EXECUTIVE SUMMARY
Clinicians can get up to speed on the latest strategies for Zika virus prevention, as well as implement the latest guidance surrounding Zika in the family planning setting, with new webinars hosted by the American College of Obstetricians and Gynecologists and the CDC.
- The Florida Department of Health has identified two areas in Miami where Zika is being spread by mosquitoes. The incidents from these areas are the first known cases of local mosquito-borne Zika virus transmission in the continental United States.
- State And Local Strategies Are Needed To Increase Access To Contraceptive Methods And Related Services, Reduce The Risk For Unintended Pregnancy, And Minimize The Number Of Pregnancies Affected By Zika Infection.
Clinicians can get up to speed on the latest strategies for Zika virus prevention, as well as implement the latest guidance surrounding Zika in the family planning setting, with new webinars hosted by the American College of Obstetricians and Gynecologists (ACOG) and the CDC.
On Aug. 24, 2016, the CDC updated its clinical guidance for healthcare providers caring for pregnant women, which is available at http://bit.ly/2bRQag6. The CDC also has issued two new handouts, “When to test for Zika virus,” available at http://bit.ly/2biMrpE, and “Zika virus testing for any pregnant woman not living in an area with Zika, which can be accessed at http://bit.ly/2bllhxM.
Public health officials are moving on all fronts after the Florida Department of Health identified two areas in Miami where Zika is being spread by mosquitoes. The incidents from these areas are the first known cases of local mosquito-borne Zika virus transmission in the continental United States. The two areas are identified as Wynwood, which is an area of less than one square mile in Miami-Dade County just north of downtown, and a 1.5-square-mile area in Miami Beach, within the boundaries of Eighth and 28th streets. Readers can access the guidance at http://bit.ly/2aDzLM6.
The CDC is working closely with Florida officials to gather and analyze new information every day, says Tom Frieden, MD, MPH, CDC director. “With the new information that there are active mosquitoes still in the area and additional Zika infections, we conclude that pregnant women should avoid this area — and make every effort to prevent mosquito bites if they live or work there,” said Frieden in a press statement. “We apply the same criteria within and outside of the United States, and are working closely with the State of Florida and Miami health departments to provide preventive services, including mosquito control.”
To estimate the prevalence of contraceptive use among nonpregnant and postpartum women at risk for unintended pregnancy and sexually active female high school students living in the 41 states where mosquito-borne transmission might be possible, the CDC has looked at 2011-2013 and 2015 survey data from four state-based surveillance systems: the Behavioral Risk Factor Surveillance System (BRFSS, 2011-2013), which surveys adult women; the Pregnancy Risk Assessment Monitoring System (PRAMS, 2013); the Maternal and Infant Health Assessment (MIHA, 2013), which surveys women with a recent live birth; and the Youth Risk Behavior Survey (YRBS, 2015), which surveys students in grades 9-12.1
The percentage of women at risk of unintended pregnancy who used long-acting reversible contraception (LARC) ranged from 5.5% to 18.9% for BRFSS-surveyed women and 6.9% to 30.5% for PRAMS/MIHA-surveyed women. The percentage of women not using any contraception ranged from 12.3% to 34.3% in one survey (BRFSS) and from 3.5% to 15.3% in others (PRAMS/MIHA). YRBS data indicate that among sexually active female high school students, use of LARC at last intercourse ranged from 1.7% to 8.4%, and use of no contraception ranged from 7.3% to 22.8%.1
State and local strategies are needed to increase access to contraceptive methods and related services, reduce the risk for unintended pregnancy, and minimize the number of pregnancies affected by Zika infection, CDC researchers report. Potentially effective strategies include addressing policies on high device costs and provider reimbursement, comprehensive provider training on insertion and removal of LARC, provision of youth-friendly services, support to resource-challenged jurisdictions, client-centered counseling, assessment of patient satisfaction, and increased consumer awareness of the full range of contraceptive methods to delay or avoid pregnancy.1
Use Zika Toolkit
In her ACOG presentation, Melissa Kottke, MD, MPH, MBA, associate professor in the Department of Gynecology and Obstetrics at the Emory University School of Medicine in Atlanta, pointed to the job aids in the free “Providing Family Planning Care for Non-Pregnant Women and Men of Reproductive Age in the Context of Zika — A Toolkit for Healthcare Providers,” developed by the federal Department of Health and Human Services’ Office of Population Affairs.2
The toolkit was developed for those in family planning services, including those in Title X clinics and in primary care sites such as federally qualified health centers, to help women and men make informed decisions about pregnancy and childbirth in the context of Zika. Readers can download the toolkit at http://bit.ly/2an4mMm.
What should family planning providers do in light of the Zika virus? Kottke outlined five important steps:
- Screen for exposure to Zika virus.
- Educate about the risks of infection during pregnancy.
- Provide basic information about strategies that can be used to prevent Zika.
- Provide contraceptive services to those who wish to prevent or delay pregnancy.
- Provide condoms to men and women who are at risk for sexual transmission of Zika.
Use strategies for contraceptive counseling in talking with women, said Kottke. Establish and maintain rapport, she said. Assess the woman’s needs, and personalize discussions accordingly, Kottke added.
“Work with her interactively to establish a plan, provide information that can be understood and retained by the woman, and confirm her understanding,” she stated.
Access the ACOG webinar at http://bit.ly/1J3LVKQ. Click on “Biting Back: Contraception and Zika Prevention.”
To access the CDC Aug. 9, 2016, webinar slides for “Updated Interim Zika Clinical Guidance for Pregnant Women and Data on Contraceptive Use to Decrease Zika-affected Pregnancies,” readers can go online to http://bit.ly/2aG3iBL. Under “Read Now,” select “Slides.”
REFERENCES
- Boulet SL, D’Angelo DV, Morrow B, et al. Contraceptive use among nonpregnant and postpartum women at risk for unintended pregnancy, and female high school students, in the context of Zika preparedness — United States, 2011–2013 and 2015. MMWR Morb Mortal Wkly Rep 2016; 65:780-787.
- Department of Health and Human Services. Providing Family Planning Care for Non-pregnant Women and Men of Reproductive Age in the Context of Zika. Rockville, MD: Department of Health and Human Services, Office of Population Affairs; 2016.
