By August 2016 the connection between Zika virus infection during pregnancy and severe debilitating neurological birth defects among infants had been confirmed by the U.S. Centers for Disease Control and Prevention four months earlier, and experts had termed the spread of the virus in Puerto Rico “explosive.” The needs to confront the virus effectively on the island, where an estimated two thirds of pregnancies were unintended, were daunting. Between that January, and March 2017 the island would report that approximately 3,300 pregnant women had laboratory evidence of Zika infection.
A survey among women delivering babies in hospitals across Puerto Rico that began that August and continued for the next four months, described today in the CDC Morbidity and Mortality Weekly Report, documented some of the challenges controlling the spread of the virus, and protecting pregnant women from infection presented.
Of 2364 women who took the self-administered survey, a little more than 93 percent reported they had worried about becoming infected. A little more than 92 percent reported worrying about the effect of the virus on the babies they were carrying. More than 94 percent reported that their health care providers had spoken to them about Zika, a little more than 89 percent said their health care providers advised them on how to avoid mosquito bites, and about 87 percent had been given information about protecting themselves from the virus, which was also now known to be transmitted sexually, by using condoms.
Still, the survey found that while a little more than 98 percent of them reported taking measures at home to control the mosquitoes that spread the virus — including keeping screens on doors and windows and keeping doors and windows closed, removing standing water around their homes, the more complicated or costly measures were less widely used. Just a little more than half had their homes professionally sprayed with insecticide, a little less than 30 percent had mosquito larvicide professionally applied, and just two in 10 — or slightly more than 17 percent slept under bed nets.
Less common among the women surveyed had been the use of personal protection, with just a little more than 45 percent reporting they used mosquito repellent every day and about 11 percent reporting they wore long sleeves and pants daily. Just one in five — or about 20 percent — reported abstaining from sex during their entire pregnancies, and among them only a quarter had abstained from sex to avoid Zika exposure, and fewer than a quarter of those who remained sexually active during their pregnancies used condoms consistently.
The surveys indicated that while women were more likely to have received information in the past about avoiding mosquito bites because of previous exposure to dengue and chikungunya, they appeared less aware of the potential for sexual exposure, and underestimated the risks. They also indicated concerns about the safety of using mosquito repellent during pregnancies, about the smell, and about difficulty remembering to reapply mosquito repellents.
The authors of the report on the survey results write that the results suggest the need for increased messaging about the safety of using mosquito repellent and the need to use it frequently, to make unscented mosquito repellents more widely accessible, and to evaluate the counseling and communications on risks of, and protection from sexual transmission of the virus.