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Prevention of sexual transmission of Zika virus - WHO

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Prevention of sexual transmission of Zika virus

Interim guidance


World Health Organization

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Publication details

Number of pages5
Publication dateUpdated 7 June 2016
WHO reference number:WHO/ZIKV/MOC/16.1 Rev.2




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The primary transmission route of Zika virus is via the Aedes mosquito. However, mounting evidence has shown that sexual transmission of Zika virus is possible and more common than previously assumed. This is of concern due to an association between Zika virus infection and adverse pregnancy and fetal outcomes, including microcephaly, neurological complications and Guillain-Barré syndrome.

The current evidence base on Zika virus remains limited. This guidance will be reviewed and the recommendations updated as new evidence emerges.

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Delay Pregnancy in Areas With Zika, W.H.O. Suggests

People living in areas where the Zika virus is circulating should consider delaying pregnancy to avoid having babies with birth defects, the World Health Organization has concluded.

The advice affects millions of couples in 46 countries across Latin America and the Caribbean where Zika transmission is occurring or expected. According to a recent study, more than five million babies are born each year in parts of the Western Hemisphere where the mosquitoes known to spread the virus are found.

At the moment, Puerto Rico, the United States Virgin Islands and American Samoa are the only parts of the United States with local transmission of the virus. But clusters of cases are expected to appear in Florida and along the Gulf Coast this summer.

The governments of five countries have issued similar advice, as has the health secretary of Puerto Rico, but the Centers for Disease Control and Prevention has decided against this approach on the grounds that government doctors should not intrude on personal decisions best made by women and their partners.

The virus, carried by the yellow fever mosquito, has been linked to abnormally small heads and brain damage in infants, a condition called microcephaly. In rare cases, the infection has caused paralysis and sometimes fatal complications in adults.

The W.H.O.’s new guidelines essentially acknowledge that, with no vaccine available and mosquito eradication efforts failing to stem the spread of the infection, delaying pregnancy may be the best way that women in affected areas can avoid having children with severe brain damage.

More than 1,500 babies have been born with microcephaly in Brazil. Six other countries and Puerto Rico have reported cases of microcephaly resulting from locally acquired Zika infections.

The W.H.O. says men and women of reproductive age “should be correctly informed and oriented to consider delaying pregnancy.” The guidance was originally issued last week but did not garner wide notice among experts until Thursday, when the W.H.O. issued a clarification, distinguishing between people who visit Zika-affected countries and those who live in them.

People living in those countries are not advised to delay for any specific amount of time, but that guidance “means delaying until we have more answers, more evidence, more science,” said Nyka Alexander, a W.H.O. spokeswoman.

“But it’s important to understand that this is not the W.H.O. saying, ‘Hey everybody, don’t get pregnant.’ It’s that they should be advised about this, so they themselves can make the final decision.”

Dr. Peter J. Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine, said of the W.H.O. recommendation, “It’s about time.”

His medical school is in Houston, and he has urged that women in areas where the virus is circulating or may circulate this summer avoid pregnancy if they can. “What happens when Zika hits Texas and the Gulf Coast this summer?” he asked.

Dr. William Schaffner, head of preventive medicine at Vanderbilt University School of Medicine, called the W.H.O.’s advice “excellent.”

“Now we just have to provide both the education and the means so that couples can implement,” he added.

Brazil has noted the W.H.O.’s new guidance in a statement for its citizens, a spokesman for the Health Ministry said. But the ministry itself has now taken a softer stance, saying, “Pregnancy is a personal decision that should be evaluated and considered by a woman together with her family.”

Some Brazilian virologists have pushed for emphatic advice to delay. The W.H.O. guidelines “understand the gravity of the situation,” said Dr. Artur Timerman, president of the Brazilian Society of Dengue and Arbovirus.

His society recommends that women living in areas of active transmission postpone getting pregnant and that men who return from such areas use condoms for six months. Brazilian health officials did not provide enough leadership on the issue, he said.

Dr. Celso Granato, a virologist at the Federal University of São Paulo, called the new W.H.O. guidelines “an important recommendation.”

“At this moment, what we know for sure is that the infection of the fetus may be catastrophic,” he said, “so I think that all the possible ways to avoid these situations have to be taken.”

In Atlanta, a C.D.C. spokeswoman said officials thought the W.H.O. guidelines were largely in line with the C.D.C.’s. On the issue of how long a man should wear a condom after visiting a Zika-affected country, they are now identical, which they were not before.

For people living in areas with Zika transmission, C.D.C. guidelines say doctors or nurses “should discuss the risks of Zika, emphasize ways to prevent Zika virus infection, and provide information about safe and effective contraceptive methods.”

Some women and their partners, they note, “may decide to delay pregnancy.”

When the epidemic began, health officials in BrazilEcuadorColombia,Jamaica and El Salvador asked women in their countries to delay pregnancy if they could. In some cases, they suggested waiting a few months; officials in Jamaica suggested a year, and those in El Salvador suggested waiting until 2018.

The advice was sharply criticized by reproductive rights’ groups, which said it was hypocritical coming from governments that often outlawed abortion and made it difficult for women to get birth control. Some Roman Catholic archbishops also objected.

Some infectious disease experts, however, said delaying pregnancy is the only sure way to prevent birth defects. Mosquito control had not previously stopped mosquito-borne viruses such as dengue or chikungunya, they pointed out, and a Zika vaccine is years away.

If women were able to delay pregnancy for just one season in which Zika was widely transmitted, it is likely that so many people would gain immunity from having been bitten that the virus would either completely disappear — as happened in previous Pacific island outbreaks — or would circulate at only very low levels the following year.

From the outset, the W.H.O. did endorse making birth control more available. Until recently, however, it had stopped short of advising women to consider delaying pregnancy.

“Theoretically, many have thought it may work,” Dr. Bruce Aylward, the organization’s chief of emergency responses, said in February. But, he said, at that time experts thought the best approach was to fight mosquitoes while scientists worked on a vaccine.

The revised guidelines are a result of meetings of global experts in mid-March “and further input from experts in the editing process,” said Ms. Alexander of the W.H.O.

They were issued May 30, and the recommendation that some couples be “oriented” to consider delaying pregnancy was included in Section 4, Paragraph 1.c.

But the agency drew no attention to it, and the new section was confusingly worded. On Thursday, the W.H.O. issued a clarification saying: “Men and women of reproductive age living in affected areas should be informed and orientated to consider delaying pregnancy. This was the original intention of the guidance. The correction makes this more clear.”

Later Ms. Alexander said, “We should have done a better job of highlighting it.”

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WHO Says People Living in Areas With Zika Should Delay Pregnancy

The World Health Organization clarifies its advice

Men and women who are living in areas where Zika is actively spreading should consider delaying pregnancy, according to the World Health Organization (WHO).

On Thursday, the agency released a correction to its guidance for preventing sexual transmission of Zika. “In order to prevent adverse pregnancy and fetal outcomes, men and women of reproductive age, living in areas where local transmission of Zika virus is known to occur, be correctly informed and oriented to consider delaying pregnancy,” the agency wrote.

The agency said that the update to the recommendation was meant to make the agency’s recommendation to delay pregnancy more clear. “This was the original intention of the guidance,” the WHO said in a press release. The guidance was released last week, but the update added more clarity for people living in countries with active transmission compared to travelers.

Other countries, like El Salvador, have been recommending that people delay pregnancies for quite some time. The country recommends people put off pregnancy for two years.

Zika has now spread to close to 50 countries. In June it was reported that a baby was born in New Jersey with Zika-related microcephaly.



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World Health Organisation advises people to delay pregnancy in Zika transmission countries

Zika outbreak: how the virus has spread - in 90 secondsPlay!01:32

The World Health Organisation has concluded that people living in areas where Zika transmission is ongoing should consider delaying pregnancy, in new advice that could affect millions of couples.

The Zika virus, which can lead to severe brain damage among babies, is prevalent in 46 countries across Latin America and the Caribbean. It has so far infected more than 7,000 babies worldwide.

The new advice from the WHO is effectively an acknowledgment that, with no vaccine available, delaying pregnancy is the best option for couples in those countries to avoid having babies with birth defects.

What is the Zika virus and how can you avoid catching it?Play!01:33

"In order to prevent adverse pregnancy and fetal outcomes, men and women of reproductive age, living in areas where local transmission of Zika virus is known to occur, [should] be correctly informed and oriented to consider delaying pregnancy," the WHO guidelines clarified on Thursday.

The governments of five countries in the region have so far issued similar advice independently, but this is the first time such a sweeping recommendation with the potential for affecting millions of people has been made by the world health body.

The WHO declared last month that the Zika virus is expected to spread to Europe in coming months, with some of the most popular holiday destinations for Britons likely to carry risks of disease transmission.

The rapid spread of Zika has caused fears ahead of the Olympics in Rio, which start in less than two months, with several athletes deciding not to travel to Brazil, the country hardest hit by Zika.

The WHO will convene experts next week to discuss the Zika outbreak, including its impact on the Rio Olympics.

Brazilian authorities have confirmed more than 1,400 cases of microcephaly in babies whose mothers were exposed to Zika during pregnancy. 

The group of independent experts will "look at evidence around the Olympics and most likely review the travel guidance around that," Christian Lindmeier, WHO spokesman, said.

A letter signed by more than 200 bioethicists and health experts has called for the WHO to recommend postponing or moving the Olympics to prevent an acceleration of the epidemic's spread. The WHO has rejected the call, saying the Games would not have a significant public health impact.

But last week, the agency said it would take up the issue during its emergency committee meeting.

Experts state the mosquito-born virus is to blame for a surge in cases of microcephaly - a serious birth defect in which babies are born with unusually small heads and brains.

As a result, all experts state that pregnant women should avoid travel to any country with active Zika transmission.



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WHO says delaying pregnancy option for women in Zika areas

FILE - In this Jan. 27, 2016, file photo, an Aedes aegypti mosquito is photographed through a microscope at the Fiocruz institute in Recife, Pernambuco state, Brazil. The World Health Organization says women who live in...

WASHINGTON (AP) — The World Health Organization says women who live in areas where Zika is spreading should consider delaying pregnancy, since there’s no other sure way to avoid the virus’ devastating birth defects.


The WHO stopped short of recommending that couples put pregnancy on hold.


“It’s not saying they should delay. They should be given the information about it and offered that as an option,” WHO spokeswoman Nyka Alexander said Thursday.


Zika is rapidly spreading through Latin America and the Caribbean, and health officials in several affected countries have made similar recommendations. But the WHO’s guidelines, updated last week, could affect millions of couples who live in outbreak areas.


Zika causes only a mild and brief illness, at worst, in most people. But it can cause fetal death and severe brain defects in the children of women infected during pregnancy.


There is no vaccine. In outbreak areas, the main defense is to avoid mosquito bites. But Zika also can be spread through unprotected sex with a man who was infected.


Around the world, health officials have advised pregnant women not to travel to areas where Zika is spreading. And the U.S. Centers for Disease Control and Prevention has additional advice for non-pregnant travelers: Women should wait at least eight weeks after a Zika illness, or possible exposure to the virus, before trying to conceive. Men who had symptoms should wait at least six months before trying, the CDC recommends.


In response to the WHO’s new guidelines, the CDC said health care providers should discuss Zika’s risks and how to prevent infection, and provide information about contraception.


“As part of their pregnancy planning and counseling with their health care providers, some women and their partners residing in areas with active Zika virus transmission might decide to delay pregnancy,” the agency said in a statement.


Zika also can be a hazard to the scientists studying it. The University of Pittsburgh said Thursday one of its researchers accidentally stuck herself with a needle during a Zika experiment and went on to develop symptoms. Pitt officials said the lab accident occurred last month and the researcher has recovered and returned to work.


Nearly 700 infections have been reported in U.S. states. All were people who had traveled abroad, or who had sex with someone who did.


The virus is spreading in Puerto Rico and health officials say clusters of illnesses are likely in the mainland U.S. as mosquito season heats up. On Thursday, CDC Director Tom Frieden made another plea for Congress to quickly provide funding needed to battle Zika.


“Give us the money so we can work with American women and children and families to monitor the effects of Zika, so we can do a better job at killing mosquitoes to protect American women, and so we can develop better tools to diagnose Zika, to control mosquitoes and ultimately, with NIH in the lead, to find a vaccine to protect women,” Frieden said.


The White House on Thursday hosted a video teleconference involving administration officials, the CDC and Southern governors such as Rick Scott of Florida to go over Zika response planning as the likelihood of Zika cases is increasing with the summer heat.


“We are likely to see single cases of transmission and we could certainly see clusters in some at-risk communities, and we want to make sure we do everything possible to get ahead of them,” Frieden told reporters later.


Frieden said a key element of the federal response is CDC rapid response teams when cases arise.


The Obama administration requested $1.9 billion in February, to allow officials to continue Zika prevention efforts and begin studying long-term effects of people infected by the disease.


In Congress, the House and Senate each passed Zika bills that would provide funding at levels lower than the administration’s request. The Senate voted late Wednesday to begin talks with the House on compromise legislation.


The Senate proposal includes $1.1 billion without spending cuts to offset the expense, while the House has backed a $622 million measure with cuts elsewhere.




Associated Press writers Mike Stobbe in New York, Kathleen Foody in Atlanta and Andrew Taylor in Washington contributed to this report.



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The World Health Organization appears to be trying to steer women toward delaying pregnancy if they live in countries where the Zika virus is spreading.

The global health organization had previously avoided issuing that type of advice, suggesting women in Zika-affected countries speak to their doctors about the issue. But in its most recent guidance, the Geneva-based agency has suggested that people of reproductive age living in affected areas “be informed and orientated to consider delaying pregnancy.”

In January, El Salvador made headlines around the globe when its deputy health minister urged women to hold off getting pregnant for the next two years. Most other governments have refrained from going that far, suggesting the decision to try to become pregnant is a personal one.


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The guidance from the Centers for Disease Control and Prevention, for instance, notes pregnancy involves “very complex, deeply personal decisions” and advises doctors to talk to women and their partners about pregnancy planning and strategies to avoid unintended pregnancies.

“As part of their pregnancy planning and counseling with their health care providers, some women and their partners residing in areas with active Zika virus transmission might decide to delay pregnancy,” the agency said Thursday in a brief statement about the WHO’s revised position.

The WHO systematically reviews new evidence and revises its advice as needed, spokeswoman Nyka Alexander told STAT by email.

Expert meetings were held in mid-March, she said. “These updates are a result of those meetings and further input from experts in the editing process.”

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Alexander stressed the importance of the way the advice is worded: “It is a matter of ensuring people are given information about delay as an option for them to consider.”

The revised guidance was published online on May 30, Alexander said. The press release issued at the time did not flag the change.  

Infectious diseases expert Michael Osterholm said it makes sense for people living in places where Zika is spreading to delay pregnancy, if they can.

Osterholm, the director of the University of Minnesota’s Center for Infectious Diseases Research and Policy, said while the risk from Zika is high now, it will likely subside. If the pattern of spread of related diseases can be used to predict what will happen with Zika, this period of explosive transmission will ebb in a year or two.

“We’re going to see this likely peak in the next 12 to 18 months in terms of the number of new infections. And then as more people become infected, and recover, the transmission dynamics will drop,” he said.

But Lawrence Gostin, a professor of global health law at Georgetown University, was not so sure the WHO’s revised guidance will help women living in Zika-affected places.

“The problem with suggesting that women postpone pregnancy is that many Latin-American countries have the most restrictive contraception and abortion laws in the world. Even though WHO recommended access to emergency contraception, there is literally no assurance that governments would comply,” Gostin said. 

Some babies born to mothers infected with Zika have been found to have a host of birth defects, including microcephaly, a condition in which newborns have abnormally small heads.

Studies have suggested that 1 in 100 women infected in pregnancy might have a child with microcephaly— though one paper said the figure might be as high as 13 percent.

Other studies have suggested microcephaly is the tip of the iceberg when it comes to Zika-related birth defects. Some babies that were infected in the womb are born with visual and hearing impairments; others have other forms of brain damage.


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