Permethrin-impregnated military uniform protection against different species of biting insects: narrative review

Today personal protection measures against mosquitoes and other medically important arthropods have a significant role in integrated vector management programs. Personal protection technologies such as insecticide-treated clothes and nets are some of the most effective tools against mosquitoes. Permethrin, as a synthetic pyrethroid insecticide, with features such as having a knockdown, repellency and residual activity, and low human and mammalian toxicity, is widely used for impregnation of fabrics and clothes. The dose required is 1250 mg/m2, which has not caused toxic effects in users. Many methods have been developed to impregnate fabrics and clothes with permethrin or similar compounds. However, new impregnation methods such as polymer-coating and microencapsulation technologies which may prolong the activity of insecticides on clothing are currently under development. These methods have the advantage of helping to overcome the inevitable reduction in efficacy over time that occurs as a result of washing, ultraviolet light exposure, and the normal wear and tear of the fabric. The aim of this review is to investigate the evidence base for the use of insecticide-treated clothing and military uniforms for protection against bites from arthropods and its effect on arthropod-borne pathogen transmission. Although insecticide-treated clothing can provide some protection against biting insects, few studies have shown complet protection (100%) in using insecticide-treated clothing alone, but most studies have mentioned complete protection against biting insects from the simultaneous use of permethrin-impregnated clothing as well as repllents on exposed skin. The effectiveness of impregnated clothing in the prevention or reducing of insect-borne diseases is not yet fully understood and the level of protection provided varies according to the vectors, impregnated fabrics and location. In general, there is reliable evidence which suggest that impregnated fabric can provide effective protection against insect bites, and providing relative protection against vector-borne diseases in bites. Nonetheless, simultaneous use of impregnated clothes and insect repellents on the skin can provide complete protection against bites and consequent disease. This approach is recommended for protection of high-risk personnel such as soldiers and outdoor workers, as well as travelers and tourists to protect against biting insects and vector-borne diseases.