Figures & Tables
Figures
- FIGURE
PRISMA Diagram of Process for Considering Eligibility in the Evidence Review
Tables
Behavior Summary of Evidence Personal Protection Applying mosquito repellent (DEET, picaridin, IR3535, or lemon eucalyptus oil, only), using each product as directed, for duration of pregnancy, to reduce risk of Zika transmission through mosquito bites. Application of mosquito repellent is highly efficacious in preventing mosquito bites, and thus the potential of vector transmission of Zika to an individual. This behavior is within the control of pregnant women and their male partners. Users should be thoroughly counseled on proper product application. Women intending to become pregnant should also consider using repellent. Using condoms to prevent sexual transmission of Zika in pregnancy. Condom use to prevent sexual transmission of Zika is highly efficacious, but sexual transmission may be a small portion of overall transmission. This behavior should be prioritized for pregnant women and their partners because pregnant women are at risk for negative pregnancy outcomes. Household and Community Vector Control Regularly removing unintentional standing water both inside and outside the house and in communal areas. This is a potentially efficacious behavior to reduce mosquito populations, and thus reduce the potential for individual- and population-level risk of Zika transmission. Promotion of the behavior must be accompanied by specific, focused instructions that target the highest density breeding sites and be conducted weekly in homes and communal areas to be effective. Efficacy is highest in areas where there is strong community engagement, including active mosquito searches in homes and communities and awareness of the mosquito life cycle. Covering water storage containers at all times with a tight-fitting cover that does not warp or touch the water. Covering long-term water storage containers has moderate potential efficacy in reducing breeding sites if a tight- fitting, long-lasting lid is available. Covering short-term water storage containers has less potential efficacy, as frequent lid use can result in wear and tear and render the lids ineffective or counterproductive. Scrubbing walls of water storage containers weekly to remove mosquito eggs. Scrubbing walls of water storage containers weekly is efficacious in removing mosquito eggs and can thus reduce the potential for individual- and population-level risk of Zika transmission. However, the specific cleaning steps that eliminate mosquito eggs must be explicitly described. Behaviors That Enable Prevention Seeking antenatal care to monitor pregnancy and discuss Zika risk and prevention. Seeking antenatal care enables providers to counsel pregnant women on Zika prevention, which can increase the chances of pregnant women taking protective measures and reducing the risk of vertical transmission of Zika from mother to child. Seeking counseling from a trained provider on modern family planning methods if not planning on getting pregnant. Family planning use (for those not intending on getting pregnant) is directly linked to reducing the risk of vertical transmission of Zika. Family planning counseling should be done by a trained health care provider. - TABLE 2
Zika Preventive Behaviors Not Selected for Full Evidence Review and Reasons for Exclusion
Behavior Outside Locus of Control Limited or No Evidence of Effectiveness Challenging in This Setting Behavior Is in Pilot Phase USAID Not Supporting Summary Use of insecticide-treated bed nets ✓ ✓ This behavior has limited efficacy, as most people sleep during the night and Aedes aegypti mosquitoes bite mainly during the day, limiting the time nets might provide Zika protection to daytime naps. Additionally, USAID is not procuring mosquito nets for Zika since they are not effective because of the daytime biting behavior of Aedes mosquitoes. Wearing long sleeves, light colors ✓ ✓ ✓ In the climate where Zika is transmitted, implementing this behavior with sufficient consistency (all day, every day) is unlikely to be feasible, reducing its potential to make an important contribution to Zika prevention. There is also limited evidence that wearing regular clothing that has not been treated with insecticide is effective in preventing mosquito bites. Application of larvicide ✓ ✓ While considered highly efficacious, larvicides should be applied by vector control technicians, rather than household members, so control over implementation of this behavior does not lie at the household level. Larvivorous fish ✓ ✓ ✓ Application of larvivorous fish to water storage containers is still in the pilot phase; limited data available on efficacy. Additionally, USAID is not procuring larvivorous fish, and the behavior is outside the locus of household control since it is currently being done by vector control specialists who visit the home. Indoor residual spraying ✓ ✓ ✓ This behavior is implemented by vector control technicians and therefore does not lie within the control of the household. There is limited literature on the efficacy of this intervention as it is traditionally only used for anopheline mosquitoes; some pilots are in progress to test for effectiveness for Aedes mosquitoes. Use of insecticide-treated curtains/screens ✓ There is some evidence that insecticide-treated curtains or screens are effective in preventing Aedes abundance indoors; however, USAID is not procuring these. Use of coils to repel mosquitoes ✓ ✓ Efficacy appears limited upon initial review, with some studies even suggesting they increase dengue risk. Planting basil plants ✓ While some research suggests that essential oils extracted from plants may have a repellent effect, no studies were identified that assess the repellent effect of basil plants. 
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