Ebola Virus Disease and Pregnancy: A Retrospective Cohort Study of Patients Managed at 5 Ebola Treatment Units in West Africa

Henwood, Patricia C.; Bebell, Lisa M.; Roshania, Reshma; Wolfman, Vanessa; Mallow, Michaela; Kalyanpur, Anushka; Levine, Adam C.

doi:10.1093/cid/cix290

Cited by 29 publications

(43 citation statements)

References 25 publications

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“…Overall CFR is high (45-90%) and if acquired in pregnancy it is almost always lethal for the fetus (213,215). However, a recent synthesis of available studies demonstrated no significant difference between mortality rates in pregnant vs. non-pregnant women (214). While this may be the case, caution is required on two counts: firstly, as the authors acknowledge, their analysis is limited by the small size, retrospective nature and considerable heterogeneity of included studies; and secondly, while pregnant women may not be intrinsically more vulnerable to EVD, the fact that they are often carers for sick relatives and make frequent visits to health facilities places them at increased risk of acquiring the disease (212).…”

Section: Ebola Virusmentioning

confidence: 99%

Innate Immune Responses to Acute Viral Infection During Pregnancy

et al. 2020

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Section: Ebola Virusmentioning

confidence: 99%

Innate Immune Responses to Acute Viral Infection During Pregnancy

et al. 2020

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“…The World Health Organization's Strategic Advisory Group of Experts on Immunization, recognizing the high risk for maternal and fetal death from Ebola virus infection, has endorsed the need for careful evaluation of risks and benefits in a local context by national regulatory authorities and ethics committees in decisionmaking about rVSVΔG-ZEBOV-GP vaccination of pregnant women during an Ebola outbreak (27). The decision to offer rVSVΔG-ZEBOV-GP vaccine to pregnant women will need to balance the risk for an adverse pregnancy outcome with the risk for exposure to and subsequent infection with Ebola (28)(29)(30)(31)(32)(33). When vaccination is offered to pregnant women, the provision of culturally appropriate information to assist women in making informed decisions about whether to accept vaccination will be critical.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy Outcomes among Women Receiving rVSVΔ-ZEBOV-GP Ebola Vaccine during the Sierra Leone Trial to Introduce a Vaccine against Ebola

Legardy-Williams¹,

Carter²,

Goldstein³

et al. 2020

Emerg. Infect. Dis.

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“…Recently, in a retrospective evaluation of outcome data from the West African epidemic, the authors found no evidence to support a significant difference in CFRs between pregnant women with suspected or confirmed EVD compared to non-pregnant women [34].…”

Section: Mortality Of Ebola Virus Infection Among Non-vaccinated Pregmentioning

confidence: 98%

Maternal and Infant Death and the rVSV-ZEBOV Vaccine Through Three Recent Ebola Virus Epidemics-West Africa, DRC Équateur and DRC Kivu: 4 Years of Excluding Pregnant and Lactating Women and Their Infants from Immunization

Schwartz

2019

Curr Trop Med Rep

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Purpose of Review Ebola virus infection has one of the highest overall case fatality rates of any viral disease. It has historically had an especially high case mortality rate among pregnant women and infants-greater than 90% for pregnant women in some outbreaks and close to 100 % in fetuses and newborns. The Merck recombinant vaccine against Ebola virus, termed rVSV-ZEBOV, underwent clinical trials during the 2013-2015 West Africa Ebola epidemic where it was found to be 100% efficacious. It was subsequently used during the 2018 DRC Équateur outbreak and in the 2018 DRC Kivu Ebola which is still ongoing, where its efficacy is 97.5 %. Pregnant and lactating women and their infants have previously been excluded from the design, clinical trials, and administration of many vaccines and drugs. This article critically examines the development of the rVSV-ZEBOV vaccine and its accessibility to pregnant and lactating women and infants as a life-saving form of prevention through three recent African Ebola epidemics-West Africa, DRC Équateur, and DRC Kivu. Recent Findings Pregnant and lactating women and their infants were excluded from participation in the clinical trials of rVSV-ZEBOV conducted during the West Africa epidemic. This policy of exclusion was continued with the occurrence of the DRC Équateur outbreak in 2018, in spite of calls from the public health and global maternal health communities to vaccinate this population. Following the onset of the DRC Kivu epidemic, the exclusion persisted. Eventually, the policy was reversed to include vaccination of pregnant and lactating women. However, it was not implemented until June 2019, 10 months after the start of the epidemic, placing hundreds of women and infants at risk for this highly fatal infection. Summary The historical policy of excluding pregnant and lactating women and infants from vaccine design, clinical trials, and implementation places them at risk, especially in situations of infectious disease outbreaks. In the future, all pregnant women, regardless of trimester, breastfeeding mothers, and infants, should have access to the Ebola vaccine.

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Ebola Virus Disease and Pregnancy: A Retrospective Cohort Study of Patients Managed at 5 Ebola Treatment Units in West Africa

Abstract: SummaryWe find no evidence to support a difference in the risk of death among pregnant women with suspected or confirmed Ebola virus disease (EVD) as compared to nonpregnant women. Limited data suggest poor fetal and neonatal outcomes in EVD-affected pregnancies.

Cited by 29 publications

References 25 publications

Innate Immune Responses to Acute Viral Infection During Pregnancy

Innate Immune Responses to Acute Viral Infection During Pregnancy

Pregnancy Outcomes among Women Receiving rVSVΔ-ZEBOV-GP Ebola Vaccine during the Sierra Leone Trial to Introduce a Vaccine against Ebola

Maternal and Infant Death and the rVSV-ZEBOV Vaccine Through Three Recent Ebola Virus Epidemics-West Africa, DRC Équateur and DRC Kivu: 4 Years of Excluding Pregnant and Lactating Women and Their Infants from Immunization

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