Research Article: An Assessment of Household and Individual-Level Mosquito Prevention Methods during the Chikungunya Virus Outbreak in the United States Virgin Islands, 2014–2015

Date Published: March 05, 2018

Publisher: The American Society of Tropical Medicine and Hygiene

Author(s): Leora R. Feldstein, Ali Rowhani-Rahbar, J. Erin Staples, M. Elizabeth Halloran, Esther M. Ellis.

http://doi.org/10.4269/ajtmh.17-0799

Abstract

Recent large-scale chikungunya virus (CHIKV) and Zika virus epidemics in the Americas
pose a growing public health threat. Given that mosquito bite prevention and vector
control are the main prevention methods available to reduce transmission of these
viruses, we assessed adherence to these methods in the United States Virgin Islands
(USVI). We interviewed 334 USVI residents between December 2014 and February 2015 to
measure differences in mosquito prevention practices by gender, income, presence of
CHIKV symptoms, and age. Only 27% (91/334) of participants reported having an air
conditioner, and of the 91 with air-conditioners, 18 (20%) reported never using it.
Annual household income > $50,000 was associated with owning and using an air
conditioner (41%; 95% confidence interval [CI]: 28–53% compared with annual
household income ≤ $50,000: 17%; 95% CI: 12–22%). The majority of
participants reported the presence of vegetation in their yard or near their home
(79%; 265) and a cistern on their property (78%; 259). Only 52 (16%) participants
reported wearing mosquito repellent more than once per week. Although the majority
(80%; 268) of participants reported having screens on all of their windows and doors,
most (82%; 273) of those interviewed still reported seeing mosquitoes in their homes.
Given the uniformly low adherence to individual- and household-level mosquito bite
prevention measures in the USVI, these findings emphasize the need for improved
public health messaging and investment in therapeutic and vaccine research to
mitigate vector-borne disease outbreaks.

Partial Text

Mosquitoes and the infectious diseases they transmit continue to be a significant public
health challenge globally. Recent large-scale chikungunya virus (CHIKV) and Zika virus
(ZIKV) epidemics in the Americas and their associated severe outcomes illustrate this
risk.1,2 Furthermore, no antiviral or therapeutic treatment or vaccine
presently exists for these diseases.1,3 Presently, mosquito bite prevention and
vector control are the main prevention methods available to reduce the transmission of
CHIKV, ZIKV, and dengue virus (DENV).4

Participants were identified from two difference sources. First, we invited USVI
residents who had symptoms compatible with CHIKV infections, specifically fever and
polyarthralgia, and tested positive for evidence of a recent CHIKV infection from June
2014 to February 2015 to participate. Second, we invited USVI residents who sought
health care from December 2014 to February 2015, and their accompanying family members
to participate in the study (Supplemental
Appendix). The second group, nonsymptomatic controls, consisted of
residents of any age in the waiting room of the emergency room of a hospital or at a
health clinic in the USVI. These individuals were either waiting to be seen by a
clinician or were accompanying a relative or friend who was waiting to be seen. The
individuals were asked about symptoms compatible with CHIKV infection since June 2014
and were excluded if they reported having fever and polyarthralgia, to compare whether
symptoms influenced behavior (Supplemental
Appendix).

Three hundred and thirty-four USVI residents were interviewed from December 2014 to
February 2015. Of all participants, 220 (66%) were female and the median age was 42
years (interquartile range of 23–58 years). A total of 269 (81%) participants
provided information on their household income; of whom, 78% (210) reported making
≤ $50,000/year. Almost half (155; 46%) of all participants reported symptoms
consistent with CHIKV infection and tested positive for evidence of recent infection.
The remainder denied having any symptoms of CHIKV infection since June 2014 when the
virus was first recognized in the USVI.

These results indicate that the proportion of persons surveyed in the USVI who practiced
mosquito bite prevention measures was low and generally not affected by gender, income,
symptoms of CHIKV infection, or age. This might be due to the general attitudes and life
styles of the population, the tropical climate, and challenges in promoting behavior
change.

 

Source:

http://doi.org/10.4269/ajtmh.17-0799

 

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