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We need to remember, some of the efforts that are more visible and might present some calming influence on the citizenship basically are spraying. And we know that residual spraying is not an effective mode of vector control long-term. It basically attacks the adults and it has an approximately 5 percent reduction in transmission.
The most effective way is actually being able to get rid of any potential breeding sites any garbage or materials that accumulate on the sides of the roads or near community centers. Places where people actually are participating in daily activities. It's being done and it's being done mostly by the municipalities at a very local level. And the key issue for us, at the state level, is to make sure that we have enough resources to do surveillance and to follow the spread of the disease. And to be able to document and follow those potentially infected pregnant women, or women of childbearing age, and follow them throughout their pregnancy.
On governments asking women to delay potential pregnancies
It all depends, what are the resources available for prenatal care? What's the access to various services? And how the population behaves, as far as vector control.
In Puerto Rico, what we're recommending is for people to take this seriously, to consider. We're not ordering or requesting or making a strong recommendation to avoid pregnancy. However, if they are women who do have pre-existing conditions such as uncontrolled diabetes, or you have other risk factors for having a child with microcephaly, then you should seriously consider this.
And if you're in an area where it's difficult to do vector control activities, then you should seriously consider this, discuss it within the nucleus of your family, talk to your physician, and make the best decision for you.
On the potential for spread within the U.S. mainland
I would say this would be similar to what we saw with chikungunya. With chikungunya it certainly spread through our population like wildfire. And there were several introductions into the U.S. They were controlled. The risk is always people traveling back to the States. However, we still need to consider that Puerto Rico wasn't the biggest importer of cases. We were among the top five. But certainly there are other regions in the area that have a higher risk and have less than adequate surveillance systems to monitor and track the development of the disease.
