
digestive issues.
 CHAPTER III

Research Design
The research study entitled "lemon as a natural repellent in preventing dengue"
used quantitative-experimental study design because it allows the researchers to know
if the lemon repellent is effective to use in preventing dengue. This study will test the
effects of the dependent variable to the independent variable. Identifying the
relationship of these two will be the main goal of the study. The researcher will be
conducting survey in which the chosen respondents in the affected Barangay in
Sta.Catalina Zamboanga City needed to answer the questions that the researcher
provided.

Research Locale
This research study will be conducted at Barangay Sta.Catalina Zamboanga city
and conducted by the southern city colleges (main campus) Students. During the 18th
century Sta. Catalina, before it has gotten its name as such, was totally a mangrove or
swampy area where wild animals abound. The place was totally green with mangrove,
nipa or palm and others. During the time, Accessibility to the place was through jovellar
road that ended up at the junction of Tumaga road (Now veterans Avenue) in front of
now Zamboanga city medical center. From there a "trail" or commonly known as "pilapil"
was connected to the interior part of the vast mangrove/swampy place. In 20th century
intermarriages from among the original settles of the area and migration pressure of
population have increased and before world war II, the place was divided in two,
Sampaloc (Now lustre) and Balete. Thus in the early time before the place acquired the
name "Santa Catalina" it is known as sampaloc or balete during the war, many families
were dislocated or educated to safer places in the city most of them returned back to
sampaloc and balete. In late 1945, the elders who were respected community leaders at
the time, decided to consolidate sampaloc and balete into one apparently with idea of
giving it a permanent name, the original settles being predominantly catholic. Came out
to name the place as "Sta. Catalina" in honor of St. Catherine Sienna.

Respondents
The respondents of this study are the residents of Barangay Santa Catalina,
Zamboanga City. The study is focusing on "A lemon home-made repellent in preventing
dengue. This study wants to measure if the lemon repellent is effective in preventing
dengue. The researchers will conduct surveys to the chosen respondents to gather
information.
Sampling Size
The respondents of this research proposal are from Barangay Santa Catalina,
Zamboanga City with a total of 20,193 populations. 52 residents will be the respondents
of this research proposal.

Sampling Techniques
This study proposal used purposive sampling techniques in which the
researchers rely on their own judgment when choosing members of the population in
Barangay Santa Catalina Zamboanga City participate in this study.

Research Instrument
The research instrument used in the conduct of this study is survey
questionnaire in a form of checklist. The survey paper contains various questions about
the topic in accordance of collecting data from the respondents. The researchers will be
able to get the data needed for the study be accomplished.

Validity and Reliability

The research study was validated by our research advisor Mrs. Derhana
Salahuddin. She is the one who validated our questionnaire who is knowledgeable
enough to correct our grammar and provide procedures to our data gathering tools to
collect the data. With this, the researchers could have approval that the research paper
is valid and contains reliable data.
Data Gathering Procedure

This research is begin with the formulating a title and if you have
already a title, the researchers’ need to formulate a research problem and your
instrument should be validated so that you can make your questionnaire. But before you
will conduct a survey, the researchers should make an approval letter. After conducting
the survey, the researchers need to analyze and interpret the data collected from their
respondents and if they already finished it, that’s the time they can make the summary,
findings, conclusion and recommendation of their research study.

Formulating a Creating Validating the Creating

research title research Instrument approval letter
problem

Creating survey Analyzing the Interpret the Creating summary,

Questionnaire data collected data collected findings, conclusion
and
recommendation
 Appendix

Acknowledgement

First and foremost, the researchers want to offer this endeavor to our almighty God for
the wisdom he bestowed upon us, the strength peace of our mind and good health in
order to finish this research. The researchers would like to express their sincere
gratitude and appreciation to the following people for their dedication and contributions
in finishing this research work. We would like to thanks Mrs. Derhana Salahuddin, our
research teacher for the assistance, encouragement and also for the support to pursue
this study. And we would like to express our special gratitude and thanks to our adviser,
Mr. Muammar Gulamurasul for imparting his knowledge, love and support in this study.
Our family, who has been our constant source of love, support and cooperation in doing
this research paper.
Budget Proposal

Description Quality Quantity Cost Total

Venue Barangay hall 1 day Php 1,500.00 Php 1,500.00

Sound system Microphone, 2 items Php2,000.00 Php 2,000.00

sound box

Projector EPSON 1 item Php 1,500.00 Php 1,500.00

Seminar

a. Speakers Professional 2 speakers Php 1,500.00 Php 3,000.00

b. Honorarium Professional 2 speakers Php 500.00 Php 1,000.00

c. Certificates Printed 54 copies Php 50.00 Php 2,700.00

Food

Snacks Burger 54 pieces Php 25.00 Php 1,350.00

Water 54 bottles Php 10.00 Php 540.00

Lunch Pack lunch 54 pieces Php 45.00 Php 2,430.00

Other expenses

a. Lemon Fresh lemon 110 Php 20.00 Php 2,200.00

b. Container Bottle spray 52 pieces (10ml) Php 18.00 Php 936.00

 Description Quality Quantity Cost Total

Venue Barangay hall 1 day Php 1,500.00 Php 1,500.00

Sound system Microphone, 2 items Php2,000.00 Php 2,000.00

sound box

Projector EPSON 1 item Php 1,500.00 Php 1,500.00

Seminar

a. Speakers Professional 2 speakers Php 500.00 Php 1,000.00

b. Honorarium Professional 2 speakers Php 500.00 Php 1,000.00

c. Certificates Printed 54 copies Php 50.00 Php 2,700.00

Food

Snacks Burger 54 pieces Php 25.00 Php 1,350.00

Water 54 bottles Php 10.00 Php 540.00

Lunch Pack lunch 54 pieces Php 45.00 Php 2,430.00

Other expenses

a. Lemon Fresh lemon 110 Php 20.00 Php 2,200.00

b. Container Bottle spray 52 pieces (10ml) Php 18.00 Php 936.00

Actual Budget
 Southern City Colleges

SENIOR HIGH SCHOOL

Pilar Street, Zamboanga City, Philippines

"Lemon: A homemade lemon repellent to prevent dengue virus

In Santa Catalina, Zamboanga City”

Name (optional):

Sex:

Directions: Read the following questions carefully. Put check [√] if you agree in the given statement and
put [X] if not.

Questions Yes No

1. Do you know what the symptoms of dengue are?

2. Do you think lemon repellent is the best medicine for
dengue virus?

3. Is there any side effect of using lemon repellent?

4. Do dengue virus can lead to death?

5. Is lemon repellent safe for pregnant?

6. Do you think organic repellent is effective?

7. Are you aware that dengue virus can kill a person?

8. If you are already experiencing dengue fever, did you
intake any kind of herbal plants?

9. Do you think that lemon is effective as a repellant?

10. Is there any benefits you can get in using lemon?
 Southern City Colleges
SENIOR HIGH SCHOOL
Pilar Street, Zamboanga City, Philippines
"Lemon: A homemade lemon repellent to prevent dengue virus
In Santa Catalina, Zamboanga City”

March 9, 2020

Dr. Magdalena Y. Lim

SHS- PRINCIPAL

Thru: SHS Department,

The undersigned are Grade 12-STEM students from Senior High School Department who
are currently working in our research study entitled “LEMON: AS A HOMEMADE
REPELLENT FPR PREVENTING DENGUE VIRUS” in partial fulfillment of our
requirements in research Capstone.

In connection to this, we would like to ask for a permission of approval to conduct a

research proposal Orientation to Grade 11-humss a students of the Senior High School
Department on March 9, 2020 from 9:00 am – 11:00 am at Humanities and Social
Sciences room as to complete our final requirements in Research Capstone for the
Academic Year 2019-2020.

Your approval and kind cooperation on this matter will be a great help to us.
Thank you and God bless!

Noted by: Approved by:

Mrs. Derhana Salahuddin Dr. Magdalena Y. Lim
 Southern City Colleges
SENIOR HIGH SCHOOL
Pilar Street, Zamboanga City, Philippines
"Lemon: A homemade lemon repellent to prevent dengue virus
In Santa Catalina, Zamboanga City”

March 9, 2020

Dr. Magdalena Y. Lim

SHS- PRINCIPAL

Thru: SHS Department,

The undersigned are Grade 12-STEM students from Senior High School Department who
are currently working in our research study entitled “LEMON: AS A HOMEMADE
REPELLENT FPR PREVENTING DENGUE VIRUS” in partial fulfillment of our
requirements in research Capstone.

In connection to this, we would like to ask for a permission to collect statistical data on
the affected Barangays by Dengue virus disease on February 19, 2020 to Grade 11-
humss a students of the Senior High School Department on March 9, 2020 to complete
our final requirements in Research Capstone for the Academic Year 2019-2020.

Your approval and kind cooperation on this matter will be a great help to us.
Thank you and God bless!

Noted by: Approved by:

Mrs. Derhana Salahuddin Dr. Magdalena Y. Lim