Zika Reproductive Health Response in the 2016–17 Outbreak in Puerto Rico

Zika Reproductive Health Response in the 2016–17 Outbreak in Puerto Rico 

Puerto Rico Section Chair Dr. Nabal J. Bracero, FACOG

The Problem

On February 1, 2016, the World Health Organization (WHO) declared Zika virus (ZIKV) disease a global public health emergency of international concern. Puerto Rico’s first confirmed ZIKV infection case was reported on December 31, 2015. During the 2016–17 ZIKV outbreak, 27,000 pregnant women and more than 700,000 women of childbearing age were potentially exposed to Zika.

The Response 

The Puerto Rico ACOG Section and PROGyn, a local nonprofit organization dedicated to women’s health, began collaborating with multiple local and national health agencies such as the PRDOH and the Centers for Disease control and Prevention (CDC) on the Zika emergency response. This monumental collaboration had a crucial reproductive component based on key concepts defined primarily by the CDC, including:

  • Education on prevention and protection against ZIKV and surveillance    
  • Adequate and timely prenatal services with emphasis on laboratory and sonographic testing
  • Patient-centered contraception access to those women who wanted to avoid pregnancy during the ZIKV crisis 

We called this effort the Puerto Rico Zika Reproductive Heath Response (ZRHR). Its components included:

  • Zika education outreach campaign
  • Zika pregnancy kit distribution 
  • Zika Active Pregnancy Surveillance System (ZAPSS) and registry  

The Outcome 

Many new programs and initiatives came out of the response to the ZIKV outbreak. One of the first was the Zika education outreach initiative, which included a ZIKV symposium, an educational tour to 12 hospitals conducted by ACOG Fellows, and near-weekly media interviews by Puerto Rico Section officers, and a half-day Zika seminar. The ZAPSS; Zika pregnancy kits; and new guidance from the Puerto Rico ACOG Section, PROgyn, PRDOH, and the Maternal-Fetal Medicine/Ob-Gyns Network also numbered among the new resources created in response to the outbreak. 
On behalf of Puerto Rico and our reproductive age patients we would like to acknowledge our deepest gratitude to the following crucial collaborators in the Puerto Rico ZRHR.

PROGyn Team

  • Linette Sanchez, Esq., Z-CAN project director

ACOG PR Section Fellows and Officers

  • Dr. Yari Vale, FACOG
  • Dr. Eduardo Muniz, FACOG
  • Dr. Luis Fernández Sifre, FACOG

Puerto Rico Ob-Gyns and Their Nurses 

HRSA and Puerto Rico’s Federally Qualified Health Centers

  • Captain Claritsa Malave, MPH, FACOG
  • Mrs. Alicia Suarez

Puerto Rico Department of Health

  • Dr. Miguel Valencia, FAAP
  • Dr. Carmen Deseda
  • Brenda Rivera, DVM

University of Puerto Rico School of Medicine Department of Obstetrics and Gynecology and University Hospital


  • Dr. Denise Jamieson, MPH, FACOG
  • Dr. Dana Thomas
  • Reproductive, Contraceptive Access, and Birth Defects Divisions

CDC Foundation

  • Dr. Judith Monroe
  • Verla Neslund, JD

University of California, San Francisco/Beyond the Pill

  • Dr. Susan Goodman, MPH

Family Planning Sub-Specialists and Fellows

Z-CAN Medical Codirector Eva Lathrop, Erin Berry, Pam Lotke, Kristyn Brandi, Stacey Leigh Rubin, Mark Hathaway, Nilda Moreno, Monica Dragoman, Erica Hinz, Kelly Cullwell, Justin Deidrich, Glenmarie Mathews, Emily Godfrey, Ana Cepin, Aparna Sridhar

ACOG District IV and National Officers

  • Dr. Tom Hepfer, FACOG
  • Dr. Wade Neiman, FACOG
  • Dr. Haywood Brown, FACOG
  • Dr. Ben Cheek, FACOG
  • Dr. Sandra Reed, FACOG
  • Dr. Scott Sullivan, FACOG
  • Dr. May Blanchard, FACOG
  • Dr. James Segars, FACOG
  • Dr. Chris Zahn, FACOG
  • Michelle Morse, ACOG District IV program manager
  • ACOG Cefalo Leadership Retreat Team 

Anonymous Donors