Charlan D. Kroelinger, PhD
Division of Reproductive Health
National Center for Chronic Disease Prevention and Health Promotion
CDC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Zika virus infection during pregnancy can cause microcephaly and other severe fetal brain defects. Doctors have also found other problems in pregnancies and among infants infected with Zika virus before birth, such as absent or poorly developed brain structures, defects of the eye, hearing deficits, and impaired growth. Nearly half of all pregnancies in the United States are unintended. Increased access to birth control may lead to reductions in unintended pregnancies, which may result in fewer adverse pregnancy and birth outcomes in the context of a Zika virus outbreak.

A new report from CDC estimates that use of highly effective, reversible forms of birth control, called long-acting reversible contraception (LARC), which includes intrauterine devices (IUDs) and implants, remains lower than use of moderate or less effective methods such as oral contraceptive pills and condoms, although contraception use varied across states and by age group and race/ethnicity.

CDC scientists used data from four state-based surveillance systems to estimate contraception use for non-pregnant and postpartum women at risk for unintended pregnancy and sexually active female high school students who live in states with the potential for local Zika virus transmission. Less than one in four sexually active women of reproductive age and fewer than one in 10 sexually active female high school students reported using LARC. A higher percentage of postpartum women reported LARC use. Moderately effective and less effective contraceptive methods, including pills, patches, rings, injections, condoms and other barrier methods, were used more frequently than highly effective methods. These estimates are of concern because the most commonly used methods of contraception are not as effective at preventing unintended pregnancy.

MedicalResearch.com: What should readers take away from your report?

Response: Efforts to increase availability of and access to the full range of FDA-approved contraceptive methods, especially highly effective methods, can reduce unintended pregnancies among women who wish to delay or avoid pregnancy and may lead to fewer adverse pregnancy and birth outcomes during a Zika virus outbreak. In areas with potential Zika virus transmission, the full range of FDA-approved contraceptive methods, including LARC, should be available and accessible for women and couples who want to delay or avoid pregnancy. States and local jurisdictions can implement strategies to increase access to contraceptive services to reduce unintended pregnancies among women who may be exposed to Zika virus.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: CDC collects surveillance data from states to better understand behaviors and experiences of adults and youth in the U.S. and territories. All of these surveillance systems regularly publish reports on health behaviors. In this report, only 39 of the 41 states with the potential for local Zika virus transmission had data from at least one surveillance system, suggesting a continued need for ongoing collection of state-level data on contraceptive use.

MedicalResearch.com: Is there anything else you would like to add?
Response:  Effective contraception use is a primary strategy to prevent poor pregnancy and birth outcomes linked to Zika infection during pregnancy. Barriers to the access and availability of contraception may include high device costs, limited provider reimbursement, lack of training for providers serving women and female adolescents on insertion and removal of LARC, provider lack of knowledge and misperceptions about LARC, limited availability of youth friendly services that address adolescent confidentiality concerns, limited client-centered counseling, and low consumer awareness of the range of contraceptive methods available. State and local jurisdictions can implement strategies to remove barriers to the access and availability of highly effective long acting reversible contraception (LARC).
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:
Boulet SL, D’Angelo DV, Morrow B, et al. Contraceptive Use Among Nonpregnant and Postpartum Women at Risk for Unintended Pregnancy, and Female High School Students, in the Context of Zika Preparedness — United States, 2011–2013 and 2015. MMWR Morb Mortal Wkly Rep. ePub: 2 August 2016.
DOI: http://dx.doi.org/10.15585/mmwr.mm6530e2.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on MedicalResearch.com

The cervical stitch is a common procedure used to prevent preterm birth. Breaking research concludes that the size of the thread used can make a significant difference to the outcome for the infant.

A small change in cervical stitch thread size could save lives.

An estimated 1 in 10 American babies are born prematurely.

Being born before the 37-week mark is the greatest contributor to infant death and a leading cause of long-term neurological disabilities.

Preterm births are triggered by the cervix opening too early and allowing the baby to enter the birth canal.

Women who are considered at high risk of miscarriage or preterm birth often undergo the cervical stitch procedure, also known as cervical cerclage.

The cervical stitch procedure involves stitching the entrance to the cervix closed with a piece of thread; globally, more than 2 million women have this intervention each year.

Not only does the procedure help the cervix stay closed and delay labor, but it also acts as a barrier to prevent potentially harmful bacteria from traveling through the cervix and into the womb.

Although the exact causes of preterm births are not known, bacterial infection is considered a potential factor; therefore, increasing the strength of the natural barrier helps minimize the risk.

Cervical stitch thread size

Surgeons completing the cervical stitch procedure use one of two types of thread. The first is a thin, 1-millimeter diameter, fishing line-like thread called monofilament; the other is a thicker thread, around 5 millimeters thick, woven from smaller threads, resembling a shoe lace.

Currently, the thicker thread is used in around 80 percent of cervical stitch procedures, predominantly because it is considered to be sturdier and more efficient at holding the cervix closed.

A group of researchers from the Department of Surgery and Cancer at Imperial College London, United Kingdom, set out to investigate which of the two threads was most medically beneficial.

The results are published this week in the journal Science Translational Medicine.

"Our current study suggests the thick multifilament thread is associated with increased risk of complications. Even after factoring in the age and overall health of the patient."

Lead author Prof. Phillip Bennett

Why thread size matters

The researchers looked at 671 women from five U.K. hospitals over the past 10 years, all of whom had undergone the cervical stitch procedure. Roughly half had the thin monofilament, and the others had the thicker shoelace thread.

The rate of intrauterine death (death of the fetus before birth) in normal pregnancy is around 0.5 percent. In the thinner thread group, that figure was 5 percent, and in the shoelace group, it jumped up to 15 percent.

When the team investigated the preterm birth rate - which is 7 percent within the general population - they found that the thicker, shoelace thread was associated with a 28 percent rate, whereas the thinner thread was just 17 percent.

As a follow-up investigation, the team, led by Prof. Bennett, followed another 50 women. Half of these women used the thinner thread, the others used the wider type. The women were monitored at 4, 8, and 16 weeks with an ultrasound scan and an analysis of bacteria collected using vaginal swabs.

It was found that the women who were given the thicker thread had an increased inflammation of the cervix and increased blood flow to the region; this change is associated with the cervix opening prior to labor.

At the start of the study, all of the women had a similar collection of naturally occurringLactobacillus. However, after 4 weeks, the group with the thicker thread were found to have more "potentially dangerous" bacteria around their cervix and inside the vagina.

These new bacteria are:

"[...] associated with poor outcomes during pregnancy, like preterm birth and infection in babies. Women who received the thinner thread maintained normal levels of harmless Lactobacillus bacteria in the birth canal or cervix."

Dr. David MacIntyre, scientific lead

Testing bacterial growth

As a third prong to the study, the team investigated how easily bacteria could grow on the two sizes of thread. Summarizing the tests, Dr. MacIntyre says: "We found potentially dangerous bacteria grew more easily on the thicker thread. This may be because bacteria can latch onto the woven structure of the thick thread more easily than the smooth, thin thread."

The conclusions drawn from the study are that, on a global basis, by switching from thicker to thinner thread, 170,000 premature births and 172,000 intrauterine deaths could be prevented.

To test these findings more thoroughly, a further study using 900 patients is already underway, organized by the University of Birmingham, U.K.

Any medical discovery that can simply, cheaply, and effectively save lives is a game-changer. Jane Brewin, chief executive of Tommy's - a charity dedicated to children's health - says: "The really good news is that a safe and proven treatment to prevent preterm birth has just been made safer by this new finding."

Learn more about the benefits of breast-feeding preterm babies.

Written by Tim Newman

APHA Get Ready fact sheet — Zika virus: How to keep your family safe

Mosquitoes are more than just an itchy nuisance. They can also pass on diseases. One of those diseases is Zika. You can take steps to help protect yourself, your family and your community from Zika.

What is Zika?

Download and share PDF

Zika is a disease caused by a virus. It’s mainly spread to people by mosquitoes. When an infected mosquito bites you, it can pass on the virus and make you sick.

Zika illness is usually very mild. You may get symptoms such as a rash, fever, red eyes or joint pain, which usually go away within a week. According to the Centers for Disease Control and Prevention, only about 20 percent of people who are infected with Zika will get sick. 

Some reports link Zika to Guillain-Barré, a rare condition that causes nerve damage, but CDC hasn’t confirmed that connection. It’s very rare for anyone to die from Zika.

Zika and pregnant women

The main health concern with Zika is the virus’ effect in pregnant women. If a woman is infected with Zika, she can pass the virus to her fetus. The virus can cause microcephaly and other serious brain, eye or hearing problems in the fetus. Microcephaly is a birth defect in which a baby is born with a small head and other possible developmental problems.

Because of these concerns, pregnant women shouldn’t travel to areas where Zika virus is being spread, CDC says. Pregnant women in areas with Zika transmission should take care to protect themselves from mosquitoes.

How else is Zika spread?

Zika virus can also be spread via sex. CDC is advising that men who may have been exposed to Zika and have pregnant partners wear condoms during sex or that they abstain from sexual activity.
There are concerns that Zika may be spread via blood. The Food and Drug Administration says that people who may have been exposed to the virus should not donate blood for at least four weeks to be sure they don’t pass Zika to others.

How can I prevent or treat Zika?

There are no vaccines or treatments for Zika, other than caring for symptoms. The best way to avoid Zika is to not get bitten by mosquitoes.

Here are some steps CDC recommends:

• When outdoors, wear approved repellents with DEET. Follow all directions on the label.
  
• Wear long-sleeved shirts and pants. Treat your clothing with the chemical repellent permethrin or buy pre-treated clothes. 
  
• Stay in places with screens on windows and doors that keep mosquitoes out

You can also play a part by getting rid of places where mosquitoes breed around your home. The Environmental Protection Agency says you should get rid of standing water in rain gutters, tires, buckets, plastic covers, toys and containers where mosquitoes might lay eggs.

It’s also a good idea to empty and change water in bird baths, rain barrels and potted plant trays at least once a week, EPA says. Water in swimming pools should be circulated and treated.

What else is known?

Zika virus is spread by a type of mosquito called Aedes. These kinds of mosquitoes also spread dengue and chikungunya. So preventing mosquito bites and mosquito breeding makes sense for many reasons.

For more tips on Zika, visit www.apha.org/zika and www.cdc.gov/zika.

Updated July 29, 2016

Spanish version
Read and share this fact sheet in Spanish. For more tips to fight the bite, visit the Get Ready mosquito page.

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(CNN) — The National Institute of Allergy and Infectious Diseases has injected two human volunteers with an experimental DNA-based Zika vaccine, Director Anthony Fauci announced today, a month ahead of its projected schedule for vaccine development.

"If it's a home run, we'll know pretty quickly,"

Fauci said, adding that if it is successful, phase 2 trials could begin as early as January.

Human trials of another DNA-based vaccine created by Inovio Pharmaceuticals started in Miami a few days ago, but Fauci stressed that those DNA inserts are diIJerent from the ones the his agency is using.

"This vaccine includes a small piece of DNA with genes that code for Zika-virus proteins,"

Fauci said. It's injected via a coil spring injector into the deltoid muscle of the arm, where the body's cells read the DNA and create virus-like particles that should activate the immune system to create antibodies. A total of 80 volunteers ages 18 to 35 will receive the vaccine by the end of August at three study sites in Bethesda, Maryland, Baltimore and Atlanta.

The volunteers will be broken into three groups that will receive the same dose at diIJerent intervals over a 20-week period. After the first injection, volunteers will be required to return for follow-up visits over a 44-week period to monitor their health. The agency stressed the safety of the vaccine, noting that

"DNA vaccines do not contain infectious material -- so they cannot cause a vaccinated individual to become infected with Zika -- and have been shown to be safe in previous clinical trials for other diseases."

If preliminary results show eIJectiveness, Fauci said, the National Institute of Allergy and Infectious Diseases has enough doses of the vaccine on hand to move from phase 1 to phase 2 trials. However, it does not have enough money to plan and administer the phase 2 study, he said, adding that Congress needs to act on the Obama administration's request for additional funding to fight Zika.

That sentiment was echoed today by White House press secretary Josh Earnest: "If Republicans continue to obstruct funding for the Zika virus, then that's going to limit our ability to rapidly develop the kind of vaccine that, next summer or the summer after that, could start protecting the American people from the Zika virus and limit the risk associated with this particular disease."

 A volunteer receives the first dose of an experimental Zika vaccine. Related Article: CDC issues historic travel warning over Miami Zika outbreak Join the conversation See the latest news and share your comments with CNN Health on Facebook and Twitter. particular disease." If phase 2 happens as planned, Fauci said, he thought the earliest the vaccine might be used would be in early 2017, with FDA approval.

"The target of the vaccine will be women of childbearing age and their sexual partners," he said, "to protect their unborn children from birth defects." Zika has been shown to be responsible for an alarming increase in microcephaly, in which babies are born with small brains and heads, as well as other hearing, vision and developmental disorders.

Because it's well-known that Zika does the most damage in the first trimester of a pregnancy, Fauci stressed that vaccinating girls before they reach puberty in areas hard-hit by Zika is the ultimate goal. "In the real world, women are most vulnerable before they even know they are pregnant," he said. "So we need to vaccinate as young as we can possibly get them."

TUESDAY, Aug. 2, 2016 (HealthDay News) -- A U.S. federal task force is prepared to recommend that teens, adults and pregnant women not be routinely tested for genital herpes if they don't have signs of infection.

About one in every six Americans between the ages of 14 and 49 has genital herpes, according to the U.S. Centers for Disease Control and Prevention.

The disease, which is transmitted through vaginal, anal and oral sex, causes symptoms like blisters, discharge, burning and bleeding between periods. Though symptoms can be treated, genital herpes is incurable.

In support of its proposed guidelines, the U.S. Preventive Services Task Force says the benefit of routine herpes screening is small, because early treatments aren't likely to make much of a difference.

"Because there's no cure, there isn't much doctors and nurses can do for people who don't have symptoms," Dr. Maureen Phipps said in a news release from the task force, of which she is a member. Phipps is chairwoman of obstetrics and gynecology at the Warren Alpert Medical School of Brown University in Rhode Island.

The task force also says screening people who have no signs of herpes may cause harm, because the blood test can be inaccurate.

Still, "people should be aware of the signs and symptoms of genital herpes and should talk to their doctor or nurse if they are concerned," said Ann Kurth, dean of the Yale University School of Nursing. "This is especially true for women who are pregnant because there are things clinicians can do to help women who have genital herpes protect their babies during delivery."

The task force does, however, recommend screening for other sexually transmitted infections such as chlamydia, gonorrhea, syphilis and HIV. It also recommends health care professionals counsel patients who are at high risk of developing sexually transmitted diseases.

More information

For more about genital herpes, try the U.S. Centers for Disease Control and Prevention.

SOURCE: U.S. Preventive Services Task Force, press release, Aug. 2, 2016

-- Randy Dotinga

Last Updated: Aug 2, 2016

Copyright © 2016 HealthDay. All rights reserved.

Written by Tim Newman

Epstein-Barr virus is one of the most common viruses to infect humans, and it also appears to play a role in breast cancer. The findings of a recent study may have uncovered the mechanism behind this relationship.

EBV's influence on breast cancer development may soon be understood.

Epstein-Barr virus (EBV), a member of the herpes virus family, is easily transmitted through oral transfer of saliva and by genital secretions.

An incredible 90 percent of all humans on earth are thought to be infected by EBV.

Most sexually active adults will pick up the virus at some point in their lives, and about half of all 5-year-olds have evidence of previous infection.

Although the majority of carriers do not display any symptoms of infection, it can lead to complications in some individuals, most commonly, infectious mononucleosis, also known as glandular fever.

EBV infects two major cell types, firstly, components of the immune system, known as B cells; secondly, epithelial cells, which line cavities of the body, blood vessels, and organs.

Over the years, EBV has also been associated with a number of specific cancer types such as African Burkitt lymphoma (a cancer of the lymphatics), Hodgkin's disease (a blood cancer), nasopharyngeal carcinoma (a rare head and neck cancer), gastric adenocarcinoma (a type of stomach cancer), and leiomyosarcoma (a smooth muscle tumor).

An estimated 200,000 malignancies are caused by EBV annually.

EBV and breast cancer

Along with the cancers named above, a number of studies have glimpsed a relationship between EBV and breast cancer. Studies carried out in India, North Africa, China, and southern Europe have all noted a relationship.

Although EBV's relationship with cancer generation has been demonstrated, it has proven tough to pin down the processes behind it. Often, the breast cancer will not appear for many years after the initial viral infection, making a causal role difficult to establish.

A team from the Hematology/Oncology Division at Beth Israel Deaconess Medical Center (BIDMC) in Massachusetts, led by Dr. Gerburg Wulf, joined forces with Harvard Medical School in Boston to investigate this puzzle in more detail. The findings are published this week in the journal EBioMedicine.

The researchers cultured breast cells in the presence of EBV; specifically, they used cells known as primary mammary epithelial cells (MECs).

The team found that EBV binds to a specific receptor on normal breast cells called CD21, which leads to infection. The viral infection caused the breast cells to behave like stem cells - they were able to keep on dividing.

Studying EBV and its impacts

Dr. Wulf and his team implanted MECs into mice; they noted that the EBV infection assisted some cancer types, enabling certain proteins to speed up the formation of breast cancer. When the genes of the MECs infected by EBV were examined, they saw genetic characteristics normally associated with a particularly aggressive breast cancer - high-grade, estrogen-receptor-negative breast cancer.

As the authors wrote, "EBV infection of MECs lowers the threshold for malignant transformation." So, although EBV is not a causal factor in itself, it increases the likelihood of developing cancer later in life.

Although the results will need to be replicated and other aspects of the pathway examined, the findings add to our understanding of the causes and influences of breast cancer.

"We think that if a young woman develops EBV during her teenage years or later, her breast epithelial cells will be exposed to the virus and can be infected.

While for most individuals, there will be no long-term consequences, in some, the infection may leave genetic scars and change the metabolism of these cells.

While these are subtle changes, they may, decades later, facilitate breast cancer formation."

Gerburg Wulf, MD, PhD

EBV, it seems, may contribute to breast cancer development by predisposing MECs to become malignant further down the road. However, once cancerous, EBV no longer worsens the disease. The authors point out that the findings add weight to the argument for childhood EBV vaccination. They may also influence the way in which screening is carried out in the future.

Vaccination against a single strain of Zika virus should be sufficient to protect against genetically diverse strains of the virus, according to a new study.

Read the full story here.

Researchers have studied the relationship between health insurance coverage and tobacco and alcohol use among reproductive age women in the US, and whether there were differences according to pregnancy status. The findings showed that pregnant women with insurance coverage had lower odds of alcohol use in the past month; however the odds of tobacco use were not affected. For non-pregnant women, insurance coverage resulted in higher odds of alcohol use but lower odds of using tobacco.

Read the full story here.

Columbia University's Mailman School of Public Health. (2016, July 26). Health insurance coverage is associated with lower odds of alcohol use by pregnant women. ScienceDaily. Retrieved August 2, 2016 from www.sciencedaily.com/releases/2016/07/160726131700.htm

CDC periodically revises its contraceptive guidance for health care providers after review of the scientific evidence and consultation with national experts. These recommendations are intended to assist health care providers when they counsel women, men, and couples about contraceptive method choice and provide evidence-based guidance to reduce medical barriers to contraception access and use.

U.S. Medical Eligibility Criteria for Contraceptive Use, 2016 (U.S. MEC)  

The U.S. MEC includes evidence-based recommendations for using specific contraceptive methods by women and men who have certain characteristics or medical conditions. The 2016 U.S. MEC updates the previous 2010 U.S. MEC with new guidance including: New recommendations for women with cystic fibrosis, women with multiple sclerosis, and women using certain psychotropic drugs or St. John’s wort. Revisions to the recommendations for emergency contraception, including the addition of ulipristal acetate. Revisions to the recommendations for postpartum women; women who are breastfeeding; women with known dyslipidemias, migraine headaches, superficial venous disease, gestational trophoblastic disease, sexually transmitted diseases (STDs), and human immunodeficiency virus (HIV); and women using antiretroviral therapy.

U.S. Selected Practice Recommendations for Contraceptive Use, 2016 (U.S. SPR)

The U.S. SPR provides evidence-based recommendations for common, but sometimes complex, questions regarding initiation and use of specific contraceptive methods. The 2016 U.S. SPR updates the previous 2013 U.S. SPR with new guidance including: New recommendations for the use of medications to ease insertion of intrauterine devices and Revised recommendations for starting regular contraception after the use of emergency contraceptive pills. Updated guidance documents, provider tools, and other electronic resources are available: U.S. Medical Eligibility Criteria for Contraceptive Use, 2016 U.S. Selected Practice Recommendations for Contraceptive Use, 2016

Increase in rate of HCV detection in women of childbearing age, HCV testing among infants

TUESDAY, July 26, 2016 (HealthDay News) -- From 2011 to 2014 there were increases in the rate of hepatitis C virus (HCV) detection among women of childbearing age, according to research published in the July 25 early-release issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report. Alaya Koneru, M.P.H., from the CDC in Atlanta, and colleagues examined trends in HCV detection among women of childbearing age, HCV testing among infants (aged ≤2 years), and the proportion of infants born to HCV-infected women nationally and in Kentucky. The researchers found that among women of childbearing age, national rates of HCV detection increased 22 percent during 2011 to 2014. Among children aged ≤2 years, HCV testing increased 14 percent. Based on data from birth certificates there was a 68 percent increase in the proportion of infants born to HCV-infected mothers (from 0.19 to 0.32 percent). In Kentucky, which had the highest incidence of acute HCV infection during 2011 to 2014, there was a more than 200 percent increase in the HCV detection rate among women of childbearing age; a 151 percent increase in HCV testing among infants; and a 124 percent increase in the proportion of infants born to HCV-infected women (0.71 to 1.59 percent). "These findings highlight the importance of following current CDC recommendations to identify, counsel, and test persons at risk for HCV infection, including pregnant women, as well as consider developing public health policies for routine HCV testing of pregnant women," the authors write. Full Text

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