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Kavunga-Membo H, Watson-Jones D, Kasonia K, Edwards T, Camacho A, Mambula G, Tetsa-Tata D, Choi EML, Aboubacar S, Brindle H, Roberts C, Manno D, Faguer B, Mossoko Z, Mukadi P, Kakule M, Balingene B, Mapendo EK, Makarimi R, Toure O, Campbell P, Mousset M, Nsaibirni R, Ama IS, Janvier KK, Keshinro B, Cissé B, Sahani MK, Johnson J, Connor N, Lees S, Imbault N, Robinson C, Grais RF, Bausch DG, Muyembe-Tamfum JJ. Delivery and Safety of a Two-Dose Preventive Ebola Virus Disease Vaccine in Pregnant and Non-Pregnant Participants during an Outbreak in the Democratic Republic of the Congo. Vaccines (Basel) 2024; 12:825. [PMID: 39203952 PMCID: PMC11359453 DOI: 10.3390/vaccines12080825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/07/2024] [Accepted: 07/18/2024] [Indexed: 08/08/2024] Open
Abstract
During the 2018-2020 Ebola virus disease (EVD) outbreak, residents in Goma, Democratic Republic of the Congo, were offered a two-dose prophylactic EVD vaccine. This was the first study to evaluate the safety of this vaccine in pregnant women. Adults, including pregnant women, and children aged ≥1 year old were offered the Ad26.ZEBOV (day 0; dose 1), MVA-BN-Filo (day 56; dose 2) EVD vaccine through an open-label clinical trial. In total, 20,408 participants, including 6635 (32.5%) children, received dose 1. Fewer than 1% of non-pregnant participants experienced a serious adverse event (SAE) following dose 1; one SAE was possibly related to the Ad26.ZEBOV vaccine. Of the 1221 pregnant women, 371 (30.4%) experienced an SAE, with caesarean section being the most common event. No SAEs in pregnant women were considered related to vaccination. Of 1169 pregnancies with a known outcome, 55 (4.7%) ended in a miscarriage, and 30 (2.6%) in a stillbirth. Eleven (1.0%) live births ended in early neonatal death, and five (0.4%) had a congenital abnormality. Overall, 188/891 (21.1%) were preterm births and 79/1032 (7.6%) had low birth weight. The uptake of the two-dose regimen was high: 15,328/20,408 (75.1%). The vaccine regimen was well-tolerated among the study participants, including pregnant women, although further data, ideally from controlled trials, are needed in this crucial group.
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Affiliation(s)
- Hugo Kavunga-Membo
- Institut National de Recherche Biomédicale, Kinshasa P.O. Box 1192, Democratic Republic of the Congo; (H.K.-M.); (Z.M.); (P.M.); (J.J.M.-T.)
| | - Deborah Watson-Jones
- Faculty of Infectious and Tropical Diseases, London School of Hygiene &Tropical Medicine, London WC1E 7HT, UK; (K.K.); (D.T.-T.); (E.M.-L.C.); (H.B.); (C.R.); (D.M.); (B.C.); (M.K.S.); (N.C.); (D.G.B.)
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza P.O. Box 1462, Tanzania
| | - Kambale Kasonia
- Faculty of Infectious and Tropical Diseases, London School of Hygiene &Tropical Medicine, London WC1E 7HT, UK; (K.K.); (D.T.-T.); (E.M.-L.C.); (H.B.); (C.R.); (D.M.); (B.C.); (M.K.S.); (N.C.); (D.G.B.)
| | - Tansy Edwards
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki 852-8131, Japan;
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
| | - Anton Camacho
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Grace Mambula
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Darius Tetsa-Tata
- Faculty of Infectious and Tropical Diseases, London School of Hygiene &Tropical Medicine, London WC1E 7HT, UK; (K.K.); (D.T.-T.); (E.M.-L.C.); (H.B.); (C.R.); (D.M.); (B.C.); (M.K.S.); (N.C.); (D.G.B.)
| | - Edward Man-Lik Choi
- Faculty of Infectious and Tropical Diseases, London School of Hygiene &Tropical Medicine, London WC1E 7HT, UK; (K.K.); (D.T.-T.); (E.M.-L.C.); (H.B.); (C.R.); (D.M.); (B.C.); (M.K.S.); (N.C.); (D.G.B.)
| | - Soumah Aboubacar
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Hannah Brindle
- Faculty of Infectious and Tropical Diseases, London School of Hygiene &Tropical Medicine, London WC1E 7HT, UK; (K.K.); (D.T.-T.); (E.M.-L.C.); (H.B.); (C.R.); (D.M.); (B.C.); (M.K.S.); (N.C.); (D.G.B.)
| | - Chrissy Roberts
- Faculty of Infectious and Tropical Diseases, London School of Hygiene &Tropical Medicine, London WC1E 7HT, UK; (K.K.); (D.T.-T.); (E.M.-L.C.); (H.B.); (C.R.); (D.M.); (B.C.); (M.K.S.); (N.C.); (D.G.B.)
| | - Daniela Manno
- Faculty of Infectious and Tropical Diseases, London School of Hygiene &Tropical Medicine, London WC1E 7HT, UK; (K.K.); (D.T.-T.); (E.M.-L.C.); (H.B.); (C.R.); (D.M.); (B.C.); (M.K.S.); (N.C.); (D.G.B.)
| | - Benjamin Faguer
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
| | - Zephyrin Mossoko
- Institut National de Recherche Biomédicale, Kinshasa P.O. Box 1192, Democratic Republic of the Congo; (H.K.-M.); (Z.M.); (P.M.); (J.J.M.-T.)
| | - Pierre Mukadi
- Institut National de Recherche Biomédicale, Kinshasa P.O. Box 1192, Democratic Republic of the Congo; (H.K.-M.); (Z.M.); (P.M.); (J.J.M.-T.)
| | - Michel Kakule
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Benith Balingene
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Esther Kaningu Mapendo
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Rockyath Makarimi
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Oumar Toure
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Paul Campbell
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Mathilde Mousset
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Robert Nsaibirni
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Ibrahim Seyni Ama
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Kikongo Kambale Janvier
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Babajide Keshinro
- Janssen Vaccines and Prevention, 2333 CN Leiden, The Netherlands; (B.K.); (C.R.)
| | - Badara Cissé
- Faculty of Infectious and Tropical Diseases, London School of Hygiene &Tropical Medicine, London WC1E 7HT, UK; (K.K.); (D.T.-T.); (E.M.-L.C.); (H.B.); (C.R.); (D.M.); (B.C.); (M.K.S.); (N.C.); (D.G.B.)
| | - Mateus Kambale Sahani
- Faculty of Infectious and Tropical Diseases, London School of Hygiene &Tropical Medicine, London WC1E 7HT, UK; (K.K.); (D.T.-T.); (E.M.-L.C.); (H.B.); (C.R.); (D.M.); (B.C.); (M.K.S.); (N.C.); (D.G.B.)
| | | | - Nicholas Connor
- Faculty of Infectious and Tropical Diseases, London School of Hygiene &Tropical Medicine, London WC1E 7HT, UK; (K.K.); (D.T.-T.); (E.M.-L.C.); (H.B.); (C.R.); (D.M.); (B.C.); (M.K.S.); (N.C.); (D.G.B.)
| | - Shelley Lees
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
| | - Nathalie Imbault
- Coalition for Epidemic Preparedness Innovations, 0277 Oslo, Norway;
| | - Cynthia Robinson
- Janssen Vaccines and Prevention, 2333 CN Leiden, The Netherlands; (B.K.); (C.R.)
| | - Rebecca F. Grais
- Epicentre, 75019 Paris, France; (A.C.); (G.M.); (S.A.); (M.K.); (B.B.); (E.K.M.); (R.M.); (O.T.); (P.C.); (M.M.); (R.N.); (I.S.A.); (K.K.J.); (R.F.G.)
| | - Daniel G. Bausch
- Faculty of Infectious and Tropical Diseases, London School of Hygiene &Tropical Medicine, London WC1E 7HT, UK; (K.K.); (D.T.-T.); (E.M.-L.C.); (H.B.); (C.R.); (D.M.); (B.C.); (M.K.S.); (N.C.); (D.G.B.)
- Foundation for Innovative New Diagnostics (FIND), Campus Biotech Chemin des Mines 9, 1202 Geneva, Switzerland
| | - Jean Jacques Muyembe-Tamfum
- Institut National de Recherche Biomédicale, Kinshasa P.O. Box 1192, Democratic Republic of the Congo; (H.K.-M.); (Z.M.); (P.M.); (J.J.M.-T.)
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Vlasova-St. Louis I, Mohei H. Molecular Diagnostics of Cryptococcus spp. and Immunomics of Cryptococcosis-Associated Immune Reconstitution Inflammatory Syndrome. Diseases 2024; 12:101. [PMID: 38785756 PMCID: PMC11120354 DOI: 10.3390/diseases12050101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/05/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
Cryptococcal infection poses a significant global public health challenge, particularly in regions near the equator. In this review, we offer a succinct exploration of the Cryptococcus spp. genome and various molecular typing methods to assess the burden and genetic diversity of cryptococcal pathogens in the environment and clinical isolates. We delve into a detailed discussion on the molecular pathogenesis and diagnosis of immune reconstitution inflammatory syndrome (IRIS) associated with cryptococcosis, with a specific emphasis on cryptococcal meningitis IRIS (CM-IRIS). Our examination includes the recent literature on CM-IRIS, covering host cellulomics, proteomics, transcriptomics, and genomics.
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Affiliation(s)
| | - Hesham Mohei
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
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Perera SM, Garbern SC, Mbong EN, Fleming MK, Muhayangabo RF, Ombeni AB, Kulkarni S, Tchoualeu DD, Kallay R, Song E, Powell J, Gainey M, Glenn B, Mutumwa RM, Mustafa SHB, Earle-Richardson G, Fukunaga R, Abad N, Soke GN, Prybylski D, Fitter DL, Levine AC, Doshi RH. Perceptions toward Ebola vaccination and correlates of vaccine uptake among high-risk community members in North Kivu, Democratic Republic of the Congo. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002566. [PMID: 38236844 PMCID: PMC10796044 DOI: 10.1371/journal.pgph.0002566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/22/2023] [Indexed: 01/22/2024]
Abstract
The tenth Ebola Virus Disease (EVD) outbreak (2018-2020, North Kivu, Ituri, South Kivu) in the Democratic Republic of the Congo (DRC) was the second-largest EVD outbreak in history. During this outbreak, Ebola vaccination was an integral part of the EVD response. We evaluated community perceptions toward Ebola vaccination and identified correlates of Ebola vaccine uptake among high-risk community members in North Kivu, DRC. In March 2021, a cross-sectional survey among adults was implemented in three health zones. We employed a sampling approach mimicking ring vaccination, targeting EVD survivors, their household members, and their neighbors. Outbreak experiences and perceptions toward the Ebola vaccine were assessed, and modified Poisson regression was used to identify correlates of Ebola vaccine uptake among those offered vaccination. Among the 631 individuals surveyed, most (90.2%) reported a high perceived risk of EVD and 71.6% believed that the vaccine could reduce EVD severity; however, 63.7% believed the vaccine had serious side effects. Among the 474 individuals who had been offered vaccination, 397 (83.8%) received the vaccine, 180 (45.3%) of those vaccinated received the vaccine after two or more offers. Correlates positively associated with vaccine uptake included having heard positive information about the vaccine (RR 1.30, 95% CI 1.06-1.60), the belief that the vaccine could prevent EVD (RR 1.23, 95% CI 1.09-1.39), and reporting that religion influenced all decisions (RR 1.13, 95% CI 1.02-1.25). Ebola vaccine uptake was high in this population, although mixed attitudes and vaccine delays were common. Communicating positive vaccine information, emphasizing the efficacy of the Ebola vaccine, and engaging religious leaders to promote vaccination may aid in increasing Ebola vaccine uptake during future outbreaks.
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Affiliation(s)
- Shiromi M. Perera
- International Medical Corps, Washington, District of Columbia, United States of America
| | - Stephanie Chow Garbern
- Department of Emergency Medicine, Brown University, Providence, Rhode Island, United States of America
| | - Eta Ngole Mbong
- International Medical Corps, Goma, Democratic Republic of the Congo
| | - Monica K. Fleming
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | - Shibani Kulkarni
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Dieula Delissaint Tchoualeu
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ruth Kallay
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Elizabeth Song
- Brown University, Providence, Rhode Island, United States of America
| | - Jasmine Powell
- Brown University, Providence, Rhode Island, United States of America
| | - Monique Gainey
- Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Bailey Glenn
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- James A. Ferguson Infectious Disease Program, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | - Giulia Earle-Richardson
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rena Fukunaga
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Neetu Abad
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Gnakub Norbert Soke
- Division of Global Health Protection, Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo
| | - Dimitri Prybylski
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - David L. Fitter
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Adam C. Levine
- Department of Emergency Medicine, Brown University, Providence, Rhode Island, United States of America
| | - Reena H. Doshi
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Salloum M, Paviotti A, Bastiaens H, Van Geertruyden JP. The inclusion of pregnant women in vaccine clinical trials: An overview of late-stage clinical trials' records between 2018 and 2023. Vaccine 2023; 41:7076-7083. [PMID: 37903681 DOI: 10.1016/j.vaccine.2023.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/17/2023] [Accepted: 10/21/2023] [Indexed: 11/01/2023]
Abstract
Pregnant women are generally excluded from clinical research over safety concerns. However, demands to include them in clinical vaccine development have intensified after recent COVID-19, Ebola, and Lassa fever outbreaks given the disproportionate effect of these diseases on pregnant women and/or their foetuses. Numerous studies highlighted the scarcity of safety data for therapeutic interventions in pregnant women. Nevertheless, only a small number have assessed the number of vaccine trials including this population. Therefore, we searched for phase 3 and 4 vaccine clinical trials in healthy populations registered between 2018 and 2023 in clinicaltrials.gov and the International Clinical Trial Registry Platform. Out of 400 registered vaccine trials matching our inclusion criteria, 217 (54 %) were industry-sponsored, and 222 (56 %) had COVID-19 as a target. We found 22 studies (6 %) that either were designed for pregnant women or included them as part of a larger population. Out of these 22 trials, 13 were designed specifically for pregnant women; seven of these were maternal vaccines aiming at protecting the foetus, namely pertussis (3), Respiratory Syncytial Virus (RSV) (3), and meningitis plus tetanus (1) vaccines, and six others targeted either flu (3), COVID-19 (2) or Ebola (1). Only the RSV and Ebola vaccine trials were industry-sponsored. We also found that nine studies targeting the general population included pregnant women. These focused on COVID-19 (3), flu (2), COVID-19 + flu (2), Ebola (1), and Hepatitis B (1). None of these studies was industry-sponsored. Our findings show that a gap still exists in terms of pregnant women's inclusion in vaccine trials. Such a gap needs to be tackled urgently to minimise the devastating effects that a future infectious disease outbreak could have on this population. This study can inform future demands for increased inclusion, especially in industry-sponsored trials, as it provides an overview of the current vaccine trials scene.
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Affiliation(s)
- Maha Salloum
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Drie Eikenstraat 663, 2650 Antwerp, Belgium; Global Health Institute, Department of Family Medicine and Population Health, University of Antwerp, Doornstraat 331, 2610 Antwerp, Belgium.
| | - Antea Paviotti
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Drie Eikenstraat 663, 2650 Antwerp, Belgium; Global Health Institute, Department of Family Medicine and Population Health, University of Antwerp, Doornstraat 331, 2610 Antwerp, Belgium
| | - Hilde Bastiaens
- Department of Family Medicine and Population Health, University of Antwerp, Doornstraat 331, 2610 Antwerp, Belgium
| | - Jean-Pierre Van Geertruyden
- Global Health Institute, Department of Family Medicine and Population Health, University of Antwerp, Doornstraat 331, 2610 Antwerp, Belgium
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Sileo FG, Bonvicini L, Mancuso P, Vicentini M, Aguzzoli L, Khalil A, Giorgi Rossi P. COVID-19 incidence in women of reproductive age: a population-based study in Reggio Emilia, northern Italy. BMC Pregnancy Childbirth 2023; 23:726. [PMID: 37833634 PMCID: PMC10576401 DOI: 10.1186/s12884-023-06044-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Despite being at higher risk of severe disease and pregnancy complications, evidence on susceptibility to SARS-CoV-2 infection in pregnancy is still limited. The aim of the study is to compare the likelihood of undergoing a SARS-CoV-2 test and testing positive for COVID-19 in pregnancy and puerperium with that of the general female population of reproductive age. METHODS This is a retrospective population-based cohort study including 117,606 women of reproductive age (March 2020-September 2021) with 6608 (5.6%) women having ≥ 1 pregnancy. Women were linked to the pregnancy registry to be classified as "non-pregnant", "pregnant", and "puerperium"; then, according to the national case-based integrated COVID-19 surveillance system, all women undergoing a SARS-CoV-2 test during the study period were identified. The Incidence Rate Ratio was calculated to compare the likelihood of being tested for SARS-CoV-2 in pregnant, puerperium and non-pregnant women among all women included. The likelihood of having a COVID-19 diagnosis was calculated using two comparators (not-pregnant women and the person-time before/after pregnancy) by means of Cox proportional hazards models, adjusting for age and with the cluster option to control standard error calculation in repeated pregnancies. Only first infection and swabs before the first one positive were included. RESULTS The probability of being tested for SARS-CoV-2 was 4.9 (95% CI: 4.8-5.1) and 3.6 times higher (95%CI: 3.4-3.9) in pregnancy (including spontaneous miscarriages) and in the puerperium, respectively. The Hazard Ratio (HR) of covid-19 diagnosis during pregnancy vs. non-pregnancy was 1.17 (95% CI 1.03-1.33) with similar results when comparing the risk during pregnancy with that of the same women outside pregnancy (puerperium excluded), with an HR of 1.13 (95% CI 0.96-1.33); the excess decreased when excluding the test performed at admission for delivery (HR 1.08 (95%CI 0.90-1.30). In the puerperium, the HR was 0.62 (95% CI 0.41-0.92) comparing women with ≥ 1childbirth with all other women and excluding the first two weeks of puerperium. CONCLUSIONS Women during pregnancy showed a small increase in the risk of infection, compatible with a higher likelihood of being tested. A lower probability of infection during the puerperium was observed during the entire pandemic period, suggesting likely protective behaviors which were effective in reducing their probability of infection.
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Affiliation(s)
- Filomena Giulia Sileo
- Department of Biomedical, Metabolic and Neural Sciences, International Doctorate School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Via Campi 80, 41125, Modena, Italy
- Prenatal Medicine Unit, Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Via del Pozzo 71, 41125, Modena, Italy
| | - Laura Bonvicini
- Epidemiology Unit, Azienda Unità Sanitaria Locale -IRCCS Di Reggio Emilia, Via Giovanni Amendola 2, 42123, Reggio Emilia, Italy
| | - Pamela Mancuso
- Epidemiology Unit, Azienda Unità Sanitaria Locale -IRCCS Di Reggio Emilia, Via Giovanni Amendola 2, 42123, Reggio Emilia, Italy
| | - Massimo Vicentini
- Epidemiology Unit, Azienda Unità Sanitaria Locale -IRCCS Di Reggio Emilia, Via Giovanni Amendola 2, 42123, Reggio Emilia, Italy
| | - Lorenzo Aguzzoli
- Unit of Obstetrics and Gynecology, Azienda Unità Sanitaria Locale-IRCCS, Viale Risorgimento, 80, 42123, Reggio Emilia, Italy
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, St George's University of London, Blackshaw Road, TootingLondon, SW17 0QT, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale -IRCCS Di Reggio Emilia, Via Giovanni Amendola 2, 42123, Reggio Emilia, Italy.
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TAJUDEEN RAJI, SILAIGWANA BLESSING, YAVLINSKY ALEXEI, EDWARDS SARAHJL. Research ethics during infectious disease outbreaks: A survey of African research stakeholders using the Ebola virus disease outbreak as a case. J Public Health Afr 2023; 14:1632. [PMID: 37881726 PMCID: PMC10594595 DOI: 10.4081/jphia.2023.1632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
Conducting research during disease outbreaks can be ethically challenging as evidenced in the 2014-2016 Ebola outbreak in West Africa and COVID-19 pandemic. Yet, there has been little empirical research conducted for understanding the views and perspectives of different stakeholders regarding ethical issues in conducting research during disease outbreaks. This preliminary study was conducted to empirically explore African public health research stakeholders' views about research ethics issues during infectious disease outbreaks in Africa. We conducted an online survey of 330 participants attending the International Conference on Re-emerging and Emerging Infectious Disease (ICREID) meeting that took place from 13-15 March 2019 in Addis Ababa, Ethiopia to elicit their views on various research ethics complexities experienced in the 2014 Ebola outbreak. Study results revealed some divergent views on several ethical themes including: ethics of using unregistered interventions in outbreaks; acceptable study design; ethics review processes; risks-benefit assessment; exclusion of pregnant women and children; and biological sample and data sharing. Majority (76.3%) of respondents felt that in the absence of available standard treatments or prevention modalities, the use of investigational interventions can be ethically justifiable if there is a strong scientific rationale and favorable risk-benefit ratio. Regarding conventional placebo-controlled trials during outbreaks with high case fatality rates, respondents that considered this unethical were more than three times those that felt such design were ethically justifiable. We were somewhat surprised that a majority (almost 60%) of respondents were satisfied with the exclusion of pregnant women and children in clinical trials during outbreaks. All respondents concurred with the prioritization of informed consent for research during an outbreak. Based on our findings, research ethics guidance is needed to equip research stakeholders in dealing with ethical complexities arising in the conduct of research during emerging disease outbreaks-especially regarding using experimental interventions; placebo trial design; inclusion or justified exclusion of pregnant women and children; and biological sample/data sharing. The findings will be used in ongoing efforts of developing a consultative and coherent African-centric framework to support ethical conduct of research for future emerging infectious disease outbreaks in Africa.
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Affiliation(s)
- RAJI TAJUDEEN
- African Union, Africa CDC, Division of Public Health Institutes and Research, Addis Ababa, Ethiopia
| | - BLESSING SILAIGWANA
- NIHR Group Tackling Infections to Benefit Africa (TIBA), University of Edinburgh
| | - ALEXEI YAVLINSKY
- University College London, Institute of Health Informatics, London, London NW1 2DA
| | - SARAH JL. EDWARDS
- University College London, Science & Technology Studies, Bloomsbury, London WC1H 0AW, UK
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Coler B, Cervantes O, Li M, Coler C, Li A, Shivakumar M, Every E, Schwartz D, Adams Waldorf KM. Common pathways targeted by viral hemorrhagic fever viruses to infect the placenta and increase the risk of stillbirth. Placenta 2023; 141:2-9. [PMID: 36939178 PMCID: PMC10102255 DOI: 10.1016/j.placenta.2022.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/19/2022] [Accepted: 10/02/2022] [Indexed: 01/06/2023]
Abstract
Viral hemorrhagic fevers (VHF) are endemic to Africa, South America and Asia and contribute to significant maternal and fetal morbidity and mortality. Viruses causing VHFs are typically zoonotic, spreading to humans through livestock, wildlife, or mosquito vectors. Some of the most lethal VHF viruses also impart a high-risk of stillbirth including ebolaviruses, Marburg virus (MARV), Lassa virus (LASV), and Rift Valley Fever Virus (RVFV). Large outbreaks and epidemics are common, though the impact on the mother, fetus and placenta is understudied from a public health, clinical and basic science perspective. Notably, these viruses utilize ubiquitous cellular surface entry receptors critical for normal placental function to enable viral invasion into multiple key cell types of the placenta and set the stage for maternal-fetal transmission and stillbirth. We employ insights from molecular virology and viral immunology to discuss how trophoblast expression of viral entry receptors for VHF viruses may increase the risk for viral transmission to the fetus and stillbirth. As the frequency of VHF outbreaks is expected to increase with worsening climate change, understanding the pathogenesis of VHF-related diseases in the placenta is paramount to predicting the impact of emerging viruses on the placenta and perinatal outcomes.
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Affiliation(s)
- Brahm Coler
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA; Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Orlando Cervantes
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Miranda Li
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA; Department of Biological Sciences, Columbia University, New York City, NY, USA
| | | | - Amanda Li
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA; Case Western Reserve, Cleveland, OH, USA
| | - Megana Shivakumar
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Emma Every
- School of Medicine, University of Washington, Seattle, WA, USA
| | | | - Kristina M Adams Waldorf
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA.
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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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Schwartz DA, Pittman PR. Mpox (Monkeypox) in Pregnancy: Viral Clade Differences and Their Associations with Varying Obstetrical and Fetal Outcomes. Viruses 2023; 15:1649. [PMID: 37631992 PMCID: PMC10458075 DOI: 10.3390/v15081649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/22/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023] Open
Abstract
In African countries where mpox (monkeypox) is endemic, infection is caused by two genetically related clades-Clade I (formerly Congo Basin), and Clade IIa (formerly West Africa), both of which are potentially life-threatening infections. Prior to the 2022-2023 global outbreak, mpox infections among pregnant women caused by Clade I were reported to have a 75% perinatal case fatality rate in the Democratic Republic of Congo, including the only documented case of placental infection and stillbirth from the Congenital Mpox Syndrome, and the Clade IIa mpox infection was associated with stillbirths in Nigeria. The 2022-2023 global mpox outbreak, caused by a genetically distinct strain, Clade IIb, has focused attention on the effects of mpox on pregnant women and fetal outcomes. There have been at least 58 cases of mpox infection occurring in pregnant women during the 2022-2023 outbreak. No confirmed cases of adverse perinatal outcome, including stillbirth, have been reported. The absence of perinatal morbidity and mortality from Clade IIb corresponds to the overall case fatality rate among non-pregnant women of <0.1%, as this clade has been demonstrated to produce a less-severe disease than the mpox Clade I or IIa variants. Thus, there are apparently important differences between mpox clades affecting pregnant women and perinatal outcomes.
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Affiliation(s)
| | - Phillip R. Pittman
- Division of Medicine, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, MD 21702, USA;
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Bouba A, Helle KB, Schneider KA. Predicting the combined effects of case isolation, safe funeral practices, and contact tracing during Ebola virus disease outbreaks. PLoS One 2023; 18:e0276351. [PMID: 36649296 PMCID: PMC9844901 DOI: 10.1371/journal.pone.0276351] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/19/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The recent outbreaks of Ebola virus disease (EVD) in Uganda and the Marburg virus disease (MVD) in Ghana reflect a persisting threat of Filoviridae to the global health community. Characteristic of Filoviridae are not just their high case fatality rates, but also that corpses are highly contagious and prone to cause infections in the absence of appropriate precautions. Vaccines against the most virulent Ebolavirus species, the Zaire ebolavirus (ZEBOV) are approved. However, there exists no approved vaccine or treatment against the Sudan ebolavirus (SUDV) which causes the current outbreak of EVD. Hence, the control of the outbreak relies on case isolation, safe funeral practices, and contact tracing. So far, the effectiveness of these control measures was studied only separately by epidemiological models, while the impact of their interaction is unclear. METHODS AND FINDINGS To sustain decision making in public health-emergency management, we introduce a predictive model to study the interaction of case isolation, safe funeral practices, and contact tracing. The model is a complex extension of an SEIR-type model, and serves as an epidemic preparedness tool. The model considers different phases of the EVD infections, the possibility of infections being treated in isolation (if appropriately diagnosed), in hospital (if not properly diagnosed), or at home (if the infected do not present to hospital for whatever reason). It is assumed that the corpses of those who died in isolation are buried with proper safety measures, while those who die outside isolation might be buried unsafely, such that transmission can occur during the funeral. Furthermore, the contacts of individuals in isolation will be traced. Based on parameter estimates from the scientific literature, the model suggests that proper diagnosis and hence isolation of cases has the highest impact in reducing the size of the outbreak. However, the combination of case isolation and safe funeral practices alone are insufficient to fully contain the epidemic under plausible parameters. This changes if these measures are combined with contact tracing. In addition, shortening the time to successfully trace back contacts contribute substantially to contain the outbreak. CONCLUSIONS In the absence of an approved vaccine and treatment, EVD management by proper and fast diagnostics in combination with epidemic awareness are fundamental. Awareness will particularly facilitate contact tracing and safe funeral practices. Moreover, proper and fast diagnostics are a major determinant of case isolation. The model introduced here is not just applicable to EVD, but also to other viral hemorrhagic fevers such as the MVD or the Lassa fever.
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Affiliation(s)
- Aliou Bouba
- Hochschule Mittweida, University of Applied Sciences Mittweida, Mittweida, Germany
- African Institute for Mathematical Sciences (AIMS), Limbe, Cameroon
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Beyond Lassa Fever: Systemic and structural barriers to disease detection and response in Sierra Leone. PLoS Negl Trop Dis 2022; 16:e0010423. [PMID: 35587495 PMCID: PMC9159599 DOI: 10.1371/journal.pntd.0010423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 06/01/2022] [Accepted: 04/17/2022] [Indexed: 11/19/2022] Open
Abstract
Background Lassa fever (LF) often presents clinically as undifferentiated febrile illness. Lassa Fever cases in Sierra Leone have been falling since the 2014–2016 Ebola epidemic. Data from other LF endemic countries suggest that this is not a true reflection of local epidemiological decline, but rather a function of either health seeking behaviour or the health/referral system. In Sierra Leone, many other diseases present with a similar early clinical picture, including COVID-19 and Marburg Disease (which has recently emerged in neighbouring Guinea). This empirical study explores the implementation of health system processes associated with International Health Regulations (IHR) requirements for early detection and timely and effective responses to the spread of febrile disease, through the case study of LF in Sierra Leone. Methodology/Principal findings This study used a qualitative approach to analyse local policy and guidance documents, key informant interviews with policy and practice actors, and focus group discussions and in-depth interviews with health care workers (HCWs) and community health workers (CHWs) in Kenema District to examine the ways in which undifferentiated fever surveillance and response policies and processes were implemented in the post-Ebola period. Multiple challenges were identified, including: issues with the LF case definition, approaches to differential diagnosis, specimen transport and the provision of results, and ownership of laboratory data. These issues lead to delays in diagnosis, and potentially worse outcomes for individual patients, as well as affecting the system’s ability to respond to outbreak-prone disease. Conclusions/Significance Identification of ways to improve the system requires balancing vertical disease surveillance programmes against other population health needs. Therefore, health system challenges to early identification of LF specifically have implications for the effectiveness of the wider Integrated Disease Surveillance and Response (IDSR) system in Sierra Leone more generally. Sentinel surveillance or improved surveillance at maternity facilities would help improve viral haemorrhagic fever (VHF) surveillance, as well as knowledge of LF epidemiology. Strengthening surveillance for vertical disease programmes, if correctly targeted, could have downstream benefits for COVID-19 surveillance and response as well as the wider health system—and therefore patient outcomes more generally. Lassa fever (LF) often presents clinically as undifferentiated febrile illness. Lassa Fever cases in Sierra Leone have been falling since the 2014–2016 Ebola epidemic. Data from other LF-endemic countries suggest the drop in case numbers reflects reduced health seeking behaviour or issues within the surveillance, response and health systems. In Sierra Leone, many other diseases present with a similar early clinical picture, including COVID-19, meaning that findings from a case study of LF have wider applicability. There are no recent empirical studies of the functionality of Sierra Leone’s disease surveillance and response system. Qualitative analysis of policy documents and primary data collected from within the health system identified multiple challenges including: issues with the LF case definition, approaches to differential diagnosis, specimen transport and the provision of results, and ownership of laboratory data. These issues lead to delays in diagnosis, and potentially worse outcomes for individual patients, as well as affecting the system’s ability to respond to outbreak-prone disease.
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Downs I, Johnson JC, Rossi F, Dyer D, Saunders DL, Twenhafel NA, Esham HL, Pratt WD, Trefry J, Zumbrun E, Facemire PR, Johnston SC, Tompkins EL, Jansen NK, Honko A, Cardile AP. Natural History of Aerosol-Induced Ebola Virus Disease in Rhesus Macaques. Viruses 2021; 13:v13112297. [PMID: 34835103 PMCID: PMC8619410 DOI: 10.3390/v13112297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/03/2021] [Accepted: 11/12/2021] [Indexed: 02/06/2023] Open
Abstract
Ebola virus disease (EVD) is a serious global health concern because case fatality rates are approximately 50% due to recent widespread outbreaks in Africa. Well-defined nonhuman primate (NHP) models for different routes of Ebola virus exposure are needed to test the efficacy of candidate countermeasures. In this natural history study, four rhesus macaques were challenged via aerosol with a target titer of 1000 plaque-forming units per milliliter of Ebola virus. The course of disease was split into the following stages for descriptive purposes: subclinical, clinical, and decompensated. During the subclinical stage, high levels of venous partial pressure of carbon dioxide led to respiratory acidemia in three of four of the NHPs, and all developed lymphopenia. During the clinical stage, all animals had fever, viremia, and respiratory alkalosis. The decompensatory stage involved coagulopathy, cytokine storm, and liver and renal injury. These events were followed by hypotension, elevated lactate, metabolic acidemia, shock and mortality similar to historic intramuscular challenge studies. Viral loads in the lungs of aerosol-exposed animals were not distinctly different compared to previous intramuscularly challenged studies. Differences in the aerosol model, compared to intramuscular model, include an extended subclinical stage, shortened clinical stage, and general decompensated stage. Therefore, the shortened timeframe for clinical detection of the aerosol-induced disease can impair timely therapeutic administration. In summary, this nonhuman primate model of aerosol-induced EVD characterizes early disease markers and additional details to enable countermeasure development.
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Affiliation(s)
- Isaac Downs
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Frederick, MD 21702, USA; (J.C.J.); (F.R.); (D.D.); (D.L.S.); (N.A.T.); (H.L.E.); (W.D.P.); (J.T.); (E.Z.); (P.R.F.); (S.C.J.); (E.L.T.); (N.K.J.); (A.H.); (A.P.C.)
- Correspondence: ; Tel.: +1-301-619-0369
| | - Joshua C. Johnson
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Frederick, MD 21702, USA; (J.C.J.); (F.R.); (D.D.); (D.L.S.); (N.A.T.); (H.L.E.); (W.D.P.); (J.T.); (E.Z.); (P.R.F.); (S.C.J.); (E.L.T.); (N.K.J.); (A.H.); (A.P.C.)
- Moderna, Inc., Cambridge, MA 02139, USA
| | - Franco Rossi
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Frederick, MD 21702, USA; (J.C.J.); (F.R.); (D.D.); (D.L.S.); (N.A.T.); (H.L.E.); (W.D.P.); (J.T.); (E.Z.); (P.R.F.); (S.C.J.); (E.L.T.); (N.K.J.); (A.H.); (A.P.C.)
| | - David Dyer
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Frederick, MD 21702, USA; (J.C.J.); (F.R.); (D.D.); (D.L.S.); (N.A.T.); (H.L.E.); (W.D.P.); (J.T.); (E.Z.); (P.R.F.); (S.C.J.); (E.L.T.); (N.K.J.); (A.H.); (A.P.C.)
| | - David L. Saunders
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Frederick, MD 21702, USA; (J.C.J.); (F.R.); (D.D.); (D.L.S.); (N.A.T.); (H.L.E.); (W.D.P.); (J.T.); (E.Z.); (P.R.F.); (S.C.J.); (E.L.T.); (N.K.J.); (A.H.); (A.P.C.)
| | - Nancy A. Twenhafel
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Frederick, MD 21702, USA; (J.C.J.); (F.R.); (D.D.); (D.L.S.); (N.A.T.); (H.L.E.); (W.D.P.); (J.T.); (E.Z.); (P.R.F.); (S.C.J.); (E.L.T.); (N.K.J.); (A.H.); (A.P.C.)
| | - Heather L. Esham
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Frederick, MD 21702, USA; (J.C.J.); (F.R.); (D.D.); (D.L.S.); (N.A.T.); (H.L.E.); (W.D.P.); (J.T.); (E.Z.); (P.R.F.); (S.C.J.); (E.L.T.); (N.K.J.); (A.H.); (A.P.C.)
| | - William D. Pratt
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Frederick, MD 21702, USA; (J.C.J.); (F.R.); (D.D.); (D.L.S.); (N.A.T.); (H.L.E.); (W.D.P.); (J.T.); (E.Z.); (P.R.F.); (S.C.J.); (E.L.T.); (N.K.J.); (A.H.); (A.P.C.)
| | - John Trefry
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Frederick, MD 21702, USA; (J.C.J.); (F.R.); (D.D.); (D.L.S.); (N.A.T.); (H.L.E.); (W.D.P.); (J.T.); (E.Z.); (P.R.F.); (S.C.J.); (E.L.T.); (N.K.J.); (A.H.); (A.P.C.)
- Defense Threat Reduction Agency, Fort Belvoir, VA 22060, USA
| | - Elizabeth Zumbrun
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Frederick, MD 21702, USA; (J.C.J.); (F.R.); (D.D.); (D.L.S.); (N.A.T.); (H.L.E.); (W.D.P.); (J.T.); (E.Z.); (P.R.F.); (S.C.J.); (E.L.T.); (N.K.J.); (A.H.); (A.P.C.)
| | - Paul R. Facemire
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Frederick, MD 21702, USA; (J.C.J.); (F.R.); (D.D.); (D.L.S.); (N.A.T.); (H.L.E.); (W.D.P.); (J.T.); (E.Z.); (P.R.F.); (S.C.J.); (E.L.T.); (N.K.J.); (A.H.); (A.P.C.)
| | - Sara C. Johnston
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Frederick, MD 21702, USA; (J.C.J.); (F.R.); (D.D.); (D.L.S.); (N.A.T.); (H.L.E.); (W.D.P.); (J.T.); (E.Z.); (P.R.F.); (S.C.J.); (E.L.T.); (N.K.J.); (A.H.); (A.P.C.)
| | - Erin L. Tompkins
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Frederick, MD 21702, USA; (J.C.J.); (F.R.); (D.D.); (D.L.S.); (N.A.T.); (H.L.E.); (W.D.P.); (J.T.); (E.Z.); (P.R.F.); (S.C.J.); (E.L.T.); (N.K.J.); (A.H.); (A.P.C.)
| | - Nathan K. Jansen
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Frederick, MD 21702, USA; (J.C.J.); (F.R.); (D.D.); (D.L.S.); (N.A.T.); (H.L.E.); (W.D.P.); (J.T.); (E.Z.); (P.R.F.); (S.C.J.); (E.L.T.); (N.K.J.); (A.H.); (A.P.C.)
| | - Anna Honko
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Frederick, MD 21702, USA; (J.C.J.); (F.R.); (D.D.); (D.L.S.); (N.A.T.); (H.L.E.); (W.D.P.); (J.T.); (E.Z.); (P.R.F.); (S.C.J.); (E.L.T.); (N.K.J.); (A.H.); (A.P.C.)
- Investigator at National Emerging Infectious Diseases Laboratories, Boston University School of Medicine, Boston, MA 02118, USA
| | - Anthony P. Cardile
- US Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Frederick, MD 21702, USA; (J.C.J.); (F.R.); (D.D.); (D.L.S.); (N.A.T.); (H.L.E.); (W.D.P.); (J.T.); (E.Z.); (P.R.F.); (S.C.J.); (E.L.T.); (N.K.J.); (A.H.); (A.P.C.)
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Kumar R, Yeni CM, Utami NA, Masand R, Asrani RK, Patel SK, Kumar A, Yatoo MI, Tiwari R, Natesan S, Vora KS, Nainu F, Bilal M, Dhawan M, Emran TB, Ahmad T, Harapan H, Dhama K. SARS-CoV-2 infection during pregnancy and pregnancy-related conditions: Concerns, challenges, management and mitigation strategies-a narrative review. J Infect Public Health 2021; 14:863-875. [PMID: 34118736 PMCID: PMC8062420 DOI: 10.1016/j.jiph.2021.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/10/2021] [Accepted: 04/19/2021] [Indexed: 02/06/2023] Open
Abstract
The ongoing coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global public health problem. The SARS-CoV-2 triggers hyper-activation of inflammatory and immune responses resulting in cytokine storm and increased inflammatory responses on several organs like lungs, kidneys, intestine, and placenta. Although SARS-CoV-2 affects individuals of all age groups and physiological statuses, immune-compromised individuals such as pregnant women are considered as a highly vulnerable group. This review aims to raise the concerns of high risk of infection, morbidity and mortality of COVID-19 in pregnant women and provides critical reviews of pathophysiology and pathobiology of how SARS-CoV-2 infection potentially increases the severity and fatality during pregnancy. This article also provides a discussion of current evidence on vertical transmission of SARS-CoV-2 during pregnancy and breastfeeding. Lastly, guidelines on management, treatment, preventive, and mitigation strategies of SARS-CoV-2 infection during pregnancy and pregnancy-related conditions such as delivery and breastfeeding are discussed.
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Affiliation(s)
- Rakesh Kumar
- Department of Veterinary Pathology, Dr. G.C Negi College of Veterinary and Animal Sciences, CSK Himachal Pradesh Agricultural University, Palampur, 176062, Himachal Pradesh, India.
| | - Cut Meurah Yeni
- Department of Obstetrics and Gynecology, School of Medicine, Universitas Syiah Kuala, 23111, Banda Aceh, Indonesia; Department of Obstetrics and Gynecology, Dr. Zainoel Abidin Hospital, Banda Aceh, 24415, Indonesia.
| | - Niken Asri Utami
- Department of Obstetrics and Gynecology, School of Medicine, Universitas Syiah Kuala, 23111, Banda Aceh, Indonesia; Department of Obstetrics and Gynecology, Dr. Zainoel Abidin Hospital, Banda Aceh, 24415, Indonesia.
| | - Rupali Masand
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, 243122, Uttar Pradesh, India.
| | - Rajesh Kumar Asrani
- Department of Veterinary Pathology, Dr. G.C Negi College of Veterinary and Animal Sciences, CSK Himachal Pradesh Agricultural University, Palampur, 176062, Himachal Pradesh, India.
| | - Shailesh Kumar Patel
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, 243122, Uttar Pradesh, India.
| | - Akshay Kumar
- Department of Cardiothoracic Surgery, Medanta Hospital, Gurgaon, 122001, India.
| | - Mohd Iqbal Yatoo
- Division of Veterinary Clinical Complex, Faculty of Veterinary Sciences and Animal Husbandry, Shuhama, Alusteng Srinagar, Sher-E-Kashmir University of Agricultural Sciences and Technology of Kashmir, Shalimar, Srinagar, 190006, Jammu and Kashmir, India.
| | - Ruchi Tiwari
- Department of Veterinary Microbiology and Immunology, College of Veterinary Sciences, Uttar Pradesh Pandit Deen Dayal Upadhyaya Pashu Chikitsa Vigyan Vishwavidyalaya Evam Go Anusandhan Sansthan (DUVASU), Mathura, 281001, India.
| | - Senthilkumar Natesan
- Indian Institute of Public Health Gandhinagar, Lekawada, Gandhinagar, Gujarat, 382042, India.
| | - Kranti Suresh Vora
- Indian Institute of Public Health Gandhinagar, Lekawada, Gandhinagar, Gujarat, 382042, India; Institute of Health Research, University of Canberra, ACT 2617, Australia.
| | - Firzan Nainu
- Faculty of Pharmacy, Hasanuddin University, Makassar 90245, Indonesia.
| | - Muhammad Bilal
- School of Life Science and Food Engineering, Huaiyin Institute of Technology, Huaian 223003, China.
| | - Manish Dhawan
- Department of Microbiology, Punjab Agricultural University, Ludhiana, 141004, India; The Trafford Group of Colleges, Manchester, WA14 5PQ, United Kingdom.
| | - Talha Bin Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, 4381, Bangladesh.
| | - Tauseef Ahmad
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, 210009, China; Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, 210009, China.
| | - Harapan Harapan
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, 23111, Indonesia; Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, 23111, Indonesia; Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, 23111, Indonesia.
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, 243122, Uttar Pradesh, India.
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Schwartz DA, Dhaliwal A. Coronavirus Diseases in Pregnant Women, the Placenta, Fetus, and Neonate. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1318:223-241. [PMID: 33973182 DOI: 10.1007/978-3-030-63761-3_14] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the etiological agent of coronavirus disease 2019 (COVID-19), is similar to two other coronaviruses, severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), in causing life-threatening respiratory infections and systemic complications in both children and adults. As the COVID-19 pandemic has continued to spread globally, increasing numbers of pregnant women have become infected, raising concern not only for their health but also for the health of their infants. This chapter discusses the effects of coronavirus infections, e.g., MERS, SARS, and COVID 19, on pregnancy and describes the evolving knowledge of COVID 19 among pregnant women. The physiological changes that occur in pregnancy, especially changes in the immune system, are reviewed in terms of their effect on susceptibility to infectious diseases. The effects of COVID-19 on the placenta, fetus, and neonate are also reviewed, including potential clinical outcomes and issues relating to testing and diagnosis. The potential mechanisms of vertical transmission of the virus between pregnant women and their infants are analyzed, including intrauterine, intrapartum, and postpartum infections. Several recent studies have reported the detection of SARS-CoV-2 in tissues from the fetal side of the placenta, permitting the diagnosis of transplacental infection of the fetus by SARS-CoV-2. Placentas from infected mothers in which intrauterine transplacental transmission of SARS-CoV-2 has occurred demonstrate an unusual combination of pathology findings which may represent risk factors for placental as well as fetal infection.
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Affiliation(s)
- David A Schwartz
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, GA, USA.
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15
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Response to Letter. Obstet Gynecol 2021; 136:431. [PMID: 32732763 DOI: 10.1097/aog.0000000000004037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dixit D, Masumbuko Claude K, Kjaldgaard L, Hawkes MT. Review of Ebola virus disease in children - how far have we come? Paediatr Int Child Health 2021; 41:12-27. [PMID: 32894024 DOI: 10.1080/20469047.2020.1805260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Ebola virus (EBOV) causes an extremely contagious viral haemorrhagic fever associated with high mortality. While, historically, children have represented a small number of total cases of Ebolavirus disease (EVD), in recent outbreaks up to a quarter of cases have been in children. They pose unique challenges in clinical management and infection prevention and control. In this review of paediatric EVD, the epidemiology of past EVD outbreaks with specific focus on children is discussed, the clinical manifestations and laboratory findings are described and key developments in clinical management including specific topics such as viral persistence and breastfeeding while considering unique psychosocial and anthropological considerations for paediatric care including of survivors and orphans and the stigma they face are discussed. In addition to summarising the literature, perspectives based on the authors' experience of EVD outbreaks in the Democratic Republic of the Congo (DRC) are described.Abbreviations: ARDS: acute respiratory distress syndrome; aOR: adjusted odds ratio; ALT: alanine transferase; ALIMA: Alliance for International Medical Action; AST: aspartate transaminase; BUN: blood urea nitrogen; CNS: central nervous system; CUBE: chambre d'urgence biosécurisée pour épidémie; COVID-19: coronavirus disease 2019; Ct: cycle threshold; DRC: Democratic Republic of Congo; ETC: ebola treatment centre; ETU: ebola treatment unit; EBOV: ebola virus; EVD: ebolavirus disease; FEAST: fluid expansion as supportive therapy; GP: glycoprotein; IV: intravenous; MEURI: monitored emergency use of unregistered interventions; NETEC: National Ebola Training and Education Centre; NP: nucleoprotein; ORS: oral rehydration solution; PALM: Pamoja Tulinde Maisha; PREVAIL: Partnership for Research on Ebola Virus in Liberia; PPE: personal protective equipment; PCR: polymerase chain reaction; PEP: post-exposure prophylaxis; RDTs: rapid diagnostic tests; RT: reverse transcriptase; RNA: ribonucleic acid; UNICEF: United Nations International Children's Emergency Fund; USA: United States of America; WHO: World Health Organization.
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Affiliation(s)
- Devika Dixit
- Department of Medicine and Pediatrics. Division of Infectious Diseases, University of Saskatchewan, Saskatoon, SK, Canada
| | | | | | - Michael T Hawkes
- Department of Pediatrics. Division of Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Canada.,Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Canada.,Stollery Science Laboratory, Edmonton, Alberta, Canada.,Women and Children's Health Research Institute, Edmonton, Alberta, Canada
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17
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Ditekemena JD, Nkamba DM, Muhindo HM, Siewe JNF, Luhata C, Van den Bergh R, Tshefu Kitoto A, Van Damme W, Muyembe JJ, Colebunders R. Factors associated with adherence to COVID-19 prevention measures in the Democratic Republic of the Congo (DRC): results of an online survey. BMJ Open 2021; 11:e043356. [PMID: 33462101 PMCID: PMC7813390 DOI: 10.1136/bmjopen-2020-043356] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES We aimed to assess the level of adherence to COVID-19 preventive measures in the Democratic Republic of the Congo (DRC) and to identify factors associated with non-adherence. DESIGN A cross-sectional population-based online survey. SETTINGS The study was conducted in 22 provinces of the DRC. Five provinces with a satisfactory number of respondents were included in the analysis: Haut Katanga, Kasaï-Central, Kasaï-Oriental, Kinshasa and North Kivu. PARTICIPANTS The participants were people aged ≥18 years, living in the DRC. A total of 3268 participants were included in the study analysis. INTERVENTIONS Both convenience sampling (surveyors themselves contacted potential participants in different districts) and snowball sampling (the participants were requested to share the link of the questionnaire with their contacts) methods were used. PRIMARY AND SECONDARY OUTCOME MEASURES We computed adherence scores using responses to 10 questions concerning COVID-19 preventive measures recommended by the WHO and the DRC Ministry of Health. We used logistic regression analysis with generalised estimating equations to identify factors of poor adherence. We also asked about the presence or absence of flu-like symptoms during the preceding 14 days, whether a COVID-19 test was done and the test result. RESULTS Data from 3268 participants were analysed. Face masks were not used by 1789 (54.7%) participants. Non-adherence to physical distancing was reported by 1364 (41.7%) participants. 501 (15.3%) participants did not observe regular handwashing. Five variables were associated with poor adherence: lower education level, living with other people at home, being jobless/students, living with a partner and not being a healthcare worker. CONCLUSION Despite compulsory restrictions imposed by the government, only about half of the respondents adhered to COVID-19 preventive measures in the DRC. Disparities across the provinces are remarkable. There is an urgent need to further explore the reasons for these disparities and factors associated with non-adherence.
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Affiliation(s)
- John Dinanga Ditekemena
- Ecole de Santé Publique, Universite de Kinshasa Faculte de Medecine, Kinshasa, Democratic Republic of the Congo
| | - Dalau Mukadi Nkamba
- Ecole de Santé Publique, Universite de Kinshasa Faculte de Medecine, Kinshasa, Democratic Republic of the Congo
- Pôle d'Épidémiologie et Biostatistique, Université catholique de Louvain (UCLouvain), Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium
| | - Hypolite Mavoko Muhindo
- Department of Tropical Medicine, Universite de Kinshasa Faculte de Medecine, Kinshasa, Democratic Republic of the Congo
| | | | - Christophe Luhata
- Ecole de Santé Publique, Universite de Kinshasa Faculte de Medecine, Kinshasa, Democratic Republic of the Congo
| | | | - Antoinette Tshefu Kitoto
- Ecole de Santé Publique, Universite de Kinshasa Faculte de Medecine, Kinshasa, Democratic Republic of the Congo
| | - Wim Van Damme
- Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jean Jacques Muyembe
- Direction of the institute, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
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Ciobanu AM, Dumitru AE, Gica N, Botezatu R, Peltecu G, Panaitescu AM. Benefits and Risks of IgG Transplacental Transfer. Diagnostics (Basel) 2020; 10:E583. [PMID: 32806663 PMCID: PMC7459488 DOI: 10.3390/diagnostics10080583] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 12/13/2022] Open
Abstract
Maternal passage of immunoglobulin G (IgG) is an important passive mechanism for protecting the infant while the neonatal immune system is still immature and ineffective. IgG is the only antibody class capable of crossing the histological layers of the placenta by attaching to the neonatal Fc receptor expressed at the level of syncytiotrophoblasts, and it offers protection against neonatal infectious pathogens. In pregnant women with autoimmune or alloimmune disorders, or in those requiring certain types of biological therapy, transplacental passage of abnormal antibodies may cause fetal or neonatal harm. In this review, we will discuss the physiological mechanisms and benefits of transplacental transfer of maternal antibodies as well as pathological maternal situations where this system is hijacked, potentially leading to adverse neonatal outcomes.
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Affiliation(s)
- Anca Marina Ciobanu
- Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania; (A.M.C.); (N.G.); (R.B.); (G.P.)
- Filantropia Clinical Hospital, Bucharest 11171, Romania;
| | | | - Nicolae Gica
- Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania; (A.M.C.); (N.G.); (R.B.); (G.P.)
- Filantropia Clinical Hospital, Bucharest 11171, Romania;
| | - Radu Botezatu
- Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania; (A.M.C.); (N.G.); (R.B.); (G.P.)
- Filantropia Clinical Hospital, Bucharest 11171, Romania;
| | - Gheorghe Peltecu
- Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania; (A.M.C.); (N.G.); (R.B.); (G.P.)
- Filantropia Clinical Hospital, Bucharest 11171, Romania;
| | - Anca Maria Panaitescu
- Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania; (A.M.C.); (N.G.); (R.B.); (G.P.)
- Filantropia Clinical Hospital, Bucharest 11171, Romania;
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19
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Protection by Exclusion: Another Missed Opportunity to Include Pregnant Women in Research During the Coronavirus Disease 2019 (COVID-19) Pandemic. Obstet Gynecol 2020; 136:430. [PMID: 32732762 DOI: 10.1097/aog.0000000000004036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Ryan NE, El Ayadi AM. A call for a gender-responsive, intersectional approach to address COVID-19. Glob Public Health 2020; 15:1404-1412. [DOI: 10.1080/17441692.2020.1791214] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Nessa E. Ryan
- Program in Public Health, University of California, Irvine, CA, USA
- School of Global Public Health, New York University, New York, NY, USA
| | - Alison M. El Ayadi
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
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21
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Engmann C, Fleming JA, Khan S, Innis BL, Smith JM, Hombach J, Sobanjo-Ter Meulen A. Closer and closer? Maternal immunization: current promise, future horizons. J Perinatol 2020; 40:844-857. [PMID: 32341454 PMCID: PMC7223555 DOI: 10.1038/s41372-020-0668-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 12/16/2022]
Abstract
This state-of-the art manuscript highlights our current understanding of maternal immunization-the practice of vaccinating pregnant women to confer protection on them as well as on their young infants, and thereby reduce vaccine-preventable morbidity and mortality. Advances in our understanding of the immunologic processes that undergird a normal pregnancy, studies from vaccines currently available and recommended for pregnant women, and vaccines for administration in special situations are beginning to build the case for safe scale-up of maternal immunization. In addition to well-known diseases, new diseases are emerging which pose threats. Several new vaccines are currently under development and increasingly include pregnant women. In this manuscript, targeted at clinicians, vaccinologists, scientists, public health practitioners, and policymakers, we also outline key considerations around maternal immunization introduction and delivery, discuss noninfectious horizons for maternal immunization, and provide a framework for the clinician faced with immunizing a pregnant woman.
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Affiliation(s)
- Cyril Engmann
- Maternal, Newborn, Child Health and Nutrition, PATH, Seattle, WA, USA.
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.
| | | | - Sadaf Khan
- Maternal, Newborn, Child Health and Nutrition, PATH, Seattle, WA, USA
| | - Bruce L Innis
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
| | - Jeffrey M Smith
- Maternal, Newborn and Child Health, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Joachim Hombach
- Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
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22
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Peyronnet V, Sibiude J, Deruelle P, Huissoud C, Lescure X, Lucet JC, Mandelbrot L, Nisand I, Vayssière C, Yazpandanah Y, Luton D, Picone O. [SARS-CoV-2 infection during pregnancy. Information and proposal of management care. CNGOF]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:436-443. [PMID: 32199996 PMCID: PMC7186548 DOI: 10.1016/j.gofs.2020.03.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Indexed: 02/07/2023]
Abstract
A new coronavirus (SARS-CoV-2) highlighted at the end of 2019 in China is spreading across all continents. Most often at the origin of a mild infectious syndrome, associating mild symptoms (fever, cough, myalgia, headache and possible digestive disorders) to different degrees, SARS-Covid-2 can cause serious pulmonary pathologies and sometimes death. Data on the consequences during pregnancy are limited. The first Chinese data published seem to show that the symptoms in pregnant women are the same as those of the general population. There are no cases of intrauterine maternal-fetal transmission, but cases of newborns infected early suggest that there could be vertical perpartum or neonatal transmission. Induced prematurity and cases of respiratory distress in newborns of infected mothers have been described. Pregnancy is known as a period at higher risk for the consequences of respiratory infections, as for influenza, so it seems important to screen for Covid-19 in the presence of symptoms and to monitor closely pregnant women. In this context of the SARS-Covid-2 epidemic, the societies of gynecology-obstetrics, infectious diseases and neonatalogy have proposed a French protocol for the management of possible and proven cases of SARS-Covid-2 in pregnant women. These proposals may evolve on a daily basis with the advancement of the epidemic and knowledge in pregnant women. Subsequently, an in-depth analysis of cases in pregnant women will be necessary in order to improve knowledge on the subject.
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Affiliation(s)
- V Peyronnet
- Service de gynécologie-obstétrique Colombes, Assistance publique-Hôpitaux de Paris, hôpital Louis-Mourier, université de Paris, 92700 Colombes, France; Infection Control Unit, Bichat University Hospital, Assistance publique-Hôpitaux de Paris, université de Paris, 75018 Paris, France
| | - J Sibiude
- Service de gynécologie-obstétrique Colombes, Assistance publique-Hôpitaux de Paris, hôpital Louis-Mourier, université de Paris, 92700 Colombes, France; Inserm IAME-U1137, 75000 Paris, France; Groupe de recherche sur les infections pendant la grossesse (GRIG), 75000 Paris, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France; Infection Control Unit, Bichat University Hospital, Assistance publique-Hôpitaux de Paris, université de Paris, 75018 Paris, France
| | - P Deruelle
- CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France; Service de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France; Infection Control Unit, Bichat University Hospital, Assistance publique-Hôpitaux de Paris, université de Paris, 75018 Paris, France
| | - C Huissoud
- University Lyon, University Claude-Bernard Lyon 1, 69100 Villeurbanne, France; Hospices civils de Lyon, hôpital de la Croix-Rousse, 69004 Lyon, France; Inserm U846, stem cell and brain research institute, 18, avenue Doyen-Lepine, 69500 Bron, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France; Infection Control Unit, Bichat University Hospital, Assistance publique-Hôpitaux de Paris, université de Paris, 75018 Paris, France
| | - X Lescure
- Inserm IAME-U1137, 75000 Paris, France; Service de maladies infectieuses et tropicales, hôpital Bichat Claude-Bernard, université de Paris, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France; Infection Control Unit, Bichat University Hospital, Assistance publique-Hôpitaux de Paris, université de Paris, 75018 Paris, France
| | - J-C Lucet
- Inserm IAME-U1137, 75000 Paris, France; Infection Control Unit, Bichat University Hospital, Assistance publique-Hôpitaux de Paris, université de Paris, 75018 Paris, France
| | - L Mandelbrot
- Service de gynécologie-obstétrique Colombes, Assistance publique-Hôpitaux de Paris, hôpital Louis-Mourier, université de Paris, 92700 Colombes, France; Inserm IAME-U1137, 75000 Paris, France; Groupe de recherche sur les infections pendant la grossesse (GRIG), 75000 Paris, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France; Infection Control Unit, Bichat University Hospital, Assistance publique-Hôpitaux de Paris, université de Paris, 75018 Paris, France
| | - I Nisand
- CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France; Infection Control Unit, Bichat University Hospital, Assistance publique-Hôpitaux de Paris, université de Paris, 75018 Paris, France
| | - C Vayssière
- Hôpital Paule-de-Viguier, CHU de Toulouse, 31000 Toulouse, France; Équipe SPHERE, Inserm UMR1027, université Toulouse III, 31000 Toulouse, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France; Infection Control Unit, Bichat University Hospital, Assistance publique-Hôpitaux de Paris, université de Paris, 75018 Paris, France
| | - Y Yazpandanah
- Inserm IAME-U1137, 75000 Paris, France; Service de maladies infectieuses et tropicales, hôpital Bichat Claude-Bernard, université de Paris, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France; Infection Control Unit, Bichat University Hospital, Assistance publique-Hôpitaux de Paris, université de Paris, 75018 Paris, France
| | - D Luton
- Service de gynécologie obstétrique, maternité Aline-de-Crepy, FHU Prematurity INSERM U1016, hôpital Bichat APHP, université de Paris, Institut Imagine, 75018 Paris, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France; Infection Control Unit, Bichat University Hospital, Assistance publique-Hôpitaux de Paris, université de Paris, 75018 Paris, France
| | - O Picone
- Service de gynécologie-obstétrique Colombes, Assistance publique-Hôpitaux de Paris, hôpital Louis-Mourier, université de Paris, 92700 Colombes, France; Inserm IAME-U1137, 75000 Paris, France; Groupe de recherche sur les infections pendant la grossesse (GRIG), 75000 Paris, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France; Infection Control Unit, Bichat University Hospital, Assistance publique-Hôpitaux de Paris, université de Paris, 75018 Paris, France.
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23
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Schwartz DA, Dhaliwal A. INFECTIONS IN PREGNANCY WITH COVID-19 AND OTHER RESPIRATORY RNA VIRUS DISEASES ARE RARELY, IF EVER, TRANSMITTED TO THE FETUS: EXPERIENCES WITH CORONAVIRUSES, HPIV, hMPV RSV, AND INFLUENZA. Arch Pathol Lab Med 2020; 144:920-928. [PMID: 32338533 DOI: 10.5858/arpa.2020-0211-sa] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
SARS-CoV-2, the agent of COVID-19, is similar to two other coronaviruses, SARS-CoV and MERS-CoV, in causing life-threatening maternal respiratory infections and systemic complications. Because of global concern for potential intrauterine transmission of SARS-CoV-2 from pregnant women to their infants, this report analyzes the effects on pregnancy of infections caused by SARS-CoV-2 and other respiratory RNA viruses, and examines the frequency of maternal-fetal transmission with SARS-CoV-2, severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), influenza, respiratory syncytial virus (RSV), parainfluenza (HPIV) and metapneumovirus (hMPV). There have been no confirmed cases of intrauterine transmission reported with COVID-19 or any other coronavirus infections. Influenza virus, despite causing approximately one billion annual infections globally, has only a few cases of confirmed or suspected intrauterine fetal infections reported. RSV is in an unusual cause of illness among pregnant women, and with the exception of one premature infant with congenital pneumonia, no other cases of maternal-fetal infection are described. Parainfluenza virus and human metapneumovirus can produce symptomatic maternal infections but do not cause intrauterine fetal infection. In summary, it appears that the absence thus far of maternal-fetal transmission of the SARS-CoV-2 virus during the COVID-19 pandemic is similar to other coronaviruses, and is also consistent with the extreme rarity of suggested or confirmed cases of intrauterine transmission of other respiratory RNA viruses. This observation has important consequences for pregnant women as it appears that if intrauterine transmission of SARSCoV-2 does eventually occur, it will be a rare event. Potential mechanisms of fetal protection from maternal viral infections are also discussed.
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Affiliation(s)
- David A Schwartz
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, GA, USA (Dr. Schwartz); Amareen Dhaliwal, BS, Boston University School of Medicine, Boston, MA, USA (Ms. Dhaliwal)
| | - Amareen Dhaliwal
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, GA, USA (Dr. Schwartz); Amareen Dhaliwal, BS, Boston University School of Medicine, Boston, MA, USA (Ms. Dhaliwal)
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Donders F, Lonnée-Hoffmann R, Tsiakalos A, Mendling W, Martinez de Oliveira J, Judlin P, Xue F, Donders GGG. ISIDOG Recommendations Concerning COVID-19 and Pregnancy. Diagnostics (Basel) 2020; 10:E243. [PMID: 32338645 PMCID: PMC7235990 DOI: 10.3390/diagnostics10040243] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 12/15/2022] Open
Abstract
Providing guidelines to health care workers during a period of rapidly evolving viral pandemic infections is not an easy task, but it is extremely necessary in order to coordinate appropriate action so that all patients will get the best possible care given the circumstances they are in. With these International Society of Infectious Disease in Obstetrics and Gynecology (ISIDOG) guidelines we aim to provide detailed information on how to diagnose and manage pregnant women living in a pandemic of COVID-19. Pregnant women need to be considered as a high-risk population for COVID-19 infection, and if suspected or proven to be infected with the virus, they require special care in order to improve their survival rate and the well-being of their babies. Both protection of healthcare workers in such specific care situations and maximal protection of mother and child are envisioned.
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Affiliation(s)
| | | | - Aristotelis Tsiakalos
- Department Ob/Gyn, LETO Obstetrician Gynecological & Surgical Center, 11525 Athens, Greece;
| | - Werner Mendling
- German Center for Infections in Gynecology and Obstetrics, 42283 Wuppertal, Germany;
| | | | - Philippe Judlin
- Department OB/Gyn, CHU De Nancy—Université de Lorraine, 54000 Nancy, France;
| | - Fengxia Xue
- Department OB/Gyn, Tianjin Medical University General Hospital, Tianjin 30000, China;
| | - Gilbert G. G. Donders
- Femicare VZW Clinical Research for Women, 3300 Tienen, Belgium;
- Department Ob/Gyn, University Hospital Antwerp, 2650 Ekeren, Belgium
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Schwartz DA, Graham AL. Potential Maternal and Infant Outcomes from (Wuhan) Coronavirus 2019-nCoV Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections. Viruses 2020; 12:v12020194. [PMID: 32050635 PMCID: PMC7077337 DOI: 10.3390/v12020194] [Citation(s) in RCA: 579] [Impact Index Per Article: 144.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 02/09/2020] [Accepted: 02/09/2020] [Indexed: 12/16/2022] Open
Abstract
In early December 2019 a cluster of cases of pneumonia of unknown cause was identified in Wuhan, a city of 11 million persons in the People’s Republic of China. Further investigation revealed these cases to result from infection with a newly identified coronavirus, initially termed 2019-nCoV and subsequently SARS-CoV-2. The infection moved rapidly through China, spread to Thailand and Japan, extended into adjacent countries through infected persons travelling by air, eventually reaching multiple countries and continents. Similar to such other coronaviruses as those causing the Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS), the new coronavirus was reported to spread via natural aerosols from human-to-human. In the early stages of this epidemic the case fatality rate is estimated to be approximately 2%, with the majority of deaths occurring in special populations. Unfortunately, there is limited experience with coronavirus infections during pregnancy, and it now appears certain that pregnant women have become infected during the present 2019-nCoV epidemic. In order to assess the potential of the Wuhan 2019-nCoV to cause maternal, fetal and neonatal morbidity and other poor obstetrical outcomes, this communication reviews the published data addressing the epidemiological and clinical effects of SARS, MERS, and other coronavirus infections on pregnant women and their infants. Recommendations are also made for the consideration of pregnant women in the design, clinical trials, and implementation of future 2019-nCoV vaccines.
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Affiliation(s)
- David A. Schwartz
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Correspondence:
| | - Ashley L. Graham
- Department of Anthropology, University of Connecticut, Storrs, CT 06269, USA;
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