PRAMS Zika Postpartum Emergency Response Survey (PRAMS-ZPER) in Puerto Rico

CDC provided funds to the Puerto Rico Department of Health (PRDH) to conduct a rapid assessment of Zika virus awareness and use of preventive measures among a representative sample of Puerto Rican residents giving birth to live infants in Puerto Rico. The study was conducted from 2016–2018 and consisted of 2 phases: PRAMS-ZPER 1.0 and PRAMS-ZPER 2.0. Each phase had a hospital-based survey and a telephone follow-up survey.

Phase 1: PRAMS-ZPER 1.0

PRAMS-ZPER Hospital-based Survey 1.0—Fall 2016

Overview and Methods

The PRAMS-ZPER 1.0 hospital-based survey was conducted from August to December 2016. The study used methods modified from PRAMS to do in-person data collection in maternity hospitals. Field staff visited women in their hospital rooms 24 to 36 hours after delivery and invited them to complete a self-administered survey either on a paper form or on a tablet. Among 2,933 selected women, 2,364 completed the survey for an overall response rate of 81%.

ZPER 1.0 Study Protocol Cdc-pdf[PDF – 511 KB]

ZPER 1.0 Sampling Appendix Cdc-pdf[PDF – 747 KB]


The PRAMS-ZPER 1.0 hospital-based questionnaire covered topics related to maternal knowledge and concern about Zika virus infection, discussions with health care providers during pregnancy about Zika virus, testing for Zika virus during pregnancy, use of measures to prevent mosquito-borne transmission of Zika during pregnancy, and use of measures to prevent sexual transmission of Zika during pregnancy.

ZPER 1.0 Maternal Hospital Survey—English Cdc-pdf[PDF – 67 KB]

ZPER 1.0 Maternal Hospital Survey—español Cdc-pdf[PDF – 68 KB]


Results from the PRAMS-ZPER 1.0 hospital-based 1.0 survey can be found on—

  1. MMWR: Measures Taken to Prevent Zika Virus Infection During Pregnancy — Puerto Rico, 2016 (Weekly / June 9, 2017 / 66(22);574–578)
  2. Preventing Zika Virus in Puerto Rico: The Provider Role
  3. Preventing Zika Virus in Puerto Rico: Maternal Use of Protective Measures

Part II: PRAMS-ZPER Telephone Follow-up Survey 1.0—Spring 2017

A subset of women who participated in the PRAMS-ZPER Hospital-based Survey 1.0 was randomly selected and re-contacted by telephone 8 to 10 months after delivery to learn about their experiences after hospital discharge. Of 1,535 women selected for the follow-up, 1,175 completed the survey for an overall response rate of 77%.


ZPER 1.0 Telephone Followup Survey—English Cdc-pdf[PDF – 318 KB]

ZPER 1.0 Telephone Followup Survey—español Cdc-pdf[PDF – 362 KB]

Phase 2: PRAMS-ZPER 2.0

PRAMS-ZPER Hospital-based Survey 2.0—Fall 2017

Overview and Methods

The second PRAMS-ZPER in-hospital survey was conducted from November to December 2017. The study methods were similar to the first study with a few modifications to adjust for the post-hurricane situation in the Puerto Rico following Hurricanes Irma and Maria. Some adjustments included reducing the sample size and eliminating the 24- to 36-hour waiting period before contact. Among 1,545 selected women, 1,482 completed the survey for an overall response rate of 96%.

The separate father/partner survey was available for completion by infants’ fathers (or mothers’ partner). Partners were approached in the hospital following the birth of their infant during the same timeframe as the mothers. Among 1,545 eligible partners, 1,182 completed the survey for an overall response rate of 77%.

ZPER 2.0 Study Protocol Cdc-pdf[PDF – 613 KB]

ZPER 2.0 Sampling Appendix Cdc-pdf[PDF – 881 KB]


The maternal questionnaire was similar to the questionnaire from PRAMS-ZPER 1.0. In addition to the original questions, more detailed information about testing during pregnancy was captured on the 2.0 version of the survey.

ZPER 2.0 Maternal Hospital Survey—English Cdc-pdf[PDF – 108 KB]

ZPER 2.0 Maternal Hospital Survey—español Cdc-pdf[PDF – 100 KB]

The partner questionnaire covered topics related to knowledge and concern about Zika virus infection, interactions with health care providers, measures to prevent mosquito-borne and sexual transmission of Zika during the pregnancy of their partner, and involvement in the pregnancy.

ZPER 2.0 Partner Hospital Survey—English Cdc-pdf[PDF – 110 KB]

ZPER 2.0 Partner Hospital Survey—español Cdc-pdf[PDF – 115 KB]

Supplementary Activity

This is a picture of materials used by field staff from the Puerto Rico Department of Health when they administered the PRAMS-ZPER hospital survey to new parents.  The materials include brochures and a presentation on maternal postpartum care, infant care, and Zika prevention.  The tokens of appreciation that were given to survey participants are also pictured, and include a crib mosquito net, insect repellent, a calendar of the baby’s first year, and a small notepad and pen.

To address the need for further information about Zika virus prevention and newborn care for new mothers and fathers, the Puerto Rico Department of Health developed a short educational presentation to share with women and their partners who were eligible for the study.

The Puerto Rico Department of Health field staff workers who administered the survey also provided the educational presentation following completion of the survey. Sampled individuals who elected not to participate in the survey could also receive the educational presentation, if interested.

For more information about the educational presentation, contact the PRAMS project in the Puerto Rico Department of Health’s Division of Maternal, Child, and Adolescent Health.

PRAMS-ZPER Telephone Follow-up Survey 2.0—Spring 2018

The second PRAMS-ZPER telephone follow-up survey was conducted from February to March of 2018.  All women who responded to the PRAMS-ZPER 2.0 hospital-based questionnaire were re-contacted and invited to participate. Among 1,482 eligible women, 1,200 completed the survey for an overall response rate of 81%. There was no telephone follow-up survey for partners.


ZPER 2.0 Telephone Survey—English Cdc-pdf[PDF – 993 KB]

ZPER 2.0 Telephone Survey—español Cdc-pdf[PDF – 1 MB]