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Background: Zika virus is transmitted primarily by Aedes aegypti, the mosquito that spreads dengue and chikungunya viruses. In Puerto Rico, the first locally acquired case of Zika virus infection was confirmed in December 2015. Since then, 40,067 laboratory-positive Zika cases have been reported by the Puerto Rico Department of Health (PRDH) with 3,508 cases in pregnant women. As of January 7, 2017, 1,017 laboratory-positive Zika cases have been reported in Caguas, a municipality in central Puerto Rico; more than 80 in pregnant women. Research has indicated that Ae. aegypti is resistant to most pyrethroid insecticides in Puerto Rico. Therefore, Caguas, CDC, and PRDH collaborated to test a new approach to reducing Ae. aegyptipopulations: Autocidal Gravid Ovitraps (AGOs).
Program background: Previous studies in Puerto Rico indicated that placing three traps in over 80% of households reduced the number of Ae. aegypti by 80% and reduced chikungunya virus transmission by 50% when compared to neighboring communities with no traps (Barrera et al. 2014a, Barrera et al. 2014b, Lorenzi et al. 2016). When Zika emerged in Puerto Rico, there was interest in expanding the use of the traps to assess if it could also help prevent Zika virus transmission. The first step in exploring the use of the traps in Caguas included engaging community leaders to demonstrate the traps and getting their feedback and guidance on how to implement an integrated Ae. aegyptivector management (IVM) plan in their communities.
Evaluation Methods and Results: From May 24-25, 2016, CDC conducted six focus groups with 50 community leaders to assess their knowledge and opinions about Zika, get feedback about the acceptability and feasibility of using traps, and provide guidance on ways to inform community members about traps distribution. CDC then performed a content analysis of notes from the group discussions. Almost all community leaders knew that Zika virus was primarily spread by Ae. aegyptiand knew its association with microcephaly and Guillain-Barré syndrome. Most leaders supported the distribution of the traps. They agreed on having town hall meetings with health officials, social media, and flyers to inform neighbors about the installation of traps. One hundred and fifty-four leaders of 150 communities participated in six trainings on Zika prevention, Ae. aegypti, IVM, AGOs, and the implementation plan. Leaders distributed and posted project flyers on social media and spoke to neighbors about the traps. In total, 21,986 of 25,164 houses have been visited to inspect yards to eliminate, treat, and apply larvicide to containers with water, and 66,958 traps have been installed. Next steps include training households on bimonthly maintenance of traps to achieve long-term use.
Conclusions: Gathering insights from community leaders about vector control strategies and how to educate the community, helped identify best ways to promote community’s acceptance and use of the traps. This, and joining efforts between the CDC, PRDH, and Caguas were key in the successful implementation of a large-scale IVM centered on AGOs use.
Implications for research and/or practice: When new technologies are proposed, taking time to engage community leaders on whether and how to introduce the technology to the community is essential.