Journal of Pediatric Nursing (2012) 27, 346349

Prevention of Vector Transmitted Diseases With Clove Oil

Insect Repellent
Rochel Shapiro BSN, RN
Duke University School of Nursing, Durham, NC

Key words:
Vector repellent is one element in the prevention of vector-borne diseases. Families that neglect
Infectious disease;
protecting their children against vectors risk their children contracting illnesses such as West Nile virus,
Insect repellent;
eastern equine encephalitis, Lyme disease, malaria, dengue hemorrhagic fever, yellow fever, babesiosis,
Pediatric dermatology;
Crimean-Congo hemorrhagic fever, Rocky Mountain spotted fever, Southern tick-associated rash
Prevention of
illness, ehrlichiosis, tick-borne relapsing fever, tularemia, and other insect and arthropod related diseases
vector-borne illness;
(CDC, 2011). Identification of families at risk includes screening of the underlying basis for reluctance
Lyme disease;
to apply insect repellent. Nurses and physicians can participate in a positive role by assisting families to
Malaria;
determine the proper prophylaxis by recommending insect repellent choices that are economical, safe,
West Nile virus;
and easy to use. A holistic alternative might include the suggestion of clove oil in cases where families
Rocky Mountain
might have trepidations regarding the use of DEET on children. This article will explore the safety and
spotted fever;
effectiveness of clove oil and its use as an insect repellent.
Clove oil;
2012 Elsevier Inc. All rights reserved.
DEET;
Holistic alternative;
Children;
Tick;
Mosquito

Background The Infectious Diseases and Immunization Committee of the

THE AMERICAN ACADEMY of Pediatrics (AAP)
states that insect repellents containing DEET are most
effective in the prevention of ticks (Lyme disease) and
mosquitoes (West Nile virus) in children older than 2 months
(AAP, 2010). Caregivers of children might consider more
natural alternatives for the insect repellent needs of children
if highly regarded authorities such as pediatricians, derma-
tologists, other physicians, and nurses endorsed essential
oils, specifically, clove oil, to be used as a safe and effective
alternative to DEET, although the AAP reports the safety of
DEET (AAP, 2003). These recommendations are in
accordance with the Food and Drug Administration (FDA)
guidelines (FDA, 2010), which purport the safety of DEET.
Corresponding author: Rochel Shapiro, BSN, RN.
E-mail address: rochelshapiro@yahoo.com.
Canadian Paediatric Society (2003) describes research on
different insect repellent products as follows: the duration of
insect repellency provided by DEET as determined by
concentration23.8% DEET provided 5 hours of protec-
tion, 20% was effective for 4 hours, 6.65% remained
effective for 2 hours, and 4.54% provided insect repellency
for 1.5 hours; soybean oil (2%) mixture protected for 1.5
hours; whereas oil of eucalyptus appeared to provide 2 hours
of protection.
Approved insect repellents have met required standards
and have been shown not to have complicated adverse
reactions on people (CDC, 2010; United States Environ-
mental Protection Agency [EPA], 2009) when used accord-
ing to label instructions. The improper use of DEET has been
associated with neurotoxicity; other side effects noted when
using DEET, Citriodiol (p-menthane 3,8-diol [PMD]),
Icaridine (KB3023, and 4), and IR3535 include local
irritative dermatitis and allergy (Sorge, 2009). Active

0882-5963/$ see front matter 2012 Elsevier Inc. All rights reserved.
doi:10.1016/j.pedn.2011.03.011
Vector Prevention With Clove Oil
ingredients are those that repel insects (EPA, 2007) in insect
repellants and require EPA registration and approval (EPA,
2009). Despite the reported safety of use, parents and
caregivers may be leery to apply chemicals to their children's
sensitive skin.
Currently, the list of EPA-approved active ingredients that
may be used in insect repellents include the following: DEET
4%100% strength (N,N-diethyl-meta-toluamide or N,N-
diethly-3-methyl-benzamide); Picaridin 5%20% (2-(2-
hydroxyethyl)-1-piperidinecarboxylic acid 1-methylpropyl
ester); oil of lemon eucalyptus 30%40% (Eucalyptus
citriodora/Corymbia citriodora; methyl nonyl ketone;
IR3535 (3-[N-Butyl-N-acetyl]-aminopropionic acid, ethyl
ester), also called Merck 3535; and oil of citronella. All can
be safely applied topically according to directions on product
labels (EPA, 2009). Permethrin, allethrin, and metofluthrin
can be used on clothing, not directly on skin to repel insects
(EPA, 2009).
Essential Oils Boast Insecticidal Properties
Oil of citronella is approved for use on humans as an
insect repellent with little or no known toxicity; however, it
is known to trigger hypersensitivity-associated dermatolog-
ical reactions (EPA, 1999). Citronella has been in use since
1948 without adverse incident (EPA, 1999). The mechanism
responsible for insect repellency in citronella is the masking
of CO2 or lactic acid discharged by humans that attracts
mosquitoes and other insects. Citronella is found on the list
of chemicals that may not require EPA registration in some
cases. Unless a product containing citronella is EPA
registered, it has not been subject to EPA review and the
EPA cannot corroborate its safety and effectiveness. Oil of
citronella goods are often marketed as repellent candles,
although topical preparations offer insect defense as well
(EPA, 2009).
Oil of lemon eucalyptus (active ingredient: PMD) was
discovered to provide insect defense comparable to low
concentrations of DEET (EPA, 2009; CDC, 2010).
DEET has been the gold standard of insect repellency for
60 years, but natural products such as oil of lemon eucalyptus
are entering the market with proven efficacy and high patient
satisfaction (Katz, Miller, & Herbert, 2008); despite the
promising research, natural products are not commonly
recommended. Natural products such as essential oils proven
to provide effective and environmentally safe insect control
have been extensively tested and offer safer human health
alternatives to insect control with synthetic chemicals (Nerio,
Olivero-Verbel, & Stashenko, 2010). Numerous plant
essential oils interfere with the octopaminergic nervous
system in insects, which is not shared with mammals, and
provide a comparatively nontoxic and safer alternative to
pest control for mammals and fish (Koul, Waliai, &
Dhaliwal, 2008). Eugenol is a natural chemical found in oil
of cloves that attracts Japanese beetles, kills insects, and is
347
considered safe and without risks when used as directed
(EPA, 2004).
Clove Oil Applications
Cloves and clove oil are both EPA classified as minimum
risk pesticides and are not subject to federal registration
requirements because their active and inert ingredients are
evidently safe for use on people and are exempt from federal
registration under section 25(b) of the Federal Insecticide,
Fungicide, and Rodenticide Act (FIFRA; EPA, 2011b). By
not falling under the guidelines requiring FIFRA registration,
the EPA is unable to endorse safety and effectiveness (EPA,
2009). However, the FDA's Select Committee on Generally
Recognized as Safe Substances (GRAS) evaluated and
classified clove oil to be GRAS (FDA, 2009b).
Various natural products are formulated with clove oil
and are marketed as over-the-counter natural products
and cosmetics. In an antimicrobial study, clove oil in
combination with other substances including arrowroot,
baking soda, basil oil, bay oil, tea tree oil, and sage oil
has been topically applied to the feet (Misner, 2007);
cutaneous hypersensitivity reactions were not noted.
Essential oils can cause skin irritation in some people,
whereas others might find the aroma offensive (Barnard,
1999). Skin irritation is not an unusual complaint in a
topically applied product and has been reported with the
use of DEET, Citriodiol (PMD), Icaridine (KB3023, and
4), and IR3535 (Sorge, 2009). Clove oil (50%) blended
with 50% geranium oil , or 50% thyme oil, was proven
highly efficacious as a topical mosquito repellent but
may produce cutaneous irritation (Barnard, 1999), which
may be the result of the higher concentration of the
essential oil against the skin. Medline (2011, para 11)
reports, In lab and field tests, undiluted clove oil
repelled multiple species of mosquitoes for up to two
hours. However, undiluted clove oil may also cause skin
rash in sensitive people.
Clove oil has been studied for its antibacterial, antimicro-
bial, and antifungal properties against cutaneous infectious
manifestations and has been shown to be environmentally
safe and nontoxic to humans for use in medicine, perfume,
and food flavoring (Trongtokit, Rongsriyam, Komalamisra,
& Apiwathnasorn, 2005). Chaieb et al. (2007) describe clove
oil to encompass antibacterial, antiviral, antimicrobial,
antifungal, anti-inflammatory, cytotoxic, insect repellency,
anesthetic, and antitumor properties. Katritzky et al. (2008,
p. 7362) report, We identified 23 compounds for synthesis
and study that we expected to be as efficacious as DEET
Astonishingly, a number of these protected (more than) 3
times as long as DEET. Researchers Trongtokit et al. (2005)
studied the mosquito repellency of 38 essential oils and found
clove oil (Syzygium aromaticum) to provide the longest and
most effective protection against three mosquito species;
mosquito defense lasted between 2 and 4 hours. Clove oil
348
(S aromaticum) and thyme oil were both found to be very
effective essential oils to repel mosquitoes (Barnard, 1999).
Clove oil is a potent antifungal agent (Nozaki, Takahashi,
Okamoto, Ito, & Hatano, 2010). Clove oil was found to repel
lice (Yang, Lee, Clark, & Ahn, 2004). Clove oil
(S aromaticum) is commonly used in Thailand as a food
flavoring and to treat dental caries (Trongtokit, Rongsrivam,
Komalamisra, Krisadphong, & Apiwathnasom, 2004). Clove
oil is an effective insect repellent (Barnard, 1999). Dayan,
Cantrell, and Duke (2009) report that clove oil is a rapid-
acting insecticide that is effective on arthropod pests,
armyworms, thrips, aphids, and mites. Clove oil is used in
organic agriculture as an alternative to nonorganic farming
methods. Because clove oil is considered a biopesticide, it is
believed to be safer than chemical pesticides (EPA, 2011a).
Clove oil is a minimum-risk pesticide (EPA, 2011b).
Acaricidal properties (destroys mites and ticks) were found
in clove oil (Kim, Kim, Choi, & Ahn, 2003). Saad, Hussien,
Saher, and Ahmed (2006) researched the acaricidal action of
14 essential oils and determined clove oil as the most
effective acaricide against household dust mites: This study
suggested that clove oil may be an ingredient to consider
when shampooing carpets as an aid to mite control.
Endorsement is needed from respected authorities such as
the AAP. Health care professionals might be able to suggest
natural clove oil as an alternative to the currently
recommended insect repellent DEET for the insect repellent
needs of their patients.
Research Questions: Clove Oil as an
Insect Repellent
Trongtokit et al. (2004) tested experimental topical gels
and creams containing clove oil developed to determine
strength and duration of efficacy against various mosquito
species. They concluded that 10% clove oil combined
with 10% makaen oil provided complete protection for
4 hours after application, and 95.7% repellency protection
5 hours following topical application to the volunteers'
legs. Additional strengths were tested resulting in a
suggestion that these preparations can be used to provide
mosquito repellency.
Further research may be needed to determine the strength,
duration of effectiveness, proper application, recommended
age to insure safe application, dermatological tolerance, and
optimum vehicle for safe dermatological application of clove
oil. However, there are clove oil products currently marketed
and in use as over-the-counter preparations. Currently, more
research is needed to determine the percent strength of clove
oil necessary to promote effective insect repellency and to
take this strength and immerse it into a neutral vehicle to test
for cutaneous reactions. Testing would also be needed to
determine the length of time that the preparation of this
composition remains active. Additional research is needed to
investigate the side effects of irritation to the eyes and other
R. Shapiro
mucous membranes and to determine if the risks outweigh
the benefit of using a natural preparation versus a chemical
insect repellent. In addition to determining parameters for a
topical application and the vehicle to ensure cutaneous
nonirritability, other mechanisms to explore would include
non-aerosol multipurpose sprays (those that can be sprayed
onto both skin and clothing) and ways to impregnate fabric
such as tents and mosquito netting with clove oil.
Conclusions
Clove oil has had success when topically applied for its
antimicrobial, antibacterial, and antiseptic properties against
infections and as a vermifuge (antiworm) (Mesbah, Mourad
& Rokaia, 2006). Clove oil is commonly used in dental
root canal surgery for its antimicrobial properties (Trong-
tokit et al., 2004) but has not gained much support for use
as an insect repellant. This might be because skepticism is
associated with clove oil because it is a natural product in
the public domain and might be regarded as less potent or
effective than DEET or because clove oil is not endorsed
by respected authorities such as the AAP and dermatology
associations. DEET is currently recommended by the AAP
(2010), EPA (2007), and CDC (2010) for its insect-
repelling properties.
Nurses and physicians are in a unique position to assist
families with questions related to the choices of insect
repellant. The physician and nurse's primary motivation in
this venue is to promote health and prevent vector-borne
illness. Interventions will include assessment of familial,
social, economic, political, and religious needs of patients
and their families. Nurses and physicians might offer
holistic approaches such as clove oil instead of DEET if
these alternatives are promoted by recognized authorities
and backed by evidenced-based research. In this way,
nurses and physicians might help protect their patients and
families from such vector-contracted illnesses as West Nile
virus, eastern equine encephalitis, Lyme disease, malaria,
dengue fever, yellow fever, babesiosis, Crimean-Congo
hemorrhagic fever, Rocky Mountain spotted fever, South-
ern tick-associated rash illness, ehrlichiosis, tick-borne
relapsing fever, and tularemia (CDC, 2011). Although it
is important to determine reasons for avoidance of chemical
prophylaxis to prevent insect bites and stings, nurses and
physicians ought to be able to suggest safe, feasible,
natural, and evidenced-based insect repellent alternatives.
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