Preventing Vectorborne Transmission of Zika Virus Infection During Pregnancy

Puerto Rico, USA, 2016-2017

Katherine Kortsmit; Beatriz Salvesen von Essen; Lee Warner; Denise V. D'Angelo; Ruben A. Smith; Carrie K. Shapiro-Mendoza; Holly B. Shulman; Wanda Hernández Virella; Aspy Taraporewalla; Leslie Harrison; Sascha Ellington; Wanda D. Barfield; Denise J. Jamieson; Shanna Cox; Karen Pazol; Patricia Garcia Díaz; Beatriz Rios Herrera; Manuel Vargas Bernal


Emerging Infectious Diseases. 2020;26(11):2717-2720. 

In This Article


Most women reported being counseled by a prenatal healthcare provider during pregnancy on using repellent and wearing protective clothing to prevent ZIKV infection from mosquito bites. Provider counseling about repellent use was associated with a higher prevalence of frequent repellent use. This finding is consistent with our previous analysis of PRAMS-ZPER data, which showed receiving provider counseling was associated with a higher prevalence of condom use to prevent sexual transmission of ZIKV infection during pregnancy.[13] In contrast, no significant association was found between receiving provider counseling and wearing protective clothing. Efforts to improve use of other risk-reduction strategies to prevent mosquito bites (e.g., repellent use, removal of standing water, screens on windows) may be beneficial, particularly when barriers, such as hot tropical climates, make wearing protective clothing less feasible. In 2017, the questionnaire was modified to include a question about using repellent on clothing in addition to exposed skin. In addition, changes in conditions after Hurricane Maria may have contributed to the increase in reported repellent use. During the ZIKV outbreak, WIC also implemented efforts to provide participants with targeted education on ZIKV prevention strategies and a prevention kit containing condoms, repellent, a bed net, and larvicide,[14] which may partially explain increased use of repellent among WIC participants in our analysis. We found a significant association between WIC participation and frequent use of repellent but were unable to further assess the frequency or type of prenatal education WIC recipients received regarding repellent use. Of note, during 2016 only, women were asked whether they received a WIC Zika prevention kit; 77% reported receiving a kit, demonstrating the broad reach of WIC services related to ZIKV prevention among this study sample.

During prenatal care visits, healthcare providers can help prevent ZIKV infection by counseling pregnant women and their partners about risk-reduction strategies. Provider counseling on repellent and condom use were both associated with increased adoption of practices that reduce the risk of ZIKV infection.[13] Findings from this study can be applied more broadly to the prevention of other vectorborne diseases among pregnant women, such as dengue, chikungunya, and malaria.[7]