Retrospective Cohort Study of Lassa Fever in Pregnancy, Southern Nigeria

Okogbenin, Sylvanus; Okoeguale, Joseph; Akpede, George O.; Colubri, Andrés; Barnes, Kayla G.; Mehta, Samar B.; Eifediyi, Reuben; Okogbo, F; Eigbefoh, J; Momoh, Mojeed O.; Rafiu, Mojeed; Adomeh, Donatus I; Odia, Ikponmwosa; Aire, Chris; Atafo, Rebecca O; Okonofua, Martha; Pahlman, Meike; Becker-Ziaja, Beate; Asogun, Danny; Okokhere, Peter O; Happi, Christian T.; Günther, Stephan; Sabeti, Pardis C.; Ogbaini-Emovon, Ephraim

doi:10.3201/eid2508.181299

Cited by 38 publications

(39 citation statements)

References 21 publications

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“…On the third day of admission she was delivered of a live male neonate who remained negative after 2 consecutive RT PCR tests for Lassa fever virus. The favorable maternal outcome associated with admission with a live fetus is consistent with the report from the Irrua specialist hospital (Okogbenin et al, 2019).…”

Section: Discussionsupporting

confidence: 86%

Lassa fever in pregnancy with a positive maternal and fetal outcome: A case report

Agboeze

Nwali

Nwakpakpa

et al. 2019

International Journal of Infectious Diseases

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Background: The signs and symptoms of Lassa fever are initially indistinguishable from other febrile illnesses common in the tropics and complications of pregnancy. Surviving Lassa fever during pregnancy is rare. Only few cases have been documented. The antiviral drug of choice is ribavirin. Case description: A 25-year-old multigravida farmer with fever who was initially thought to have malaria in pregnancy at 29 weeks gestation. Further changes in her clinical state and laboratory tests led to a confirmation of Lassa fever. The Liver enzymes were markedly deranged and the packed cell volume was 27%. She commenced on ribavirin and subsequently was delivered of a live male neonate who was RT PCR negative for Lassa fever virus. Her clinical state improved, repeat RT PCR on day 15 was negative and she made full recovery. Discussion: The case reported had similar clinical features of fever and abdominal pain and resulted in the initial diagnoses of Malaria in pregnancy. When she failed to respond to antimalarial and antibiotics treatments, a strong suspicion of viral hemorrhagic fever was made. At this time the patient was in advanced stage of the disease with bleeding from vagina and puncture sites. On the third day of admission she was delivered of a live male neonate who remained negative after 2 consecutive RT PCR tests for Lassa fever virus. Lassa fever carries a high risk of death to the fetus throughout pregnancy and to the mother in the third trimester. Mothers with Lassa fever improved rapidly after evacuation of the uterus by spontaneous abortion, or normal delivery. She was clinically stable following delivery. Her laboratory investigations were essentially normal. Throughout her management transmission based precautions were observed. None of the six close contacts developed symptoms after been followed up for 21 days. Conclusion: This report adds to the body of literature that individuals can survive Lassa fever during pregnancy with good maternal and fetal outcome.

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Section: Discussionsupporting

confidence: 86%

Lassa fever in pregnancy with a positive maternal and fetal outcome: A case report

Agboeze

Nwali

Nwakpakpa

et al. 2019

International Journal of Infectious Diseases

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“…Lassa virus is a single-stranded RNA virus belonging to the family Arenaviridae. It is endemic in several West African countries, in particular Sierra Leone, Liberia, Guinea and Nigeria, although cases had been reported only sporadically in the Tonkolili region [7,8]. Rodents act as a reservoir and shed the virus in urine and droppings.…”

Section: Discussionmentioning

confidence: 99%

“…This report shows that LASV can pose an infection risk during routine invasive hospital procedures involving patients in endemic areas, in particular on maternity wards as LASV has a high affinity for placenta and vascular tissues [7,12]. Awareness of the local risks and implementation of standard precautions to reduce the risk of transmission of blood-borne pathogens are essential to prevent nosocomial transmission [8,13].…”

Section: Discussionmentioning

confidence: 99%

Public health response to two imported, epidemiologically related cases of Lassa fever in the Netherlands (ex Sierra Leone), November 2019

et al. 2020

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On 20 November 2019, Lassa fever was diagnosed in a physician repatriated from Sierra Leone to the Netherlands. A second physician with suspected Lassa fever, repatriated a few days later from the same healthcare facility, was confirmed infected with Lassa virus on 21 November. Comprehensive contact monitoring involving high- and low-risk contacts proved to be feasible and follow-up of the contacts did not reveal any case of secondary transmission in the Netherlands.

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“…Our findings may also inform pressing decisions regarding vaccination of pregnant women during outbreaks. In this setting, benefits might exceed potential harms when the disease manifestations are severe for pregnant women and/or their offspring and the probability of exposure is high, as is the case with Ebola and Lassa Fever [74,75].…”

Section: Discussionmentioning

confidence: 99%

Safety of Administering Live Vaccines during Pregnancy: A Systematic Review and Meta-Analysis of Pregnancy Outcomes

et al. 2020

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Live-attenuated vaccines (LAV) are currently contraindicated during pregnancy, given uncertain safety records for the mother–infant pair. LAV might, however, play an important role to protect them against serious emerging diseases, such as Ebola and Lassa fever. For this systematic review we searched relevant databases to identify studies published up to November 2019. Controlled observational studies reporting pregnancy outcomes after maternal immunization with LAV were included. The ROBINS-I tool was used to assess risk of bias. Pooled odds ratios (OR) were obtained under a random-effects model. Of 2831 studies identified, fifteen fulfilled inclusion criteria. Smallpox, rubella, poliovirus, yellow fever and dengue vaccines were assessed in these studies. No association was found between vaccination and miscarriage (OR 0.98, 95% CI 0.87–1.10), stillbirth (OR 1.04, 95% CI 0.74–1.48), malformations (OR 1.09, 95% CI 0.98–1.21), prematurity (OR 0.99, 95% CI 0.90–1.08) or neonatal death (OR 1.06, 95% CI 0.68–1.65) overall. However, increased odds of malformations (OR 1.24; 95% CI 1.03–1.49) and miscarriage after first trimester immunization (OR 4.82; 95% CI 2.38–9.77) was found for smallpox vaccine. Thus, we did not find evidence of harm related to LAV other than smallpox with regards to pregnancy outcomes, but quality of evidence was very low. Overall risks appear to be small and have to be balanced against potential benefits for the mother-infant pair.

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Retrospective Cohort Study of Lassa Fever in Pregnancy, Southern Nigeria

Abstract: The positive outcomes observed support a conservative approach to disease management.

Cited by 38 publications

References 21 publications

Lassa fever in pregnancy with a positive maternal and fetal outcome: A case report

Lassa fever in pregnancy with a positive maternal and fetal outcome: A case report

Public health response to two imported, epidemiologically related cases of Lassa fever in the Netherlands (ex Sierra Leone), November 2019

Safety of Administering Live Vaccines during Pregnancy: A Systematic Review and Meta-Analysis of Pregnancy Outcomes

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