Epidemic potential of Zika virus in Australia: implications for blood transfusion safety.

BACKGROUND: Zika virus (ZIKV) is transfusion-transmissible. In Australia the primary vector, Aedes aegypti, is established in the north-east, such that local transmission is possible following importation of an index case, which has the potential to impact on blood transfusion safety and public health. We estimated the basic reproduction number (R 0 ) to model the epidemic potential of ZIKV in Australian locations, compared this with the ecologically similar dengue viruses (DENV), and examined possible implications for blood transfusion safety. STUDY DESIGN AND METHODS: Varying estimates of vector control efficiency and extrinsic incubation period, "best-case" and "worst-case" scenarios of monthly R 0 for ZIKV and DENV were modeled from 1996 to 2015 in 11 areas. We visualized the geographical distribution of blood donors in relation to areas with epidemic potential for ZIKV. RESULTS: Epidemic potential (R 0 > 1) existed for ZIKV and DENV throughout the study period in a number of locations in northern Australia (Cairns, Darwin, Rockhampton, Thursday Island, Townsville, and Brisbane) during the warmer months of the year. R 0 for DENV was greater than ZIKV and was broadly consistent with annual estimates in Cairns. Increased vector control efficiency markedly reduced the epidemic potential and shortened the season of local transmission. Australian locations that provide the greatest number of blood donors did not have epidemic potential for ZIKV. CONCLUSION: We estimate that areas of north-eastern Australia could sustain local transmission of ZIKV. This early contribution to understanding the epidemic potential of ZIKV may assist in the assessment and management of threats to blood transfusion safety.

Ross River Virus and the Necessity of Multiscale, Eco-epidemiological Analyses.

Background: Zoonotic vector-borne disease prevalence is affected by vector, human, and reservoir host factors, which are influenced by habitat and climate; these 5 components interact on microhabitat-to-landscape scales but are often analyzed at a single spatial scale. Methods: We present an information theoretic, multiscale, multiple regression analysis of the ecological drivers of Ross River virus. We analyze the spatial pattern of 20 years of Ross River virus infections from South Australia (1992-2012; n = 5261), using variables across these 5 components of disease ecology at 3 spatial scales. Results: We found that covariate importance depended on the spatial scale of the analysis; some biotic variables were more important at fine scales and some abiotic variables were more important at coarser spatial scales. The urban score of an area was most predictive of infections, and mosquito variables did not improve the explanatory power of these models. Conclusions: Through this multiscale analysis, we identified novel drivers of the spatial distribution of disease and recommend public health interventions. Our results underline that single-scale analyses may paint an incomplete picture of disease drivers, potentially creating a major flaw in epidemiological analyses. Multiscale, ecological analyses are needed to better understand infectious disease transmission.

Assessing the threat of chikungunya virus emergence in Australia.

BACKGROUND: Chikungunya virus (CHIKV) is a major threat to Australia given the distribution of competent vectors, and the large number of travellers returning from endemic regions. We describe current knowledge of CHIKV importations into Australia, and quantify reported viraemic cases, with the aim of facilitating the formulation of public health policy and ensuring maintenance of blood safety. METHODS: Cases reported to the National Notifiable Disease Surveillance System (NNDSS) from 2002 to 2012 were analysed by place, month of acquisition, and place of residence. Rates of chikungunya importation were estimated based on reported cases and on the numbers of short-term movements. RESULTS: Between 2002 and 2012, there were 168 cases of chikungunya virus (CHIKV) imported into Australia. Victoria and New South Wales had the largest number of notifications. The main sources were Indonesia, India and Malaysia. The number of cases increased from 2008 to reach a peak in 2010 (n=64; 40%). Although Indonesia accounted for the majority of CHIKV notifications in Australia, travel from India had the highest CHIKV importation rate (number of imported cases per 100,000 travellers). CONCLUSIONS: The Australian population is increasingly at risk from CHIKV. Arrivals from endemic countries have increased concurrently with vector incursions via imported goods, as well as via local movement from the Torres Strait to North Queensland ports. An outbreak of CHIKV could have a significant impact on health, the safety of the blood supply and on tourism. Case and vector surveillance as well as population health responses are crucial for minimising any potential impact of CHIKV establishment in Australia.

Flowering timing prediction in Australian native understorey species (Acrotriche R.Br Ericaceae) using meteorological data.

The aim of this study was to determine the climatic influences on floral development for five members of the Australian native plant genus Acrotriche R.Br (Ericaceae). An observed period of summer floral dormancy suggests temperature is involved in flowering regulation in these species. Models were developed to determine temperature requirements associated with the likelihood of flowering occurring on any one day. To this end, the timing of flowering and meteorological data were collated for several sites, and multivariate logistic regressions performed to identify variables with a significant influence on flowering timing. The resultant models described a large amount of variation in flowering presence/absence, with (r2) values ranging from 0.72 to 0.79. Temperature was identified as influential on both floral development and flowering timing in each of the study species. The positive influence of short photoperiods on flowering in three of the winter flowering species was not surprising. However, the reporting here ofa significant association between interdiurnal temperature and flowering in one species is novel. The predictive power of the models was validated through a jackknife sequential recalculation approach, revealing strong positive and negative predictive ability for flowering for four of the five species. Applications of the models include assisting in determination of the suitability of areas for vegetation restoration and identifying the possible effects of climate change on flowering in the study species.

Citizen Science Mosquito Surveillance by Ad Hoc Observation Using the iNaturalist Platform.

Citizen science mosquito surveillance has been growing in recent years due to both increasing concern about mosquito-borne disease and the increasing popularity of citizen science projects globally. Health authorities are recognising the potential importance of citizen science to expanding or enhancing traditional surveillance programs. Different programs have shown success in engaging communities to monitor species of medical importance through low-cost methods. The Mozzie Monitors project was established on iNaturalist-an open citizen science platform that allows participants to upload photos (i.e., observers) and assist identification (i.e., identifiers). This article describes the likelihood of citizen scientists submitting photos of mosquitoes, assesses user submission behaviour, and evaluates public health utility from these citizen science-derived data. From October 2018 to July 2021, the Mozzie Monitors project on iNaturalist received 2118 observations of 57 different species of mosquitoes across Australia. The number of observers in the system increased over time with more than 500 observers and 180 identifiers being active in the project since its establishment. Data showed species bias with large-bodied and colourful mosquitoes being over-represented. Analyses also indicate regional differentiation of mosquito fauna per state, seasonality of activity, and ecological information about mosquitoes. The iNaturalist citizen science platform also allows connectedness, facilitated communication and collaboration between overall users and expert entomologists, of value to medical entomology and mosquito management.

Japanese Encephalitis Virus Emergence in Australia: Public Health Importance and Implications for Future Surveillance.

Japanese encephalitis virus (JEV) continues to cause significant numbers of human infections and fatalities despite the availability of efficacious vaccines. It is regarded as an emerging mosquito-borne pathogen with the potential of introduction into many countries. In 2022, JEV was detected in Australia on a hitherto unprecedented scale, with local transmission by indigenous mosquitoes to amplifying swine hosts and to humans. In this study, we review this recent disease activity, propose possible routes of virus movement, ecological drivers of activity, and consider possible future transmission scenarios. Measures to enhance current surveillance systems and potential strategies for health authorities to minimize future risks are discussed.

Nature-Based Citizen Science as a Mechanism to Improve Human Health in Urban Areas.

The world is becoming increasingly urbanised, impacting human interactions with natural environments (NEs). NEs take a number of forms, ranging from pristine, modified, to built NEs, which are common in many urban areas. NEs may include nature-based solutions, such as introducing nature elements and biological processes into cities that are used to solve problems created by urbanisation. Whilst urbanisation has negative impacts on human health, impacting mental and physical wellbeing through a number of mechanisms, exposure to NEs may improve human health and wellbeing. Here, we review the mechanisms by which health can be improved by exposure to NEs, as explained by Stress Reduction Theory, Attention Restoration Theory, and the 'Old Friends'/biodiversity hypothesis. Such exposures may have physiological and immunological benefits, mediated through endocrine pathways and altered microbiota. Citizen Science, which often causes exposure to NEs and social activity, is being increasingly used to not only collect scientific data but also to engage individuals and communities. Despite being a named component of scientific and environmental strategies of governments, to our knowledge, the intrinsic health benefits of Citizen Science in NEs do not form part of public health policy. We contend that Citizen Science programs that facilitate exposure to NEs in urban areas may represent an important public health policy advance.

Past and future epidemic potential of chikungunya virus in Australia.

BACKGROUND: Australia is theoretically at risk of epidemic chikungunya virus (CHIKV) activity as the principal vectors are present on the mainland Aedes aegypti) and some islands of the Torres Strait (Ae. aegypti and Ae. albopictus). Both vectors are highly invasive and adapted to urban environments with a capacity to expand their distributions into south-east Queensland and other states in Australia. We sought to estimate the epidemic potential of CHIKV, which is not currently endemic in Australia, by considering exclusively transmission by the established vector in Australia, Ae. aegypti, due to the historical relevance and anthropophilic nature of the vector. METHODOLOGY/PRINCIPAL FINDINGS: We estimated the historical (1995-2019) epidemic potential of CHIKV in eleven Australian locations, including the Torres Strait, using a basic reproduction number equation. We found that the main urban centres of Northern Australia could sustain an epidemic of CHIKV. We then estimated future trends in epidemic potential for the main centres for the years 2020 to 2029. We also conducted uncertainty and sensitivity analyses on the variables comprising the basic reproduction number and found high sensitivity to mosquito population size, human population size, impact of vector control and human infectious period. CONCLUSIONS/SIGNIFICANCE: By estimating the epidemic potential for CHIKV transmission on mainland Australia and the Torres Strait, we identified key areas of focus for controlling vector populations and reducing human exposure. As the epidemic potential of the virus is estimated to rise towards 2029, a greater focus on control and prevention measures should be implemented in at-risk locations.

The development of predictive tools for pre-emptive dengue vector control: a study of Aedes aegypti abundance and meteorological variables in North Queensland, Australia.

SUMMARY OBJECTIVES: To describe the meteorological influences on adult dengue vector abundance in Australia for the development of predictive models to trigger pre-emptive control operation. METHODS: Multiple linear regression analyses were performed using meteorological data and female Aedes aegypti collection data from BG-Sentinel Mosquito traps placed at 11 monitoring sites in Cairns, north Queensland. RESULTS: Considerable regression coefficients (R(2) = 0.64 and 0.61) for longer- and shorter-term factor models respectively were derived. Longer-term factors significantly associated with abundance of adult vectors were mean minimum temperature (lagged 6 month) and mean daily temperature (lagged 4 month), explaining the predictable increase in abundance during the wet season. Factors explaining fluctuation in abundance in the shorter term were mean relative humidity over the previous 2 weeks and current daily average temperature. Rainfall variables were not found to be strong predictors of A. aegypti abundance in either longer- or shorter-term models. CONCLUSIONS: The implications of these findings for the development of useful predictive models for vector abundance risks are discussed. Such models can be used to guide the application of pre-emptive dengue vector control, and thereby enhance disease management.

Prevalence, incidence, and natural history of simple ovarian cysts among women >55 years old in a large cancer screening trial.

OBJECTIVE: The purpose of this study was to measure the occurrence and natural history of simple ovarian cysts in a cohort of older women. STUDY DESIGN: Simple cysts were ascertained among a cohort of 15,735 women from the intervention arm of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial through 4 years of transvaginal ultrasound screening. RESULTS: Simple cysts were seen in 14% of women the first time that their ovaries were visualized. The 1-year incidence of new simple cysts was 8%. Among ovaries with 1 simple cyst at the first screen, 54% retained 1 simple cyst, and 32% had no cyst 1 year later. Simple cysts did not increase risk of subsequent invasive ovarian cancer. CONCLUSION: Simple ovarian cysts are fairly common among postmenopausal women, and most cysts appear stable or resolve by the next annual examination. These findings support recent recommendations to follow unilocular simple cysts in postmenopausal women without intervention.

Citizen science and smartphone e-entomology enables low-cost upscaling of mosquito surveillance.

Mosquito surveillance remains a cornerstone of pest and disease control operations globally but is strongly limited in scale by resources. The use of citizen science to upscale scientific data collection is commonplace, and mosquito surveillance programs have begun to make use of citizen scientists in several countries, particularly for exotic species detection. Here we report on a proof of concept trial in southern Australia for a citizen science mosquito surveillance program characterised by fixed point trapping with BG GAT devices and remote mosquito identification through emailed images, which we term 'e-entomology'. In a study with 126 participants, we detected mosquito seasonality with peak abundance in mid-summer (1.78 mosquitoes per trap per day), weather correlations (positive correlation with maximum temperature, r = 0.41) and a diversity of species (15 of 22 known species in the region) in a metropolitan setting. Whilst we demonstrated that the costs of a citizen science program is only about 20% of a comparable professional surveillance program, the mosquito community sampled by citizen scientists was biased towards container-inhabiting species, particularly Aedes notoscriptus. This is the first time fixed-point mosquito trapping has been combined with citizen science e-entomology to deliver comprehensive surveillance of urban mosquitoes.

Estimation of mosquito-borne and sexual transmission of Zika virus in Australia: Risks to blood transfusion safety.

BACKGROUND: Since 2015, Zika virus (ZIKV) outbreaks have occurred in the Americas and the Pacific involving mosquito-borne and sexual transmission. ZIKV has also emerged as a risk to global blood transfusion safety. Aedes aegypti, a mosquito well established in north and some parts of central and southern Queensland, Australia, transmits ZIKV. Aedes albopictus, another potential ZIKV vector, is a threat to mainland Australia. Since these conditions create the potential for local transmission in Australia and a possible uncertainty in the effectiveness of blood donor risk-mitigation programs, we investigated the possible impact of mosquito-borne and sexual transmission of ZIKV in Australia on local blood transfusion safety. METHODOLOGY/PRINCIPAL FINDINGS: We estimated 'best-' and 'worst-' case scenarios of monthly reproduction number (R0) for both transmission pathways of ZIKV from 1996-2015 in 11 urban or regional population centres, by varying epidemiological and entomological estimates. We then estimated the attack rate and subsequent number of infectious people to quantify the ZIKV transfusion-transmission risk using the European Up-Front Risk Assessment Tool. For all scenarios and with both vector species R0 was lower than one for ZIKV transmission. However, a higher risk of a sustained outbreak was estimated for Cairns, Rockhampton, Thursday Island, and theoretically in Darwin during the warmest months of the year. The yearly estimation of the risk of transmitting ZIKV infection by blood transfusion remained low through the study period for all locations, with the highest potential risk estimated in Darwin. CONCLUSIONS/SIGNIFICANCE: Given the increasing demand for plasma products in Australia, the current strategy of restricting donors returning from infectious disease outbreak regions to source plasma collection provides a simple and effective risk management approach. However, if local transmission was suspected in the main urban centres of Australia, potentially facilitated by the geographic range expansion of Ae. aegypti or Ae. albopictus, this mitigation strategy would need urgent review.

Environmental and entomological factors determining Ross River virus activity in the River Murray Valley of South Australia.

OBJECTIVES: 1) To determine whether environmental and mosquito abundance variables could be used to explain fluctuations in the activity of Ross River (RR) virus, in the River Murray Valley of South Australia (SA). 2) To develop models at the local government spatial scale to understand local variability in RR activity factors. METHOD: Notification data of RR virus positive serology, mosquito surveillance, meteorological and river height data were analysed for the period 1999 to 2006. Stepwise multiple regression was used to determine significant environmental factors and to create descriptive models. RESULTS: The three models developed for different regions of the Valley explained significant amounts of variation in notification rates (R(2) 0.77 - 0.98). Regional variation in the models was observed, with differences in significant mosquito species evident. Rainfall was a significant predictor of RR virus activity in two of the models, while the height of the River Murray was significant in the third. An overall model for the entire SA section of the Valley contained only time-lagged mosquito abundance variables (R(2) 0.52). CONCLUSION: Although rainfall, river height and mosquito abundance are significant factors in determining RR virus activity, there are regional differences in this relationship. IMPLICATIONS: The regional variability of RR virus activity drivers has been defined, and has implications for the forecasting of future activity in this part of SA. The models provided here can provide the foundation for an effective RR virus early warning system, but only if criteria for action, lines of responsibility and the resources required have been determined.

The epidemiology of CA-125 in women without evidence of ovarian cancer in the Prostate, Lung, Colorectal and Ovarian Cancer (PLCO) Screening Trial.

OBJECTIVE: To determine the epidemiology of CA-125 in women without ovarian cancer. METHODS: We analyzed demographic, medical and lifestyle characteristics related to CA-125, measured using the Centocor CA-125II RIA assay, among 25,608 multi-ethnic U.S. women aged 55-74 years enrolled in a cancer screening trial and found to have no evidence of ovarian cancer. RESULTS: Mean CA-125 level was 11.9 U/ml (SD 8.3); median 10.0 U/ml, interquartile range 8.0-14.0. High levels, using the clinical cut point of >or=35 U/ml, were associated with increased age (p<0.001) and former smoking (p<0.021), while hysterectomy and obesity were protective (p<0.001). Mean levels were higher with increasing age (p<0.001), ever use of hormone therapy (p<0.001), former smoking (p<0.017) and history of breast cancer (p<0.002), but lower (p<0.001) with non-White status, previous hysterectomy, current smoking, and obesity. Current hormone therapy use was not associated with CA-125 in women without a uterus. CONCLUSION: In post-menopausal women without ovarian cancer, CA-125 level is influenced by a number of factors, including race/ethnicity, age, hysterectomy, smoking history and obesity.

Rapid estimation of Aedes aegypti population size using simulation modeling, with a novel approach to calibration and field validation.

New approaches for control of the dengue vector Aedes aegypti (L.) are being developed, including the potential introduction of life-shortening symbiont bacteria into field populations and the release of transgenic strains with reduced vector competency. With these new approaches comes the need for rapid estimations of existing field population size. Here, we describe the use of simulation modeling with container-inhabiting mosquito simulation (CIMSiM) for estimation of Ae. aegypti pupal crop size in north Queensland, Australia. CIMSiM was calibrated for local conditions by deploying "sentinel key containers" (tire, 2-liter plastic bucket, 0.6-liter pot plant base, and tarpaulin indentation) in which water flux and pupal productivity were studied for 72 d. Iterative adjustment of CIMSiM parameters was used to fit model outputs to match that of sentinel key containers. This calibrated model was then used in a blind field validation, in which breeding container and local meteorological data were used to populate CIMSiM, and model outputs were compared with a field pupal survey. Actual pupae per ha during two 10-d periods in 2007 fell within 95% confidence intervals of simulated pupal crop estimates made by 10 replicate simulations in CIMSiM, thus providing a successful field validation. Although the stochasticity of the field environment can never be wholly simulated, CIMSiM can provide field-validated estimates of pupal crop in a timely manner by using simple container surveys.

A biodegradable lethal ovitrap for control of container-breeding Aedes.

Lethal ovitraps (LO) have been successfully deployed in dengue control operations in north Queensland, Australia since 2004. However, the current plastic-bucket LO must be retrieved before the pesticide-treated strip degrades and the trap begins producing mosquitoes. The logistics involved with trap retrieval are considerable and include recording trap location and retrieval date onto a database, locating and retrieving each trap, and examining lethal ovitraps for eggs. Collectively, these necessary activities greatly reduce the efficiency of dengue control. In response, we have developed a biodegradable lethal ovitrap (BLO) that does not need to be retrieved for the control of container-breeding Aedes, particularly Aedes aegypti. The BLOs were made by injection molding with the use of 2 proprietary blends of thermoplastic starch (TPS) polymer based on plasticised amylose maize polymers. In field trials, Ae. aegypti readily oviposited in BLOs, with those dyed black with the use of carbon black preferred. Water loss was higher in BLOs than in standard plastic LO because of weeping from the walls, although none of the BLOs failed in the 5 wk of the trial. The occurrence and rate of Ae. aegypti oviposition in both BLOs and the LO was comparable. In an accelerated standard composting trial (ISO16929:2002E), both BLOs fragmented within 4 wk, and no BLO particles were visible after 12 wk. Large numbers of BLOs could be deployed in a "set it and forget it" strategy to control Ae. aegypti and to stop dengue transmission, and could be used in a community participation program to maximize coverage.

Mosquito traps for urban surveillance: collection efficacy and potential for use by citizen scientists.

Mosquito-borne diseases are a pervasive public health problem on a global scale, and effective management of them requires well-designed surveillance programs for both vectors and pathogens. Mosquito traps are a common component of such programs, and their reach can be expanded by engaging citizen scientists. In this study in a southern Australian city, we compared the mosquito collection efficacy of two types of traps and assessed their suitability for use in citizen science programs. BG Sentinels and BG Gravid Aedes Trap (BG-GAT) traps both collected Aedes and Culex species in similar proportions, albeit with the former collecting approximately nine times as many mosquitoes. However, BG Sentinels have a greater per unit cost than BG-GATs and are restricted to deployment near power outlets. Importantly, despite being devised for collection of Aedes (Stegomyia) dengue vectors (such as Aedes aegypti), both traps can be effectively used in temperate climates for collection of a range of mosquito species. These traps could conceivably be used in citizen science programs to enhance the reach of surveillance at reduced cost.

Impact of a bifenthrin-treated lethal ovitrap on Aedes aegypti oviposition and mortality in north Queensland, Australia.

Lethal ovitraps (LOs) containing an insecticide-treated ovistrip are used as a lure-and-kill device for the container-breeding dengue vector, Aedes aegypti (L.). We aimed to affirm that the pyrethroid bifenthrin could be used effectively in LOs against Ae. aegypti in north Queensland, Australia, by quantifying oviposition in and mortality caused by LOs. Small cage experiments in which individual gravid Ae. aegypti were given a choice of LOs and untreated ovitraps revealed that although LOs were less acceptable for oviposition, they provided an average 64.6% adjusted mortality. Although 92% of mosquitoes ovipositing in LOs died, 61.8% of mosquitoes that visited but did not oviposit in an LO also died, demonstrating that lethal contact occurred without egg laying. The bifenthrin content of strips (approximately 0.1 mg/cm2; 7 mg/strip) did not decrease significantly after 4 wk of field exposure nor did the toxic effect of the LOs. Large cage trials with groups of 10 Ae. aegypti confirmed that bifenthrin-treated LOs provided consistent control (average adjusted mortality 79.7%). Four-week field trials in north Queensland showed that although LOs were acceptable to ovipositing Ae. aegypti (mean time to first egg 10.9 d; mean eggs 47.3), insecticide-free ovitraps were oviposited in more readily (6.8 d, 199 eggs). The number of eggs laid per mosquito in laboratory LOs allowed calculation of the number of Ae. aegypti killed in field-deployed LOs; rapid estimates can be made by simply dividing the number of eggs on the strip by 2.84. Overall, the studies demonstrated that bifenthrin-treated LOs have potential for use as a lure-and-kill device against Ae. aegypti and that they should be effective in the field for at least 4 wk. Given that untreated ovitraps were more acceptable for Ae. aegypti oviposition, the removal of alternative oviposition sites before deployment of LOs in the field should maximize their effectiveness.

Aedes aegypti population sampling using BG-Sentinel traps in north Queensland Australia: statistical considerations for trap deployment and sampling strategy.

BG-Sentinel mosquito traps were trialed as a tool for the rapid assessment (24-h collections) and routine monitoring (72-h collections) of adult Aedes aegypti L. populations in north Queensland. Analysis of Ae. aegypti collections using BG-Sentinels set in suburban Cairns for 24 h permitted the calculation of sample size for a range of precision levels. Clusters of houses with BG-Sentinels operating continuously for 15 d, with collections every 72 h, also permitted required sample size calculation. Evidence of Ae. aegypti spatial clustering at the house scale was revealed, with statistically significant effects detected for all collection days. Less variation was detected at each trap location, with only nine of 32 trap locations revealing significant clustering over time. Trap-out effects through continuous BG-Sentinel operation at a fixed location were absent. The findings support fixed position sampling at 72-h intervals for routine monitoring ofAe. aegypti populations in Cairns. Despite the relationship between collections of adult vectors and the incidence of disease remaining unknown, BG-Sentinel collections provide an alternative and less labor-intensive abundance measure for assessing risk of dengue virus transmission and success of dengue vector control programs.

Field evaluation of New Mountain Sandalwood Mosquito Sticks and New Mountain Sandalwood Botanical Repellent against mosquitoes in North Queensland, Australia.

The mosquito repellent efficacy of New Mountain Sandalwood Mosquito Sticks (containing 0.5% w/w essential oils) and New Mountain Sandalwood Botanical Repellent (containing soybean and geranium oils) was assessed. Tests were conducted in the field with 4 volunteers in a wooded area near Cairns, North Queensland, Australia. Predominant biting species were Verrallina funerea and Ve. lineata. A pair of burning Mosquito Sticks immediately upwind of the subject (acting as an area repellent) provided a 73.1% mean reduction in mosquito landing and probing over the 3-h test period. The Botanical Repellent and a DEET-based control were both 100% effective in preventing mosquito probing for 3 h. These data are consistent with other studies of area repellents in that such products provide significant protection from mosquito bites, albeit inferior to the protection provided by topically applied repellents.