Two patients are receiving treatment at Rambam Health Care Campus (Rambam) in Haifa, Israel, for complications related to West Nile fever following a recent outbreak in the country. The National Poison Information Center at Rambam has issued guidelines and recommendations for the general public and pregnant women.
Dr. Shahar Shelly. Credit: Rambam HCC.
A 57-year-old woman and a 66-year-old man have been hospitalized in Rambam’s Department of Neurology after contracting West Nile fever and developing virus-related neurological complications.
West Nile fever is transmitted by infected mosquitoes. Most cases exhibit no symptoms or only mild flu-like symptoms, but a small number of patients develop neurological complications.. “Despite the increase in cases in Israel, the hospitalization of these two patients does not indicate the presence of infected mosquitoes in the country’s northern region,” notes Professor Mical Paul, director of Rambam’s Infectious Diseases Institute.
Dr. Shahar Shelly, director of the Department of Neurology, is optimistic: “The patients are under strict medical supervision and receiving supportive care. Unfortunately, after contracting the disease, there is little that can be done, but we hope their conditions will improve.”
Recommendations for Pregnant Women Using Mosquito Repellents
Rambam’s National Poison Information Center recently issued guidelines for pregnant women.
Dr. Noa Markovits, a senior physician at the Center and coordinator of Rambam’s pregnancy and breastfeeding service, explains, “Following multiple inquiries, we have compiled a list of guidelines.” She emphasizes that the information is Israel-centric. “If a pregnant woman is traveling to a country where there is a risk of malaria or other diseases transmitted by flying insects, she must consult with an authorized medical travel clinic.”
The guidelines include recommendations regarding the use of mosquito repellents, as follows:
Products containing low concentrations of Icaridin or DEET are safe for topical use during pregnancy. They disrupt the mosquito’s sense of smell, making them less attracted to humans. Although there is no information from controlled studies, no side effects in pregnant women have been reported, nor an increased rate of complications, including the risk of congenital anomalies, premature birth, or impaired development.
Despite the lack of controlled studies, products containing eucalyptus oil and citronella are considered safe. However, if these products are ineffective, switch to repellents containing low concentrations of Icaridin or DEET (10%).
If a pregnant woman is bitten despite taking general protective measures and using low-concentrations of Icaridin or DEET repellents, it is recommended to switch to higher concentrations of Icaridin (20%) or DEET (25%), which are effective for about four hours.
General Recommendations
The following general recommendations should be observed by the public:
Avoid places with mosquito concentrations.
Wear long clothing and tuck your shirt in to reduce skin exposure.
Read the manufacturer’s instructions prior to use of mosquito repellents and apply accordingly.
If permissible, the repellent can be applied to the edges of clothing.
Do not apply repellents on the inside of clothing or on areas of skin protected by clothing.
Use sunscreen during sun exposure. Apply the sunscreen first, and after it dries, apply the repellent.
Home Use
For home use, there are electric indoor repellents that contain a low-concentration insecticide from the pyrethroid family. Used according to the manufacturer’s instructions, they do not pose any additional risk to pregnant women.
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