Relapsing fever primary prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Wearing clothing that fully covers the arms and legs outdoors, Insect repellents such as DEET on the skin and clothing also work. Tick and lice control in high-risk areas is another important public health measure. Rodent( reservoir) control. Epidemics are controlled by sterilizing clothing to eliminate lice, using pediculicides, and by improving personal hygiene.

In order to prevent TBRF relapsing fever, one should:

• Avoid sleeping in rodent-infested buildings.
• Limit tick bites by using insect repellent containing DEET (on skin or clothing) or permethrin (applied to cloth or equipment).
• Identify and remove any rodent nesting material from walls, ceilings, and floors.
• In combination with removing the rodent material, fumigate the building with preparations containing pyrethrins and permethrins. More than one treatment is often needed to effectively rid the building of the vectors, the soft-ticks. Always follow product instructions, and consider consulting a licensed pest control specialist.^[1]

Louse-borne relapsing fever (LBRF) can be prevented by:

• Eliminating circumstances that promote louse infection (eg, crowding, homelessness)
• Good personal hygiene (eg, changing clothes at frequent intervals, bathing, boiling and washing clothes and bedding).
• Delousing with 1% lindane, DDT powder, or Lysol is useful in shelters and household contacts
• Breaking louse transmission is essential for the control of an epidemic. Infested clothing should be deloused using heat (>60 °C) or washing at 52 °C for 30 min.
• Patients should be bathed with soap. Head lice should be removed by washed or shaving although their role in LBRF is unproven.
• Separating infested clothes from wearers for 10 days starves lice to death at any ambient temperature.

• Currently, no vaccine against relapsing fever is available. Developing a vaccine is very difficult because the spirochetes avoid the immune response of the infected person (or animal) through antigenic variation (changing its surface proteins).