EXECUTIVE SUMMARY
U.S. public health officials are moving swiftly to prepare a coordinated response to the Zika virus.
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The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine have issued an updated practice advisory on the Zika virus to share prevention strategies and guidance for management of pregnant women and women of reproductive age.
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Public Knowledge Of Zika Needs Improvement. About Four In 10 U.s. Adults In Households In Which Someone Is Pregnant Or Considering Becoming Pregnant Don’t Realize The Zika Virus Can Be Transmitted Sexually.
Approximately four in 10 (42%) U.S. adults in households in which someone is pregnant or considering becoming pregnant don’t realize the Zika virus can be sexually transmitted, according to results from a new national survey. The poll is part of an ongoing series of surveys focused on the public’s response to public health emergencies by the Harvard Opinion Research Program at the Boston-based Harvard T.H. Chan School of Public Health.
In households in which someone is pregnant or considering getting pregnant, researchers found that about one in four (23%) is not aware of the association between Zika virus and microcephaly, a birth defect. (A just-published review of evidence by scientists at the Centers for Disease Control and Prevention, available at http://bit.ly/1My4V6U, confirms that Zika virus is a cause of microcephaly and other severe fetal brain defects.) One in five (20%) incorrectly believe there is a vaccine to protect against the virus, and 25% think individuals infected with Zika virus are “very likely” to show symptoms.
The survey was conducted to help guide public communication and outreach regarding the Zika virus, says Gillian SteelFisher, PhD, director of the survey and research scientist in the Department of Health Policy and Management at Harvard Chan School. The poll allows public health officials to identify gaps in public understanding of the risks of Zika virus infection, its modes of transmission, and ways to protect against infection, she notes.
“We share this information broadly and also specifically with the National Public Health Information Coalition, which is an association serving communication officers at state and local public health departments,” states SteelFisher. “They can help make sure families have the right information to make the healthiest decisions for their pregnancies.”
Evidence shared
U.S. public health officials are moving swiftly to prepare a coordinated response to the Zika virus. The Centers for Disease Control and Prevention (CDC) held a one-day national summit in April 2016 to bring together officials from local, state, and federal jurisdictions and non-government organizations to discuss such a response. (A CDC handout encapsulates what is known on preventing the sexual transmission of the virus. You can download it at http://1.usa.gov/1Q0evKv. A separate handout, Protecting Pregnant and Reproductive Age Women, also is available. You ocan download it at http://1.usa.gov/1RKxcY2.)
The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine have issued an updated practice advisory on the Zika virus to share prevention strategies and guidance for management of pregnant women and women of reproductive age. (Download the advisory at http://bit.ly/1P9wNtp.) The CDC also has issued updated interim information for prevention of sexual transmission.1 (Readers can access the information online at http://1.usa.gov/1S91RQM. Also, readers can see Contraceptive Technology Update’s April 2016 article, “Sexual transmission of Zika virus possible: Will it impact virus spread?” at http://bit.ly/1qeg1mY.)
Robert Hatcher, MD, MPH, professor emeritus of gynecology and obstetrics at Emory University School of Medicine in Atlanta, says, “CDC Director Tom Frieden, MD, MPH, recently focused attention on the economic impact of Zika when he pointed out that care for a single child with birth defects can cost upward of $10 million. This certainly suggests to me that a woman who is pregnant and has a known Zika infection should seriously consider her options ... .”
What do we know?
The CDC has issued recommendations that apply to men who have traveled to or reside in areas with active Zika virus transmission and their female or male sex partners. (Check the online CDC map at http://1.usa.gov/1ovAJyh for countries with active local Zika virus transmission.)
The recommendations are as follows:
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Couples in which the woman is pregnant should consistently and correctly use condoms during sex (vaginal intercourse, anal intercourse, or fellatio) or abstain from sex for the duration of the pregnancy, advises the CDC. This course is the best way to avoid even a minimal risk of sexual transmission of Zika virus.1
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For couples who want to reduce the risk for sexual transmission of Zika virus, the recommendations call for consistent and correct use of condoms during sex, or abstinence from sex. Based on expert opinion, as well as limited but evolving information about the sexual transmission of Zika virus, the recommended duration of consistent condom use or abstinence from sex depends on whether men had confirmed infections or clinical illness consistent with Zika virus disease and whether men are residing in an area with active transmission.1
Zika virus testing is recommended for persons who have had possible sexual exposure to Zika virus and develop signs or symptoms consistent with Zika virus disease. The most common symptoms of Zika are fever, rash, joint pain, and conjunctivitis (red eyes). A pregnant woman with possible sexual exposure to Zika virus should be tested if she or her male partner develop symptoms consistent with Zika virus disease.1
Avoiding unintended pregnancy in regions in which Zika is endemic has put a spotlight on Puerto Rico, the part of the United States with the highest number of Zika cases, says Andrew Kaunitz, MD, University of Florida Research Foundation professor and associate chairman of the Department of Obstetrics and Gynecology at the University of Florida College of Medicine–Jacksonville
According to a new report, an estimated 138,000 women of reproductive age in Puerto Rico do not desire pregnancy and aren’t using an effective contraceptive. Public health estimates indicate access to contraception is constrained by availability, especially of highly effective long-acting reversible contraceptives (LARCs); high cost; incomplete insurance coverage; and lack of trained providers. To prevent unintended pregnancies, health officials propose applying the distribution of methods observed in the CHOICE project, a prospective cohort study of reproductive-aged women designed to promote the use of LARCs by eliminating cost, access, and knowledge barriers. Using the CHOICE project distribution plan, the estimate calls for intrauterine contraception for 68,000 women, contraceptive implants for 33,000 women, depot medroxyprogesterone acetate for 11,000 women, oral contraceptives for 14,000 women, vaginal rings for 9,000 women, and contraceptive patches for 3,000 women.2
“As we in the contiguous 50 states of the U.S. watch for evidence of mosquito-borne transmission of Zika closer to home, the example of Puerto Rico should serve as a wake-up call for us regarding the importance of ensuring that all women have access to information about Zika and pregnancy, as well as effective birth control,” notes Kaunitz.
REFERENCES
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Oster AM, Russell K, Stryker JE, et al. Update: Interim guidance for prevention of sexual transmission of Zika virus — United States, 2016. Morb Mortal Wkly Rep 2016; 65(12):323-325.
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Tepper NK, Goldberg HI, Bernal MI, et al. Estimating contraceptive needs and increasing access to contraception in response to the Zika virus disease outbreak — Puerto Rico, 2016. Morb Mortal Wkly Rep 2016; 65(12):311-314.
