Personal protective measures of pregnant women against Zika virus infection

Beyond COVID-19, the case for collecting, analysing and using sex-disaggregated data and gendered data to inform outbreak response: a scoping review

INTRODUCTION

Understanding sex and gender differences during outbreaks is critical to delivering an effective response. Although recommendations and minimum requirements exist, the incorporation of sex-disaggregated data and gender analysis into outbreak analytics and response for informed decision-making remains infrequent. A scoping review was conducted to provide an overview of the extent of sex-disaggregated data and gender analysis in outbreak response within low- and middle-income countries (LMICs).

METHODS

Five databases were searched for peer-reviewed literature examining sex- and gender-specific outcomes for communicable disease outbreaks published in English between 1 January 2012 and 12 April 2022. An adapted version of the WHO's Gender Analysis Matrix was used to synthesise evidence, which was then mapped across four phases of the outbreak timeline: prevention, detection, treatment/management and recovery.

RESULTS

71 articles met inclusion criteria and were included in this review. Sex-, gender-, and pregnancy-related disparities were identified throughout all four phases of the outbreak timeline. These disparities encompassed a wide range of risk factors for disease, vulnerability, access to and use of services, health-seeking behaviour, healthcare options, as well as experiences in healthcare settings and health and social outcomes and consequences.

CONCLUSION

Significant gender-evidence gaps remain in outbreak response. Evidence that is available illustrates that sex and gender disparities in outbreaks vary by disease, setting and population, and these differences play significant roles in shaping outbreak dynamics. As such, failing to collect, analyse or use sex-disaggregated data and gendered data during outbreaks results in less effective responses, differential adverse health outcomes, increased vulnerability among certain groups and insufficient evidence for effective prevention and response efforts. Systematic sex- and gender-based analyses to ensure gender-responsive outbreak prevention, detection, treatment/management and recovery are urgently needed.

Increased Repellent Effect of DEET on Aedes aegypti (Diptera: Culicidae) Field Population

Insecticides and repellents are routinely used in Brazil because of the high rates of arbovirus transmission and the nuisance caused by mosquitoes. However, few studies have assessed the effectiveness of repellents against mosquito populations that have been under exposure to xenobiotics, mainly insecticides and repellents. This study investigated the sensitivity of a field population of Aedes aegypti (Linnaeus, 1762) from a dengue-endemic area under high insecticide pressure to N,N-diethylmethylbenzamide (DEET), the active ingredient in common repellent products. The field (Laranjeiras, Sergipe, Brazil) and laboratory (Rockefeller) populations were characterized for the presence of the Val1016Ile kdr mutation, associated with pyrethroid resistance, and locomotor activity. Repellency bioassays were performed to assess the response of the mosquitoes to human odor by exposing them to 10% DEET applied to the skin in ethanol. Samples from the field population showed higher frequency of the kdr mutation, 21.9% homozygous and 21.9% heterozygous, greater locomotor activity and greater sensitivity to DEET than the laboratory population. These results suggest increased sensitivity to DEET in field populations and a possible interaction between insecticide exposure and sensitivity to DEET.

Social determinants associated with Zika virus infection in pregnant women

This study aims to describe the sociodemographic determinants associated with exposure to Zika Virus (ZIKV) in pregnant women during the 2015–2016 epidemic in Salvador, Brazil.

The Zika virus (ZIKV) epidemic in Brazil has intensified global concern about congenital defects associated with intrauterine exposure. Social determinants are factors that reinforce and contribute to the transmission and spread of ZIKV as well as other arboviruses like Dengue. We performed a cross-sectional study to describe the prevalence of ZIKV and the contribution of social determinants to transmission among pregnant women during the 2015–2016 ZIKV epidemic in Salvador, Brazil. We found that 61% of pregnant women were ZIKV seropositive. We also found that lower education level, food insecurity and lower maternal age were associated with higher ZIKV infection risk. These findings contribute to understanding the role of social determinants in ZIKV transmission, providing key social factors that can be combined with pre-existing tactics (vector control and environmental improvement) to create policies and interventions which reduce social inequalities and risk of infection in vulnerable populations like pregnant women.

Knowledge of Zika Virus Transmission and Its Prevention among High-Risk Pregnant Women in Brazil

Recent outbreaks of Zika virus (ZIKV) infection highlight the urgent need to evaluate the efficacy of current public health measures to educate susceptible groups about how to prevent infection, modes of viral transmission, and consequences of infection. We performed a cross-sectional study in the city of Jundiaí, São-Paulo, from March 2016 to August 2017. In 315 high-risk pregnant women we evaluated the rate of ZIKV infection, knowledge of pathways of ZIKV transmission, and the use of protective measures. Data were analyzed and correlated with sociodemographic variables. The rate of ZIKV infection was 10.8%. ZIKV transmission by mosquitoes was the best-known means of virus acquisition, while transmission of ZIKV by sexual intercourse as well as mother–fetus transmission was known by less than half of the women. The use of insect repellent, reported by 53% of participants, was correlated with higher education and personal directives from health professionals. Condom use was reported by 19.5% of subjects. Improved strategies to increase awareness of ZIKV infection and its consequences, designed to appeal to specific, targeted populations, are clearly necessary to more accurately prevent the spread of this infection and diminish adverse consequences in the pregnant population.