Lessons Learned from Zika Virus: A Systematic Literature Review on Strategic Responses in Puerto Rico and the US Virgin Islands Open Access

Ceesay, Binta (Spring 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/6395w7131?locale=en


Background: Zika virus (ZIKV) is an arbovirus transmitted by Aedes aegypti mosquitoes. The most recent outbreak in the Americas left a tremendous burden with numerous cases of congenital zika syndrome which can cause birth defects like microcephaly and Guillain-Barre Syndrome. A Community Assessment for Public Health Emergency Response (CASPER) was conducted on ZIKV in the US Virgin Islands (USVI) in 2017. That fieldwork was appended  by a systematic review of the literature which assessed the lessons learned from strategic responses to ZIKV in American territories, Puerto Rico and USVI.


Methods: CASPER used a two-stage probability sampling method to implement household-based surveys. PubMed and Popline were used to identify peer-reviewed articles that met the inclusion and exclusion criteria. CDC’s Stacks and WHO’s IRIS databases were used to identify grey-literature. All full-text publications were entered using EndNote X8 and organized into a Summary of Findings table.


Results: The CASPER revealed less than 45% of households knew ZIKV was sexually transmitted compared to 96% of households who knew ZIKV was transmitted by mosquitoes. Results also reveal the most common and trusted sources for ZIKV messaging within the community. The literature search identified 2,513 peer-reviewed articles related to ZIKV strategic response; of those, 42 articles were selected for this review. Twelve grey literature publications were included. The primary topic and areas and policy concerning ZIKV were consolidated around detection, prevention, care & support, and research.


Conclusion: Although ZIKV is no longer a global health emergency, there are adverse health outcomes, the extent of which, are not thoroughly known. This is particularly true of the outcomes for pregnant women and their infants, Further research in both the clinical and policy arenas is required to address this priority population. For example, it will be critical to focus on solutions related to vaccine development within a pregnancy-specific ethical framework and antiviral therapeutics for affected communities. An integrated and multidisciplinary response approach that includes scientists, all levels of government, clinicians, local community members and public health professionals will be the ideal option for addressing ZIKV.

Table of Contents

Table of Contents



History and Emergence of Zika Virus 3

Problem Statement 5

Objective and Aims 6


CASPER  Methods 8

Ethical Considerations 8

Systematic Literature Review Methods 9

Inclusion and Exclusion Criteria. 9

Data Synthesis 9

Ethical Considerations 11


USVI CASPER Results 12

Literature Review.. 15

Search Results 15

Detection and Surveillance of ZIKV.. 17

Prevention Mechanisms 21

Care and support for CZS and resulting complications 25

Research priorities for ZIKV.. 28

Limitations 30


Public Health Implications 33

Increase Public Funding. 33

Improve Risk Communication. 34

Enhance Access to Contraceptives 36

Address Human Rights 38

Further Research Agendas 39




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