Contraceptive sales in the setting of the Zika virus epidemic.
Contraceptive sales in the setting of the Zika virus epidemic.
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DOI：
10.1093/humrep/dew310
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发表时间：
2017-01
期刊：
影响因子：
--
通讯作者：
Fernandes A
中科院分区：
文献类型：
--
作者：
Bahamondes L;Ali M;Monteiro I;Fernandes A
寨卡病毒（ZIKV）爆发对巴西避孕方法的销售有影响吗？在24个月的评估中，避孕药具的销售变化很小，自ZIKV爆发以来没有观察到显著变化。ZIKV的传播主要是通过埃及伊蚊;然而，性传播也有描述。已经确定了几种出生缺陷与妊娠期间ZIKV感染的相关性，并且估计在巴西的巴伊亚，感染率可以在10%至80%的范围内。世界卫生组织（WHO）于2016年2月1日宣布该群小头畸形病例和其他神经系统疾病为卫生紧急情况。巴西政府还建议计划怀孕和居住在ZIKV感染地区的妇女重新考虑或推迟怀孕。这项研究的目的是评估避孕方法在巴西的销售情况，从ZIKV爆发之前到爆发期间进行跟踪。我们从巴西的所有制药公司和长效可逆避孕药（LARC）制造商（包括铜宫内节育器（IUD），左炔诺孕酮宫内释放系统（LNG-IUS）和植入物）获得了2014年9月至2016年8月期间公共和私营部门避孕药销售的信息。我们分析了以下数据：（i）口服避孕药，即复方口服避孕药（COC）和仅含孕激素的药丸（POP），以及阴道和透皮避孕药，（ii）注射避孕药，即每月一次和长效醋酸甲羟孕酮，（iii）LARC和（iv）紧急避孕药（EC）药丸。COC、POP、贴片和阴道环的月销量代表了市场的主要销售部分，即每月1270 - 1380万个周期/单位（90%）。第二大销售类别是注射剂，每月销售0.8-1.5万支（9.5%）。其次是LARC方法，每月销售37000 - 41000件器械（0.5%）。值得注意的是，尽管每组避孕药具的销售高峰月份不同，但观察月份之间总体上没有显著差异。EC药丸的销售量在每月100万至130万粒之间。虽然避孕方法的使用率已经很高，但没有注意到任何变化，但ZIKV疫情可能改变了巴西妇女的怀孕意愿。因此，计划怀孕的妇女人数可能低于记录的人数。避孕药的销售数字不包括避孕套。由于避孕套不仅可以预防怀孕，而且可以预防ZIKV的性传播，因此缺乏信息是一个限制。该评估的结果表明，在巴西ZIKV疫情期间，避孕药的销售变化不大。此外，获得LARC方法的机会可能有限。虽然我们没有调查LARC使用率低的原因，但我们怀疑这是由于公共部门缺乏LARC，方法成本高以及妇女避孕保险覆盖面不全。预测估计还有数百万ZIKV传播病例。因此，需要采取协调一致的应对措施，以确保在ZIKV爆发期间妇女能够获得广泛的避孕方法。总之，对巴西避孕药具销售情况的评估确定了避孕药具获得方面的挑战，特别是LARC方法，并代表了另一种数据来源，以帮助我们了解ZIKV受影响地区避孕药具需求的趋势。本研究获得了Fundação de Apoio à Pesquisa do Estado de São Paulo（FAPESP）奖# 2015/20504-9和匿名捐赠者的部分资金支持。资金来源在研究设计、数据收集、分析和解释、报告撰写或提交文章发表的决定中不发挥作用。作者声明本研究无利益冲突。N/A
Has there been any influence of the Zika virus (ZIKV) outbreak on the sales of contraceptive methods in Brazil? Contraceptive sales in the 24 months of evaluation showed little variation and no significant change has been observed since the ZIKV outbreak. Transmission of ZIKV is primarily by Aedes aegypti mosquitoes; however, sexual transmission has also been described. The association of several birth defects and the ZIKV infection during pregnancy has been established, and it was estimated in Bahia, Brazil that the infection rate could range from 10% to 80%. The World Health Organisation (WHO) declared the cluster of microcephaly cases and other neurological disorders a health emergency on 1 February 2016. The Brazilian government also made recommendations for women who were planning to become pregnant and who reside in ZIKV-affected areas to reconsider or postpone pregnancy. The objective of this study was to assess the sales of contraceptive methods in Brazil, tracking it from before and through the ZIKV outbreak. We obtained information from all pharmaceutical companies based in Brazil and from the manufacturers of long-acting reversible contraceptives (LARCs), including the copper-intrauterine device (IUD), the levonorgestrel-releasing intrauterine system (LNG-IUS) and implants, about contraceptives sales in the public and private sectors between September 2014 and August 2016. We analyzed the data for: (i) oral contraceptives, i.e. combined oral contraceptives (COC) and progestin-only pills (POP), and vaginal and transdermal contraceptives, (ii) injectable contraceptives, i.e. once-a-month and depot-medroxyprogesterone acetate, (iii) LARCs and (iv) emergency contraceptive (EC) pills. Monthly sales of COC, POP, patches and vaginal rings represent the major sales segment of the market, i.e. 12.7–13.8 million cycles/units per month (90%). The second largest group of sales was injectables, representing 0.8–1.5 million ampoules per month (9.5%). Following this, are LARC methods with sales of 37 000–41 000 devices per month (0.5%). It is important to note that although the peak months of sales were different for each group of contraceptives, there were no significant differences overall between the months of observation. The EC pill sales were between 1.0 million and 1.3 million of pills per month. Although the use of contraceptive methods was already high and no change was noted, the ZIKV outbreak may have changed the pregnancy intentions of Brazilian women. Consequently, the number of women planning pregnancy may be lower than that recorded. The contraceptive sales figures did not include condoms. Since condoms might not only prevent pregnancies, but also sexual transmission of ZIKV, this lack of information is a limitation. The results from this assessment showed that the sales of contraceptives presented little variation during the ZIKV outbreak in Brazil. Furthermore, it is possible that access to LARC methods was limited. Although we did not investigate the reason for low LARC uptake, we suspect that it is due to lack of availability of LARC in the public sector, the high cost of the methods and the incomplete insurance coverage on contraception for women. Projections estimate millions of additional cases of ZIKV transmission. Thus, a coordinated response is needed to ensure access to a wide range of contraceptive methods for women during the ZIKV outbreak. In conclusion, this assessment of contraceptive sales in Brazil identifies challenges in contraceptive access, especially for LARC methods, and represents an alternative source of data to help us understand the trends in demand for contraception in ZIKV-affected areas. This study received partial financial support from Fundação de Apoio à Pesquisa do Estado de São Paulo (FAPESP) award # 2015/20504-9 and from an anonymous donor. The funding sources did not play a role in the study design, in the collection, analysis and interpretation of data, in the writing of the report, or in the decision to submit the article for publication. The authors declare no conflict of interest associated with this study. N/A
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影响因子：
7.2
作者：
Peipert JF;Madden T;Allsworth JE;Secura GM
通讯作者：
Secura GM
DOI：
10.1056/nejmoa1602412
发表时间：
2016-12-15
期刊：
The New England journal of medicine
影响因子：
--
作者：
Brasil P;Pereira JP Jr;Moreira ME;Ribeiro Nogueira RM;Damasceno L;Wakimoto M;Rabello RS;Valderramos SG;Halai UA;Salles TS;Zin AA;Horovitz D;Daltro P;Boechat M;Raja Gabaglia C;Carvalho de Sequeira P;Pilotto JH;Medialdea-Carrera R;Cotrim da Cunha D;Abreu de Carvalho LM;Pone M;Machado Siqueira A;Calvet GA;Rodrigues Baião AE;Neves ES;Nassar de Carvalho PR;Hasue RH;Marschik PB;Einspieler C;Janzen C;Cherry JD;Bispo de Filippis AM;Nielsen-Saines K
通讯作者：
Nielsen-Saines K
影响因子：
33.9
作者：
Brooks, John T.;Friedman, Allison;Jamieson, Denise J.
通讯作者：
Jamieson, Denise J.
影响因子：
19
作者：
Musso, D.;Nhan, T.;Broult, J.
通讯作者：
Broult, J.
影响因子：
33.9
作者：
Armstrong, Paige;Hennessey, Morgan;Williams, Charnetta
通讯作者：
Williams, Charnetta