Abstract
BackgroundArboviruses transmitted by day-biting Aedes mosquitoes are a major public health concern. With the challenges inherent in arbovirus vaccine and therapeutics development, vector control and bite prevention strategies are among the limited options available for immediate intervention. Bite prevention through personal protective technologies (PPT), such as topical mosquito repellents or repellent-impregnated clothing, may help to decrease biting rates and, therefore, the risk of disease in groups most susceptible to adverse outcomes from Zika virus. However, achieving high uptake and compliance with PPT can be challenging.Methodology/Principal findingsTo gain an insight into the knowledge and concerns of pregnant women surrounding Zika and their opinions regarding PPT, particularly repellent clothing, a focus group study was carried out with pregnant women, women of reproductive age, and semi-structured interviews with their male partners in two cities in Colombia. The discussions revealed shortfalls in basic knowledge of Zika virus, with several pregnant participants reporting being unaware of the potential for Zika-related congenital malformations. Although participants generally considered Zika to be a significant personal threat, most rated it as less of a concern than dengue or diarrheal diseases. Overall, repellent clothing and other forms of PPT were viewed as effective, although some participants expressed concerns over the high costs of repellents, and safety fears of regular contact with repellent chemicals, which they perceived as potentially harmful. Plant-derived repellents were considered to be safer than synthetic chemical repellents. Discussions also highlighted that health centers were the preferred source of information on bite-reduction.Conclusions/SignificanceAchieving high uptake and compliance with PPT in populations most at risk of adverse outcomes from Zika infection requires engaging key users in open dialogue to identify and address any practical issues regarding PPT use, and concerns over safety. The findings presented here suggest that educational campaigns should strongly emphasize the risks associated with Zika during pregnancy, and discuss safety profiles of approved synthetic repellents and the availability of EPA-approved plant-based repellents. In addition, the economic and political context should be a major consideration when evaluating personal mosquito-repellent strategies.
Highlights
An epidemic outbreak of Zika virus was declared in Colombia in early October 2015 [1]
Some participants viewed arboviruses as a significant daily worry and this was often paired with a personal history of infection, or infection of a close family member or acquaintance
Reasons given included a belief that dengue had the most serious acute symptoms, with a high probability of hospitalization, and the risks of mortality associated with severe dengue
Summary
An epidemic outbreak of Zika virus was declared in Colombia in early October 2015 [1]. 108,000 suspected clinical cases were reported between August 2015 and November 2016, which included nearly 20,000 cases in pregnant women (~18%) [1]. In Cali, the third largest city in Colombia with approximately 2.5 million inhabitants, a total of 15,181 Zika cases were reported [2]. In Villavicencio, a city with just over 500,000 inhabitants, 2278 Zika cases were reported to the public health surveillance system [3]. In the post-epidemic year (2017), 2130 cases were reported, of which 368 (17.2%) were in pregnant women [4]. While the Zika virus usually causes a mild and self-limiting febrile illness, the recent outbreak revealed a concomitant rise in fetal birth defects for women infected during pregnancy. Achieving high uptake and compliance with PPT can be challenging
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