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Viral fever in child medicine. Viral Fever in Children: Essential Guide for Parents on Symptoms, Treatment, and Prevention

How can parents recognize viral fever symptoms in children. What are the best home remedies for managing viral fever in kids. When should parents seek medical attention for a child’s fever. How can viral infections in children be prevented.

Understanding Viral Fever in Children: Causes and Symptoms

Viral fever is a common occurrence in children, caused by various viral infections. Unlike bacterial infections, viral illnesses don’t respond to antibiotics and typically need to run their course. The body’s immune response to the viral invasion often results in an elevated temperature, which is the body’s natural defense mechanism against pathogens.

Common symptoms of viral fever in children include:

  • Elevated body temperature (above 98.6°F or 37°C)
  • Fatigue and weakness
  • Body aches and pains
  • Headache
  • Loss of appetite
  • Irritability
  • Congestion or runny nose
  • Cough or sore throat

The duration of a viral fever can vary depending on the specific virus causing the infection, typically lasting anywhere from a couple of days to a week or longer.

Differentiating Between Viral and Bacterial Infections

One of the challenges parents face is distinguishing between viral and bacterial infections. While both can present similar symptoms, the treatment approaches differ significantly. Dr. Nipunie Rajapakse, a pediatric infectious diseases specialist at Mayo Clinic’s Children’s Center, emphasizes the importance of understanding this distinction.

Key differences between viral and bacterial infections include:

  • Treatment approach: Viral infections don’t respond to antibiotics, while bacterial infections often do
  • Duration: Viral infections typically resolve on their own, while bacterial infections may require medical intervention
  • Onset: Viral symptoms often develop gradually, while bacterial infections can have a more sudden onset

This knowledge is crucial for parents to avoid unnecessary antibiotic use, which can lead to antibiotic resistance and potential harm to the child.

Home Remedies and Management Strategies for Viral Fever in Children

While viral infections need to run their course, there are several ways parents can help manage their child’s symptoms and provide comfort:

  1. Ensure adequate hydration: Offer plenty of fluids to prevent dehydration
  2. Rest: Encourage your child to get plenty of sleep and rest
  3. Use fever-reducing medications: Acetaminophen or ibuprofen can help reduce fever and discomfort
  4. Cool compresses: Apply a cool, damp cloth to the forehead to help lower body temperature
  5. Dress appropriately: Use light clothing and bedding to prevent overheating
  6. Maintain a comfortable room temperature: Keep the environment cool but not cold
  7. Offer light, nutritious foods: Even if appetite is reduced, try to provide easy-to-digest meals

These strategies can help alleviate discomfort and support the body’s natural healing process.

When to Seek Medical Attention for a Child’s Fever

While most viral fevers resolve on their own, there are instances when medical attention is necessary. Parents should be aware of the following guidelines:

For infants (0-3 months):

Contact a healthcare provider if the rectal temperature is 100.4°F (38°C) or higher.

For babies (3-6 months):

Seek medical advice if the rectal temperature exceeds 102°F (39°C) and the child appears irritable or unusually sleepy.

For toddlers (6-24 months):

Consult a doctor if the rectal temperature is above 102°F (39°C).

Additionally, parents should be alert to other concerning symptoms such as:

  • Difficulty breathing
  • Signs of dehydration (dry mouth, no tears when crying, decreased urination)
  • Persistent vomiting or diarrhea
  • Seizures
  • Extreme lethargy or unresponsiveness
  • Severe headache or neck stiffness
  • Unexplained rash

These symptoms may indicate a more serious condition requiring immediate medical attention.

The Dangers of Misusing Antibiotics for Viral Infections

A common misconception among parents is that antibiotics are necessary for all fevers. Dr. Rajapakse emphasizes the importance of understanding that antibiotics are ineffective against viral infections and can actually cause harm when used inappropriately.

Risks associated with unnecessary antibiotic use include:

  • Antibiotic resistance: Overuse can lead to the development of antibiotic-resistant bacteria
  • Disruption of gut flora: Antibiotics can upset the balance of beneficial bacteria in the digestive system
  • Side effects: Unnecessary antibiotics may cause adverse reactions such as diarrhea, nausea, or allergic reactions
  • Delayed proper treatment: Focusing on antibiotics may delay identifying and addressing the true cause of symptoms

Parents should trust their healthcare providers when they advise against antibiotic use for viral infections. This approach helps preserve the effectiveness of antibiotics for serious bacterial infections where they are truly needed.

Prevention Strategies: Keeping Your Child Healthy

While it’s impossible to prevent all viral infections, there are several strategies parents can employ to reduce their child’s risk:

  1. Encourage proper hand hygiene: Teach children to wash their hands frequently with soap and water
  2. Promote a healthy lifestyle: Ensure your child gets adequate sleep, exercises regularly, and maintains a balanced diet
  3. Keep vaccinations up to date: Follow the recommended immunization schedule to protect against preventable diseases
  4. Avoid close contact with sick individuals: Teach children to maintain distance from those who are ill
  5. Practice respiratory etiquette: Encourage covering the mouth and nose when coughing or sneezing
  6. Maintain a clean environment: Regularly disinfect frequently touched surfaces in your home
  7. Boost immune health: Consider incorporating immune-supporting foods and supplements as advised by your pediatrician

These preventive measures can significantly reduce the likelihood of viral infections and promote overall health.

Understanding the Body’s Immune Response to Viral Infections

The human body has a remarkable defense system designed to combat viral invaders. When a virus enters the body, it triggers a complex cascade of immune responses aimed at eliminating the threat. Understanding this process can help parents appreciate why certain symptoms occur and how to support their child’s recovery.

The Stages of Immune Response:

  1. Recognition: The immune system identifies the virus as foreign
  2. Activation: Immune cells are mobilized to fight the infection
  3. Inflammation: This process helps isolate and destroy the virus
  4. Fever: Elevated body temperature creates an inhospitable environment for the virus
  5. Antibody production: The body creates specific antibodies to target the virus
  6. Recovery: As the virus is eliminated, symptoms subside

Fever, while uncomfortable, is a sign that the body is actively fighting the infection. By understanding this, parents can feel more confident in allowing the fever to run its course while providing supportive care.

Supporting Your Child’s Immune System:

There are several ways to bolster your child’s natural defenses:

  • Ensure adequate sleep: Sleep is crucial for immune function
  • Provide a nutrient-rich diet: Focus on fruits, vegetables, and lean proteins
  • Encourage physical activity: Regular exercise supports overall health and immunity
  • Manage stress: Help your child develop stress-management techniques
  • Consider probiotics: These can support gut health, which is linked to immune function

By supporting the immune system, parents can help their children recover more quickly from viral infections and potentially reduce the frequency of illnesses.

The Role of Fever in Fighting Infections

Fever is often viewed with concern by parents, but it’s important to understand its vital role in combating infections. A fever is not an illness itself, but rather a symptom and a natural defense mechanism of the body.

Benefits of Fever:

  • Slows down bacterial and viral replication
  • Enhances immune cell function
  • Increases production of disease-fighting substances
  • Accelerates the body’s metabolic processes

While it’s natural to want to reduce a child’s fever for comfort, it’s not always necessary to lower it with medication unless it’s causing significant discomfort or is dangerously high.

Monitoring Fever:

When monitoring your child’s fever, consider these factors:

  1. Age of the child
  2. Temperature reading
  3. Duration of the fever
  4. Accompanying symptoms
  5. The child’s overall behavior and comfort level

Remember, a child’s behavior and overall condition are often more indicative of the severity of illness than the temperature alone. A child who is playing and eating normally, despite a fever, may not require medical attention unless other concerning symptoms are present.

Long-Term Health Implications of Recurrent Viral Infections in Children

While most children recover fully from viral infections without complications, frequent or severe infections can sometimes have long-term health implications. Understanding these potential effects can help parents take proactive measures to support their child’s overall health.

Possible Long-Term Effects:

  • Weakened immune system: Recurrent infections may temporarily suppress immune function
  • Developmental delays: Frequent illnesses can impact a child’s growth and development
  • Chronic fatigue: Repeated infections may lead to prolonged periods of low energy
  • Nutritional deficiencies: Decreased appetite during illnesses can affect nutrient intake
  • Respiratory issues: Some viral infections can lead to chronic respiratory problems

To mitigate these risks, parents should focus on supporting their child’s overall health and immune function. This includes ensuring proper nutrition, adequate sleep, regular exercise, and managing stress levels.

When to Consult a Specialist:

If a child experiences frequent or severe viral infections, it may be beneficial to consult with a pediatric immunologist. They can assess whether there are underlying factors contributing to the recurrent illnesses and provide tailored advice for boosting the child’s immune health.

Factors that might warrant specialist consultation include:

  • More than 8-10 colds or other viral infections per year
  • Infections that are unusually severe or long-lasting
  • Infections that don’t respond to standard treatments
  • Family history of immune disorders

By addressing these concerns early, parents can help ensure their child’s long-term health and well-being.

Mayo Clinic Minute: What to do and not do when your child has a viral fever

  • By

    DeeDee Stiepan

When kids get sick, most of the time, viruses or bacteria cause their infections. While viral and bacterial infections can have similar symptoms, such as coughing, sore throat and fever, one big difference between the two is how they are treated.

In this Mayo Clinic Minute, Dr. Nipunie Rajapakse, a pediatric infectious diseases specialist at Mayo Clinic’s Children’s Center, explains the differences between the two infections and why antibiotics won’t help and why they may even hurt if taken to treat viral infections.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (1:09) is in the downloads at the end of this post. Please “Courtesy: Mayo Clinic News Network.” Read the script.

The most common circulating viruses for the fall and winter, such as colds and flus, rely on the immune system to fight them off. So don’t expect your health care professional to prescribe an antibiotic.

Antibiotics don’t kill off viruses. Dr. Rajapakse says a common misconception she tries to dispel is that children with fevers need to be on an antibiotic before they can return to school or day care.

“Giving a child with a viral infection, an antibiotic, does not help them at all. It won’t help them get better faster, and it can cause them harm,” says Dr. Rajapakse.

She says there’s also the issue of overuse, which is driving antibiotic-resistant bacteria and making infections more difficult to treat.

“We’re trying to reduce the instances that this is happening in bacterial infections. If you have one, an antibiotic can be lifesaving. And, so, these are things like pneumonia or blood infections, or infections of the bone, for example, where antibiotics definitely should be used. And in order to keep them effective for these types of serious infections, we really need to only use them when we know that there’ll be effective and treat patients.”

For viral infections, fever-reducing medications, such as acetaminophen or ibuprofen, can reduce symptoms while the body fights off the virus.

Related posts:

  • “Mayo Clinic Minute: The 3 best ways to keep kids healthy when heading back to school.”

For the safety of its patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was recorded prior to COVID-19 or recorded in an area not designated for patient care, where social distancing and other safety protocols were followed.

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Viral Fever Home Remedies for Treating Children and Adults

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Unlike bacteria, viruses don’t respond to antibiotics. In most cases, viral illnesses simply have to run their course. Staying hydrated or using over-the-counter fever-reducing medications can help until it resolves.

A viral fever is any fever that happens as a result of a viral infection. Viruses are tiny germs that spread easily from person to person.

When you contract a viral condition, such as a cold or flu, your immune system responds by going into overdrive. Part of this response often involves raising your body’s temperature to make it less hospitable to the virus and other germs.

Most people’s usual body temperature is around 98.6°F (37°C). Anything 1 degree or more above this is considered a fever. A fever can last anywhere from a couple of days to a week or longer, depending on the type of infection causing it.

While the virus runs its course, there are several things you can do to help manage your symptoms. Read on to learn more.

Fevers usually aren’t something to worry about. But when they’re high enough, they can pose some health risks.

For children

A high fever can be more dangerous for a young child than an adult. Here’s when to call your child’s doctor:

  • Children ages 0 to 3 months: Rectal temperature is 100. 4°F (38°C) or higher.
  • Children ages 3 to 6 months: Rectal temperature is above 102°F (39°C) and they’re irritable or sleepy.
  • Children ages 6 to 24 months: Rectal temperature is above 102°F (39°C) that lasts for more than a day. If they have other symptoms, such as a rash, cough, or diarrhea, you may want to call sooner.

For children 2 and older, call their doctor if they have a fever that repeatedly rises above 104°F (40°C). Also seek medical advice if your child has a fever and:

  • They seem unusually lethargic and irritable or have other severe symptoms.
  • The fever lasts longer than three days.
  • The fever doesn’t respond to medication.
  • They don’t maintain eye contact with you.
  • They can’t keep fluids down.

For adults

Fevers can also be risky for adults in some cases. See your doctor for a fever that’s 103°F (39°C) or higher that isn’t responding to medication or lasts longer than three days. Also seek treatment if a fever is accompanied by:

  • severe headache
  • rash
  • sensitivity to bright light
  • stiff neck
  • frequent vomiting
  • trouble breathing
  • chest or abdominal pain
  • convulsions or seizures

A viral fever makes your body much warmer than usual. This causes your body to sweat in an effort to cool down. But this leads to fluid loss, which can cause dehydration.

Try to drink as much as you can when you have a viral fever to replenish lost fluids. It doesn’t have to be just water, either. Any of the following can provide hydration:

  • juice
  • sports drinks
  • broths
  • soups
  • decaffeinated tea

Babies and toddlers may benefit from a specially formulated drink with electrolytes, such as Pedialyte. You can purchase these drinks at a local grocery store or online. You can also make your own electrolyte drink at home.

A viral fever is a sign that your body is working hard to fight off an infection. Cut yourself some slack by resting as much as possible. Even if you can’t spend the day in bed, try to avoid as much physical activity as possible. Aim for eight to nine hours or more of sleep per night. During the day, take it easy.

It’s also best to put your exercise routine on a temporary hold. Exerting yourself can further raise your temperature.

Over-the-counter (OTC) fever reducers are the easiest way to manage a fever. In addition to temporarily reducing your fever, they’ll help you feel a little less uncomfortable and more like yourself.

Just make sure you keep getting plenty of rest, even if you feel better for a few hours after taking an OTC drug.

Common OTC fever reducers include:

  • acetaminophen (Tylenol, Children’s Tylenol)
  • ibuprofen (Advil, Children’s Advil, Motrin)
  • aspirin
  • naproxen (Aleve)

Before you turn to OTC fever reducers, keep this safety information in mind:

  • Never give aspirin to children. It can greatly increase the risk of Reye’s syndrome, a rare but very serious condition.
  • Don’t take more than what’s recommended by the manufacturer. Doing so can lead to stomach bleeding, liver damage, or kidney problems.
  • Jot down the time when you take an OTC medication so you can make sure you don’t take too much in a 24-hour period.

People sometimes try herbal remedies to treat a fever. Keep in mind that these supplements have been shown to improve fever in animals. There’s no reliable evidence that they work in humans. Their safety in children is often unclear or unknown, too. It’s best to avoid these remedies in children.

It’s also important to note that the Food and Drug Administration doesn’t monitor the quality of supplements like they do for drugs. Talk to your doctor before trying any supplements. Follow the manufacturer’s instructions.

Moringa

Moringa is a tropical plant that has a variety of nutritional and medicinal benefits. Almost all parts of the plant contain vitamins, minerals, antioxidants, and antibacterial agents. A 2014 study found that moringa bark reduced fevers in rabbits.

More research is needed to determine how this plant can reduce fevers in humans. Some research suggests it may be gentler on the liver than over-the-counter medication such as acetaminophen.

Don’t use moringa if you:

  • are pregnant
  • take medications that are substrates of cytochrome P450, such as lovastatin (Altoprev), fexofenadine (Allegra), or ketoconazole (Nizoral)

In one case report, consumption of moringa leaves lead to a rare disease of the skin and mucous membranes called Stevens-Johnson syndrome (SJS). This suggests people at risk of developing SJS should avoid using moringa. However, this was the first reported case and the reaction should be considered extremely rare.

Kudzu root

Kudzu root is an herb used in traditional Chinese medicine. It has anti-inflammatory properties and may help reduce pain. A 2012 study also suggests that it reduced fevers in rats, but human studies are needed to evaluate this properly.

Avoid using kudzu root if you:

  • take tamoxifen
  • have hormonal-sensitive cancer, such as ER-positive breast cancer
  • take methotrexate (Rasuvo)

If you take diabetes medications, talk to your doctor before trying kudzu root. It may lead to low blood sugar, requiring a change in medication.

You can find kudzu root in the form a powder, capsule, or liquid extract online.

You can help cool down your body by surrounding it with cooler temperatures. Make sure you don’t overdo it. If you start to shiver, stop immediately. Shivering can cause your fever to rise.

Things you can do to safely cool off include the following:

  • Sit in a bath of lukewarm water, which will feel cool when you have a fever. (Cold water will actually cause your body to warm up instead of cool down.)
  • Give yourself a sponge bath with lukewarm water.
  • Wear light pajamas or clothing.
  • Try to avoid using too many extra blankets when you have chills.
  • Drink plenty of cool or room-temperature water.
  • Eat popsicles.
  • Use a fan to keep air circulating.

A viral fever is usually nothing to worry about. In both children and adults, most viruses resolve on their own and are part of the healing process. But if you notice unusual symptoms, or a fever doesn’t go away after a day or so, it’s best to call your doctor.

Read this article in Spanish.

Ebola: symptoms, treatment, prevention

The most dangerous infectious disease, leading to death in 90% of cases of infection, is Ebola fever. This is a viral fever, the course of which is accompanied by a pronounced hemorrhagic syndrome. The causative agent of the disease, the Ebola virus, was discovered in 1976 in Africa and got its name from the river of the same name, in the valley of which an outbreak of infectious fever occurred. The last and most severe epidemic outbreak occurred in 2014, after which the disease was recognized as a global threat.

General

Ebola disease is a zoonotic endemic infection, i.e. the main reservoir for the virus are animals that live in the jungles of Africa. Human infection occurs during contact with an infected animal or its carcass. In the future, the virus is transmitted from a sick person to healthy people. To date, several ways of transmission of Ebola are known:

  • contact – through direct contact with infected people, their biological materials and household items, including clothing and bedding;
  • injection – when using one injection syringe for several people;
  • sexual – during sexual intercourse.

In an infected person, the virus is present in all secretions and biological fluids: in blood, saliva, urine, nasopharyngeal mucus, semen, etc. Through microtraumas on the skin or mucous membrane, it enters the body and affects, first of all, the lymph nodes and spleen, then disseminates to other organs and tissues, causing numerous necrosis and bleeding, including internal ones. Most cases end in the death of the patient due to severe blood loss, infectious intoxication and hypovolemic shock.

How to recognize the disease

In our country, a risk factor for contracting the Ebola virus is a trip to Equatorial Africa or contact with a person who has recently returned from this region with severe manifestations of the infection. Before the onset of symptoms, the patient does not spread the infection, since there are no viruses in his secretions.

At the onset of the disease, the clinical signs of Ebola are similar to most acute infectious diseases and include:

  • sudden rise in temperature up to 38-39°C, fever;
  • pain in joints and muscles;
  • headache;
  • weakness, fatigue, malaise;
  • pain and sensation of a lump in the throat.

During the first few days, the patient develops a sore throat or ulcerative pharyngitis, abdominal pain and severe diarrhea. A characteristic symptom of Ebola is a change in the face of the patient, which becomes like a mask expressing longing or aggression, with deeply sunken eyes.

After about a week or a little less, severe chest pains appear, abdominal pains intensify, blood appears in the feces. A reddish rash appears on the skin, covering the lower half of the trunk and limbs. Hemorrhage develops, expressed by external and internal bleeding. With a favorable course of the disease, clinical recovery occurs after two to three weeks, but the recovery period continues for the next two to three months.

Diagnostic methods

For our country, Ebola remains an extremely rare disease, so diagnostic tests are performed in specialized virological laboratories that comply with the highest biological safety standards. The virus is isolated from any biological fluids of the patient, after which it is transferred to cell cultures, PCR tests are performed, biopsies of the skin and internal organs are examined using an electron microscope. In addition, a general analysis and a blood coagulogram are performed to identify characteristic changes.

Features of the treatment process

For Ebola treatment, a patient in a special isolation box is taken to an equipped medical facility and placed in a closed box with appropriate measures to prevent further spread of the infection. Medical personnel use complex barrier protection and conduct round-the-clock monitoring of the patient’s condition. Therapy consists mainly in eliminating the effect of toxins on the patient’s body, combating dehydration that occurs due to prolonged diarrhea, and manifestations of hemorrhage. The introduction of blood plasma taken from recovered people in some cases has a positive effect on the course of the disease.

To date, a vaccine against hemorrhagic fever has not yet been developed, although experimental samples are being tested in laboratories in several countries. Ebola prevention consists in tracing the contacts of the sick and isolating in a timely manner all people who have been in contact with them, even for a short time.

Considerable importance is attached to sanitary measures – quarantine control at airports, compliance with the rules of individual protection, disinfection of premises and household items used by the infected. People who are suspected of being infected with the Ebola virus are given an injection of a specific immunoglobulin, which is produced from blood serum. The highest lethality and contagiousness of the infection make it necessary to apply the most severe measures to prevent the possibility of its spread.

Frequently Asked Questions

How to make sure you don’t get Ebola when you travel to Africa?

At present, areas at some risk of Ebola infection are limited to Nigeria, Guinea, Liberia and Sierra Leone. To avoid infection, it is necessary to avoid contact with sick people, their secretions, as well as with those who have recently been ill and cured. It is not recommended to participate in the funeral of people who died from this disease. In addition, you should beware of wild animals that can transmit the disease by biting, do not eat poorly fried meat. Careful observance of the rules of personal hygiene is a prerequisite for your safety.

Can you get sick while sitting on a plane with an Ebola patient?

As practice shows, the Ebola virus is transmitted only through close contact, during which the patient’s body fluids or secretions come into contact with the skin or mucous membrane of a healthy person. This infection is not transmitted by airborne droplets.

Do I need to be screened after traveling to Africa?

When traveling to countries in Equatorial Africa, the risk of Ebola infection remains extremely small, especially if you did not come into contact with a sick person during the trip. If there are no signs of illness within three weeks after returning, then you are completely healthy. If you have any suspicious symptoms, you should call your doctor on the phone and report the suspected infection.

Mosquito viral fevers – Clinical Polyclinic No. 28

Hot days have come, and with them all kinds of living creatures are making a real invasion of the inhabitants of the Volgograd region. But if the “raids” of butterflies and dragonflies are beautiful, the invasion of bedbugs is unpleasant, but not particularly dangerous, then the story of mosquitoes is a completely different matter. Mosquitoes can carry viral infections; when bitten with the saliva of an infected carrier, the virus enters the human body and causes viral fevers. West Nile fever (WNF) and Zika fever are registered in our region.

No matter how exotic and at the same time terrible West Nile fever may seem to us, it is not new for Russia. Experts know that outbreaks of the disease were recorded in 1999, 2010 and 2011 in different regions throughout the South of Russia. And for the first time, the fever virus itself was discovered back in 1937, in the state of Uganda, located in equatorial Africa just at the source of the Nile, on its West Bank. From there, the disease got its name. During the 20th century, the virus spread almost all over the world. Its outbreaks have been recorded in many other countries.

The main source and reservoir of the WNF virus in natural biocenoses are wild birds of aquatic and semi-aquatic complexes. More than 60 species of mosquitoes are carriers of the WNV virus. Human susceptibility to WNV is high. The rural population living along the banks of rivers and lakes, fish ponds, in floodplains, river deltas, where there are a large number of wild waterfowl and mosquitoes, as well as urban residents visiting summer cottages and recreation centers in the above places, hunters, fishermen are often affected. Hot and dry summers lead to the accumulation of birds and mosquitoes near intra-city water bodies. Residents of houses in the basements of which have conditions for year-round breeding of mosquitoes are subject to the threat of infection.

West Nile fever can present as a flu-like form with headaches, fever, and a sore throat. Rashes on the skin may appear, symptoms of intestinal upset – abdominal pain, frequent stools, prolonged fever is possible without pronounced symptoms. In any case, when the temperature rises, it is necessary to urgently consult a doctor, since late treatment leads to the progression of the disease and a complicated course in the form of meningitis and meningoencephalitis.

There is no specific treatment for West Nile. It all depends on the individual characteristics of the patient, his condition and the results of medical research.

For people, the main recommendations on how to avoid infection are to prevent a mosquito bite, especially to protect children, both when going out into nature and in places of permanent residence.

To do this, you need:

  1. Use mosquito repellents: (ointments, creams, sprays) approved for use in the Russian Federation, in accordance with the attached instructions.
  2. Use indoors:

– fumigators – devices that slowly evaporate insecticides;

Coils which, when burned, give off smoke to repel or kill mosquitoes;

– ultrasonic mosquito repellent devices;

– ultraviolet devices for killing mosquitoes;

– aerosols that smoke mosquitoes out of the room.