Elsevier

Vaccine

Volume 36, Issue 1, 2 January 2018, Pages 165-169
Vaccine

U.S. pregnant women’s knowledge and attitudes about behavioral strategies and vaccines to prevent Zika acquisition

https://doi.org/10.1016/j.vaccine.2017.11.021Get rights and content

Highlights

  • Most (74%) pregnant women expressed concerns about the Zika virus.

  • Low perceived knowledge of Zika corresponded to low factual knowledge.

  • Developing a Zika vaccine was very important to the majority (72%) of respondents.

  • Women (38%) supported a universal strategy that would vaccinate men and women.

Abstract

Introduction

Zika virus infection during pregnancy can cause significant infant morbidity. Little is known about pregnant women’s attitudes regarding behavioral strategies and hypothetical vaccination to prevent Zika infections and sequelae.

Methods

Pregnant women across the United States (N = 362) completed an online questionnaire regarding attitudes about Zika, including six behavioral prevention strategies (i.e., abstaining from sex, using condoms, not traveling to an area with Zika, their partner not traveling into an area with Zika, using mosquito repellant, wearing long pants and sleeves) and vaccination.

Results

Most women (91%) were married/living with the baby’s father, 65% were non-Hispanic White, and 71% had been pregnant. Seventy-four percent were worried about Zika, while 30% thought they were knowledgeable about Zika. The mean knowledge score was 5.0 out of 8 (SD = 2.09), and the mean behavioral strategies score was 4.9 out of 12 (SD = 3.7) with a range of 0 (none would be hard to do) to 12 (all would be hard to do). In a multivariable model, having had a sexually transmitted infection, living/traveling in an area with Zika, and worrying about Zika were significantly related to reporting behavioral strategies as hard to do. Seventy-two percent would be willing to be vaccinated. In the multivariable model, living/traveling in an area with Zika, believing they knew a lot about Zika, worrying about Zika, and considering Zika vaccine development as important were significantly associated with willingness to get vaccinated.

Conclusions

Pregnant women were worried about Zika, yet had gaps in their factual knowledge. Most women reported they would get vaccinated if a vaccine was available. Pregnant women who reported themselves as vulnerable (being worried, having lived in or traveled to a Zika area) were more likely to view behavioral strategies as hard to do and to accept vaccination.

Introduction

Zika virus is part of the virus family Flaviviridae that can be carried by Aedes mosquitoes [1], [2], [3]. Since 2015, the virus has spread quickly in the tropical regions of the Americas [4], [5], [6]. Transmission of Zika virus can occur through serum, prenatally, or sexually [7], [8], [9]. The majority of infected adults are asymptomatic [10], [11]. If they do present symptoms, the symptoms commonly are mild and include joint pain, conjunctivitis, and rash or a fever that lasts two to seven days [12], [13]. However, the infection can have severe consequences when transmitted perinatally [5], [9], [14]. In March 2016, the World Health Organization (WHO) reported that Zika virus infections during pregnancy can cause neonatal microcephaly and other congenital birth disorders [15]. Thus, prevention of Zika infection during pregnancy is of high importance. As of July 5th 2017, the Centers for Disease Control and Prevention (CDC) had documented a total of 663 symptomatic Zika cases in the United States (U.S.) and territories [16].

The WHO has listed developing a Zika vaccine as a top research priority [17]. Vaccination is among the most successful public health strategies, and is a priority for prevention of congenital Zika, given the severity of the disease and that mosquito-borne infections are hard to prevent through other interventions [18]. Until a vaccine is available, women will need to rely on other methods to prevent sexual or mosquito transmission [19].

Given the severity of neonatal infection and the promise of a vaccine, it is timely to assess pregnant women’s attitudes about Zika prevention. Previous research has found gaps in knowledge about transmission, including sexual transmission, and vaccine acceptability ranged from 21% of pregnant women in Greece to 56% of female college students in Virginia [20], [21]. We extended this research by drawing on a national sample of pregnant women in the U.S. to understand: (1) pregnant women’s attitudes and knowledge about Zika virus, (2) factors associated with perceptions of their ability to implement behavioral strategies to prevent Zika acquisition during pregnancy, and 3) factors associated with their willingness to receive a Zika vaccine if one were developed and available.

Section snippets

Materials and methods

A U.S. national sample of pregnant women (N = 362) completed an online survey addressing attitudes about health during pregnancy. Responses were collected from November 8th to November 16th, 2016. Eligibility criteria included being pregnant and over the age of 18 years, living in the U.S., and speaking Spanish or English. Participants were enrolled through Survey Sampling International (SSI) [22] a survey research company that maintains a national panel of over four million individuals in the

Sample

The majority of women (91%) were married or living with the father of the baby, 67% were 25–35 years, and 65% were non-Hispanic Caucasian. (Table 1) The respondents represented 43 states and Puerto Rico. Seventy-two percent reported that they either had not lived/traveled or were not sure whether they had lived/traveled in an area with Zika, and 28% reported they had. Eight percent had “never heard about it”, 20% had “heard about it but didn’t know much about it”, 43% thought they knew “a

Discussion

WHO continues to view Zika as a public health issue that needs a long-term programmatic approach [23]. In order to modulate the course of Zika and potentially eradicate it, the development of an effective vaccine remains one of the best options [17], [18], [24]. However, until a vaccine is developed and available, other preventative strategies will need to be used.

A necessary, although not sufficient, factor to foster preventive behaviors and vaccine uptake is adequate knowledge about one’s

Conclusions

This study has increased our knowledge about pregnant women’s understanding of Zika virus and their perceptions about preventative options. We demonstrated a gap between pregnant women’s worry about Zika (74%) and their knowledge, both perceived (only 30% thought they knew a lot) and factual (mean of 5.0 out of 8 items). Thus, we need to engage health care providers (who themselves may have knowledge gaps) in playing an active role in ensuring pregnant women are educated about the risks and

Conflicts of interest

None.

Funding sources

National Institutes of Health National Institute of Allergy and Infectious Diseases R21-R33AI098654, Vanier Canada Graduate Scholarship, and Queen Elizabeth II Diamond Jubilee Scholarship programs.

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