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MINISTRY OF TOURISM AND CIVIL AVIATION
REPUBLIC OF MALDIVES
C I R C U L A R

Circular No:
88-QM/CIR/2006/38
Date:

26th December 2006 All tourist resorts / Picnic Islands / Yacht marinas/ hotels/Safari vessels Subject:
Elimination of Mosquito breeding sites

If transmission is not clear or incomplete, please inform Quality Management Section at Tel no: 3323224 (ext.

233)

Dear Sir / Madam,
Unusually prolonged rain in the past several weeks in the country has raised concerns that it may create mosquito breeding sites. You would agree that both the elimination of mosquito breeding sites and the adoption of mosquito control measures are essential to reduce the risk of vector borne diseases. We are, therefore, transmitting herewith a copy of the recommended prevention measures against mosquito borne diseases released today by the Ministry of Health to help resorts respond to prevailing concerns and to reduce risks. We trust that you would study these measures and adopt them as you deem necessary. We will remain in touch with you over the matter, and we assure you of our best co- cooperation and consideration at all times. Yours sincerely, Director

Prevention Measures against mosquito borne diseases

Bite prevention
Most important aspect of mosquito borne disease prevention is mosquito control and
prevention of breeding.
Following steps are recommended to reduce the risk of being bitten by an infected
mosquito:
• Use insect repellent on exposed skin surfaces when outdoors, particularly during the day as the mosquito that transmits dengue and chikungunya is a daytime biter. • Repellents containing 30% to 50% DEET (N,N-diethyl-m-toluamide) are recommended as the most reliable and long-lasting. Lower concentrations of DEET offer shorter-term protection and require more frequent reapplication. • Length of protection also varies with ambient temperature, amount of perspiration, any water exposure, abrasive removal, and other factors. • DEET formulations as high as 50% are recommended for both adults and children over 2 months of age. Protect infants less than 2 months of age by using a carrier draped with mosquito netting with an elastic edge for a tight fit. • The recommendations for DEET use in pregnant women do not differ from those for non-pregnant adults. • Repellent products that do not contain DEET are not likely to offer the same degree of protection from mosquito bites as products containing DEET. • DEET-based repellents applied according to label instructions may be used with sunscreen with no reduction in repellent activity. When using sunscreen, apply sunscreen first and then repellent. • Clothing may also be sprayed with repellent containing permethrin for greater protection. Permethrin is not labeled for use directly on skin. Most repellent is generally removed from clothing and gear by a single washing, but permethrin-treated clothing is effective for up to 5 washings. • Repellent should be washed off at the end of the day before going to bed. • If illness develops, stay under a mosquito net or indoors to limit mosquito bites and to avoid further spread of infection. DEET is a well studied repellant and adverse reaction to this is very unlikely. However, the possibility of adverse reactions to DEET will be minimized if they take the following precautions: • Use enough repellent to cover exposed skin or clothing. Do not apply repellent to skin that is under clothing. Heavy application is not necessary to achieve protection. • Do not apply repellent to cuts, wounds, or irritated skin. • After returning indoors, wash treated skin with soap and water. • Do not spray aerosol or pump products in enclosed areas; do not inhale the aerosol. • Do not apply aerosol or pump products directly to the face. Spray your hands and then rub them carefully over the face, avoiding eyes and mouth. • When using repellent on a child, apply it to your own hands and then rub them on the child. Avoid the child's eyes and mouth and apply sparingly around the ears. • Do not apply repellent to children's hands. (Children tend to put their hands in their * This is a computer generated fax tserver users VIEW CIRCULAR QM 2006 mos.doc
Ministry of Tourism and Civil Aviation , Ghaazee Building, Ameeru Ahmed MaguMalé 20 - 05, Republic of Maldives Tel. +960 3323224, 332 3226, Fax:+ 960 3322512, E-mail: ts@maldivestourism.gov.mv , Website: www.maldivestourism.gov.mv • Do not allow children <10 years old to apply insect repellent to themselves; have an adult do it for them. Keep repellents out of reach of children. • Protect infants 2 months of age by using a carrier draped with mosquito netting with an elastic edge for a tight fit.
Larva control
• Destroy or dispose of tin cans, plastic bottles, old tires, buckets, or other containers that collect and hold water. Do not allow water to accumulate in the saucers of flowerpots or in pet dishes for more than 2 days. • Clean debris from rain gutters and remove any standing water under or around structures, or on flat roofs. Check around faucets and air conditioner units and repair leaks or eliminate puddles that remain for several days. • Cover water tanks and other water collecting devices to prevent access of mosquitoes. All the overflow outlets should be covered with mesh/nets. • Check for trapped water in plastic or canvas tarps used to cover boats, catamarans, surf boards, etc. Arrange the tarp to drain the water. • Check around construction sites to ensure that proper drainage mechanisms are in place. Where water holding is necessary, put a thin film of oil on the water surface. • If ditches do not flow and contain stagnant water for one week or longer, they can produce large numbers of mosquitoes. Report such conditions to concerned authorities.
Adult Control
The adult control measures do not manage insects for long periods of time.
Mechanical Barriers
Mosquitoes can be kept out of the home by keeping windows, doors and porches tightly
screened with mesh/nets. Those insects that do get into structures can be eliminated with an
aerosol space spray containing synergized pyrethrum.
Space sprays
Household aerosol space sprays containing synergized pyrethrum or synthetic pyrethroids
(allethrin, resmethrin, etc.).
Only insecticides labeled for flying insect management should be sprayed into the air. Best
results are obtained if doors and windows are kept closed during spraying and for 5-10
minutes after spraying. Always follow directions on the label.
Indoor mosquito repellants
Use mosquito repellants like coils, mats or vapours.
Outdoor Control
Fogging can be used for temporary relief from flying mosquitoes. However, it has to be noted
that this itself is not a solution for mosquito control. It has inherent disadvantages like
atmospheric pollution, short-term health problems like aggravation of asthma, long-term
health hazards on prolonged and overuse, etc. Pyrethrins or 5% malathion can be fogged
outdoors.
* This is a computer generated fax tserver users VIEW CIRCULAR QM 2006 mos.doc
Ministry of Tourism and Civil Aviation , Ghaazee Building, Ameeru Ahmed MaguMalé 20 - 05, Republic of Maldives Tel. +960 3323224, 332 3226, Fax:+ 960 3322512, E-mail: ts@maldivestourism.gov.mv , Website: www.maldivestourism.gov.mv

Source: http://www.tourism.gov.mv/downloads/Eliminationof-Mosquito-beering-sites06.pdf

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Methylprednisolone in patients undergoing cardiopulmonary bypass (SIRS): a randomised, double-blind, placebo-controlled trial Richard P Whitlock, P J Devereaux, Kevin H Teoh, Andre Lamy, Jessica Vincent, Janice Pogue, Domenico Paparella, Daniel I Sessler, Ganesan Karthikeyan, Juan Carlos Villar, Yunxia Zuo, Álvaro Avezum, Mackenzie Quantz, Georgios I Tagarakis, Pallav J Shah, Seyed Hesameddin Abbasi, Hong Zheng, Shirley Pettit, Susan Chrolavicius, Salim Yusuf, for the SIRS Investigators*