Knowledge and perceptions about Zika virus in Qatar
Authors: Cheema Sohaila , Maisonneuve Patrick , Weber Ingmar , Fernandez-Luque Luis , Abraham Amit , Alrouh Hekmat , Sheikh Javaid , Lowenfels Albert , Mamtani Ravinder 
Published: June 2019

BACKGROUND: Zika virus, an emerging serious infectious disease, is a threat to persons living or travelling to regions where it is currently endemic, and to contacts of infected individuals. Qatar, located on the northeastern coast of the Arabian peninsula, harbors the primary vector species, Aedes aegypti for Zika virus. Additionally, Qatar Airways, the national airline has daily flights to and from countries and territories such as Sao Paulo in Brazil, Miami in Florida, and in Argentina where active transmission of Zika virus has been reported and confirmed. This may increase the likelihood of importation of Zika virus cases to the country. Successful disease prevention programs depend upon public awareness of risk factors and disease characteristics. The aim of this study was to assess knowledge and perceptions about this new public health threat to persons residing in Qatar. METHODS: We conducted a self-administered survey in English at several international universities in Qatar to assess students, faculty, and staff knowledge and awareness about this disease. An adapted version of the survey (English and Arabic) was also conducted on Qatar based websites to additionally reach the general public. Data was collected from August to September 2016. The survey questionnaire collected data on participant demographic characteristics (gender, age, nationality, marital status, education, role, and institution), general information about Zika virus (source of information, existence of a vaccine to prevent Zika, mode of transmission of Zika, individuals at risk of Zika infection), personal knowledge about Zika and questions related to participants’ travel to endemic countries. Participants’ general knowledge about Zika virus were classified in three categories: i) “poor”, when participants did not know that there is currently no vaccine for Zika virus, and/or that the disease is transmitted by infected mosquitoes, and/or anyone could get Zika virus; ii) “basic”, when participants knew that there is currently no vaccine for Zika virus, that the disease is transmitted by infected mosquitoes, and anyone could get Zika virus; and iii) “broad”, when in addition, participants knew that the disease could be transmitted through sexual intercourse, blood transfusion, or during pregnancy, and that if pregnant woman has Zika virus, there are risks for her baby/fetus. We conducted logistic regression to assess the association between level of knowledge about Zika (“poor”, “basic”, and “broad”) and participants’ characteristics. Analyses were conducted on SAS software. RESULTS: The median age of the 446 respondants was 25 years, 280 (63%) were females, and 141 (32%) were from Gulf Cooperation Council (GCC) or other Middle East countries. Based upon their knowledge about availability of a vaccine, role of mosquitoes and other modes of transmission, and disease complications, 66%, 27%, and 7% of respondents were classified as have poor, basic, and broad knowledge about Zika virus, respectively. Forty-five (16%) persons with poor knowledge considered themselves to be well-informed. The proportion of respondents with such an erroneous perception of knowledge was not associated with gender, age, nationality, marital status, or education. However, this erroneous perception was significantly in higher proportion among students, staff, and faculty from the art and design college. Faculty (10%) and staff (9%) were the two groups with the highest proportion of individuals with broad general knowledge about Zika. Internet was the most common source of information (61%) among those who ever heard about Zika virus. Our survey demonstrates that students had the lowest proportion of individuals with basic (22%) and broad (4%) general knowledge about Zika, and about a quarter of them (23%) did not hear about Zika virus before the survey. Among students, staff, and faculty from the international universities, those from the medical college had higher general knowledge about Zika virus (OR (95%CI) = 1.81 (1.03-3.2). p-value = 0.009); while those from the art and design college had the lower general knowledge about the virus (OR (95%CI) = 0.19 (0.06-0.67). p-value = 0.04). In the past year, only 5% of the respondents reported having travelled to at least one of the countries where Zika virus is endemic. DISCUSSION AND CONCLUSION: Although few cases have been reported in the region, future cases are possible, since Qatar is a hub with many flights to countries or areas where the disease is widespread. A likely pathway of Zika virus transmission to residents living in Qatar is person-to-person transmission either by sexual contact or by other inadvertent exchange of body fluids. This could be a threat not only to family members but also to health care workers caring for patients returning from a region with a high prevalence of Zika virus who have had or currently are ill with Zika virus. Blood or body fluids from Zika virus-infected patients may harbor the virus for up to 3 weeks and possibly longer. We conducted the study at about the time of the 2016 Olympics in Brazil, a period when there was great international interest about the threat of Zika virus to athletes and to travelers. Despite the widespread global media interest at the time of the survey, the questionnaire revealed that many respondents are unaware of critical information concerning the Zika virus. We conclude that an educational program about Zika virus would be valuable, especially for individuals or family members travelling to afflicted regions. Additionally, health care workers should be vigilant when caring for persons who have recently returned from high risk regions. Our study findings are relevant keeping in mind the 2022 FIFA World Cup during which a substantial number of individuals will visit Qatar from all over the world. Our findings indicate a need for a broader educational and outreach program targeting Qatar's general population and health care workers so that they are more aware about new and re-emerging threats to health.