Effectiveness of permethrin-treated clothing to prevent tick exposure in foresters in the central Appalachian region of the USA.

Outdoor workers are at risk from mosquito and tick bites and the extent to which exposures are linked to vector-borne disease is not understood. This pilot study characterizes for ester exposure to mosquitoes and ticks, and assesses effectiveness of permethrin-treated clothing for prevention of tick bites. Foresters (N = 34) from Kentucky, North Carolina, Ohio, Tennessee, Virginia, and West Virginia were placed into treatment (permethrin-treated clothing) or control (untreated clothing) groups. Foresters completed questionnaires about work-related tick/mosquito exposure and 454 ticks were collected/identified from May to June 2013. A time-weighted analysis based on information submitted by foresters about time working outdoors showed that control participants received a lower rate of tick exposure (0.15 tick bites/hour; 13 bites/person) compared to treatment participants (0.27 bites/hour; 21 bites/person). However, more control participants (85 %) received at least one tick bite compared to treatment participants (52 %). Outdoor workers should be aware of available protective measures, such as permethrin-treated clothing, that may mitigate occupational risks.