Chapter 4
Public Health Pesticides
Robert J. Novak1 and Richard L. Lampman2
1
University of Alabama at Birmingham, Birmingham, Alabama
2
Illinois Natural History Survey, Champaign, Illinois
4.1 Introduction
The spectacular success with synthetic insecticides in the
decade immediately following World War II generated wide-
spread enthusiasm that the major scourges of mankind, such
as yellow fever, malaria, and typhus, could be conquered.
From 1955 to 1969, the World Health Organization (WHO)
Global Malaria Eradication Program eliminated malaria
from 36 countries, primarily by spraying inside human habi-
tats with a relatively inexpensive residual insecticide, DDT
(Metcalf and Novak, 1994). The annual number of malaria
cases in India was reduced from 75 million to 150,000 and
deaths from 750,000 to 1500 during the period from 1952 to
1966, largely due to the use of organochlorine insecticides
(Metcalf, 1998). Unfortunately, by the late 1960s, govern-
ments throughout the world were forced to reevaluate vec-
tor and pest control techniques. In addition to insecticide
resistance, there was a precipitous decline in beneficial
insect species, outbreaks of secondary pests, contamina-
tion of the environment and foodstuffs, and bioaccumula-
tion of pesticide residues in nontarget organisms, including
humans (Brogdon and McAllister, 1998; Brown et al., 1976;
National Academy of Sciences, 1980; WHO, 1972, 1992).
Furthermore, once malaria seemed to be under control, there
was a loss of trained vector control specialists in some coun-
tries, and in other countries pathogens started to develop
resistance to antimalarials (Gubler, 1996, 1998). The esca-
lating problems with agricultural pests and public health
vectors sparked a conceptual change in insect control, which
shifted from an almost exclusive reliance on insecticides to
a blend of cultural, physical, biological, and chemical meth-
ods (Curtis, 2001; Luckmann and Metcalf, 1994; WHO,
1995). Thus, currently the goal of WHO is disease manage-
ment through a combination of site-specific integrated pest
management (IPM) techniques in coordination with medi-
cal diagnosis, treatment, and epidemiological trend analysis
(see http://www.who.int/health-topics/malaria/en).
In general, IPM is an applied ecological approach to
curtailing the damage of injurious plants and animals to
Hayes’ Handbook of Pesticide Toxicology
Copyright © 2010 Elsevier Inc. All rights reserved
economically acceptable levels using a variety of long-
term and short-term interventions that are environmentally
and socially sound. With the advent of IPM, it is no longer
proper to discuss the use of pesticides without including
the context in which they are to be used and their potential
detrimental side effects (WHO, 1995). However, pesti-
cides remain a critical component of vector management
programs because they provide a rapid and highly effica-
cious means of reducing arthropod populations, particu-
larly when the potential for disease transmission is high. In
developing countries, approximately 10% of total pesticide
use is for vector management (Leng, 1999). In the United
States, it has been estimated that $150 million is spent on
vector control and surveillance for arboviral encephalitides
(see http://www.cdc.gov/ncidod/dvbid/Arbor/arbofact.htm).
To provide a general review of public health pesticides,
we briefly cover the following topics: (1) common terms
and concepts in medical entomology in order to introduce
the diverse relationships among humans, arthropods, and
disease pathogens; (2) the historical and current impact of
arthropods on human health; (3) the basic concepts of vector
management; (4) a brief list of noninsecticidal alternatives;
(5) the classification schemes and general properties of pub-
lic health pesticides and repellents; and (6) specific examples
of pesticides in vector management, particularly mosquito
control. Our approach to vector management is analogous
to that of modern medicine. Vector control specialists should
have the same degree of understanding about insecticides
and acaricides as a physician has for prescription drugs. The
impact of these chemicals on wellness of a human body or
an ecosystem has to be addressed before and after treatment.
The prevailing doctrine should be “Do no harm.”
4.2 Definition of terms in
vector-borne diseases
The science that deals with the impact of arthropods on
humans is typically called medical entomology, despite
231
232 Hayes’ Handbook of Pesticide Toxicology

the fact that noninsect species such as ticks, mites, and spi-
ders are generally included. The interaction of humans and
arthropod pests can be categorized into direct and indirect
effects (Harwood and James, 1979). Direct effects are phys-
ical, physiological, or psychological responses of humans
to the actions or the presence of arthropods. Direct effects
include blood loss, ectoparasitic skin irritations (dermatitis),
allergic reactions, envenomization, urticating hairs of cat-
erpillars, invasion of tissues and organs as with endoparasites
(such as myiasis with dipterans), and a wide range of
mental disturbances that range from prevention of normal
activities to delusional parasitosis (Table 4.1). Common
arthropods that cause direct effects include cockroaches,
bedbugs, blister beetles, spiders, scabies and chigger mites,
head and pubic lice, horse flies and deer flies, stable flies,
mosquitoes, ticks, and various species of ants, bees, cater-
pillars, and wasps.
Indirect effects are those where arthropods serve as car-
riers (vectors) of etiological agents (pathogens) to humans
and animals (hosts). The pathogen transfer may be by
mechanical transmission, carried on the outside of the
arthropod, or by biological transmission, carried internally
and typically transmitted through some arthropod product
such as salivary secretions or feces. In biological trans-
mission, the pathogen may undergo partial or complete
development, as well as multiplication, within the vector.
The principal vectors worldwide are flies and mosquitoes
(Diptera), ticks (Acarina), fleas (Siphonaptera), sucking

Table 4.1 Examples of Arthropods by Order and Family That Cause Indirect Annoyances to Humans and Animals
through Venoms and Toxins, Allergens, and Pests
Blood loss—prevention of normal activities
Culicidae (mosquitoes): Aedes vexans, Ae. sollicitans, Ae. dorsalis, Culex tarsalis, Psorophora columbiae
Simuliidae (black flies): Simulium vittatum, S. venustrum, Prosimulium hirtipes
Ceratopogonidae (no-see-ums): Culicoides canithorax, C. melleus, C. furens, C. obsoletus
Muscidae: Stomoxys (stable flies): Stomoxys calcitrans, S. irritans
Tabanidae (deer and horse flies): Chrysops sp., Tabanus sp.
Cimicidae (bedbugs): Cimex lectularis
Ixodidae (hard ticks): Dermacentor andersoni, D. variabilis, Rhipicephalis sanguineus
Dermatosis/dermatitis (skin irritations)
Pediculidae (head and pubic lice): Pediculis humanis capitus, Phthirus pubis
Sarcoptidae (scabies mites): Sarcoptes scabiei, Sarcoptes sp.
Trombiculidae (chigger mites): Trombicula autumnalis, T. alfreddugesi, T. splendens
Occupational mites: Pyemotis tritici, Tyrophagusputrescentiae, Glycyphagus domesticus
Liparidae (tussock moth)
Meloidae (blister beetles) and Oedemeridae (false blister beetle)
Invasion of tissues and organs
Flies (myiasis), beetles, and other insects
Hippoboscidae (louse flies): Melophagus ovinus
Muscidae (house, horn, stable flies): Haematobia irritans
Oestridae (bot flies): Gastrophilus equi, G. intestinalis, Hypoderma lineatum
Calliphoridae (blue bottle flies): Cochliomyia hominivorax (screw worm)
Envenomization, bites, and urticating hairs (wasps, ants, bees, spiders, caterpillars, stings, bites, localized reactions)
Apidiae (honeybees, bumblebees): Apis mellifera, Apis mellifera scutellata
Vespidae (wasp, yellow jackets, hornets): Vespula sp., Dolichovespula sp.
Mutillidae (velvet ants): Ephuta, Photomorphus, Pseudomethoca, Sphaeropthalma, and Timulla sp.
Formicidae (ants): Solenopsis sp. (fire ants), Camponotus sp. (carpenter ants), Formica sp. (wood ants)
Lepidoptera (caterpillars or larvae, urticating hairs)
Chapter | 4 Public Health Pesticides 233

Table 4.1 (Continued)

Saturniidae: Hemileuca oliviae, Automeris sp. (Io moths)
Lymantriidae: Nygmia phaeorrhoes (brown-tailed moth)
Megalopygidae (flannel moths): Megalopyge lanata
Arctiidae: Lithosa caniola, Arctia caja, Euchaetias egle
Nymphalidae: Nymphalis antiopa
Noctuidae: Acronicta lepusculina, A. oblinita, Catocala sp.
Thysanoptera (thrips): Thrips tabaci, Chirothrips aculeatus, Heliothrips jumipennis, H. sudanensis, H. indicus
Coleoptera (beetles): Meloidae (blister beetles): Lytta vesicatoria; Oedemeridae (false blister beetle)
Injection of toxin
Acarina: Metastigmata (can cause tick paralysis)
Ixodidae (hard-bodied ticks): Amblyomma sp., Dermacentor sp., Hyalomma sp., Rhipicephalus sp., Boophilis sp.
Argasidae (soft-bodied ticks): Ornithodorus sp.
Araneida (spiders): ������Phoneutria nigriventer (banana spider), Loxoceles reclusa (brown recluse spider), Lactrodectans mactans (black
widow spider)
Chilopoda (centipedes): Scolopendra subspinipes
Scorpiones (scorpions): Centruroides sp.
Allergic reactions (localized and systemic), insect body parts, by-products, bites, anaphylactic shock
Apidae (honeybees, bumblebees): Apis mellifera, A. mellifera scutellata
Vespidae (wasp, yellow jackets, hornets): Vespula sp., Dolichovespula sp.
Mutillidae (velvet ants): numerous species
Formicidae (ants): Solenopsis sp. (fire ants)
Culicidae (mosquitoes): numerous species
Simuliidae (black flies): numerous species
Acarina (house dust mites): Dermatophagoides pteronyssuss, D. farinae, numerous other species
Blattidae (cockroaches): ingested feces, numerous species
Acarina: Ixodidae and Argasidae (soft- and hard-bodied ticks)
Entomophobia and delusionary parasitosis
Numerous examples for all insects, spiders, ticks, and mites

lice (Anoplura), and true bugs (Hemiptera). The major
pathogens include viruses, rickettsia, bacteria, helminths,
and protozoa. Viruses transmitted by arthropods are called
arboviruses. Zoonoses are diseases in which the pathogens
are maintained in vertebrate hosts other than humans (i.e.,
yellow fever and arboviral encephalitis). Anthroponoses
are those diseases in which humans are the only known
vertebrate host (i.e., malaria and epidemic typhus).
Common vectors and pathogens for several important
tick- and mite-borne diseases are listed in Table 4.2. Insect-
borne pathogens and vectors are listed in Table 4.3, and
those transmitted by mosquitoes are listed in Table 4.4.
Mosquitoes deserve special recognition because they are
responsible for transmitting more pathogens to humans,
causing greater hardships worldwide, than all the other
vector-borne diseases combined (Busvine, 1993). Examples
of vectors and associated diseases include Anopheles mos-
quito species and the different types of malaria; the human
body louse, Pediculus humanus humanus L., and epi-
demic typhus; the mosquito, Aedes aegypti L., and yellow
fever and dengue; the oriental rat flea, Xenopsylla cheopis
(Rothschild), and plague; the tsetse flies, Glossina spp.,
and African trypanosomiasis; the Triatominae bugs and
American trypanosomiasis; Simulium species and onchocer-
ciasis; Leptotrombidium tick species and scrub typhus; and
the black-legged tick or deer tick, Ixodes scapularis, and
Lyme disease (Eldridge and Edman, 2000). Arthropods may
be both nuisance pests (direct effects) and disease vectors
234 Hayes’ Handbook of Pesticide Toxicology

Table 4.2 Vector-Borne Pathogens Transmitted by Mites and Ticks

Disease Pathogen Vector

Mites

Bacteria

Rickettsial pox Rickettsia akari Liponyssoides sanquineus

Scrub typhus R. tsutsugamushi Trombiculidae and Leptotrombium species

Ticks

Arboviruses

Tick-borne encephalitis Flavivirus Ixodes ricinus

Omsk hemorrhagic fever Flavivirus
Kyasanur forest disease Flavivirus
Powassan encephalitis Flavivirus
Russian spring–summer fever Flavivirus
Haemphysalis concinna
Crimean–Congo hemorrhagic fever Bunyaviridae, Nairovirus
Colorado tick fever Reoviridae and other tick species
Dermacentor pictus
D. marginalis
Ixodes persulcatus
Haemaphysalis species
Dermacentor andersoni
Ixodes persulcatus
H. japonica douglasi
Hyalomma marginatus and other tick genera
Dermacentor andersoni

Bacteria

Tick-borne relapsing fever Borrelia recurrentis Ornithodorus spp.

Tularemia Francisella tularensis Ixodes and Dermacentor sp.
Rocky Mountain spotted fever Rickettsia rickettsia Dermacentor andersoni
D. variabilis
Lyme disease Borrelia burgdorferi Ixodes scapularis
Dermacentor variabilis
Ehrlichiosis Ehrlichia sp. D. variabilis, Amblyomma americanum

Protozoa
Texas cattle fever Babesia bigemina Boophilus annulatus
East coast fever Theileria parva Rhipicephalus appendiculatus
Babesiosis Babesia microti Ixodes sp.

(indirect effects). For example, the forest day (Asian tiger)
mosquito, Aedes albopictus Skuse, which was introduced
into the United States presumably in used tires from Japan,
is a potential vector of several arboviruses; however, even
in the absence of disease transmission, it is an aggressive
daytime biter, making it a major pest wherever it becomes
established (Hawley, 1988; Hawley et al., 1987; Mitchell,
1991, 1995; Moore and Mitchell, 1997; Novak, 1995;
Shroyer, 1986).
The transmission of a pathogen may be classified as
either horizontal or vertical. Horizontal transmission is
from an infected animal host via vector to a new, unin-
fected animal host. Some pathogens, particularly viruses,
are also transmitted vertically. Vertical transmission may
be between an infected female host and her offspring or
between developmental stages of a vector arthropod. An
infected female insect may transfer pathogens to the eggs
(transovarial transmission) and the pathogens may be
transferred from the eggs to the different developmental
stages (transtadial transmission). Adult males may also
transmit pathogens to females during mating (venereal
transmission). A key concept in medical entomology is
that all species of arthropods are not capable of transmit-
ting all possible pathogens. Evolutionarily, a pathogen has
adapted by various means to the biological and ecological
barriers associated with its invertebrate vectors and verte-
brate hosts. Thus, mosquitoes, in general, do not transmit
the human immunodeficiency virus, Culex species are not
vectors of malaria, and Anopheles species are not a con-
cern for arboviral encephalitis. For a pathogen to pass from
an infected host to a blood-feeding vector, there must be
a relatively high level of circulating pathogens in the host
because of the extremely small percentage of total blood
taken in the blood meal. Many disease agents, such as
arboviruses and the malaria parasite, have overcome this
hurdle by causing either a viremia or a periodic release of
Chapter | 4 Public Health Pesticides 235

Table 4.3 Vector-Borne Pathogens Transmitted by Nonmosquito Insects

Insect species Disease Pathogen Distribution

Arboviruses
Phlebotomus papatasi Sand fly fever Bunyaviridae Africa, Asia, Europe
and other species
Culicoides sp. Bluetongue virus Reoviridae Africa, Asia, United States

Bacteria
Xenopsylla cheopis and Plague Yersinia pestis Worldwide
other rodent fleas
Xenopsylla cheopis, Murine typhus Rickettsia typhi North America, Europe
various species
Pediculus humanus Epidemic typhus Rickettsia prowazekii Worldwide, scattered foci

Pediculus humanus Louse-borne relapsing fever Borrelia recurrentis Mainly Africa

Phlebotomus spp. Bartonellosis Bartonella bacilliformis South America
Chrysops spp. Tularemia Francisella tularensis Worldwide

Protozoa
Glossina spp. African trypanosomiasis, African Trypanosoma gambiense, Africa
sleeping sickness T. rhodesiense
Triatominae spp. American trypanosomiasis Trypanosoma cruzi Central and South America
(Chagas disease) Panstrongylus spp.
Rhodnius spp.
Phlebotomus spp. Visceral leishmaniasis Leishmania spp. Mediterranean, North Africa,
L. donovani Middle East, Asia, Central and
South America

Phlebotomus spp. Cutaneous leishmaniasis Leishmania spp. North Africa, Middle East
L. tropica
Lutzomyia spp. American leishmaniasis L. braziliensis Central and South America
Psychodopygus spp.

Nematodes
Simulium spp. Onchocerciasis Onchocerca volvulus Central and South America, Africa
Chrysops spp. Loiasis, eye worm Loa loa West and central Africa

an infective stage in their hosts, respectively. For example,
Plasmodium parasites must pass through several biological
barriers in the mosquito vector, including the midgut and
hemolymph, in order to eventually concentrate in internal
organs such as the salivary glands where they are trans-
mitted to a host with the next blood-feeding cycle (Beier,
1998). If the pathogen completes this passage and can
infect a host, the arthropod carrier is called a competent
vector, even if it has not been demonstrated to be an eco-
logically significant one. Transmission efficiency may vary
considerably among species, and their role in transmission
in an area may depend on their abundance, longevity, and
feeding behavior. Animal hosts that do not produce a high
level of circulating pathogens for a biologically significant
period of time are dead-end hosts. They may contract the
disease but are not important in maintaining the transmis-
sion cycle. Such is the relationship of humans and many
arboviruses, such as St. Louis encephalitis virus (SLEV)
and eastern equine encephalitis virus (Monath, 1988).
Transmission does not invariably lead to disease in hosts
because many sylvatic hosts are asymptomatic. The patho-
gen also faces the possibility of being introduced by a com-
petent vector into a host capable of clearing the invading
pathogen or a previously infected host with a stimulated
immune system. Often, vertebrate hosts become immune
for an extended period of time after an initial infection;
however, there are also cases of recrudescence (in which
the host exhibits clinical symptoms of a disease from a
previous infection after a prolonged period of recovery).
Pathogens can also evade the immune response of hosts by
changing the antigen signal presented to the host’s immune
system (Mandell, 1990; Manson-Bahr and Bell, 1987). The
time from the introduction of the pathogen into the host
to the first clinical expression of the disease is called the
intrinsic incubation period. The extrinsic incubation period
is the time from which the vector acquires the pathogen
236 Hayes’ Handbook of Pesticide Toxicology

Table 4.4 Major Vector-Borne Pathogens Transmitted by Mosquitoes

Mosquito species Disease/agent Distribution

Aedes and Culex species
Culiseta melanura and Aedes species
Culex tarsalis and Culiseta species
Aedes aegypti
Culex tritaeniorhynchus
Culex pipiens, Cx. quinquefasciatus, Cx.
tarsalis,
Cx. Nigripalpus
Culex, Anopheles, and Aedes species
Aedes aegypti
Arboviruses—Togaviridae
Venezuelan equine encephalitis (VEEV) Tropical Americas
Eastern equine encephalitis (EEEV) Americas, Southeast Asia, eastern
Europe
Western equine encephalitis (WEEV) United States
Arboviruses—Flaviviridae
Dengue (DENV-1, -2, -3, -4) Worldwide Tropics
Japanese encephalitis (JEV) Asia, Japan
St. Louis encephalitis (SLEV) North and South America
West Nile virus (WNV) Israel, Europe, Russia, northern Africa
Yellow fever (YFV) South and Central America, Africa

Arboviruses—Bunyaviridae
Aedes triseriatus LaCrosse encephalitis (LACV) United States
Culex quinquefasciatus Rift Valley fever (RVF) Africa

Protozoa
Anopheles species Malaria Worldwide, Tropics and
An. gambiae, An. funestris, Plasmodium falciparum Subtropics
An. stephensi, An. albimanus, P. vivax
An. darlingi, An. darius, An. P. malariae
arabiensis, and others P. ovale

Nematodes
Aedes, Anopheles, and Brugian filariasis Southeast Asia
Mansonia species Brugia malayi Subtropics and Tropics,
Aedes, Culex, and Anopheles Bancroftian filariasis Worldwide
species Wuchereria bancrofti
Various mosquito species Dog heartworm, dirofilariasis, Dirofilaria Worldwide
immitis

to the point at which it can be transmitted to a new host
(Eldridge and Edman, 2000; Harwood and James, 1979).
Vectorial capacity is the effectiveness of a vector popu-
lation to transmit a pathogen at a specific time and loca-
tion. Measuring vectorial capacity means quantifying the
key biological interactions of the vector, host, and patho-
gen under different environmental conditions (Metcalf and
Novak, 1994). It generally represents a composite of patho-
gen virulence, host and vector susceptibility, vector ecol-
ogy (longevity, feeding preferences, mobility, abundance,
diurnal activity, etc.), and the influence of local ecological
variables and meteorological parameters (primarily rainfall
and temperature) on vector population dynamics (Lehane,
1991; Walker et al., 1996). Understanding vector ecol-
ogy provides the basis for determining when and where to
apply control interventions, and it is particularly important
for selective pesticide application (Service, 1993).
To determine the spatial and temporal distribution
of vector species, effective surveillance techniques are
required. Light traps are used for many flying insects,
carbon dioxide-baited traps for hematophagous arthropods,
chemical- and visual-baited traps for tsetse flies and black
flies, oviposition and gravid traps for mosquito eggs and
females, dippers for mosquito larvae, and dragging and
flagging for ticks (Bidlingmeyer, 1974; Calvin and Gibson,
1992; Reeves, 1990; Service, 1993). Note that most moni-
toring techniques collect both vector and nonvector species
and that accurate taxonomic description of the specimens
can be critical. For example, within the genus Anopheles,
there are considerable species-specific differences in vec-
tor competency and feeding behavior (Curtis and Townson,
1998). Some species avidly blood-feed on humans (anthro-
pophagy); however, their importance in transmission in a
particular area may be related to their occurrence inside or
outside of human habitats (endophily and exophily, respec-
tively). Refinement of surveillance techniques comes with
a better understanding of vector ecology and behavior.
Almost all of these techniques provide a relative estimate
of population abundance rather than an absolute estimate
(number per unit area or volume), and they are best used
Chapter | 4 Public Health Pesticides
as indicators of the presence or absence of the vector or for
seasonal changes in relative abundance (e.g., an increase in
oviposition or blood-feeding activity).
The transmission cycles of vector-borne diseases can
range from simple insect–man–insect transmission (e.g.,
malaria) to complex interactions with multiple hosts, res-
ervoir species, and vectors that may vary in different eco-
logical habitats (Eldridge and Edman, 2000; Harwood
and James, 1979). Vector and host interactions also vary
between arthropod developmental stages. For example,
ticks generally have larval and nymphal stages associated
with small mammal and bird hosts, whereas the adults are
often found on larger wild and domestic mammals and
humans. Ixodes scapularis, the black-legged tick or deer tick,
requires a blood meal for each developmental stage, which
takes approximately 2 years from larva to adult (Hinrichsen
et al., 2001; U.S. Armed Forces Pest Control, 1990). Each
stage feeds only once and each takes several days to ingest
the blood. Larvae and nymphs typically become infected
with the Lyme disease bacteria, Borrelia burgdorferi, when
they feed on infected white-footed mice (Peromyscus leu-
copus) or chipmunks (Tamias striatus). The adult stage is
found on larger animals and is often extremely abundant
on white-tailed deer that are usually asymptomatic for the
disease. Most Lyme disease cases in humans are associated
with the bite of the nymphal stage of I. scapularis, which
are difficult to detect because of their small size. Humans
primarily contract Lyme disease when they invade the tick
habitat either for work or for recreation and due to close
proximity of housing to natural areas with an abundance of
vectors and small, medium, and large blood hosts.
Transmission cycles that occur in the absence of humans,
generally under natural or sylvatic conditions, are called
enzootic or maintenance cycles, and those involving an
increase in transmission to domestic and peridomestic hosts,
as well as humans, are called epizootic or epidemic cycles
(Eldridge and Edman, 2000). Transmission cycles of a
pathogen can vary geographically. St. Louis encephalitis in
the United States has at least three distinct vector–pathogen
relationships in the western, east central, and southeast-
ern parts of the United States (Monath, 1988; Tsai and
Mitchell, 1989). Evidence indicates that genetic variability
in the pathogen, some of which may relate to virulence,
can be found between large-scale geographic areas, such
as the eastern and western United States, as well as small-
scale areas, such as differences in SLEV within a single
county in Texas (Chandler and Nordoff, 1999; Charrel
et al., 1999; Trent et al., 1980). Furthermore, an insect or tick
may transmit more than one pathogen, such as I. scapularis,
which has been implicated as the main vector for Lyme
disease (Borrelia burgdorferi), babesiosis (Babesia
microti), and ehrlichiosis (Ehrlichia chafeensis), or
Ae. aegypti, which transmits different serotypes of dengue,
as well as the yellow fever virus (Calisher and Monath,
1988; Lederberg et al., 1992; Zeidner et al., 2000).
237
Epidemiology is the study of the determinants, occur-
rence, and distribution of diseases in a defined population
(Nutter, 1999). It attempts to discover the linkage between
the environment and three aspects of disease transmission:
host–pathogen, pathogen–vector, and vector–host interac-
tions. The goal is to define the determinants and risk fac-
tors in order to develop the most effective measures for
prevention and control. For example, control tactics aimed
at reducing yellow fever epidemics had only marginal suc-
cess until it was determined that the mosquito Ae. aegypti
transmitted the virus (Karlen, 1995; McGrew, 1995). In
general, the more quantifiable information available about
the dynamics of the pathogen, vector, and host interactions,
the greater the opportunities are for disrupting the trans-
mission cycle (Metcalf and Novak, 1994).
4.3 Impact of arthropods on
human health
In addition to the emotional burden, vector-borne dis-
eases impose a huge economic encumbrance on families
and governments worldwide through lost productivity and
health care costs. For example, there are 300–500 mil-
lion clinical cases of malaria annually, with 1.5–2.7 mil-
lion deaths each year, including approximately 1 million
deaths among children younger than 5 years of age (WHO,
1995; see http://www.who.int/tdr/diseases/malaria/default.
htm). In sub-Saharan Africa, malaria accounts for 20% of
all childhood deaths. Lymphatic filariasis, another mos-
quito-borne disease, is second only to mental illness as
the world’s leading cause of long-term disability, disfigur-
ing more than 40 million people. Onchocerciasis, or river
blindness, transmitted by black flies, places more than 85
million people in Africa, Latin America, and the Arabian
Peninsula at risk for visual impairment, blindness, and
skin lesions. Sleeping sickness, transmitted by the tsetse
fly, threatens 55 million people in 36 countries of sub-
Saharan Africa. In Latin America, up to 18 million people
are infected with Chagas disease, a parasitic disease trans-
mitted by blood-sucking true bugs. The chronic stage of
Chagas disease can last for years as parasites invade the
internal organs. Leishmaniases, caused by flagellate pro-
tozoans transmitted by Old and New World phlebotomine
sand flies, affects more than 12 million people, damaging
internal organs and producing skin lesions and mutilations
of the nose and mouth. Approximately two-thirds of the
world’s inhabitable land mass is at risk for vector-borne
diseases, although it is undeniable that the Tropics have
the greatest hardship.
There can be little doubt that vector-borne diseases
have been instrumental in shaping human history, deter-
mining the outcome of wars and limiting human expan-
sion into potentially habitable tropical areas. The reader
is referred to several texts about the historical impact of
238
vector-borne diseases on human society (Busvine, 1993;
Karlen, 1995; Mandell, 1990; McGrew, 1995). It appears
that the Eurasian cradle of civilization in the Old World
was also the cradle of infectious and vector-borne dis-
eases, which is not surprising considering that the factors
favoring domestication of livestock and the development
of a stratified society also favored disease transmission
(Diamond, 1999). When Europeans started to conquer
and colonize the Americas, far more natives died due to
the introduction of lethal microbes (smallpox, measles,
influenza, mumps, pertussis, tuberculosis, etc.) than on
any battlefield. Of approximately 12 infectious diseases
of exotic origin that became established in the Americas,
4 were vector-borne – epidemic typhus, malaria, plague,
and yellow fever (Diamond, 1999). However, Europeans
and their progeny in the New World were not immune to
2 vector-borne diseases introduced through slave trade
from tropical Africa, namely yellow fever and malaria
(Manson-Bahr and Bell, 1987). Yellow fever was intro-
duced to the New World in the 1500s, and in some cases,
cities suffered a 10–15% mortality rate. Colonists and
slaves in the 16th and 17th centuries introduced two spe-
cies of Plasmodium malarial parasites (P. vivax and P. fal-
ciparum) into the Americas. During the Lewis and Clark
expedition across the Louisiana Purchase in the early 19th
century, Peruvian bark powder (containing quinine and
quinidine) was considered essential to fight the inescapable
fevers of malaria (Ambrose, 1996). Many of these malari-
ous areas had never been visited by Europeans or African
slaves; however, the disease had spread through native
American trade routes from areas of initial contact. Many
of the same vector-borne diseases remain as major impedi-
ments to the economic development of tropical areas in
both the New World and the Old World.
The decline of several vector-borne diseases during
the 20th century in the United States was due to a com-
plex mix of variables, including changes in housing con-
ditions, demographics, nutrition, medical diagnosis and
treatment, outdoor exposure times, and mosquito abate-
ment. However, North America is far from being free of
vector-borne diseases. The vector-borne pathogens in the
United States are the arboviral encephalitis viruses trans-
mitted by mosquitoes and the tick-borne borrelial and
rickettsial disease agents. Malaria cases do occur in the
United States, but they are primarily imported, brought in
by travelers from endemic areas. Occasionally, autochtho-
nous transmission does occur, especially in areas near air-
ports and areas where large groups of exposed individuals
congregate (Zucker, 1996). Competent vectors of malaria,
An. quadrimaculatus and An. freeborni, are still present in
the United States. This is true for several arthropod-borne
diseases. Outbreaks of dengue in Mexico annually threaten
Gulf Coast states such as Texas because they also have the
major vector, Ae. aegypti. It is important to realize that
although the incidence of major vector-borne diseases has
Hayes’ Handbook of Pesticide Toxicology
been reduced in the temperate zones of Europe and North
America, conditions do exist for their emergence and
reemergence (Childs et al., 1999; Mellor and Leake, 2000).
In the past 40 years, the leading industrialized nations have
been overconfident that new technologies, such as vacci-
nations, pharmaceuticals, synthetic pesticides, and genetic
engineering, will eventually manage vector-borne diseases
(Gubler, 1998). Although the benefits of technology have
not always been as anticipated, they have provided consid-
erable insight into the evolutionary processes governing the
co-adaptations of pathogens, vectors, and hosts.
Recent events have made us aware that even major
industrialized nations can be poorly prepared for the intro-
duction of new pathogens. For example, the West Nile
virus (WNV), a flavivirus in the Japanese encephalitis sub-
group, was introduced by unknown means into New York
City in 1999 and was perceived as two separate epidem-
ics, one in humans and the other in zoo and feral birds
[Centers for Disease Control and Prevention (CDC), 1999].
Apparently, by the time the pathogen was correctly identi-
fied from the different host sources and vector control was
implemented, the epidemic was already declining. Mosquito
pools positive for the virus implicated Culex pipiens as the
main vector and possibly the overwintering reservoir (CDC,
2000a–c). By the end of the following year, the virus had
spread to 12 states, with 21 human cases from Connecticut,
New Jersey, and New York; 4323 birds documented to be
infected in 12 states; and 60 horse cases in 7 states. The
number of mosquito species implicated as potential vectors
grew to approximately 12 (CDC, 2001a,b). This human
and wildlife threat may severely challenge the public
health and vector management infrastructures in the United
States.
4.4 Integrated pest management
and vector management
The concepts and practices of IPM, which were largely
developed in response to crop pests, were found to be read-
ily adaptable to arthropod public health pests (Dent, 1995;
Kogan, 1998; Metcalf and Novak, 1994). The initial step
in vector management is to identify and define, as best as
possible, the components of the pest management unit for
a specific area. Once the transmission cycle of the patho-
gen and the life histories of the vector, host, and reservoir
or maintenance species are identified, the cornerstone of
vector pest management is surveillance. An IPM program
can be initiated for almost any public health pest, even
with a limited knowledge of the transmission dynamics,
by implementing a monitoring strategy. Surveillance deter-
mines potential risk, when and where to treat, and the basis
for adapting management interventions to a particular area
(Service, 1993). Monitoring typically focuses on the inci-
dence of the vector and pathogens. Pathogen surveillance
Chapter | 4 Public Health Pesticides
may be in vectors, sentinel hosts, or humans (disease sur-
veillance). The detection of pathogens can be broadly
classified into direct and indirect methods (Duvallet et al.,
1999; Hoeprich et al., 1994; Mandell, 1990; Manson-Bahr
and Bell, 1987). Direct pathogen surveillance includes any
method that isolates the disease agent, in vivo or in vitro,
or some characteristic biochemical or structural compo-
nent of the pathogen. This includes visual detection, bio-
chemical response to the pathogen, and identification of
DNA/RNA sequences or fragmentation patterns. Indirect
pathogen surveillance includes methods that rely on an
in vivo or in vitro response to the pathogen, including
detection of characteristic pathology or antibody response
(host serology or various immunoassay methods) (Coyle,
1997). Federal, state, and/or local public health agencies in
the United States are usually responsible for pathogen or
disease surveillance and measuring trends in disease inci-
dence. However, human disease surveillance is seldom an
effective tool for managing an outbreak (Teutsch, 1994).
For example, the response to the WNV outbreak in New
York City included distribution of repellents to the public,
aerial applications of malathion and sumithrin, and a vast
public relations effort to warn and advise residents how
to avoid pesticide and mosquito exposure. An examina-
tion of the 1999 case data and onset dates indicates that the
epidemic had already peaked before the majority of these
actions were taken (CDC, 1999). In contrast, vector con-
trol may have reduced the number of human WNV cases
in 2000, although it was unable to contain the spread of the
virus (CDC, 2001b).
Most mosquito abatement districts (MADs) in the
United States focus on monitoring vector species (MADs
generally focus on mosquito management; however, their
mandate frequently includes other nuisance and vector
arthropods and vertebrate pests). The goal of vector man-
agement is to implement control techniques to reduce
pest abundance below the levels necessary for the transi-
tion from enzootic transmission to epizootic or epidemic
transmission. Unfortunately, due to the ecological and bio-
logical complexities of pathogen transmission, predictive
models are few (CDC, 1993; Monath, 1988; Reiter, 1988).
Thus, most MADs attempt to prophylactically reduce vec-
tor populations without knowing whether they are disrupt-
ing a pathogen transmission cycle or not. Typically, they
rely on seroconversion of sentinel animal hosts (e.g., chick-
ens for SLEV) or public health bulletins of human cases
before they implement emergency control measures, such
as ultra-low-volume (ULV) spraying for adult mosqui-
toes. For several vector-borne diseases, the ability to detect
pathogens in low concentration, as well as identify vector
and pathogen species and species subgroups by molecular
techniques, has revolutionized epidemiological studies and
provided vector management groups with an early warning
system (Crabtree et al., 1995; DeBrenner-Vossbrinck et al.,
1996; Howe et al., 1992; Munstermann and Conn, 1997).
239
Monitoring trends in vector populations and disease
incidence in humans and animal hosts is the basis for
developing and refining predictive epidemiological mod-
els, as well as for determining intervention failures and the
development of insecticide and/or pharmaceutical resis-
tance. In general, operational failures (e.g., the incorrect
amount of pesticide applied to the target vector) are more
common than cases of pesticide resistance, especially with
the advent of biodegradable carbamates and organophos-
phorous and pyrethroid insecticides and acaricides (note
that not all pesticides within each of these classes can be
considered biodegradable) (Bloomquist, 2001; Ware, 1991,
2001; WHO, 1997). However, the possibility of resistance
should never be ignored (Brogdon and McAllister, 1998;
Hemingway and Ranson, 2000). It has been estimated that
56 of the 66 important Anopheles vectors of human malaria
are resistant to three residual insecticides (DDT, lindane,
and dieldrin) that were widely used for malaria eradica-
tion. At least 31 of these species have additional resistance
to the organophosphates malathion and fenitrothion, and
another 14 species have multiple resistance to the carbar-
nate propoxur. Eight Anopheles species are resistant to
pyrethroids (Metcalf, 1989a,b). Any management pro-
gram that relies heavily on a limited number of chemicals
for vector abatement should be concerned about resistance
(Brown and Pal, 1971).
Integrated pest management attempts to minimize the
development of insecticide resistance by reducing the
selection pressure from a specific chemical agent through
the application of physiological, ecological, and/or behav-
ioral specificities (Metcalf, 1998, 1999). Specificity can
include the selection of pesticides that are more active
against the target organism than nontargets. It also includes
rotating chemicals of different classes and/or different vec-
tor detoxification mechanisms within and between vector
developmental stages. For example, in mosquito control,
an early season treatment with an organophosphorous com-
pound may be rotated with a later season treatment with a
pyrethroid or by not using the same pesticide for adult and
immature stages (e.g., malathion ULV for mosquito adults
and temephos liquid formulations for mosquito larvae).
Selection pressures can also be reduced by mixing chemi-
cal and nonchemical control techniques and by targeting
the placement of pesticides to maximize impact on the vec-
tor. This includes treating specific areas where there is a
concentration of the target vector, such as larval habitats or
resting sites of adults, and adjusting the seasonal and diur-
nal timing of applications to vector population dynamics
and flight periodicity.
Despite the similarities of vector management to crop
pest management, there are significant differences between
the two, many of which impact insecticide use. For example,
a pathogen transmission cycle may include enzootic and epi-
zootic cycles, involving multiple hosts, reservoirs, and vectors
that exhibit considerable habitat, seasonal, and/or bionomic
240
variation (Harwood and James, 1979). Transmission cycles
may be unknown, not apparent, or difficult to detect and
predict. In general, the number of confirmed cases of a
vector-borne disease underestimates the number of people
infected with a pathogen. Furthermore, action thresholds in
vector management (the level of tolerance of disease trans-
mission before a management intervention is taken) are
lower than economic thresholds for crop pests (the level
of damage tolerance before an intervention is taken). For
these reasons, public health management programs rely on
long-term and short-term prophylactic treatments to reduce
vector populations and eliminate breeding sites before
pathogen transmission has been detected, unlike crop pest
management (Curtis, 1990; Metcalf and Metcalf, 1993;
Mulla, 1994; Reeves, 1990; WHO, 1995). This approach
allows the use of natural enemies, source reduction, sani-
tation and sewage management, vegetation and water-flow
(salt, water, and freshwater) management, growth regula-
tors, microbial control agents, and relatively host-specific
insecticides (Beidler, 1995; Carlson et al., 1999; Dale
et al., 1998; Kramer et al., 1995; Russell, 1999; Wolfe,
1996). Prophylactic interventions are generally habitat and
vector specific, whereas emergency interventions tend to
rely on insecticides dispensed over broader areas that affect
a greater number of nontarget organisms. Insecticides will
probably always be an important component of vector
management programs because of their ease of applica-
tion, efficacy, and rapid action. The benefit:cost ratio for
pest control is $3 to $5 per $1 invested in agriculture and,
for vector control, approximately $2.7 per $1 invested
(Metcalf, 1998). Direct treatment of humans with insec-
ticides for vector control is rare, except for ectoparasites
such as head lice and scabies mites. Personal protection
includes repellents, antibacterials, vaccines (few are avail-
able for arthropod-borne diseases), and physical avoidance
of the vector. Integrated pest management for public health
pests is an areawide problem, involving public and private
lands in urban, agricultural, and natural habitats. Therefore,
vector abatement programs often require the cooperation
of several agencies and/or quasi-legal groups at the local,
regional, and national levels. Vector management also deals
with several potentially volatile topics, such as human and
animal health, pesticide application in urban environments,
insecticide impact on feral and domestic wildlife, and mod-
ification of human behavior to avoid exposure. Therefore, it
typically requires the cooperation of the public and various
governmental bodies. In the United States, the MADs are
area specific, taxing bodies that focus on monitoring and
controlling the vector within a county, suburb, or metro-
politan area. Pathogen and/or disease surveillance by local
or state public health departments and the CDC assists in
detection, trend analysis, standardization of techniques,
and training in vector and disease management. Primary
caregivers generally control prophylactic and/or therapeutic
drugs. The cost of vector management may exceed the
Hayes’ Handbook of Pesticide Toxicology
capabilities of local areas, thus requiring a governmental
presence. Unfortunately, those countries at greatest risk
for vector-borne diseases are also among the poorest, per
capita, countries in the world.
The arsenal of insecticides registered for public health
pests is relatively limited compared to crop pesticides and,
in areas with protected wildlife, consists of less than two or
three alternatives. The WHO Pesticide Evaluation Scheme
(WHOPES) lists less than 30 insecticides and acaricides
for use in public health (http://www.who.int/whopes/qual-
ity/en). Despite a WHO evaluation program to identify
new pesticides during the past 30 years, less than 5 have
been introduced in the past decade. One of the basic con-
cepts of IPM is the sagacious use of insecticides and acari-
cides. This strategy preserves the pesticide’s efficacy and is
essential for maintaining the limited arsenal. An unforeseen
dilemma in early attempts at vector eradication was the
loss of insecticides and acaricides to resistance. The loss of
public health insecticides is also due to a conflict between
projected profit, based on anticipated usage, and the cost of
meeting federal registration requirements. Legislation that
regulates registration of a pesticide, such as the Federal
Insecticide, Fungicide, and Rodenticide Act, has produced
tremendous benefits for U.S. citizens; however, many
chemical industries often conclude that the profit/cost mar-
gins are too small (or negative) and do not attempt to reg-
ister new products or reregister old ones for vector species.
Furthermore, the possible elimination of broad classes of
insecticides, such as the organophosphorous compounds
by the U.S. Environmental Protection Agency (EPA) under
the Food Quality Protection Act, has sparked considerable
discussion about the future of vector abatement (DiFonzo,
2001). Undoubtedly, the management of arthropod public
health pests will become increasingly more important in
the future but considerably more challenging.
4.4.1 Noninsecticidal Methods in Vector
Management
The optimal vector control program has several basic compo-
nents that include an IPM program planning group, seasonal
and full-time employees, facilities and equipment, vector
surveillance, disease detection, chemical and nonchemical
intervention activities, public education and public relations
activities, intergovernmental coordination, data record-
ing and analysis, applied research, emergency contingency
plans, and a continuing education component for staff.
Most vector management programs employ a wide range of
chemical and nonchemical methods to reduce pest arthropod
populations before the transmission of a pathogen occurs.
The noninsecticidal methods include environmental
manipulation; physical, behavioral, and chemical avoidance
methods; biological control; the burgeoning field of trans-
genics and molecular biology; vaccines and therapeutic
medicine; and legislative actions. It is beyond the scope of
Chapter | 4 Public Health Pesticides
this chapter to cover noninsecticidal control methods; there-
fore, we provide a brief annotated list of possible interven-
tions that vary in compatibility with insecticide treatments:
1. Environmental manipulation or habitat alteration:
Environmental manipulation temporarily or permanently
changes the environment to eliminate or reduce the num-
ber of breeding areas, or the habitat is altered to make
the breeding areas less hospitable for the arthropod
vector or host (Carlson et al., 1999; Hagmann, 1981;
Nayar, 1985; O’Meara, 1992; Shroyer, 1989; TVA,
1947; Wolfe, 1996).
Source reduction
Removal (drainage)
Sanitation and hygiene
Temperature treatment of infested materials
Source modification
Saltwater marsh management and tidal flooding
Stormwater and river management
2. Avoidance methods: Several cultural control techniques
attempt to physically or chemically prevent or at least
reduce the likelihood of contact between humans and
the vector (WHO, 1995). Probably one of the most suc-
cessful cultural controls of flying insects has been the
use of physical barriers to make the home a “vector-
free zone” (Gubler, 1998).
Quarantines and inspections
Timing human activities or place
Physical barriers
Housing characteristics (screens, air-conditioning, and
internal sprays)
Bed nets
Chemical repellents
3. Biological control: Biological control refers to all of
the natural biotic causes of mortality, including preda-
tors, parasites, and pathogens (Beidler, 1995; Couch
and Bland, 1985; Courtenay et al., 1989; Kerwin and
Washino, 1985; Mulla and Chao, 1991; Petersen, 1985;
Porter et al., 1993; Rupp and Rupp, 1995; Steelman and
Meisch, 1990; Woodring et al., 1996). The terms biolog-
ical and biorational insecticides are sometimes used to
group microbial insecticides with chemical products that
are arthropod specific and have minimal environmental
impact, such as insect growth regulators (juvenile hor-
mone analogs) or chitinase inhibitors. These are grouped
together in the section on chemical control methods.
Predators and natural enemies (vertebrates and
invertebrates)
Parasites (nematodes and arthropods)
Pathogens (viruses, bacteria, fungi, and protozoa)
Microbial insecticides
4. Transgenics: The refinement of molecular techniques
made possible the use of transgenics to control insects
(Brousseau et al., 1999; Crampton et al., 1990; James
241
et al., 1999; Kokoza et al., 2000; Marshall, 1998; Riebe,
1999). However, some have challenged the utility of
transgenics as a method of managing major vector spe-
cies (Jacobslorena and Lemos, 1995; Spielman, 1994).
Carriers of toxic genes
Altered vector competence
Symbionts
5. Medical treatment: Vaccines are not available for many
of the major protozoan and arboviral diseases, although
considerable work has been done with malaria vaccine
(Brown et al., 1999; Heppner and Ballou, 1998; Kaslow
et al., 1999) and experimental vaccines for eastern
equine encephalitis (Wilson et al., 1992). Antibiotics
successfully treat some protozoan and bacterial patho-
gens (Strickland, 2000).
Antibacterials
Vaccines
Convalescent care
6. Regulatory or legislative actions:
Local, state, and federal laws and policy statements
4.4.2 Chemicals in Vector Management
Pesticides are important components of most IPM pro-
grams. They are the pharmaceuticals of vector management,
and their application should be done on a case-by-case basis
with emphasis on doing no harm to nontarget organisms or
the environment.
4.4.2.1 Categorizing Insecticides
and Acaricides
Pesticides are divided into different classes or catego-
ries based on target organism, chemistry, general nature
or source, the developmental stage affected, acute and
chronic toxicity, general action on pests, biochemical or
physiological activity, application method, and formu-
lation. For a more comprehensive review of the mode of
action and formulation of pesticides, several texts are rec-
ommended (Barlow, 1985; Bloomquist, 2001; CDC, 1981;
Curtis, 1990; Goss et al., 1997; Metcalf, 1989b; Metcalf
and Novak, 1994; Sukumar et al., 1991; Tomlin, 1994;
Ware, 1991, 2001; WHO, 1985, 1988, 1990, 1997, 2001;
Worthing and Hance, 1991).
The main classification of pesticides is based on the tar-
get organism: herbicides, fungicides, rodenticides, bacteri-
cides, nematicides, piscicides, avicides, insecticides, and
acaricides. Insecticides and acaricides can be grouped by
specific target insects, such as termiticides (termites), pedic-
ulicides (lice), and miticides (mites). For mosquitoes, the
major vector of arboviruses in the United States, insecticides
are generally divided into categories based on the develop-
mental stage they affect (i.e., adulticides and larvicides).
242 Hayes’ Handbook of Pesticide Toxicology

Insecticides and acaricides are commonly grouped into

categories based on a combination of their chemistry and Table 4.5 Insecticides by Category for Arthropods of
general nature or source (Table 4.5). Insecticides may be Medical Importancea
grouped into inorganic compounds, microbial insecticides, Inorganic compounds
oils and surfactants, compounds of botanical origin, insect
Arsenical insecticides
growth regulators (IGRs), organochlorines, carbamates,
organophosphorous compounds, pyrethroids, pyridine Copper acetoarsenite (Paris green)
insecticides, and a general group of unclassified insec- Fluorine insecticides
ticides. Each of these groups can be subdivided based on
Barium hexafluorosilicate
chemistry or mode of action. For example, the organophos-
phorous compounds are subgrouped based on their specific Cryolite
chemical structure, such as the organophosphates, organo- Sodium fluoride
thiophosphates, and organophosphonates. Alternatively,
Sodium hexafluorosilicate
the IGRs are subgrouped by the natural compounds they
mimic – that is, juvenile hormone analogs and chitin syn- Sulfluramid
thesis inhibitors. Microbial insecticides
The U.S. EPA groups pesticides derived from natural
Bacillus thuringiensis israelensis
materials, such as animals, plants, bacteria, and some inor-
ganics, as biopesticides. Biopesticides have three major Bacillus sphaericus
categories: transgenic organisms with pesticidal genes, Lagenidium species
microbial pesticides, and biochemical pesticides such as Mosquito larvicidal films
IGRs and behavior-modifying chemicals. In vector control,
the majority of the research has focused on creating a car- Larvicidal oils
rier for Bacillus thuringiensis var. israelensis endotoxin Golden bear oils (GBOs)
genes that provides a slower settling rate, better uptake rate Bonide
by mosquito larvae, and photostability.
Categorizing insecticides by their mode of action yields Surfactants
several different groups, depending on whether the focus is BVA larvicides
their selectivity, their route of entry, or their site of action. Arosurf/Agnique
Insecticides may be broad spectrum, impacting many ani-
Plant essential oils
mal groups, or specific, primarily active against the target
group of arthropods. Based on route of entry, insecticides Botanical insecticides
are divided into contact, stomach, systemic, or respiratory Neem
poisons. They can be persistent (residual insecticides) or
Azadirachtin
short term (biodegradable). Unfortunately, within the bio-
degradable synthetic insecticides (e.g., carbamates, pyre- Pyrethrins
throids, and organophosphorus compounds), there are often Cinerin I, II
exceptions to the rule regarding persistence and acute tox-
Jasmolin I, II
icity. Probably the most informative classification system
is that based on the biochemical and physiological systems Pyrethrin I, II
attacked, which provides a better indication of the target Rotenone
specificity. For example, insecticides may be divided into
Ryania
neurotoxins, muscle poisons, metabolic inhibitors, and
physical toxicants. These can be even further subdivided. Sabadilla
Neurotoxins include chemicals that interfere with nerve Numerous toxic phytochemicals
transmission (acting on sodium or chloride channels), such
Insect growth regulators
as DDT, the pyrethroids, and -aminobutyric acid antago-
nists; neurotransmitter mimics, such as the nicotinoids and Chitin synthesis inhibitors
octopamine-related synthetics; and synaptic enzyme inhibi- Diflubenzuron
tors, such as the carbamate and organophosphorous anti-
Juvenile hormone analogs
acetylcholinesterases. A detailed discussion of insecticides
and their mode of action can be found in Metcalf (1989b) or Fenoxycarb
on the World Wide Web (Bloomquist, 2001; Ware, 2001). Hydroprene
Grouping pesticides based on toxicity also yields sev- Kinoprene
eral categories. A key decision that must be made by the
U.S. EPA during the registration process is determining the
Chapter | 4 Public Health Pesticides 243

Table 4.5 (Continued) Phoxim

Methoprene Phosphonate insecticides
Unclassified IGRs Trichlorfon
Azadirachtin Pyrethroid insecticides
Dicyclanil
First generation
Organochlorine insecticides
Allethrin
Chlorinated diphenyls
Second generation
DDT
Bioresmethrin
Methoxychlor
Bioallethrin
Chlorinated benzene
Phenothrin  sumithrin
-HCH, lindane
Resmethrin
Cyclodiene insecticides
Third generation
Chlordane
Fenvalerate
Dieldrin
Permethrin
Endosulfan
Fourth generation
Carbamate insecticides
Bifenthrin
Bendiocarb
-Cyhalothrin
Carbaryl
Cypermethrin
Propoxur
Organophosphorous insecticides Cyfluthrin

Organophosphate insecticides Deltamethrin

Dichlorvos Tralomethrin

Naled Etofenprox

Aliphatic organothiophosphates Pyridine insecticides

Malathion Acetamiprid

Heterocyclic organothiophosphates Imidacloprid

Coumaphos Thiacloprid
Pyridine organothiophosphates Unclassified insecticides
Chlorpyrifos Borax
Chlorpyrifosmethyl Crotamiton
Pyrimidine organothiophosphates Diafenthiuron
Diazinon a
Not all chemicals are currently registered.
Pirimiphosmethyl
Phenyl organothiophosphates
Fenitrothion
effect a pesticide will have on the environment and nontar-
get organisms. If a formulated pesticide will not generally
Fenthion
cause unreasonable effects, it is classified as “general use.”
Temephos Conversely, a pesticide that may cause adverse effects on
Fensulfothion the environment, including injury to the applicator and
wildlife, is usually classified as “restricted use.” Restricted-
Iodofenphos
use pesticides may be applied only by or under the direct
Aliphatic amide organothiophosphates supervision of a licensed applicator. The level of toxicity
Dimethoate of a pesticide is measured by the response to oral, dermal,
Oxime organothiophosphates or respiratory doses of the pure or technical-grade com-
pound. The measurements can be either acute (single dose)
or chronic (repeated exposure). Acute toxicity is usually
244
reported as the dose of a compound that causes the death of
50% of the test organisms (LD50). Tests on nontarget organisms
often include rodents, birds, and fish. Pesticide labels reflect
the toxicity of these formulations, based on signal words such
as “Danger – Poison” on highly toxic compounds (oral LD50,
50 mg/kg), “Warning” on moderately toxic compounds (oral
LD50, 50–500 mg/kg), “Caution” on slightly toxic compounds
(oral LD50, 500–5000 mg/kg), and “Caution” on compounds
with low toxicity (oral LD50, 5000 mg/kg). Chronic tox-
icity is the effect of a substance following prolonged and
repeated exposure. Dose is expressed as weight of the test
substance per unit body weight of test animal (milligram
per kilogram) or as weight of the test substance in parts per
million in an aqueous solution. For inhalation exposure,
dose is expressed as weight of the test substance per unit
volume of air (milligrams per liter) or as parts per million
per day. For dermal exposure, dose is expressed as weight
of the test substance per unit body weight of the test ani-
mal or as weight of the substance per unit of surface area
(milligrams per square centimeter). In chronic toxicity
studies, the no-observed-effect level (NOEL) is the maxi-
mum dose used in testing that produces no adverse effects
in the test animals (usually mice). The NOEL is usually
expressed in terms of the weight of a test substance given
daily per unit weight of test animal (milligrams per kilo-
gram per day).
The formulated pesticide, the commercial product, sel-
dom contains only technical-grade chemicals. The mar-
keted product typically consists of the active ingredients
and sometimes synergists, as well as several inert ingredi-
ents that are responsible for improving storage, handling,
ease of application, efficacy, and safety. The inert ingredi-
ents include surfactants or emulsifiers, stickers, diluents,
encapsulants, and other adjuvants. The carrier is the main
constituent of the final product and is usually water or oil
in the case of sprays, inorganic clays or talcs in the case
of dusts or granules, and organic material such as corncob
grits in the case of some granules. Most pesticide com-
pounds are relatively insoluble in water and require an
emulsifier for them to be mixed with water. Common for-
mulations of insecticides and acaricides include emulsifi-
able concentrates, wetable powders or water-dispensable
powders, flowable suspensions, oil solutions, dusts, gran-
ules, aerosols, fumigants, microencapsulated formulations,
and baits. Sprays and dusts allow small amounts of pesti-
cide to be applied directly onto the pest or its immediate
environment, but both of these formulations tend to have
a problem with spray drift. Use of granules is one way
to overcome problems with drift if the pesticide does not
have to be applied directly onto the pest. Granule formu-
lations are common for several mosquito larvicides, such
as methoprene and Bacillus thuringiensis var. israelensis.
Insecticides and acaricides for ectoparasites of humans,
such as lice and mites, are typically formulated as creams,
lotions, or shampoos.
Hayes’ Handbook of Pesticide Toxicology
4.4.2.2 Examples of Pesticides for Public
Health Pests
(a) Ectoparasites (Scabies Mite, Head Louse, Body
Louse, and Crab Louse)
It has been estimated that more than 2 million school-age
children develop a lice or scabies infestation each year
(Adams, 1996; Brown et al., 1995; Downs, 2000). Scabies
is caused by Sarcoptes scabiei mites, which burrow under
the skin, leaving a trail of feces and eggs and causing a
rash and intense itching. The eggs hatch in 3–8 days, and
the larvae move to the surface of the skin, where they
molt to two nymphal stages and finally to adults. From
egg hatch to adult can take 10–14 days. The scabies mite
is generally spread by direct contact and from the clothes
or bed linens of an infected individual (Strickland, 2000;
van Neste, 1988). Ivermectin is being tested for the treat-
ment of human scabies (Chouela et al., 1999; Yeruham and
Hadani, 1998). Lindane is still commonly used to control
scabies in Third World countries, along with sulfur com-
pounds and permethrin (Kenawi et al., 1993).
The infestation of the body with head or body lice
(Pediculus capitis and Pediculus humanus, respectively)
is termed pediculiasis, and the condition of having head
or body lice is called pediculosis. Infestation with pubic
(“crab”) lice (Pthirus pubis) is known as pthiraisis. Head
lice and crab lice are not believed to be important vectors,
although they may cause intense itching (Burgess, 1990;
Harwood and James, 1979; Strickland, 2000). In general,
head lice are readily spread by physical contact particularly
among schoolchildren, whereas pubic lice are characteris-
tic of adults and spread is often by venereal contact. The
body louse, a vector of typhus, trench fever, and epidemic
relapsing fever, is less common in the United States than
the other two species. A number of insecticides formulated
for topical application are available for these pests, includ-
ing the following:
Crotamiton (Eurax) (Burkhart et al., 1998; Ragheb et al.,
1995)
Lindane (Kwell, Scabene) (Fusia et al., 1987; Robinson
and Shepherd, 1980)
Malathion (Prioderm) (Brown et al., 1995)
Permethrin (Elimite, Nix-OTC) (Fusia et al., 1987; Nassif
et al., 1980)
RID A-200 Pyrinate (Culver et al., 1988)
(b) Acaricides
Humans generally encounter ticks on paths and trails in
parks or natural areas. The best methods of control are
through prevention tactics of the individual. People going
to these areas should wear appropriate clothing, including
long-sleeved shirts, trousers, and socks. High-top boots
should be worn with the trouser legs tucked into either the
socks or the boots. Shirts should be tucked into the trousers
Chapter | 4 Public Health Pesticides
and the long sleeves buttoned. Repellents, such as diethyl-
toluamide (DEET) or permethrin, applied to the clothing
will also provide additional protection from ticks, although
permethrin-based products are generally considered better
for ticks. Typically, the repellent only needs to be applied
as a band around the ankles and waistband. Attached ticks
should be carefully removed with tweezers. Pets should
be regularly checked for tick attachment and treated as
prescribed by a veterinarian. When local premises are
infested, a variety of insecticides have been employed suc-
cessfully to control ticks.
The following acaricides have been used for the control
of ticks in turf, ornamental, and recreational areas: carbaryl
(Sevin), chlorpyrifos (Dursban), cyfluthrin (Tempo), diazi-
non (Diazinon,), s-fenvalerate (Zema Lawn Spray), fluval-
inate (Mavrik Aquaflow, Yardex), and permethrin (Aziz and
Osman, 1985; Baxter et al., 1999; Goddard, 1998; Khan,
1999; Monsen et al., 1999; Schuurman, 1988). Several of
these pesticides are hazardous to humans and nontarget
insects. All pesticides should be applied only as directed on
the label. In some cases, licensed personnel are required.
A commercially available permethrin product (Damminix)
targets the larvae and nymphs of I. scapularis on
white-footed mice by filling tubes with insecticide-treated
cotton, which mice collect as nesting material (Fehrenbach,
1990; Mejlon et al., 1995). Ticks on the mice are killed,
which in turn is supposed to ultimately reduce the
number of infected ticks on a treated property; however,
mixed results have been reported (Daniels et al., 1991;
Stafford, 1992).
4.4.2.3 Insecticides in Mosquito Management
Mosquito pesticides are generally classified into two cat-
egories: those used to manage the immature stages, or
larvicides, and those used to manage the adult stages, or
adulticides. An effective pesticide targeting the egg stage,
or ovicide, for mosquitoes has not been developed.
A variety of larvicides are available to kill mosquitoes,
including petroleum and mineral oils, as well as organo-
phosphate compounds, which have been used for decades.
In recent years, several effective new insecticides have been
used that are less harmful and less persistent in the aquatic
environment. These include the microbial insecticides
Bacillus thuringiensis var. israelensis (Bti) and Bacillus
sphaericus (Bsph) and the IGR methoprene. A new min-
eral oil coupled with a surfactant is also being used in sev-
eral areas of the United States. This lightweight surfactant
has negligible adverse effects on plants and other aquatic
organisms. Table 4.6 lists the current mosquito larvicides
registered by the U.S. EPA. There are numerous reports
about natural products for mosquito control; however, few
have been evaluated for efficacy under field conditions
(Dennett et al., 2000; Eckenbach et al., 1999; Lampman
et al., 2000; Sukumar et al., 1991).
245
It is important that larvicides are applied according to label
specifications and only where larvae are present. Control per-
sonnel should also be aware that a single larvicide might not
be suitable for every mosquito-producing habitat. For exam-
ple, Bti is only effective against certain species of mosquito,
especially floodwater species such as Aedes vexans where the
water is relatively clean with little or no organic pollutants. For
polluted sites with heavy organic contents, Bsph should be the
microbial insecticide of choice. Methoprene is the basic com-
pound for registered IGRs for mosquito control. Because this
compound impairs or stops arthropod growth and molting, it
should be used only in habitats where mosquitoes are the pre-
dominant species or where other beneficial arthropods would
not be affected adversely. All insecticides should be used
in accordance with the registered label instructions, which
include the amount (dose) in pounds or gallons per acre (or
kilograms/liters per hectare) and a list of aquatic habitats.
A variety of equipment is available for mosquito-
larviciding operations, ranging from simple hand-pressurized
spray cans to complex equipment mounted on either
vehicles or aircraft. The type and quantity of equipment
depend on the size of the community and the number
and different types of larval habitats. A small community
can run an effective program with handheld equipment,
whereas larger communities or communities with large
tracts of inaccessible habitats such as salt marshes, large
flood plains of rivers, or irrigated farmland require more
sophisticated application equipment and techniques. More
information about larval insecticides and specific products
and equipment can be found on the American Mosquito
Control Association website at http://www.mosquito.org or
from WHOPES at http://www.who.int/whopes.
The method of mosquito control most familiar to the
public is space spraying, employing vehicle-mounted or
aircraft-mounted spray equipment to kill flying adult mos-
quitoes. A list of registered adult mosquito pesticides is
shown in Table 4.6. When space spraying is the principal
or only mosquito control activity, good IPM principles are
not being followed. In many instances, reliance on space
spraying indicates a failure or the lack of proper preven-
tative larvicidal measures against the nuisance or vector
mosquito species. Adulticide treatments for mosquitoes
must be based on sound ecological and behavioral infor-
mation about the species to be treated. Mosquitoes exhibit
different periods of activity; for example, Ae. vexans and
Ae. sollictians are crepuscular with primary activity after
sunset and before dawn (Bidlingmeyer, 1974; Horsfall
et al., 1973), whereas Ae. triseriatus, Ae. aegypti, and
Ae albopictus are active primarily during daylight hours
(Hawley, 1988; Novak et al., 1981). The spraying of har-
borage or aggregation sites can be very effective, as are
barrier sprays to minimize mosquitoes moving into an
area (Groves et al., 1994; Ham et al., 1999; Mount, 1998;
Mount et al., 1996). However, the effectiveness of the
treatment is based on good surveillance methods.
246 Hayes’ Handbook of Pesticide Toxicology

Table 4.6 Insecticides Registered in the United States for Use in Mosquito Control
Product Description of use

Larval control insecticides

Temephos
Methoprene
Bacillus thuringiensis
var. israelensis (Bti)
Bacillus sphaericus (Bsph)
Oils
Available in several formulations, including emulsifiable concentrate and on sand or corn cob
granules. Higher application rates may be necessary in polluted water. This product is also
registered for use against mosquitoes in artificial containers (cans, tires, bird baths, rain gutters,
etc.).
Available in liquid, pellet, briquet, and granular formulations. The briquets are suitable for
use in small depressions and containers. The insect growth regulator kills mosquito larvae by
interfering with the insect hormones that regulate growth. This compound also affects the growth
of arthropods and should be used only in habitats as designated on the registered label.
Both Bti and Bsph are microbial larvicides formulated from extracts of bacterial cultures. They
are available in liquid, granular, and briquet formulations. Liquid formulations have also been
successfully used for ULV ground and air application. Bti is used primarily in unpolluted waters,
and Bsph is most effective in polluted and high organic waters
Larvicidal oils that are formulated to spread and cover a water surface function by preventing the
larvae/pupae from reaching the air at the water’s surface or by causing internal toxinosis via the
air tube. Particular care should be taken when using an oil in areas where fish, aquatic animals,
and plants could be harmed.

Adult control insecticides

Naled An organophosphate insecticide available as a liquid concentrate. It is generally used as a ULV spray
from aircraft and ground ULV equipment.
Malathion An organophosphate available in several liquid formulations. It is generally used as a ULV spray from
aircraft and ground ULV equipment.
Pyrethyrins [and piperonyl A botanically derived insecticide generally formulated with PBO. This insecticide has a quick knock-
butoxide, (PBO)] down action on flying mosquitoes.
Permethrin A synthetic pyrethroid insecticide that can be formulated with a synergist (PBO). It is used primarily
as a ULV application or as a perimeter treatment around buildings, parks, etc. to kill resting adults.
Pyrethroids have high bee and fish toxicity; follow label directions.
Resmethrin A synthetic pyrethroid formulated insecticide with PBO. The product has a quick knock-down action
on adult mosquitoes. It is more effective at lower temperatures than some other products.

Phenothrin  sumithrin A synthetic pyrethroid often formulated with other pyrethroids and PBO (used in New York City for
West Nile virus vector control).

Adult control treatments must be conducted under envi-
ronmental and climatological conditions suitable for the
application of insecticides using thermal fogs, cold aero-
sols, or ULV techniques. These treatments should not be
conducted if the temperature is below 55°F or above 85°F.
These treatments should also be done when wind speed is
low (5 mph). When adulticides are sprayed on windy days,
turbulence makes a uniform pattern difficult to achieve,
resulting in poor control. Also during windy days, the insec-
ticide may be dispersed into areas that are not desirable.
Ideally, wind speed should be calculated using an anemom-
eter. The manufacturer of both the adulticiding equipment
and the insecticide will provide recommendations for wind,
temperature, and, in many cases, relative humidity for deter-
mining the limits for ground-applied adulticides.
The ULV technique is the most frequently used method
of adult mosquito control [see Mount (1998) for a review
of ground ULV applications]. This technique does require
special training in the use and especially the maintenance
of ULV equipment. Moreover, training for the application
of pesticides is mandatory because highly concentrated
insecticides are used. For ULV techniques to be effective,
the droplets must strike the mosquitoes either in flight or
during exposure when resting. Droplets that are too small
will not affect active mosquitoes, nor will droplets that are
too large because they will settle out of the air too rapidly.
Large droplets can also cause spotting on painted surfaces,
especially those containing malathion or a corrosive carrier
such as oils and synergists. Therefore, the droplets must
stay within a specific range in order to achieve maximum
Chapter | 4 Public Health Pesticides
effect. It is essential that the applicators using this technique
consult and adhere to the pesticide’s label and follow the
operating instructions for the ULV unit so that the machine
is calibrated properly to produce the correct droplet size.
Aircraft have been used for many years to apply insec-
ticide dusts, granules, sprays, and aerosols [see Mount
et al. (1996) for a review of aerial applications]. Some
mosquito control personnel consider it better to use a large
volume of low concentrate (e.g., 2 quarts of 55% spray per
acre) to obtain better coverage, whereas others believe it
is preferable to use a small volume of higher concentrate
(e.g., 1 pint of 20% spray per acre). The standard used
today assumes that large areas can be covered more eco-
nomically, especially with a reduction of expensive aircraft
downtime, by using small volumes of highly concentrated
spray. This led to the development of the ULV spray tech-
nique, defined as a method that uses less than 2 quarts of
liquid per acre. For example, using malathion at 3 ounces
of technical-grade material per acre, 1 gallon (128 ounces)
would treat 43 acres. The ULV technique was modified
and adapted for the application of 0.5–3 ounces of highly
concentrated insecticide per acre for the control of mosqui-
toes by aerial application.
Aerial ULV spraying is used for both nuisance and
disease management of mosquitoes. For example, it was
used against Culex species during an outbreak of SLEV in
Texas in 1966; in New England in 1973, 1974, and 1990
to control mosquitoes transmitting EEEV (Monath, 1988);
and for pest management during the major floods in the
Midwest in 1993. Aerial applications have also been used
very effectively during disasters, for example, in 1989 in
South Carolina following Hurricane Hugo and in 1992
in Florida following Hurricane Andrew. For a complete
review of aerial applications for adult and larval treatment,
see Mount et al. (1996).
Because of the highly technical nature of this control
method, mosquito control agencies should consult with the
manufacturers of the insecticides and application equipment as
well as the appropriate regulatory agencies before conducting
aerial adulticiding. For more information, see the American
Mosquito Control Association website at http://www.mosquito.
org or the WHOPES at http://www.who.int/whopes.
4.4.2.4 Personal Protection: Vector and
Pest Repellents
Even the most effective mosquito abatement program can-
not totally eliminate the nuisances caused by mosquitoes.
Therefore, it is necessary at times and in certain environ-
ments (picnics, fishing trips, nature trails, natural areas,
etc.) to employ personnel protection geared toward mini-
mizing biting mosquitoes. This can be done in a number
of ways, including screens in windows and doors, protec-
tive clothing, and repellents. Mosquitoes are generally less
attracted to white clothes than darker colored clothes and
247
clothing that lacks contrasts (i.e., solid colors are better
than patterned). Loose-fitting long-sleeve shirts and long
pants offer a great deal of protection against mosquitoes
and other biting flies. A complete bibliography of repel-
lents for blood-sucking arthropods can be found in Gerberg
and Rutledge (2001).
Personnel repellents containing DEET are consid-
ered to be some of the best mosquito repellents (Elston,
1998; Rutledge et al., 1999). However, their effective-
ness depends on the surface area covered and on climatic
conditions. On hot, humid summer days, perspiration can
effectively wash off the repellent, thus necessitating fre-
quent reapplication. Also, differential repellency by gender
has been studied by Golenda et al. (1999). It is not recom-
mended that DEET be applied to the bare skin of preteen
children (Garrettson, 1997), and even for adults the appli-
cations should be concentrated on clothing and not the bare
skin (Chou et al., 1997; Goodyear and Behrens, 1998; Qiu
et al., 1998; Young and Evans, 1998). All repellents should
be kept away from the eyes, lips, and nasal membranes.
Synthetic chemical repellents that are combined with other
skin products and sunscreens should be used sparingly.
It is very important to read the label and use each product
accordingly. For a clinician’s guide to mosquito repellents,
see Fradin (1998).
Area repellents are available to repulse mosquitoes and
other biting flies from a limited area such as patios, gar-
dens, and porches. Many of these products include naph-
thalene granules, which can be spread on lawn and foliage,
and others contain citronella delivered as smoke or from a
candle. Many stores carry a variety of electric bug zappers
that the manufacturers claim will prevent mosquitoes from
biting. These devices also have a “black” (ultraviolet) light
that attracts mosquitoes to an electric grid where they are
killed. Field trials of these and other devices, such as sonic
repellers and mosquito-repellent plants, have been shown
not to work against mosquitoes. For more information on
these products, see Jensen et al. (2000). Following is a
list of synthetic repellents produced commercially or for
military, public health emergency applications: diethyltolu-
amide or N,N-diethyl-3-methylbenzamide (DEET); buto-
pyronoxyl; dibutyl phthalate; dimethyl carbate; dimethyl
phthalate; ethyl hexanediol; hexamide; methoquin-butyl;
oxamate; and piperidine analogs (Bayrepel).
A complete list of phytochemicals and essential oils
reported to have repellent activity toward vectors and other
arthropods is beyond the scope of this chapter; see Curtis
et al. (1990) for a complete review of natural repellents. The
following list contains chemicals that have been reported
in the literature as repellents, although in some cases
their efficacy is unsupported (e.g., the use of vitamin B1).
We have made no attempt to rate their effectiveness based
on the literature, and they are presented merely as a ref-
erence to the variety of natural products claimed to have
repellency. In general, natural products are considerably
248
less effective than synthetic repellents, such as DEET, at
equivalent concentrations. Several chemicals and essential
oils do provide relatively short periods of mosquito repel-
lency (Rutledge and Gupta, 1999). Repellency should be
considered to have several components. The first compo-
nent is whether it affects the entire sample population; in
laboratory and field tests with mosquitoes, DEET often
shows a 100% repellency with initial exposure.
A U.S. EPA Scientific Advisory Panel found that “no
claim” should be made regarding repellent efficacy for
protection against transmission of arthropod-borne dis-
ease pathogens. The reasons for this strong response were
numerous because most arthropods that interact with
humans and animals are capable of transmitting pathogens.
Natural products – identified (Hwang et al., 1985; Matsuda
et al., 1996; Saxena and Sumithra, 1986):
Limonene Vitamin B1
Linalool Geraniol
Camphor Rotundial
Cineole
Plant essential oils (Ansari and Razdan, 1995; Barnard,
1999; Curtis et al., 1992; Das et al., 1999; Jensen et al.,
2000; Leal and Uchida, 1998; Mulla and Su, 1999;
Thorsell et al., 1998):
Neem oil Garlic oil
Aniseed oil Thyme oil
Geranium oil Eucalyptus oil
Bergamot oil Pyrethrum
Lavender oil Coconut oil
Birchwood tar Soybean oil
Nutmeg oil Pine oil
Orange blossom oil Clove oil
Cinnamon oil Pennyroyal oil
Peppermint oil Citronella oil
For example, we are constantly seeing new worldwide
invasions of exotic arthropod-borne diseases such as West
Nile virus due to the increasing movement of humans, ani-
mals, and domestic goods. Also, individual factors such
as proper application, individual variability and suscep-
tibility, and environmental factors all affect the degree of
protection afforded by the repellent. In fact, in Gupta and
Rutledge (1994), the use of repellents to reduce human–
vector contact and reduce the transmission of mosquito-
borne diseases was not scientifically proven. Therefore, in
Hayes’ Handbook of Pesticide Toxicology
order for the U.S. EPA to rely on the best scientific stan-
dards for registration, the use of repellents for reducing
arthropod-borne diseases must be determined.
4.4.2.5 Indoor Residual Spraying
Indoor residual spraying (IRS) is one of the primary vector
control interventions that have been employed to reduce or
interrupt the transmission of malaria. However, for many
years it has received relatively little attention. Recent data
reconfirm the efficacy and effectiveness of IRS in malaria
control in countries where it has been implemented. For
example, the application of IRS consistently over time
in large areas has changed vector distribution and thus
altered the epidemiological pattern of malaria in Botswana,
Namibia, South Africa, Swaziland, and Zimbabwe.
The results of these studies and reports have shown that
Anopheles funestus, a major vector, has been either elimi-
nated or reduced to very low levels. The major vector, An.
gambiae s.s., which rests and bites mostly indoors, was
also controlled primarily due to its proclivity to move into
houses. Anopheles arabiensis, which does not move or rest
indoors as much as An. gambiae, is less affected by IRS.
This was found even in areas where high levels of cover-
age occurred (Hansford, 1972; Sharp et al., 1990; Southern
African Malaria Control, 2000).
Anopheles malaria vectors that land and rest inside
houses after taking a blood meal (endophilic) are particu-
larly susceptible to control through IRS with contact insec-
ticides. IRS techniques involve coating the walls and other
surfaces within a house with a long-lasting residual insec-
ticide. The insecticide of choice should remain active for
1–3 months, killing mosquitoes and other insects on con-
tact. Note that IRS does not directly prevent people from
being bitten by mosquitoes because mosquitoes are usu-
ally killed after they have fed when they rest on the sprayed
surface. The rationale for using IRS is to reduce the
vector population to prevent transmission of malaria to
other human hosts. Therefore, for this technique to be effec-
tive, it must be applied to a large number of households to
reduce the vector population to transmission levels or lower.
Several ongoing programs have seen dramatic results using
IRS as a tactic to reduce malaria transmission in Africa,
Asia, and Central America (Arredondo-Jiménez et al., 1993;
Charlwood et al., 2001; Doke et al., 2000; Rodríguez et al.,
2006; Rowland et al., 2000; Sharp et al., 2007).
IRS with DDT and dieldrin was the primary malaria
control method used during the Global Malaria Eradication
Campaign (1955–1969). Based on its historical impact,
several countries have reinitiated DDT as the insecticide of
choice for IRS (Gunasekaran et al., 2005; Sharma et al.,
2005). Although several African countries have adopted
the use of DDT, it is still controversial and has not been
endorsed (Casimiro et al., 2007; Kapp, 2004; Sadasivaiah
et al., 2007).
Chapter | 4 Public Health Pesticides
Currently, 12 insecticides are recommended by WHO
for IRS, belonging to four chemical groups (1 organo-
chlorine, 6 pyrethroids, 3 organophosphates, and 2 carba-
mates). The choice of insecticide must be informed by the
following considerations:
l Insecticide susceptibility and vector behavior
l Safety for humans and the environment
l Efficacy and cost-effectiveness
IRS will only be effective if the target vectors are suscep-
tible to the insecticide in use. The development of resistance
to insecticides constitutes a major threat to the chemical
control of malaria vectors because it compromises the insec-
ticide’s efficacy. In the past, countries deploying IRS have
often been forced to switch to alternative and more expen-
sive insecticides due to the development of vector resistance.
Outside Africa, the prevalence and distribution of insecticide
resistance in malaria vectors have not been major impedi-
ments to insecticide-based interventions, except in some
areas of India, the Middle East, and Central America.
However, in Africa, the potential threat of resistance
to public health insecticides appears to be significant.
Resistance to DDT and pyrethroids in major malaria vec-
tors has been found throughout West and Central Africa,
in some areas at a high level, as well as in several areas of
eastern and southern Africa. Resistance to carbamates has
been found in countries of West Africa, with a mechanism
that also induces cross-resistance to organophosphates. The
selection of resistance in most malaria vectors is thought
to be largely the result of past and present use of insecti-
cides in agriculture. The precise operational implications
of insecticide resistance are not fully understood.
A comprehensive assessment of resistance at the local
level must be carried out before planning any IRS program,
especially in West and Central Africa. The possibility of
insecticide resistance calls for the careful monitoring of the
susceptibility of malaria vectors to insecticides throughout
the world and the sound management of resistance.
There are specific interactions between insecticides and
malaria vectors. Some insecticides tend to repel more than to
kill vector mosquitoes. Changes in vector behavior induced
by insecticides may have important operational implica-
tions, and it is important to be aware of them when selecting
insecticides for IRS. DDT is the only insecticide that is used
exclusively for public health; therefore, unlike with other
insecticides, resistance development to it is no longer influ-
enced by other uses such as in agriculture. In the context of
resistance management, it is therefore advisable to maintain
the use of DDT until a suitable alternative is available. WHO
recommends that national governments do the following (see
http://malaria.who.int/docs/IRS-position.pdf):
1. Introduce and/or scale up coverage of targeted IRS as a
primary malaria control intervention in countries where
available data indicate that it can be effective toward
achieving malaria targets.
249
2. Take all necessary steps to ensure effective implemen-
tation of IRS interventions – including selecting the
appropriate insecticide, spraying where and when nec-
essary and sustaining a high level of coverage – and to
prevent unauthorized or unrecommended use of public
health insecticides.
3. Strengthen the managerial capacity of national malaria
control programs and improve human, technical, and
financial resources for the timely delivery and high
coverage of effective interventions including IRS, with
adequate monitoring and evaluation.
Effective implementation of IRS with DDT or other rec-
ommended insecticides should be a central part of national
malaria control strategies where this intervention is appro-
priate. It is implemented with the objective of reducing
malaria morbidity and mortality and accelerating progress
toward global and national malaria targets. However, there
are important considerations that must be taken into account
when determining whether to introduce or scale up IRS. In
particular, there must be sufficient capacity to deliver the
intervention effectively, prevent unauthorized and unrecom-
mended use of public health pesticides, and manage insec-
ticide resistance. Intensified research efforts are needed, for
example, to develop new insecticides, long-acting formula-
tions, and improved application technologies.
Along with producing IRS manuals and guidelines,
WHO will support countries with collecting and analyzing
data to determine the potential effectiveness and feasibility
of IRS in the national context and with planning and imple-
menting the intervention. WHO requests countries report on
coverage and impact as IRS is implemented or scaled up.
This position statement is intended for public health
policymakers, malaria control program managers, develop-
ment agencies, development banks, academic and research
institutions, and private sector corporations involved in
scaling up malaria control programs.
4.4.2.6 Insecticide-Treated Bed Nets
Insecticide-treated bed nets (ITNs) are a form of personal
protection that has been shown to reduce severe disease
and mortality, especially in children, due to malaria. In
communitywide trials in several African settings, ITNs
have been shown to reduce all-cause mortality by approxi-
mately 20% (D’Alessandro et al., 1995; Gimnig et al.,
2003; Wiseman et al., 2007).
The use of untreated bed nets to form a protective barrier
around the people using them has been employed for years
to prevent the transmission of malaria via anopheline mos-
quito bites. However, mosquitoes can feed on people through
the nets, and nets that have holes no matter the size provide
little protection. The development and implementation of
bed nets impregnated with a residual insecticide has greatly
enhanced their protective efficacy. The insecticides that
have been employed kill the mosquitoes and other insects
250
on contact. Some of the insecticides, especially DDT, also
have repellent properties that reduce the number of mosqui-
toes that enter houses (Roberts, 1998). In addition, if high
numbers of nets are deployed and used within a community,
the numbers and longevity of mosquitoes will be reduced.
In these circumstances, even those who do not use a bed net
will afford protection from biting anopheline mosquitoes
(Etang et al., 2007). However, to achieve such effects, high
community coverage is required (Fernando et al., 2008a,b).
Early programmatic implementation of ITNs required
a reapplication of insecticide at intervals ranging from
6 to 12 months. Moreover, nets had to be retreated every
time they were washed. Retreatment was accomplished by
simply dipping them in a mixture of water and insecticide
and allowing them to dry in an area protected from direct
sunlight. This process was considered a major logistical and
economic barrier to full implementation of ITNs in countries
within malaria (Kroeger et al., 2004; Rafinejad et al., 2008).
Currently, several types of nets are available for use
in malaria control programs. Nets can vary by size, mate-
rial, and/or insecticide treatment. The majority of nets are
made of polyester, but nets are also available in cotton,
polyethylene, or even polypropylene (Sharma et al., 2006;
Skovmand et al., 2008).
WHO has approved only pyrethroid insecticides for
use on ITNs, primarily due to their very low mamma-
lian (human) toxicity but high toxicity to mosquitoes and
other insects (N’Guessan et al., 2001; Snow et al., 1999).
Pyrethroid insecticides also exhibit a rapid knock-down
effect, even at very low doses. In addition, pyrethroids have
a high residual effect and do not rapidly break down unless
washed or exposed to sunlight, which is minimal because
they are used and stored indoors (Dabiré et al., 2006).
Several companies have developed long-lasting insec-
ticide-treated nets (LLINs) that retain lethal concentra-
tions of insecticide for at least 3 years. The WHO Pesticide
Evaluation Scheme recommends the following LLINs for
use in the prevention of malaria:
DuraNet (Clarke Mosquito Control; http://duranetmosqui-
tonet.com)
Interceptor Net (BASF; http://www.basfpublichealth.com/
products/interceptor.html)
NetProtect (Intelligent Insect Control; http://www.insect-
control.net/netprotect) [also marketed as ICONLife
(Syngenta)]
Olyset Net (Sumitomo Chemical; http://www.olyset.net)
PermaNet (Vestergaard-Frandsen; http://www.vestergaard-
frandsen.com/permanet.htm)
Detailed reviews by Sexton (1994) and Curtis (1994) pro-
vide a comprehensive account of the impact of bed nets on
malaria control and as a tactic for vector control. The use
of impregnated bed nets by the community has shown good
results and is a positive tool for the reduction of malaria
(Brieger et al., 1996).
Hayes’ Handbook of Pesticide Toxicology
Conclusion
The spectacular success of synthetic insecticides in the
decade immediately following World War II generated wide-
spread enthusiasm that the major scourges of mankind, such
as yellow fever, malaria, and typhus, could be conquered.
This in fact did occur, with major reductions in malaria and
yellow fever and a significant reduction in other arthropod-
borne pathogens such as typhus and plague. However, these
short-term successes resulted in major increases in disease
transmission primarily due to resistance in both the arthro-
pod to insecticides and to drugs by the pathogen. The result
of these failures has forced the public health community to
reevaluate strategies and has resulted in the development of
evidence-based management or integrated disease manage-
ment. Employing this management strategy, both insecti-
cides or drugs are used in a targeted manner that results in
a significant increase in efficacy, environmental safety, and
cost-effectiveness. The challenge for the future is to better
understand the natural history and bionomics of arthropod-
borne disease systems and to use this information to target
effective control measures. In short, the when, where, and
how, coupled with the principle of addressing where the
arthropods or pathogens are the most concentrated, immo-
bile, and accessible, should form the basis for future investi-
gations and management programs.
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