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Montoya MCM, Sánchez CH, Souto EP, Pérez EA, Matta GC, Daza M, Gama GL, Pimentel C, Mercado M, Niño AMA, Leegstra LM, Castro EM, Manders OC, Maxwell L. "I found out about Zika virus after she was born." Women's experiences of risk communication during the Zika virus epidemic in Brazil, Colombia, and Puerto Rico. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002808. [PMID: 38865420 PMCID: PMC11168637 DOI: 10.1371/journal.pgph.0002808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 05/16/2024] [Indexed: 06/14/2024]
Abstract
Providing accurate, evidence-based information to women with Zika infection during pregnancy was problematic because of the high degree of uncertainty in the diagnosis of the infection and the associated risk. The 2015-17 Zika virus epidemic overwhelmingly affected women in countries with limited access to safe abortion. Understanding women's perspectives on risk communication during pregnancy in the context of an emerging pathogen can help inform risk communication in response to future outbreaks that affect fetal or child development. We conducted a cross-sectional qualitative interview study with 73 women from 7 locations in Brazil, Colombia, and Puerto Rico to understand women's experiences of Zika virus (ZIKV) test and outcome-related communication during the ZIKV pandemic. We used thematic analysis to analyze the in-depth interviews. Participants in Brazil and Colombia reported that the healthcare system's lack of preparation and organization in communicating ZIKV test results and associated adverse outcomes led to their feeling abandoned and alone in confronting the challenges of a ZIKV-affected pregnancy. In contrast, participants in Puerto Rico reported that the regular testing schedules and clear, well-planned communication between the care team and between providers and pregnant women helped them to feel they could prepare for a ZIKV-affected pregnancy. Communication of the risk associated with an emerging pathogen suspected to affect pregnancy and developmental outcomes is a fraught issue. Public health authorities and healthcare providers should work together in the interpandemic period to understand families' preferences for risk communication during pregnancy in the presence of uncertainty and develop a community-informed plan for risk communication.
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Affiliation(s)
| | - Claudia Hormiga Sánchez
- Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Fundación INFOVIDA, Bucaramanga, Colombia
| | - Ester Paiva Souto
- Interdisciplinary Centre for Public Health Emergencies (NIESP-CEE-FIOCRUZ), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Edna Acosta Pérez
- Graduate School of Public Health / Hispanic Alliance for Clinical and Translational Research, Medical Science Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Gustavo Corrêa Matta
- Interdisciplinary Centre for Public Health Emergencies (NIESP-CEE-FIOCRUZ), Center for Data and Knowledge Integration for Health (CIDACS/FIOCRUZ-Bahia), Rio de Janeiro, Brazil
| | - Marcela Daza
- Grupo de Salud Materna y Perinatal, Instituto Nacional de Salud, Bogotá, Colombia
| | - Gabriela Lopes Gama
- Professor Joaquim Amorim Neto Research Institute (IPESQ), UNIFACISA University Center, Paraíba, Brazil
| | - Camila Pimentel
- Laboratory for Studies on Drugs, Vulnerabilities and Social Markers (LED), Department of Public Health (NESC), Aggeu Magalhães Institute—Fiocruz Pernambuco, Recife, Pernambuco, Brazil
| | - Marcela Mercado
- Dirección de Investigación en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Angélica María Amado Niño
- Facultad de Salud, Departamento de Salud Pública, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Luz Marina Leegstra
- Heidelberger Institut für Global Health, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | - Olivia C. Manders
- Rollins School of Public Health, Hubert Department of Global Health, Emory University, Atlanta, Georgia, United States of America
| | - Lauren Maxwell
- Heidelberger Institut für Global Health, Universitätsklinikum Heidelberg, Heidelberg, Germany
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Mulkey SB, Williams ME, Peyton C, Arroyave-Wessel M, Berl MM, Cure C, Msall ME. Understanding the multidimensional neurodevelopmental outcomes in children after congenital Zika virus exposure. Pediatr Res 2024:10.1038/s41390-024-03056-z. [PMID: 38438554 DOI: 10.1038/s41390-024-03056-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/04/2023] [Accepted: 01/15/2024] [Indexed: 03/06/2024]
Abstract
Since 2016, international research groups have focused on assessing outcomes of children with in utero Zika virus (ZIKV) exposure. While the more severe outcomes of congenital Zika syndrome (CZS) occur in up to 10% of children with antenatal exposure, early findings among ZIKV-exposed children without CZS ages 0-5 years suggest that they may also have differences in multiple domains of neurodevelopment. Thus, longitudinal follow-up of all children with antenatal ZIKV exposure has been recommended. This review presents a summary of neurodevelopmental phenotypes of infants and children following antenatal ZIKV exposure. We present a multidimensional framework to understand child neurodevelopment from an interdisciplinary and whole-child perspective (International Classification of Functioning, Disability and Health model) and multi-domain ZIKV Outcome Toolboxes. The toolboxes are for clinicians, researchers, child educators, and others to implement longitudinal multi-domain neurodevelopmental assessments between ages 0-12 years. Recent innovations in telehealth and neuroimaging can help evaluate outcomes in ZIKV exposed children. The objective is to describe the multiple facets of neurodevelopmental focused care that can support the health, function, and well-being of children with antenatal ZIKV exposure. The research and clinical follow-up strategies are applicable to ZIKV and other congenital infectious or environmental exposures that can impact child neurodevelopment. IMPACT: International longitudinal cohort studies have revealed a range of differences in neurodevelopment among children with antenatal Zika virus (ZIKV) exposure. A multidimensional and whole-child framework is necessary to understand the neurodevelopment of children with antenatal ZIKV exposure in relation to family life, community participation, and environment. Multi-domain toolboxes that utilize parent questionnaires and child evaluations are presented. These toolboxes can be used internationally alongside telehealth, brain imaging, and other innovations to improve understanding of child outcomes.
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Affiliation(s)
- Sarah B Mulkey
- Children's National Hospital, Washington, DC, USA.
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | | | - Colleen Peyton
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | | | - Madison M Berl
- Children's National Hospital, Washington, DC, USA
- Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Michael E Msall
- University of Chicago Medicine Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, Chicago, IL, USA
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Petra PC, Marbán-Castro E, Matta G, Sánchez CMH, Pimentel C, Gama GL, Melo A, Daza M, Amado AM, Montoya MCM, Maxwell L, Pérez EA, Mercado M, Paiva E. Pregnant women's perceptions on Information Sources on Zika Virus: a qualitative study. PHYSIS (RIO DE JANEIRO, BRAZIL) 2024; 34:e34SP112. [PMID: 38966594 PMCID: PMC11221405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
The Zika virus (ZIKV) epidemic had a sanitary, psychosocial, and economic impact on individuals of reproductive age. The primary concern revolved around infection during pregnancy due to possible vertical transmission and its association with adverse fetal and infant outcomes, known as Congenital Zika Syndrome (CZS). This qualitative study employs phenomenology and grounded theory. This study includes interviews with 98 women, some pregnant during the ZIKV epidemic in Brazil, Colombia, and Puerto Rico, who had children with CZS or without diagnosed neurological impairment. Additionally, the study included a group of women who were pregnant during the COVID-19 pandemic in these same countries. In both groups, interviewees had varying levels of knowledge about ZIKV. The study found that messages conveyed through the media tended to be alarmist, in contrast to the information provided by healthcare professionals, which was considered more trustworthy. Pregnant women during the ZIKV epidemic reported receiving their ZIKV and CSZ infection diagnoses late, either during or after childbirth. The study underscores the needs of pregnant women in high-risk scenarios, the importance of health education processes, and the necessity to reinforce communication and continuing education.
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Affiliation(s)
| | | | - Gustavo Matta
- Escola Nacional de Saúde Pública, Fiocruz. Rio de Janeiro-RJ, Brazil
| | | | | | - Gabriela Lopes Gama
- Instituto de Pesquisa Professor Joaquim Amorim Neto. Campina Grande-PB, Brazil
| | - Adriana Melo
- Grupo de Epidemiología Clínica, Universidad Industrial de Santander, Bucaramanga, Santander, Colombia
| | | | | | | | - Lauren Maxwell
- Heidelberg Institute for Global Health, Heidelberg University, Heidelberg Germany
| | - Edna Acosta Pérez
- University of Puerto Rico, Medical Sciences Campus, / University Albizu, San Juan, Puerto Rico
| | | | - Ester Paiva
- Escola Nacional de Saúde Pública, Fiocruz. Rio de Janeiro-RJ, Brazil
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Estupiñan-Perez VH, Jiménez-Urrego AM, Cruz-Mosquera FE, Botero-Carvajal A. Developmental assessment of children with intrauterine exposure to Zika virus: cross-sectional observational study. Rev Peru Med Exp Salud Publica 2023; 40:333-339. [PMID: 37991037 PMCID: PMC10959516 DOI: 10.17843/rpmesp.2023.403.12880] [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: 05/17/2023] [Accepted: 09/01/2023] [Indexed: 11/23/2023] Open
Abstract
Zika virus infection affects the development of the nervous system. This study describes the cognitive, adaptative, communicative, social and motor neurodevelopment of children exposed to Zika virus in utero. We used the Batelle scale to assess neurodevelopment three years after birth. Thirty children were included, who had a mean age at evaluation of 37.5 (IQR: 35.7-39.2) months. We found the following equivalent ages in months for each area: motor 25.8 (SD: 7.8), adaptive 26.7 (SD: 5.8), communicative 30.2 (SD: 6.9), social personal 33.5 (SD: 8.3) and cognitive 35.6 (SD: 5.9). Children showed development delay for their chronological age, 25 children were delayed in one of the five areas assessed. A high rate of children exposed to Zika virus during gestation presented delayed developmental age, mainly regarding the adaptive and motor areas.
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Christie CD, Lue AM, Melbourne-Chambers RH. Dengue, chikungunya and zika arbovirus infections in Caribbean children. Curr Opin Pediatr 2023; 35:155-165. [PMID: 36801979 PMCID: PMC10090388 DOI: 10.1097/mop.0000000000001229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
PURPOSE OF REVIEW Dengue, chikungunya and zika have caused significant epidemics in the Caribbean in recent years. This review highlights their impact in Caribbean children. RECENT FINDINGS Dengue has been increasingly intense and severe, seroprevalence is 80-100% in the Caribbean, children have increased attributable morbidity and mortality. Severe dengue, especially dengue with haemorrhage was significantly associated with haemoglobin SC disease and multiple organ-systems involved. These included the gastrointestinal and haematologic systems with extremely high lactate dehydrogenases and creatinine phosphokinases and severely abnormal bleeding indices. Despite appropriate interventions, mortality was highest within the first 48 h of admission. Chikungunya, a togavirus, affected 80% of some Caribbean populations. Paediatric presentations included high fever, skin, joint and neurological manifestations. Children less than 5 years of age had the highest morbidity and mortality. This maiden chikungunya epidemic was explosive and overwhelmed public health systems. Zika, another flavivirus, has a seroprevalence of 15% in pregnancy, so the Caribbean remains susceptible. Paediatric complications include pregnancy losses, stillbirths, Congenital Zika syndrome, Guillain-Barre syndrome, acute disseminated encephalomyelitis and transverse myelitis. Neurodevelopment stimulation programs for zika-exposed infants have been effective in improving language and positive behaviour scores. SUMMARY Caribbean children remain at risk for dengue, chikungunya and zika, with high attributable morbidity and mortality.
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Affiliation(s)
- Celia D.C. Christie
- Department of Child (Pediatrics) and Adolescent Health, University of the West Indies
- Department of Child (Pediatrics) and Adolescent Health (Infectious Diseases), University Hospital of the West Indies, Mona
| | | | - Roxanne H. Melbourne-Chambers
- Department of Child (Pediatrics) and Adolescent Health, University of the West Indies
- Department of Child (Pediatrics) and Adolescent Health (Neurology), University Hospital of the West Indies, Mona, Kingston, Jamaica
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Coelho MLG, Campos TNC, Magalhães AG, Felix JB, Melo A, Tavares JS, Monteiro KS, Longo E. My child is growing and now? Exploring the environmental needs of children with congenital Zika syndrome according to their caregivers' perceptions. Health Expect 2022; 25:2828-2836. [DOI: 10.1111/hex.13587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/07/2022] [Accepted: 08/07/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Monique L. G. Coelho
- Faculty of Health Science of Trairi Federal University of Rio Grande do Norte Santa Cruz Brazil
| | - Taynah N. C. Campos
- Faculty of Health Science of Trairi Federal University of Rio Grande do Norte Santa Cruz Brazil
| | | | - Jean B. Felix
- Faculty of Health Science of Trairi Federal University of Rio Grande do Norte Santa Cruz Brazil
| | | | | | - Karolline S. Monteiro
- Faculty of Health Science of Trairi Federal University of Rio Grande do Norte Santa Cruz Brazil
| | - Egmar Longo
- Faculty of Health Science of Trairi Federal University of Rio Grande do Norte Santa Cruz Brazil
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