Résumé exécutif

TL;DR

This executive summary presents 31 consensus recommendations on personal anti-vector protection (PPAV) produced by the Société de Médecine des voyages and the Société française de Parasitologie, using the Haute Autorité de santé's "Recommandations pour la pratique clinique" method. It defines the place of repellents, impregnated nets, impregnated clothing and adjunct measures, and grades each recommendation A, B or C according to the level of evidence.

Key findings

• For protection against *Anopheles* in malaria-endemic areas, effective field concentrations giving at least 4 hours of protection are DEET 30–50%, IR3535 20–35%, picaridine 20–30% and PMD 20–30% (Grade A); the same concentrations are also shown to be effective for longer against *Aedes* and *Culex*.
• Essential oils are strongly advised against as skin repellents because their efficacy against the main vectors is generally under 20 minutes and because of recognised allergic and photosensitising risks (Grade B).
• Impregnated bed nets are the PPAV measure to be prioritised before walking age (Grade A); impregnated polyethylene sheeting at ≥360 mg/m² deltamethrin, tents at 1,000 mg/m² permethrin (double-roof) or 2,000 mg/m² (single roof), and sheets/cloths/blankets at 1,000 mg/m² permethrin are recommended where nets or hammock nets cannot be used (Grade B).
• Insect-repellent bracelets (Grade A), ultrasound devices, vitamin B1 (Grade A), homeopathy, electric swatters and non-insecticidal sticky tapes are strongly advised against; repellents available are not effective against hymenopteran stings (Grade B).

Methods

• Design: clinical practice recommendations developed by a multidisciplinary expert working group, financially supported by the Direction générale de la santé, using the HAS "Recommandations pour la pratique clinique" (RPC) method.
• Evidence base: four general PubMed search equations built with the documentation service of the Afssaps, covering the identified protection means (insecticides, clothing impregnation, nets, repellents), target arthropods, vector-borne infectious agents and the diseases they cause, plus documents from national and international bodies (WHO/WHOPES, US-CDC, US-EPA, ARLA-Canada, HPA, NaTHNaC, and French agencies including InVS, Afssaps, Afsset and others).
• Grading: recommendations classified grade A (high-level evidence such as high-power randomised controlled trials or meta-analyses, evidence level 1), grade B (intermediate-level evidence such as low-power RCTs, well-conducted non-randomised comparative studies, cohort studies, level 2) or grade C (case-control, retrospective studies, case series, comparative studies with major bias, levels 3–4), adapted from Kisch; in the absence of studies, recommendations rest on professional agreement and are ungraded.

Limitations

• Stated: in the absence of studies, recommendations are based on professional agreement within the working group after consultation of the reading group; tests of repellents against nuisance arthropods other than Culicidae (Reduviidae, Ceratopogonidae, Phlebotominae, Pediculicidae, ticks) — where protections sometimes exceeding 6 hours were obtained — need to be standardised to allow better comparison of results and better evaluation of real efficacy; the low level of knowledge of travellers and residents is explicitly cited as a reason for information and decision-tree approaches.
• Evident from the text: the document is a consensus recommendation summary rather than a primary study, and it reports no new empirical data of its own; the text also notes that current usage recommendations vary between issuing bodies nationally and internationally, producing controversy and a confusing message for the public and prescribers.