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Philpott D, Rupani N, Gainey M, Mbong EN, Musimwa PI, Perera SM, Laghari R, Ververs M, Levine AC. Maternal, fetal, and perinatal outcomes among pregnant women admitted to an Ebola treatment center in the Democratic Republic of Congo, 2018-2020. PLoS One 2023; 18:e0286843. [PMID: 37682812 PMCID: PMC10490991 DOI: 10.1371/journal.pone.0286843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/24/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVE This study aims to investigate maternal, fetal, and perinatal outcomes during the 2018-2020 Ebola outbreak in Democratic Republic of Congo (DRC). METHODS Mortality between pregnant and non-pregnant women of reproductive age admitted to DRC's Mangina Ebola treatment center (ETC) were compared using propensity score matching. Propensity scores were calculated using age, initial Ebola viral load, Ebola vaccination status, and investigational therapeutic. Additionally, fetal and perinatal outcomes of pregnancies were also described. RESULTS Twenty-seven pregnant women were admitted to the Mangina ETC during December 2018-January 2020 among 162 women of childbearing age. We found no evidence of increase mortality among pregnant women compared to non-pregnant women (relative risk:1.0, 95%CI: 0.58-1.72). Among surviving mothers, pregnancy outcomes were poor with at least 58% (11/19) experiencing loss of pregnancy while 16% (3/19) were discharged with viable pregnancy. Two mothers with viable pregnancies were vaccinated, and all received investigational therapeutics. Two live births occurred, with one infant surviving after the infant and mother received an investigational post-exposure prophylaxis and Ebola therapeutic respectively. CONCLUSIONS Pregnancy was not associated with increased mortality among women with EVD in the Mangina ETC. Fetal and perinatal outcomes remained poor in pregnancies complicated by EVD, though novel therapeutics may have potential for improving these outcomes.
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Affiliation(s)
- David Philpott
- Johns Hopkins Children’s Center, Baltimore, Maryland, United States of America
| | - Neil Rupani
- Brown University, Providence, Rhode Island, United States of America
| | - Monique Gainey
- Department of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Eta N. Mbong
- International Medical Corps, Goma, Democratic Republic of Congo
| | - Prince Imani Musimwa
- Department of Gynecology and Obstetrics, University of Goma, Goma, Democratic Republic of Congo
| | - Shiromi M. Perera
- International Medical Corps, Washington, District of Colombia, United States of America
| | - Razia Laghari
- International Medical Corps, Goma, Democratic Republic of Congo
| | - Mija Ververs
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Adam C. Levine
- Department of Emergency Medicine, Brown University, Providence, Rhode Island, United States of America
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Dhanya CR, Shailaja A, Mary AS, Kandiyil SP, Savithri A, Lathakumari VS, Veettil JT, Vandanamthadathil JJ, Madhavan M. RNA Viruses, Pregnancy and Vaccination: Emerging Lessons from COVID-19 and Ebola Virus Disease. Pathogens 2022; 11:800. [PMID: 35890044 PMCID: PMC9322689 DOI: 10.3390/pathogens11070800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 02/01/2023] Open
Abstract
Pathogenic viruses with an RNA genome represent a challenge for global human health since they have the tremendous potential to develop into devastating pandemics/epidemics. The management of the recent COVID-19 pandemic was possible to a certain extent only because of the strong foundations laid by the research on previous viral outbreaks, especially Ebola Virus Disease (EVD). A clear understanding of the mechanisms of the host immune response generated upon viral infections is a prime requisite for the development of new therapeutic strategies. Hence, we present here a comparative study of alterations in immune response upon SARS-CoV-2 and Ebola virus infections that illustrate many common features. Vaccination and pregnancy are two important aspects that need to be studied from an immunological perspective. So, we summarize the outcomes and immune responses in vaccinated and pregnant individuals in the context of COVID-19 and EVD. Considering the significance of immunomodulatory approaches in combating both these diseases, we have also presented the state of the art of such therapeutics and prophylactics. Currently, several vaccines against these viruses have been approved or are under clinical trials in various parts of the world. Therefore, we also recapitulate the latest developments in these which would inspire researchers to look for possibilities of developing vaccines against many other RNA viruses. We hope that the similar aspects in COVID-19 and EVD open up new avenues for the development of pan-viral therapies.
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Affiliation(s)
| | - Aswathy Shailaja
- Department of Pediatrics, Duke University School of Medicine, Durham, NC 27710, USA;
| | - Aarcha Shanmugha Mary
- Department of Microbiology, School of Life Sciences, Central University of Tamil Nadu, Thiruvarur 610105, India;
| | | | - Ambili Savithri
- Department of Biochemistry, Sree Narayana College, Kollam 691001, India;
| | | | | | | | - Maya Madhavan
- Department of Biochemistry, Government College for Women, Thiruvananthapuram 695014, India
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3
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Cihlar T, Mackman RL. Journey of remdesivir from the inhibition of hepatitis C virus to the treatment of COVID-19. Antivir Ther 2022; 27:13596535221082773. [DOI: 10.1177/13596535221082773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
If a planned path reaches a dead-end, one can simply stop. Or one can turn around, walk back to the last intersection and take another path, or one can consider taking few paths in parallel. The last scenario is reflective of the journey of remdesivir, the first antiviral for the treatment of COVID-19, that was approved by FDA less than 10 months after the isolation of SARS-CoV-2, the virus responsible for the COVID-19 pandemic. As of January 2022, 10 million COVID-19 patients have been treated with remdesivir worldwide, but the journey of this molecule started more than a decade earlier with the search for a cure of hepatitis C virus. The development path of remdesivir before the emergence of COVID-19 represents a valuable example of a preemptive pandemic preparedness, but the pursuit of this path would not have been possible without sustaining support of John C. Martin, whom we will sorely miss for his piercing vision, uncompromising leadership, and genuine compassion for patients suffering around the world.
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4
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Kayem ND, Benson C, Aye CYL, Barker S, Tome M, Kennedy S, Ariana P, Horby P. Ebola virus disease in pregnancy: a systematic review and meta-analysis. Trans R Soc Trop Med Hyg 2021; 116:509-522. [PMID: 34865173 PMCID: PMC9157681 DOI: 10.1093/trstmh/trab180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/25/2021] [Accepted: 11/09/2021] [Indexed: 11/24/2022] Open
Abstract
This review synthesises and appraises evidence on the effects of Ebola virus disease (EVD) in pregnancy. We searched bibliographic databases from dates of inception to November 2020, yielding 28 included studies. The absolute risk of maternal death associated with EVD was estimated at 67.8% (95% confidence interval [CI] 49.8 to 83.7, I2=85%, p<0.01) and the relative risk of death in pregnant women compared with non-pregnant women was estimated at 1.18 (95% CI 0.59 to 2.35, I2=31.0%, p=0.230). The absolute risk for foetal losses was estimated at 76.9% (95% CI 45.0 to 98.3, I2=96%, p<0.01) and neonatal death was 98.5% (95% CI 84.9 to 100, I2=0.0%, p=0.40). The gap analysis suggests limited or no data on the clinical course, non-fatal perinatal outcomes and EVD management in pregnant women. The review suggests that EVD has a high maternal and perinatal mortality, underscoring the urgent need for preventative and therapeutic solutions and improved screening and follow-up of pregnant women and newborns during outbreaks. There is not enough evidence to conclusively rule out pregnancy as a risk factor for mortality and there is limited evidence on the disease course, outcomes and management of EVD in pregnancy, and this supports the need for robust clinical trials and prospective studies that include pregnant women.
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Affiliation(s)
- Nzelle D Kayem
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
| | - Charlotte Benson
- Women's Centre, John Radcliffe Hospital, Oxford University Hospitals, Oxford OX3 9DU, UK
| | - Christina Y L Aye
- Women's Centre, John Radcliffe Hospital, Oxford University Hospitals, Oxford OX3 9DU, UK.,Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford OX3 9DU, UK
| | - Sarah Barker
- Women's Centre, John Radcliffe Hospital, Oxford University Hospitals, Oxford OX3 9DU, UK
| | - Mariana Tome
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford OX3 9DU, UK
| | - Stephen Kennedy
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford OX3 9DU, UK
| | - Proochista Ariana
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
| | - Peter Horby
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
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5
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Fan C, Lei D, Fang C, Li C, Wang M, Liu Y, Bao Y, Sun Y, Huang J, Guo Y, Yu Y, Wang S. Perinatal Transmission of 2019 Coronavirus Disease-Associated Severe Acute Respiratory Syndrome Coronavirus 2: Should We Worry? Clin Infect Dis 2021; 72:862-864. [PMID: 32182347 PMCID: PMC7184438 DOI: 10.1093/cid/ciaa226] [Citation(s) in RCA: 230] [Impact Index Per Article: 76.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/03/2020] [Indexed: 02/02/2023] Open
Abstract
We presented two cases of COVID-19 associated SARS-CoV-2 infection during third trimester of pregnancy. Both mothers and newborns had excellent outcomes. We failed to identify SARS-CoV-2 in all the products of conception and the newborns. This report provided evidence of low risk of intrauterine infection by vertical transmission of SARS-CoV-2.
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Affiliation(s)
- Cuifang Fan
- Department of Obstetrics, Renmin Hospital of Wuhan University, Hubei, Wuhan, China
| | - Di Lei
- Department of Obstetrics, Renmin Hospital of Wuhan University, Hubei, Wuhan, China
| | - Congcong Fang
- Department of Pediatrics, Renmin Hospital of Wuhan University, Hubei, Wuhan, China
| | - Chunyan Li
- Department of Obstetrics, Renmin Hospital of Wuhan University, Hubei, Wuhan, China
| | - Ming Wang
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Hubei, Wuhan, China
| | - Yuling Liu
- Department of Obstetrics, Renmin Hospital of Wuhan University, Hubei, Wuhan, China
| | - Yan Bao
- Department of Obstetrics, Renmin Hospital of Wuhan University, Hubei, Wuhan, China
| | - Yanmei Sun
- Department of Obstetrics, Renmin Hospital of Wuhan University, Hubei, Wuhan, China
| | - Jinfa Huang
- Department of Obstetrics, Renmin Hospital of Wuhan University, Hubei, Wuhan, China
| | - Yuping Guo
- Department of Obstetrics, Renmin Hospital of Wuhan University, Hubei, Wuhan, China
| | - Ying Yu
- Department of Obstetrics, Renmin Hospital of Wuhan University, Hubei, Wuhan, China
| | - Suqing Wang
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, Hubei, Wuhan, China
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Analysing the intersection between health emergencies and abortion during Zika in Brazil, El Salvador and Colombia. Soc Sci Med 2021; 270:113671. [PMID: 33486425 PMCID: PMC7895814 DOI: 10.1016/j.socscimed.2021.113671] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 01/19/2023]
Abstract
The Zika outbreak of 2015-7 is a lens to analyse the positioning of abortion within in global health security. The sequelae of the virus almost exclusively affected newborn children, manifested through Congenital Zika Syndrome (CZS), and a focus on women at risk of, planning or being pregnant. At the global level, debate considered whether Zika would provide impetus for regulatory change for reproductive rights in Latin America, a region with some of the most restrictive abortion regulation in the world. However, regulatory change for abortion did not occur. We analyse why the Zika health emergency did not lead to any changes in abortion regulation through multi-method analysis of the intersection between Zika, health emergencies and abortion in Brazil, Colombia and El Salvador. These case study countries were purposefully selected; each had Zika infected women (albeit with differing incidence) yet represent diverse regulatory environments for abortion. Our comparative research is multi-method: framework analysis of key informant interviews (n = 49); content analysis of women's enquiries to a medical abortion telemedicine provider; and, policy analysis of (inter)national-level Zika response and abortion policies. We consider this within literature on global health security, and the prioritisation of a particular approach to epidemic control. Within this securitized landscape, despite increased public debate about abortion regulatory change, no meaningful change occurred, due to a dominant epidemiological approach to the Zika health emergency in all three countries and prominent conservative forces in government and within anti-abortion rights movements. Simultaneously, we demonstrate that regulation did not deter all women from seeking such service clandestinely. Zika affected reproductive decision making, but did not impact abortion regulation. Epidemiological framing ignored reproductive dimensions of emergency responses. Conservative forces instrumentalized disability concerns to oppose abortion rights. Women sought abortions clandestinely, citing Zika as a justification. Abortion provision must form part of health emergency planning and response.
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7
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Ottoni MP, Ricciardone JD, Nadimpalli A, Singh S, Katsomya AM, Pokoso LM, Petrucci R. Ebola-negative neonates born to Ebola-infected mothers after monoclonal antibody therapy: a case series. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 4:884-888. [PMID: 33217357 DOI: 10.1016/s2352-4642(20)30278-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/23/2020] [Accepted: 08/04/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Few fetuses survive childbirth when the mother is positive for Ebola virus, with almost all being miscarried or stillborn, or dying shortly after birth. Before 2019, only two infants had been reported surviving past 28 days, of whom one tested positive for Ebola virus and subsequently received experimental therapies. Little is understood regarding the care of surviving neonates born to Ebola virus-positive mothers in the postnatal period and how novel anti-Ebola virus therapies might affect neonatal outcomes. METHODS In this case series, we report on two neonates liveborn during the 2018-20 North Kivu Ebola epidemic in the Democratic Republic of the Congo who, along with their Ebola virus-positive mothers, received investigational monoclonal antibody treatment (mAB114 or REGN-EB3) as part of a randomised controlled trial (NCT03719586). FINDINGS Both infants were born Ebola-negative and progressed well while in the Ebola Treatment Centre. Neither neonate developed evidence of Ebola virus disease during the course of the admission, and both were Ebola-negative at 21 days and remained healthy at discharge. INTERPRETATION To our knowledge these neonates are the first documented as Ebola virus-negative at birth after being born to Ebola virus-positive mothers, and only the third and fourth neonates ever documented to have survived into infancy. Although no conclusions can be drawn from this small case series, and further research is required to investigate the neonatal effects of antibody therapies, these cases warrant review regarding whether post-delivery antibody therapy should be considered for all liveborn neonates of Ebola virus-positive mothers. In the context of a low resource setting, where survival of low-birthweight infants is poor, these cases also highlight the importance of adequate neonatal care. FUNDING None.
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8
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Atypical clinical presentation of Ebola virus disease in pregnancy: Implications for clinical and public health management. Int J Infect Dis 2020; 97:167-173. [PMID: 32450292 PMCID: PMC7383225 DOI: 10.1016/j.ijid.2020.05.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Between December 2013 and June 2016, West Africa experienced the largest Ebola virus disease (EVD) outbreak in history. Understanding EVD in pregnancy is important for EVD clinical screening and infection prevention and control. METHODS We conducted a review of medical records and EVD investigation reports from three districts in Sierra Leone. We report the clinical presentations and maternal and fetal outcomes of six pregnant women with atypical EVD, and subsequent transmission events from perinatal care. RESULTS The six women (ages 18-38) were all in the third trimester. Each presented with signs and symptoms initially attributed to pregnancy. None met EVD case definition; only one was known at presentation to be a contact of an EVD case. Five women died, and all six fetuses/neonates died. These cases resulted in at least 35 additional EVD cases. CONCLUSIONS These cases add to the sparse literature focusing on pregnant women with EVD, highlighting challenges and implications for outbreak control. Infected newborns may also present atypically and may shed virus while apparently asymptomatic. Pregnant women identified a priori as contacts of EVD cases require special attention and planning for obstetrical care.
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Foeller ME, Carvalho Ribeiro do Valle C, Foeller TM, Oladapo OT, Roos E, Thorson AE. Pregnancy and breastfeeding in the context of Ebola: a systematic review. THE LANCET. INFECTIOUS DISEASES 2020; 20:e149-e158. [PMID: 32595045 DOI: 10.1016/s1473-3099(20)30194-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/06/2020] [Accepted: 03/06/2020] [Indexed: 12/31/2022]
Abstract
The outbreaks of Ebola virus between 2014 and 2020 have drawn attention to knowledge gaps related to Ebola virus disease in pregnant women. The aim of this study was to systematically evaluate available data on pregnant and lactating women with acute Ebola virus disease or following recovery. We searched MEDLINE, Embase, Cochrane Library (CENTRAL), Web of Science Core Collection, CINAHL, POPLINE, Global Health, and WHO Global Index Medicus, in addition to grey literature, for relevant articles. Studies of all types and published between database inception and Aug 19, 2019, were eligible (PROSPERO 129335). We identified 1060 records, of which 52 studies met our inclusion criteria. Overall, mortality in 274 pregnant women with Ebola virus disease was 72% (197 women died); mortality for pregnant women with Ebola virus disease were not higher than those in the general population of patients with Ebola virus disease. Nearly all women with Ebola virus disease had adverse pregnancy outcomes. Among survivors, Ebola virus RNA was detected by RT-PCR in amniotic fluid up to 32 days after maternal clearance of Ebola virus from the blood and in breastmilk 26 days after symptom onset. A risk of transmission of Ebola virus from pregnancy-related fluids and breastmilk probably exists, and precautions should be taken.
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Affiliation(s)
- Megan E Foeller
- UNDP/UN Population Fund/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HPR), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland; Obstetrics and Gynecology, Stanford University, Stanford, CA, USA; Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO, USA
| | | | - Timothy M Foeller
- Department of Internal Medicine, Stanford University, Stanford, CA, USA
| | - Olufemi T Oladapo
- UNDP/UN Population Fund/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HPR), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Elin Roos
- UNDP/UN Population Fund/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HPR), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Anna E Thorson
- UNDP/UN Population Fund/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HPR), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
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10
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Legardy-Williams JK, Carter RJ, Goldstein ST, Jarrett OD, Szefer E, Fombah AE, Tinker SC, Samai M, Mahon BE. Pregnancy Outcomes among Women Receiving rVSVΔ-ZEBOV-GP Ebola Vaccine during the Sierra Leone Trial to Introduce a Vaccine against Ebola. Emerg Infect Dis 2020; 26:541-548. [PMID: 32017677 PMCID: PMC7045819 DOI: 10.3201/eid2603.191018] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Little information exists regarding Ebola vaccine rVSVΔG-ZEBOV-GP and pregnancy. The Sierra Leone Trial to Introduce a Vaccine against Ebola (STRIVE) randomized participants without blinding to immediate or deferred (18–24 weeks postenrollment) vaccination. Pregnancy was an exclusion criterion, but 84 women were inadvertently vaccinated in early pregnancy or became pregnant <60 days after vaccination or enrollment. Among immediate vaccinated women, 45% (14/31) reported pregnancy loss, compared with 33% (11/33) of unvaccinated women with contemporaneous pregnancies (relative risk 1.35, 95% CI 0.73–2.52). Pregnancy loss was similar among women with higher risk for vaccine viremia (conception before or <14 days after vaccination) (44% [4/9]) and women with lower risk (conception >15 days after vaccination) (45% [10/22]). No congenital anomalies were detected among 44 live-born infants examined. These data highlight the need for Ebola vaccination decisions to balance the possible risk for an adverse pregnancy outcome with the risk for Ebola exposure.
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11
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Wenham C, Arevalo A, Coast E, Corrêa S, Cuellar K, Leone T, Valongueiro S. Zika, abortion and health emergencies: a review of contemporary debates. Global Health 2019; 15:49. [PMID: 31340836 PMCID: PMC6657045 DOI: 10.1186/s12992-019-0489-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/03/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The Zika outbreak provides pertinent case study for considering the impact of health emergencies on abortion decision-making and/or for positioning abortion in global health security debates. MAIN BODY This paper provides a baseline of contemporary debates taking place in the intersection of two key health policy areas, and seeks to understand how health emergency preparedness frameworks and the broader global health security infrastructure is prepared to respond to future crises which implicate sexual and reproductive rights. Our paper suggests there are three key themes that emerge from the literature; 1) the lack of consideration of sexual and reproductive health (SRH) services in outbreak response 2) structural inequalities permeate the landscape of health emergencies, epitomised by Zika, and 3) the need for rights based approaches to health. CONCLUSION Global health security planning and response should specifically include programmatic activity for SRH provision during health emergencies.
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Affiliation(s)
- Clare Wenham
- Department of Health Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE UK
| | - Amaral Arevalo
- Instituto de Medicina Social-Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier 524, Maracanã, Bloco D, 7° andar, UERJ, Rio de Janeiro, RJ 20550-013 Brazil
| | - Ernestina Coast
- Department of International Development, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE UK
| | - Sonia Corrêa
- ABIA, Sexuality Policy Watch, Avenida Presidente Vargas, 446, 13th floor, CEP 20071-907, Rio de Janeiro, RJ Brazil
| | - Katherine Cuellar
- National Faculty of Public Health, Universidad de Antioquia, Calle 62 #52-59, Medellín, Colombia
| | - Tiziana Leone
- Department of International Development, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE UK
| | - Sandra Valongueiro
- Post-graduate Programe of Public Health, Federal University of Pernambuco, Av Prof Moraes Rego, s/n. Hospital das Clínicas, Bloco “E” – 4° Andar. Cidade Universitária CEP: 50.670-901, Recife, PE Brazil
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12
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Mpofu JJ, Soud F, Lyman M, Koroma AP, Morof D, Ellington S, Kargbo SS, Callaghan W. Clinical presentation of pregnant women in isolation units for Ebola virus disease in Sierra Leone, 2014. Int J Gynaecol Obstet 2019; 145:76-82. [PMID: 30706470 DOI: 10.1002/ijgo.12775] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/28/2018] [Accepted: 01/30/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To examine Ebola virus disease (EVD) symptom prevalence and EVD status among pregnant women in Ebola isolation units in Sierra Leone. METHODS In an observational study, data were obtained for pregnant women admitted to Ebola isolation units across four districts in Sierra Leone from June 29, 2014, to December 20, 2014. Women were admitted to isolation units if they had suspected EVD exposures or fever (temperature >38°C) and three or more self-reported symptoms suggestive of EVD. Associations were examined between EVD status and each symptom using χ2 tests and logistic regression adjusting for age/labor status. RESULTS Of 176 pregnant women isolated, 55 (32.5%) tested positive for EVD. Using logistic regression models adjusted for age, EVD-positive women were significantly more likely to have fever, self-reported fatigue/weakness, nausea/vomiting, headache, muscle/joint pain, chest pain, vaginal bleeding, unexplained bleeding, or sore throat upon admission. In models adjusted for age/labor, only women with fever or vaginal bleeding upon admission were significantly more likely to be EVD-positive. CONCLUSIONS Several EVD symptoms and complications increased the odds of testing EVD-positive; some of these were also signs and symptoms of labor/pregnancy complications. The study results highlight the need to refine screening for pregnant women with EVD.
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Affiliation(s)
- Jonetta J Mpofu
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.,US Public Health Service Commissioned Corps, Rockville, MD, USA
| | - Fatma Soud
- Zambia Country Office, Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Meghan Lyman
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Office of Public Health Scientific Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Diane Morof
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.,US Public Health Service Commissioned Corps, Rockville, MD, USA
| | - Sascha Ellington
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - William Callaghan
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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