A rapid review of personal protective measures for preventing Zika virus infection among pregnant women

Abstract

Background. Zika virus (ZIKV) infection during pregnancy is associated with fetal microcephaly and other severe malformations, and the World Health Organization declared that this situation is a Public Health Emergency of International Concern in 2016. ZIKV is predominantly transmitted by Aedes spp. mosquitos, and although there is no direct evidence regarding personal protective measures targeting ZIKV infection, there is indirect evidence from studies of other arboviruses that share the same vector (e.g., dengue and chikungunya fever). Therefore, this rapid review evaluated personal protective measures that aim to prevent Aedes spp. mosquito bites and/or infection with related arboviruses. Methods. We searched the PubMed and Embase databases and grey literature for the last 10 years (up to March 25, 2016) to identify studies that evaluate the safety, efficacy, and effectiveness of personal protective measures. A total of 17 studies were included. Findings. Mosquito repellents (e.g., N,N-Diethyl-meta-toluamide/DEET, icaridin/picaridin, and IR3535) effectively prevented mosquito bites at different dosages, although these repellents were not evaluated in the context of preventing arbovirus infections. Citriodora extracts provided low efficacy. Nets that were treated using permethrin and deltamethrin effectively prevented dengue. There was no evidence of any teratogenic effects from the in vitro and animal model studies that evaluated these substances. Only DEET and permethrin were tested in clinical trials that included pregnant women, and both substances were considered safe. Conclusion. Although definitive data is lacking, insecticide-treated nets and mosquito repellents may be considered safe and potentially effective measures for preventing ZIKV infection during pregnancy.