Tick-borne diseases are a growing threat to public health in the United States, especially among outdoor workers who experience high occupational exposure to ticks. Long-lasting
permethrin-impregnated clothing has demonstrated high initial protection against
bites from blacklegged ticks, Ixodes scapularis Say (Acari: Ixodidae), in laboratory settings, and sustained protection against
bites from the lone star tick, Amblyomma americanum (L.) (Acari: Ixodidae), in field tests. However, long-lasting
permethrin impregnation of clothing has not been field tested among outdoor workers who are frequently exposed to blacklegged ticks. We conducted a 2-yr randomized, placebo-controlled, double-blinded trial among 82 outdoor workers in Rhode Island and southern Massachusetts. Participants in the treatment arm wore factory-impregnated
permethrin clothing, and the control group wore
sham-treated clothing. Outdoor working hours, tick encounters, and
bites were recorded weekly to assess protective effectiveness of long-lasting
permethrin-impregnated garments. Factory-impregnated clothing significantly reduced
tick bites by 65% in the first study year and by 50% in the second year for a 2-yr protective effect of 58%. No significant difference in other
tick bite prevention method utilization occurred between treatment and control groups, and no treatment-related adverse outcomes were reported. Factory
permethrin impregnation of clothing is safe and effective for the prevention of
tick bites among outdoor workers whose primary exposure is to blacklegged ticks in the northeastern United States.