Lone Simonsen holds a PhD in population genetics from University of Massachusetts, Amherst and later trained at the Centers for Disease Control (CDC) in infectious disease epidemiology. She is currently a research professor in the department of global health at George Washington University where she happily mentors MPH, DrPH and PhD students in topics relating to global health epidemiology. She spent 6 months as a Lundbeck visiting professor at the University of Copenhagen in 2014, to develop research in historic epidemiology and health transitions. She is a senior fellow in the RAPIDD (mathematical modeling for policy) network hosted at the Fogarty International Center at the National institutes of Health (NIH) and Princeton University. She is an elected member of the American Epidemiological Society AES, and the Danish Royal Academy of Sciences & Letters. Over the past 20+ years she has worked as a researcher at the CDC, World Health Organization (WHO) and NIH on issues including unsafe medical injections, global patterns of HIV/AIDS, TB drug resistance, SARS, pandemic influenza, e-health data, surveillance systems and vaccine program evaluation. Before moving to academia in 2007, she was a senior epidemiologist at the National Institutes of Health-NIAID where she assisted the office of the director with its research response to emerging health issues, including work on rotavirus vaccine adverse events for which she received the Department of Health & Human Services DHHS Secretary’s Distinguished Service Award She has published more than 150 well-cited peer-reviewed papers, book chapters, commentaries and letters, in collaboration with a global network of researchers. Her research currently focuses on modeling of historic and contemporary pandemics and emerging infectious diseases, population transitions in health, modeing the burden of influenza and other vaccine-preventable diseases, and evaluating health benefits associated with vaccine programs on a grant from the Gates Foundation. Simonsen is a frequent speaker at national and international meetings, she served on an influenza expert panel for the Council of Foreign Relations, and presented on pandemic surveillance issues at the President's Council of Advisors on Science andTechnology Policy in 2009. She is currently also working with her RAPIDD collaborators on modeling the Ebola disaster in West africa. She recently led a WHO-sponsored multi-country collaboration to model the 2009 influenza pandemic burden, and is frequently called on by WHO to participate in workshops and meetings on pandemic preparedness, frameworks/policy issues for pandemic preparedness, methodology issues in disease surveillance, including monitoring and evaluation of vaccine program impact. Scientific Productivity (by 2008/ever): H-inex: 44/55 and I10-index:98/111
Because of the potential link between the ongoing Zika virus outbreak and a surge in the number of cases of congenital microcephaly, officials in Latin America have recommended that women postpone pregnancy until this association is firmly established or the outbreak subsides. However, in all these countries a large proportion of babies are still born out of unplanned pregnancies. Teenage girls are particularly at high risk, as they often lack access to preventive contraception methods, or the knowledge to use them appropriately. To gauge the magnitude of the barriers preventing the implementation of such a recommendation in Brazil, the country so far most affected by the Zika epidemic, we evaluated pregnancy rates in teenage girls, and their spatial heterogeneity in the country, in recent years (2012-2014). Nearly 20% of children born in Brazil today (~560,000 live births) are by teenage mothers. Birth incidence is far higher in the tropical and poorer northern states. However, in absolute terms most births occur in the populous southeastern states, matching to a large extent the geographic distribution of dengue (an indicator of suitable climatic and sociodemographic conditions for the circulation of Aedes mosquitoes). These findings indicate that recommendation to delay pregnancy will leave over half a million pregnant adolescents in Brazil vulnerable to infection every year if not accompanied by effective education and real access to prevention.
The World Health Organization has recently declared the emerging Zika virus an international public health emergency
However, the biggest concern about the Zika outbreak is the potential link with the surge of reported cases of microcephaly and other malformations of the central nervous system in newborns from mothers infected with the virus during pregnancy
The implementation of such a recommendation requires, however, that women in these areas are not only clearly informed about the risks posed by infection, but also have control over their reproductive choices. There are few reasons to doubt that most women will be aware and informed about the disease and its consequences through the widespread media. Yet ensuring control over the timing of pregnancy is a more daunting challenge, especially considering that many babies are born out of unplanned pregnancies - even when strong motives for avoiding them exist (e.g. age, economic, social, professional and health-related).
In Brazil, the country most affected by the Zika outbreak so far, data from a demographic survey from 2006 indicate that approximately half of all births that happened five years prior to the survey were unplanned
To gauge the magnitude of the barriers preventing the postponement of parenthood in Brazil, we evaluated pregnancy rates in adolescent groups, and their spatial heterogeneity in the country, in recent years for which data are available (2012-2014). Data on live births were obtained from the Information System on Live Births (SINASC
Although Brazil has experienced a substantial decline in fertility rate and a corresponding displacement of reproduction towards older ages over the last decades, nearly 20% of children born in Brazil today are by teenage mothers, a proportion nearly twice as high as the world average (11%) in this age group
The states with the highest incidence of births from adolescents in Brazil are those in the northern region (coinciding with a large part of the Amazon area) and Mato Grosso do Sul (Fig.2). The pattern is similar for mothers aged 10-14 years (Fig.2a) and 15-19 years (Fig.2b). When birth incidence among adolescent mothers (10-19y) is plotted against latitude (Fig.3), it is clear that it increases with decreasing latitudes, being far higher in the tropical northern states. In absolute terms, however, most births occur in the most populous southeastern states, most notably São Paulo (Fig.1). The distribution of dengue cases in 2015 by state is shown in Figure 1, as an indicator of those states with climatological and sociodemographic suitable conditions for the circulation of Aedes mosquitoes. As shown in Fig.1, the highest number of dengue cases also occur in populous states in the southeast (predominantly São Paulo), matching to a large extent the spatial distribution of the absolute number of births from adolescent mothers.
The pre-existing high incidence of what are most likely unplanned births by adolescent mothers in high-risk areas emphasizes that the recommendation to delay pregnancy during the current crisis is only a partial solution to protect babies from the putative effects of infection. Unless accompanied by changes in the accessibility to contraception methods and a drastic change in health education, access to and attitudes towards family planning, the recommendation to delay pregnancy will leave over half a million pregnant adolescents vulnerable every year until effective interventions (including vaccines) to prevent Zika infection are not available
More complicated yet is the communication of risk at a time when microcephaly has not been firmly linked to Zika infection. While we await the final verdict of the magnitude of risk and strength of association, recommendations related to conception in the time of Zika should be approached with care, health education and real access to prevention.
The authors have declared that no competing interests exist.