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Wong LP, Alias H, Lee HY, AbuBakar S, Lin Y, Hu Z. Has Zika been forgotten? A qualitative exploration of knowledge gaps, perceived risk and preventive practices in pregnant women in Malaysia. BMC Womens Health 2024; 24:190. [PMID: 38515067 PMCID: PMC10956172 DOI: 10.1186/s12905-024-02999-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/26/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Although Zika virus infection is rarely reported now, continuous prevention is needed to achieve sustained eradication. This study aimed to explore the knowledge gaps, risk perception and preventive measures against Zika virus infection (ZIKV) in pregnant women in Malaysia. METHODS We conducted in-depth virtual interviews with pregnant women between February and April 2022. The interviews were recorded and transcribed, and data were analyzed by content analysis. RESULTS The majority of the participants demonstrated a commendable level of awareness regarding the signs and symptoms associated with ZIKV infection. They also exhibited a clear understanding of preventive measures, particularly emphasizing the importance of avoiding mosquito bites to minimize the risk of ZIKV transmission. However, a noteworthy gap in knowledge surfaced as a subset of participants remained uninformed about the potential for sexual transmission of ZIKV, which could lead to congenital ZIKV in pregnant women. Even among women who were cognizant of ZIKV and its potential negative health outcomes, associated with the infection, many of them did not perceive themselves to be at risk, mainly because ZIKV infection is infrequently discussed or heard of, leading to a sense of infections' rarity. While the adoption of preventive measures such as mosquito bite prevention during pregnancy was a common practice, however, prevention of sexually transmitted infections (STIs) including mosquito-borne diseases such as Zika is low. A minority of women express concerns about the sensitivity surrounding discussions and prevention of STIs within the context of marriage. Most of the participants were supportive of the provision of awareness of ZIKV infection in women during pregnancy and the involvement of men, especially in initiatives aimed at preventing transmission through sexual contact. CONCLUSION This study uncovered gaps in both knowledge and practices pertaining ZIKV infection among pregnant women in the aftermath of the ZIKV pandemic. The insights gleaned from our research are valuable for shaping future interventions geared towards preventing the resurgence or facilitating the sustainable eradication of ZIKV.
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Affiliation(s)
- Li Ping Wong
- Fujian Key Laboratory of Environmental Factors and Cancer, Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, 350122, Fujian Province, China.
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Haridah Alias
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Hai Yen Lee
- Tropical Infectious Diseases Research and Educational Centre (TIDREC), Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Sazaly AbuBakar
- Tropical Infectious Diseases Research and Educational Centre (TIDREC), Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Yulan Lin
- Fujian Key Laboratory of Environmental Factors and Cancer, Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, 350122, Fujian Province, China.
| | - Zhijian Hu
- Fujian Key Laboratory of Environmental Factors and Cancer, Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, 350122, Fujian Province, China.
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Rosinski JR, Raasch LE, Barros Tiburcio P, Breitbach ME, Shepherd PM, Yamamoto K, Razo E, Krabbe NP, Bliss MI, Richardson AD, Einwalter MA, Weiler AM, Sneed EL, Fuchs KB, Zeng X, Noguchi KK, Morgan TK, Alberts AJ, Antony KM, Kabakov S, Ausderau KK, Bohm EK, Pritchard JC, Spanton RV, Ver Hoove JN, Kim CBY, Nork TM, Katz AW, Rasmussen CA, Hartman A, Mejia A, Basu P, Simmons HA, Eickhoff JC, Friedrich TC, Aliota MT, Mohr EL, Dudley DM, O’Connor DH, Newman CM. Frequent first-trimester pregnancy loss in rhesus macaques infected with African-lineage Zika virus. PLoS Pathog 2023; 19:e1011282. [PMID: 36976812 PMCID: PMC10081769 DOI: 10.1371/journal.ppat.1011282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/07/2023] [Accepted: 03/08/2023] [Indexed: 03/29/2023] Open
Abstract
In the 2016 Zika virus (ZIKV) pandemic, a previously unrecognized risk of birth defects surfaced in babies whose mothers were infected with Asian-lineage ZIKV during pregnancy. Less is known about the impacts of gestational African-lineage ZIKV infections. Given high human immunodeficiency virus (HIV) burdens in regions where African-lineage ZIKV circulates, we evaluated whether pregnant rhesus macaques infected with simian immunodeficiency virus (SIV) have a higher risk of African-lineage ZIKV-associated birth defects. Remarkably, in both SIV+ and SIV- animals, ZIKV infection early in the first trimester caused a high incidence (78%) of spontaneous pregnancy loss within 20 days. These findings suggest a significant risk for early pregnancy loss associated with African-lineage ZIKV infection and provide the first consistent ZIKV-associated phenotype in macaques for testing medical countermeasures.
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Affiliation(s)
- Jenna R. Rosinski
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Lauren E. Raasch
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Patrick Barros Tiburcio
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Meghan E. Breitbach
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Phoenix M. Shepherd
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Keisuke Yamamoto
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Elaina Razo
- Department of Pediatrics, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Nicholas P. Krabbe
- Department of Pediatrics, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Mason I. Bliss
- Wisconsin National Primate Research Center, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Alexander D. Richardson
- Wisconsin National Primate Research Center, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Morgan A. Einwalter
- Wisconsin National Primate Research Center, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Andrea M. Weiler
- Wisconsin National Primate Research Center, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Emily L. Sneed
- Wisconsin National Primate Research Center, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Kerri B. Fuchs
- Wisconsin National Primate Research Center, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Xiankun Zeng
- United States Army Medical Research Institute of Infectious Diseases; Fort Detrick, Maryland, Unites States of America
| | - Kevin K. Noguchi
- Department of Psychiatry, Washington University School of Medicine; St. Louis, Washington, Unites States of America
| | - Terry K. Morgan
- Department of Pathology, Oregon Health and Science University; Portland, Oregon, Unites States of America
- Department of Obstetrics and Gynecology, Oregon Health and Science University; Portland, Oregon, Unites States of America
| | - Alexandra J. Alberts
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Kathleen M. Antony
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Sabrina Kabakov
- Department of Kinesiology, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Karla K. Ausderau
- Department of Kinesiology, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
- Waisman Center, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Ellie K. Bohm
- Department of Veterinary and Biomedical Science, University of Minnesota; St. Paul, Minnesota, Unites States of America
| | - Julia C. Pritchard
- Department of Veterinary and Biomedical Science, University of Minnesota; St. Paul, Minnesota, Unites States of America
| | - Rachel V. Spanton
- Department of Kinesiology, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - James N. Ver Hoove
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Charlene B. Y. Kim
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - T. Michael Nork
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Alex W. Katz
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Carol A. Rasmussen
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Amy Hartman
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Andres Mejia
- Wisconsin National Primate Research Center, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Puja Basu
- Wisconsin National Primate Research Center, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Heather A. Simmons
- Wisconsin National Primate Research Center, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Jens C. Eickhoff
- Department of Biostatistics & Medical Informatics, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Thomas C. Friedrich
- Department of Pathobiological Sciences, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Matthew T. Aliota
- Department of Veterinary and Biomedical Science, University of Minnesota; St. Paul, Minnesota, Unites States of America
| | - Emma L. Mohr
- Department of Pediatrics, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Dawn M. Dudley
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - David H. O’Connor
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
- Wisconsin National Primate Research Center, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
| | - Christina M. Newman
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison; Madison, Wisconsin, Unites States of America
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Low Transmission of Chikungunya Virus by Aedes aegypti from Vientiane Capital, Lao PDR. Pathogens 2022; 12:pathogens12010031. [PMID: 36678379 PMCID: PMC9860973 DOI: 10.3390/pathogens12010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 12/28/2022] Open
Abstract
In 2012−2013, chikungunya virus (CHIKV) was the cause of a major outbreak in the southern part of Lao People’s Democratic Republic (Lao PDR). Since then, only a few imported cases, with isolates belonging to different lineages, were recorded between 2014 and 2020 in Vientiane capital and few autochthonous cases of ECSA-IOL lineage were detected in the south of the country in 2020. The CHIKV epidemiological profile contrasts with the continuous and intensive circulation of dengue virus in the country, especially in Vientiane capital. The study’s aim was to investigate the ability of the local field-derived Aedes aegypti population from Vientiane capital to transmit the Asian and ECSA-IOL lineages of CHIKV. Our results revealed that, for both CHIKV lineages, infection rates were low and dissemination rates were high. The transmission rates and efficiencies evidenced a low vector competence for the CHIKV tested. Although this population of Ae. aegypti showed a relatively modest vector competence for these two CHIKV lineages, several other factors could influence arbovirus emergence such as the longevity and density of female mosquitoes. Due to the active circulation of CHIKV in Southeast Asia, investigations on these factors should be done to prevent the risk of CHIKV emergence and spread in Lao PDR and neighboring countries.
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Has Zika Been Forgotten? Findings From Nationwide Survey on Knowledge, Attitudes, and Mosquito Preventive Practices in Malaysia. Disaster Med Public Health Prep 2022; 17:e131. [PMID: 35400356 DOI: 10.1017/dmp.2022.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study is to assess knowledge and attitudes toward Zika virus disease (ZVD) as well as mosquito prevention practices in Malaysia at a nationwide level. METHODS Computer-assisted telephone interviews (CATI) were conducted between June 2019 and February 2020. RESULTS There are gaps in knowledge about the symptoms, mode of transmission, and risk of microcephaly. The mean for the Zika-related knowledge score was 5.9 (SD ± 4.4) out of a possible score of 14. The majority perceived little or no risk of getting ZVD (75.0%) and 75.5% were a little or not at all worried about ZVD. A high proportion reported the use of insect sprays or mosquito coils to prevent mosquito bites; however, a relatively lower proportion of people reported fixing mosquito netting on doors and windows, and using mosquito bed nets. The mean for the mosquito prevention practices score was 11.9 (SD ± 4.7) out of a possible score of 27. Important factors influencing mosquito prevention practices include household income, environment factors, risk perception, and Zika-related knowledge. CONCLUSION Zika prevention measures should be targeted in priority toward residents in lower socioeconomic neighborhoods. Campaigns should focus on messages highlighting the high risk of getting dengue.
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Lobkowicz L, Power GM, De Souza WV, Montarroyos UR, Martelli CMT, de Araùjo TVB, Bezerra LCA, Dhalia R, Marques ETA, Miranda-Filho DDB, Brickley EB, Ximenes RADA. Neighbourhood-level income and Zika virus infection during pregnancy in Recife, Pernambuco, Brazil: an ecological perspective, 2015-2017. BMJ Glob Health 2021; 6:bmjgh-2021-006811. [PMID: 34857522 PMCID: PMC8640636 DOI: 10.1136/bmjgh-2021-006811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/28/2021] [Indexed: 11/24/2022] Open
Abstract
Zika virus (ZIKV) infections during pregnancy can lead to adverse neurodevelopmental and clinical outcomes in congenitally infected offspring. As the city of Recife in Pernambuco State, Brazil—the epicentre of the Brazilian microcephaly epidemic—has considerable disparities in living conditions, this study used an ecological approach to investigate the association between income at the neighbourhood level and the risk of ZIKV infections in pregnant individuals between December 2015 and April 2017. The spatial distribution of pregnant individuals with ZIKV infection was plotted on a map of Recife stratified into four categories based on mean monthly income of household heads. Additionally, a Poisson regression model with robust variance was fitted to compare proportions of ZIKV infections among pregnant individuals in relation to the mean monthly income of household heads, based on the 2010 census data, across 94 neighbourhoods in Recife. The results provide evidence that the risk of ZIKV infection to pregnant individuals was higher among those residing in lower-income neighbourhoods: relative to neighbourhoods that had a mean monthly income of ≥5 times minimum wage, neighbourhoods with <1 and 1 to <2 times minimum wage had more than four times the risk (incidence rate ratio, 95% CI 4.08, 1.88 to 8.85 and 4.30, 2.00 to 9.20, respectively). This study provides evidence of a strong association between neighbourhood-level income and ZIKV infection risks in the pregnant population of Recife. In settings prone to arboviral outbreaks, locally targeted interventions to improve living conditions, sanitation, and mosquito control should be a key focus of governmental interventions to reduce risks associated with ZIKV infections during pregnancy.
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Affiliation(s)
- Ludmila Lobkowicz
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Grace M Power
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK.,MRC Integrative Epidemiology Unit, Department of Population Health Sciences, Bristol Medical School, Bristol, UK
| | | | | | | | | | | | - Rafael Dhalia
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
| | - Ernesto T A Marques
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil.,Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Elizabeth B Brickley
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ricardo Arraes de Alencar Ximenes
- Departamento de Medicina Interna, Universidade de Pernambuco, Recife, PE, Brasil.,Departamento de Medicina Tropical, Universidade Federal de Pernambuco, Recife, PE, Brasil
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