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Limaye RJ, Singh P, Fesshaye B, Lee C, Schue J, Karron RA. "Why has this new vaccine come and for what reasons?" key antecedents and questions for acceptance of a future maternal GBS vaccine: Perspectives of pregnant women, lactating women, and community members in Kenya. Hum Vaccin Immunother 2024; 20:2314826. [PMID: 38345050 PMCID: PMC10863339 DOI: 10.1080/21645515.2024.2314826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/02/2024] [Indexed: 02/15/2024] Open
Abstract
Group B streptococcus (GBS) is a leading global cause of neonatal sepsis and meningitis, stillbirth, and puerperal sepsis. While intrapartum antibiotic prophylaxis (IAP) is a currently available GBS disease prevention strategy, IAP is programmatically complex to implement, precluding use in low- and middle-income countries. In Kenya, 2% of stillbirths are attributable to GBS infection. Two maternal GBS vaccines are in late-stage clinical development. However, licensure of a maternal GBS vaccine does not translate into reduction of disease. We conducted 28 in-depth interviews with pregnant people, lactating people, and community members across two counties in Kenya to better understand the attitudes and informational needs of primary vaccine beneficiaries. We identified two emerging themes from the data. The first focused on antecedents to maternal GBS vaccine acceptability. The most common antecedents focused on the vaccine's ability to protect the baby and/or the mother, followed by community sensitization before the vaccine was available. The second key theme focused on questions that would need to be addressed before someone could accept a maternal GBS vaccine. Three key categories of questions were identified, including vaccine safety compared to vaccine benefits, who gets the vaccine, and how the vaccine works. Realizing the potential benefits of a future GBS maternal vaccine will require a multifactorial approach, including ensuring that communities are aware of GBS-related harms as well as the safety and effectiveness of a maternal GBS vaccine. Our study contributes to informing this multifactorial approach by elucidating the attitudes and concerns of key populations.
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Affiliation(s)
- Rupali J. Limaye
- Department of International Health, Department of Epidemiology, Department of Health, Behavior & Society, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Prachi Singh
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Berhaun Fesshaye
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Clarice Lee
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jessica Schue
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ruth A. Karron
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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González R, Nhampossa T, Mombo-Ngoma G, Mischlinger J, Esen M, Tchouatieu AM, Mendes A, Figueroa-Romero A, Zoleko-Manego R, Lell B, Lagler H, Stoeger L, Dimessa LB, El Gaaloul M, Sanz S, Méndez S, Piqueras M, Sevene E, Ramharter M, Saúte F, Menendez C. Safety and efficacy of dihydroartemisinin-piperaquine for intermittent preventive treatment of malaria in pregnant women with HIV from Gabon and Mozambique: a randomised, double-blind, placebo-controlled trial. Lancet Infect Dis 2024; 24:476-487. [PMID: 38224706 DOI: 10.1016/s1473-3099(23)00738-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND The cornerstone of malaria prevention in pregnancy, intermittent preventive treatment (IPTp) with sulfadoxine-pyrimethamine, is contraindicated in women with HIV who are receiving co-trimoxazole prophylaxis. We assessed whether IPTp with dihydroartemisinin-piperaquine is safe and effective in reducing the risk of malaria infection in women with HIV receiving co-trimoxazole prophylaxis and antiretroviral drugs. METHODS For this randomised, double-blind, placebo-controlled clinical trial, women with HIV attending the first antenatal care clinic visit, resident in the study area, and with a gestational age up to 28 weeks were enrolled at five sites in Gabon and Mozambique. Participants were randomly assigned (1:1) to receive either IPTp with dihydroartemisinin-piperaquine at each scheduled antenatal care visit plus daily co-trimoxazole (intervention group) or placebo at each scheduled antenatal care visit plus daily co-trimoxazole (control group). Randomisation was done centrally via block randomisation (block sizes of eight), stratified by country. IPTp was given over 3 days under direct observation by masked study personnel. The number of daily IPTp tablets was based on bodyweight and according to the treatment guidelines set by WHO (target dose of 4 mg/kg per day [range 2-10 mg/kg per day] of dihydroartemisinin and 18 mg/kg per day [range 16-27 mg/kg per day] of piperaquine given once a day for 3 days). At enrolment, all participants received co-trimoxazole (fixed combination drug containing 800 mg trimethoprim and 160 mg sulfamethoxazole) for daily intake. The primary study outcome was prevalence of peripheral parasitaemia detected by microscopy at delivery. The modified intention-to-treat population included all randomly assigned women who had data for the primary outcome. Secondary outcomes included frequency of adverse events, incidence of clinical malaria during pregnancy, and frequency of poor pregnancy outcomes. All study personnel, investigators, outcome assessors, data analysts, and participants were masked to treatment assignment. This study is registered with ClinicalTrials.gov, NCT03671109. FINDINGS From Sept 18, 2019, to Nov 26, 2021, 666 women (mean age 28·5 years [SD 6·4]) were enrolled and randomly assigned to the intervention (n=332) and control (n=334) groups. 294 women in the intervention group and 308 women in the control group had peripheral blood samples taken at delivery and were included in the primary analysis. Peripheral parasitaemia at delivery was detected in one (<1%) of 294 women in the intervention group and none of 308 women in the control group. The incidence of clinical malaria during pregnancy was lower in the intervention group than in the control group (one episode in the intervention group vs six in the control group; relative risk [RR] 0·12, 95% CI 0·03-0·52, p=0·045). In a post-hoc analysis, the composite outcome of overall malaria infection (detected by any diagnostic test during pregnancy or delivery) was lower in the intervention group than in the control group (14 [5%] of 311 women vs 31 [10%] of 320 women; RR 0·48, 95% CI 0·27-0·84, p=0·010). The frequency of serious adverse events and poor pregnancy outcomes (such as miscarriages, stillbirths, premature births, and congenital malformations) did not differ between groups. The most frequently reported drug-related adverse events were gastrointestinal disorder (reported in less than 4% of participants) and headache (reported in less than 2% of participants), with no differences between study groups. INTERPRETATION In the context of low malaria transmission, the addition of IPTp with dihydroartemisinin-piperaquine to co-trimoxazole prophylaxis in pregnant women with HIV did not reduce peripheral parasitaemia at delivery. However, the intervention was safe and associated with a decreased risk of clinical malaria and overall Plasmodium falciparum infection, so it should be considered as a strategy to protect pregnant women with HIV from malaria. FUNDING European and Developing Countries Clinical Trials Partnership 2 (EDCTP2) and Medicines for Malaria Venture. TRANSLATIONS For the Portuguese and French translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Raquel González
- Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain.
| | - Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique
| | - Ghyslain Mombo-Ngoma
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon; Center for Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I Dept of Medicine University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Johannes Mischlinger
- Center for Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I Dept of Medicine University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Meral Esen
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon; German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany; Institut für Tropenmedizin, Eberhard Karls University of Tübingen, Tübingen, Germany; Cluster of Excellence EXC 2124 Controlling Microbes to Fight Infection, Tübingen, Germany
| | | | - Anete Mendes
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique
| | - Antía Figueroa-Romero
- Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | | | - Bertrand Lell
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon; Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Heimo Lagler
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Linda Stoeger
- Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | | | | | - Sergi Sanz
- Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain; Department of Basic Clinical Practice, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Susana Méndez
- Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Mireia Piqueras
- Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Esperança Sevene
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique; Department of Physiological Science, Clinical Pharmacology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Michael Ramharter
- Center for Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I Dept of Medicine University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Francisco Saúte
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique
| | - Clara Menendez
- Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
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Hackett C, Frank L, Heldt-Werle L, Loosier PS. Provider-Reported Barriers in Sexual Health Care Services for Women With Upstream Barriers: The Case of Syphilis and Congenital Syphilis in Southern Colorado, 2022. Sex Transm Dis 2024; 51:337-341. [PMID: 38301636 PMCID: PMC11018457 DOI: 10.1097/olq.0000000000001936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Syphilis and congenital syphilis rates have increased sharply in Colorado in the past 5 years. Congenital syphilis is passed during pregnancy in utero and can cause lifelong physical, developmental, and neurologic problems for the child, or can lead to miscarriage, stillbirth, or early infant death. Congenital syphilis is easily prevented if the mother receives timely testing, treatment, and prenatal care. Providers can play a key role in preventing congenital syphilis for women with social vulnerabilities, who have a higher likelihood of syphilis and/or congenital syphilis infection. METHODS We surveyed 23 and interviewed 4 health care providers in southern Colorado in 2022 to record their experiences in providing sexual health care services. We asked providers with direct care experience about perceived barriers in effectively treating syphilis. RESULTS The most significant barriers reported in the survey were the cost of treatment (26%) and the loss to follow-up (22%). Interviews revealed further challenges, including discretionary testing procedures, delays in screening results, treatment referral issues, and stigma around substance use and sexual activity. CONCLUSIONS Elevated syphilis and congenital syphilis rates pose significant public health challenges. Coordinated interventions are necessary to effectively reduce the transmission of syphilis and congenital syphilis among women with upstream barriers. Potential care solutions include expanding rapid, point-of care testing and treatment options, supporting bicillin delivery or web-based inventory systems, offering anti-stigma training for providers, offering mental and behavioral health resources at providers' clinics, and expanding partnerships with syringe access programs.
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Affiliation(s)
- Colleen Hackett
- From the Department of Criminology and Criminal Justice, Northern Arizona University, Flagstaff, AZ
| | - Leslie Frank
- Office of STI, HIV and Viral Hepatitis Colorado Department of Public Health and Environment, Denver, CO
| | - Lindsey Heldt-Werle
- Office of STI, HIV and Viral Hepatitis Colorado Department of Public Health and Environment, Denver, CO
| | - Penny S Loosier
- Division of STD Prevention Centers for Disease Control and Prevention, Atlanta, GA
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Lyimo A, Mmbaga B, Mahmoud A, Eliamini WS, Ngowi NB, Mitao M, Pancras G, Malindisa E, Kidayi P, Conserve DF, Bartlett J, Sunguya B, Lyamuya E, Kidenya B, Balandya E, Ngocho JS. Efficacy of mobile phone intervention to increase male partner antenatal care attendance for HIV testing in Moshi municipal, Tanzania: a randomized controlled trial. BMC Pregnancy Childbirth 2024; 24:306. [PMID: 38658860 PMCID: PMC11040948 DOI: 10.1186/s12884-024-06337-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/08/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND HIV partner counselling and testing in antenatal care (ANC) is a crucial strategy to raise the number of males who know their HIV status. However, in many settings like Tanzania, male involvement in antenatal care remains low, and there is a definite need for innovative strategies to increase male partner involvement. This study was designed to evaluate the efficacy of mobile phone intervention increase male partner ANC attendance for HIV testing in Moshi municipal, Tanzania. METHODS Between April and July 2022, we enrolled pregnant women presenting to a first ANC visit at Majengo and St. Joseph reproductive health facilities without their male partners. Eligible pregnant women were randomly assigned to invitation of their male partners either via phone calls, text messages from clinic staff and verbal invites from pregnant partners (intervention arm) or verbal invites only from the pregnant partners (control arm). Neither healthcare provider nor participant were blinded. The primary outcome was the proportion of male partners who attended ANC with their pregnant partners during a follow-up period of two consecutive visits. The secondary outcome measure was HIV testing among male partners following the invitation. Participants were analyzed as originally assigned (intention to treat). RESULTS A total of 350 pregnant women presenting to ANC for the first time were enrolled, with 175 women enrolled in each arm. The efficacy of male attendance with their pregnant women following the invitations was 83.4% (147/175) in the intervention arm and 46.3% (81/175) in the control arm. Overall, the results suggest a positive and statistically significant average treatment effect among men who received mobile phone intervention on ANC attendance. For the secondary outcome, the percent of male partners who accepted HIV counselling and testing was 99.3% (146/147) in the intervention arm and 93.8% (76/81) in the control arm. Married men were having higher odds of ANC attendance compared with single men (aOR:6.40(3.26-12.56), Males with multigravida women were having lower odds of ANC attendance compared with primigravida women (aOR:0.17(0.09-0.33). CONCLUSION The study demonstrates that supplementing verbal invitations with mobile phone calls and text messages from clinic staff can significantly increase male partner ANC attendance and HIV testing. This combined approach is recommended in improving ANC attendance and HIV testing of male partners who do not accompany their pregnant partners to antenatal clinics in the first visits. TRIAL REGISTRATION PACTR202209769991162.
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Affiliation(s)
- Angela Lyimo
- Faculty of Nursing, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania.
| | - Blandina Mmbaga
- Kilimanjaro Clinical Research Institute, Box 2236, Moshi, Tanzania
| | - Ashraf Mahmoud
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania
| | - Wilson Saimon Eliamini
- Faculty of Nursing, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania
| | | | - Modesta Mitao
- Kilimanjaro Clinical Research Institute, Box 2236, Moshi, Tanzania
| | - Godwin Pancras
- Muhimbili University of Health and Allied Science, Box 65001, Dar es Salam, Tanzania
| | | | - Paulo Kidayi
- Faculty of Nursing, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania
| | - Donaldson F Conserve
- Milken Institute of Public Health, The George Washington University, Washington, DC, USA
| | | | - Bruno Sunguya
- Muhimbili University of Health and Allied Science, Box 65001, Dar es Salam, Tanzania
| | - Eligius Lyamuya
- Muhimbili University of Health and Allied Science, Box 65001, Dar es Salam, Tanzania
| | - Benson Kidenya
- Catholic University of Health and Allied Science, Box 1464, Mwanza, Tanzania
| | - Emmanuel Balandya
- Muhimbili University of Health and Allied Science, Box 65001, Dar es Salam, Tanzania
| | - James Samwel Ngocho
- Department of Epidemiology and Applied Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania
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Amone A, Gabagaya G, Wavamunno P, Rukundo G, Namale-Matovu J, Malamba SS, Lubega I, Homsy J, King R, Nakabiito C, Namukwaya Z, Fowler MG, Musoke P. Enhanced peer-group strategies to support the prevention of mother-to-child HIV transmission leads to increased retention in care in Uganda: A randomized controlled trial. PLoS One 2024; 19:e0297652. [PMID: 38640123 PMCID: PMC11029615 DOI: 10.1371/journal.pone.0297652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 01/09/2024] [Indexed: 04/21/2024] Open
Abstract
INTRODUCTION Despite the scale-up of Option B+, long-term retention of women in HIV care during pregnancy and the postpartum period remains an important challenge. We compared adherence to clinic appointments and antiretroviral therapy (ART) at 6 weeks, 6, and and 24 months postpartum among pregnant women living with HIV and initiating Option B+. Women were randomized to a peer group support, community-based drug distribution and income-generating intervention called "Friends for Life Circles" (FLCs) versus the standard of care (SOC). Our secondary outcome was infant HIV status and HIV-free survival at 6 weeks and 18 months postpartum. METHODS Between 16 May 2016 and 12 September 2017, 540 ART-naïve pregnant women living with HIV at urban and rural health facilities in Uganda were enrolled in the study at any gestational age. Participants were randomized 1:1 to the unblinded FLC intervention or SOC at enrolment and assessed for adherence to the prevention of mother-to-child HIV transmission (PMTCT) clinic appointments at 6 weeks, 12, and 24 months postpartum, self-reported adherence to ART at 6 weeks, 6 and 24 months postpartum and supported by plasma HIV-1 RNA viral load (VL) measured at the same time points, retention in care through the end of study, and HIV status and HIV-free survival of infants at 18 months postpartum. The FLC groups were formed during pregnancy within 4 months of enrollment and held monthly meetings in their communites, and were followed up until the last group participant reached 24 months post delivery. We used Log-rank and Chi-Square p-values to test the equality of Kaplan-Meier survival probabilities and hazard rates (HR) for failure to retain in care for any reason by study arm. RESULTS There was no significant difference in adherence to PMTCT clinic visits or to ART or in median viral loads between FLC and SOC arms at any follow-up time points. Retention in care through the end of study was high in both arms but significantly higher among participants randomized to FLC (86.7%) compared to SOC (79.3%), p = 0.022. The adjusted HR of visit dropout was 2.4 times greater among participants randomized to SOC compared to FLC (aHR = 2.363, 95% CI: 1.199-4.656, p = 0.013). Median VL remained < 400 copies/ml in both arms at 6 weeks, 6, and 24 months postpartum. Eight of the 431 infants tested at 18 months were HIV positive (1.9%), however, this was not statistically different among mothers enrolled in the FLC arm compared to those in the SOC arm. At 18 months, HIV-free survival of children born to mothers in the FLC arm was significantly higher than that of children born to mothers in the SOC arm. CONCLUSIONS Our findings suggest that programmatic interventions that provide group support, community-based ART distribution, and income-generation activities may contribute to retention in PMTCT care, HIV-free survival of children born to women living with HIV, and ultimately, to the elimination of mother-to-child HIV transmission (EMTCT). TRIAL REGISTRATION NCT02515370 (04/08/2015) on ClinicalTrials.gov.
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Affiliation(s)
- Alexander Amone
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Grace Gabagaya
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Priscilla Wavamunno
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Gordon Rukundo
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Joyce Namale-Matovu
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | - Irene Lubega
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Jaco Homsy
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Rachel King
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Clemensia Nakabiito
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Zikulah Namukwaya
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Mary Glenn Fowler
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Philippa Musoke
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
- Department of Pediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
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Tegueni K, Gbeasor-Komlanvi FA, Adama OIW, Sadio AJ, Amenyah-Ehlan AP, Dagnra CA, Ekouevi DK. Epidemiological and virological surveillance of the prevention of mother-to-child transmission of HIV among pregnant women in Togo. BMC Pregnancy Childbirth 2024; 24:278. [PMID: 38622544 PMCID: PMC11017652 DOI: 10.1186/s12884-024-06435-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 03/18/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND In 2015, Togo introduced the "test-and-treat" strategy for the prevention of mother-to-child transmission (PMTCT) of HIV. Pediatric HIV infection remains a public health problem in Togo, with a mother-to-child transmission (MTCT) rate of 3.6% in 2020. This study aimed to estimate cases of HIV seroconversion during pregnancy and to identify pregnant women at high risk of transmitting HIV to their children in Lomé, Togo. METHODS A descriptive cross-sectional study was carried out from 18 March to 22 May 2022 among women who had given birth in five maternity units providing PMTCT services in Lomé. Umbilical cord blood samples were taken from the maternal side by midwives after delivery. HIV serology was performed in the laboratory using the Alere™ HIV Combo SET and First Response HIV 1-2. Card Test version 2.0. A sample was considered positive if both tests were positive. The HIV-1 viral load in HIV-1-positive samples was measured using Cobas/Roche 4800 equipment. Information on the women was extracted from maternal antenatal records and antenatal consultation registers. RESULTS A total of 3148 umbilical cord blood samples (median maternal age: 28 years (interquartile range [24-32]) were collected. Among them, 99.3% (3145/3148) had presented for at least one antenatal clinic visit before giving birth, and 78.7% (2456/3122) had presented for at least four visits. One hundred and twenty-one (121) cord samples were HIV-1 positive, representing a seroprevalence of 3.8% (95% CI = [3.2-4.6]). Among them, 67.8% (82/121) were known HIV-positive before the current pregnancy, 29.7 (36/121) were diagnosed as HIV-positive at the antenatal visits and 2.5% (3/121) were diagnosed as HIV-positive in the delivery room. Of the HIV-positive women, 85.9% (104/121) were on ARV treatment before delivery. The viral load was < 1000 copies/ml in 97.5% (118/121) cases. CONCLUSION This study explored the virologic and epidemiological aspects of HIV among pregnant women in Togo. The results show significant viral suppression at delivery in women ART. Surveillance based on umbilical cord blood specimen screening is an interesting approach for monitoring the effectiveness of PMTCT programmes.
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Affiliation(s)
- Kokou Tegueni
- Département des Sciences Fondamentales, Laboratoire de Biologie Moléculaire et d'Immunologie (BIOLIM- FSS/UL), Université de Lomé, Lomé, Togo
- Programme National de Lutte contre le VIH/Sida, les Hépatites virales et les Infections Sexuellement Transmissibles (PNLS/HV/IST), Lomé, Togo
- Laboratoire National de Référence pour tests VIH, les Hépatites virales et les Infections Sexuellement Transmissibles (LNR/HV/IST), Lomé, Togo
| | - Fifonsi Adjidossi Gbeasor-Komlanvi
- Département de Santé Publique, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo
- Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
| | - Oumarou I Wone Adama
- Département de Santé Publique, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo
- Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
| | - Arnold Junior Sadio
- Département de Santé Publique, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo
- Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
| | - Amivi Phyllis Amenyah-Ehlan
- Département des Sciences Fondamentales, Laboratoire de Biologie Moléculaire et d'Immunologie (BIOLIM- FSS/UL), Université de Lomé, Lomé, Togo
- Programme National de Lutte contre le VIH/Sida, les Hépatites virales et les Infections Sexuellement Transmissibles (PNLS/HV/IST), Lomé, Togo
- Laboratoire National de Référence pour tests VIH, les Hépatites virales et les Infections Sexuellement Transmissibles (LNR/HV/IST), Lomé, Togo
| | - Claver Anoumou Dagnra
- Département des Sciences Fondamentales, Laboratoire de Biologie Moléculaire et d'Immunologie (BIOLIM- FSS/UL), Université de Lomé, Lomé, Togo
- Programme National de Lutte contre le VIH/Sida, les Hépatites virales et les Infections Sexuellement Transmissibles (PNLS/HV/IST), Lomé, Togo
- Laboratoire National de Référence pour tests VIH, les Hépatites virales et les Infections Sexuellement Transmissibles (LNR/HV/IST), Lomé, Togo
| | - Didier Koumavi Ekouevi
- Département de Santé Publique, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo.
- Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo.
- Global Health in the Global South (GHiGS) Team, Bordeaux Population Health Research Center, University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux, France.
- Institut de Santé Publique Epidémiologie Développement (ISPED), Université de Bordeaux, Bordeaux, France.
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Engjom HM, Ramakrishnan R, Vousden N, Bunch K, Morris E, Simpson N, Gale C, O'Brien P, Quigley M, Brocklehurst P, Kurinczuk JJ, Knight M. Perinatal outcomes after admission with COVID-19 in pregnancy: a UK national cohort study. Nat Commun 2024; 15:3234. [PMID: 38622110 PMCID: PMC11018846 DOI: 10.1038/s41467-024-47181-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/22/2024] [Indexed: 04/17/2024] Open
Abstract
There are few population-based studies of sufficient size and follow-up duration to have reliably assessed perinatal outcomes for pregnant women hospitalised with SARS-CoV-2 infection. The United Kingdom Obstetric Surveillance System (UKOSS) covers all 194 consultant-led UK maternity units and included all pregnant women admitted to hospital with an ongoing SARS-CoV-2 infection. Here we show that in this large national cohort comprising two years' active surveillance over four SARS-CoV-2 variant periods and with near complete follow-up of pregnancy outcomes for 16,627 included women, severe perinatal outcomes were more common in women with moderate to severe COVID-19, during the delta dominant period and among unvaccinated women. We provide strong evidence to recommend continuous surveillance of pregnancy outcomes in future pandemics and to continue to recommend SARS-CoV-2 vaccination in pregnancy to protect both mothers and babies.
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Affiliation(s)
- Hilde Marie Engjom
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
- Division of Physical and Mental Health, Norwegian Institute of Public Health, 5015, Bergen, Norway
| | - Rema Ramakrishnan
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Nicola Vousden
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Kathryn Bunch
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Edward Morris
- Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - Nigel Simpson
- Department of Women's and Children's Health, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, London, London, UK, SW7 2BX and Centre for Paediatrics and Child Health, Imperial College, London, SW7 2AZ, UK
| | - Pat O'Brien
- Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
- Institute for Women's Health, University College London, London, UK
| | - Maria Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK.
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8
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Torimiro JNE, Duri K, Goumkwa NM, Atah SM, Ndzie Ondigui JL, Lobe C, Bouyou M, Ndeboko B, Mahamat Moussa A, Police C, Awoumou P, Peyonga P, Djivida PV, Felix A, Nchinda GW, Wandji B, Simo RK, Agnès Moudourou S, Gutierrez A, Garcia R, Fernandez I, Mah E, Rowland-Jones S, Mbu R. Toward the elimination of hepatitis B: networking to promote the prevention of vertical transmission of hepatitis B virus through population-based interventions and multidisciplinary groups in Africa. Front Public Health 2024; 12:1283350. [PMID: 38645447 PMCID: PMC11026850 DOI: 10.3389/fpubh.2024.1283350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/16/2024] [Indexed: 04/23/2024] Open
Abstract
The WHO African Region had 81 million people with chronic hepatitis B in 2019, which remains a silent killer. Hepatitis B virus (HBV), hepatitis delta virus (HDV), and HIV can be transmitted from the mother to child. If the HBV infection is acquired at infancy, it may lead to chronic hepatitis B in 90% of the cases. WHO reports that 6.4 million children under 5 years live with chronic hepatitis B infection worldwide. The prevention of mother-to-child transmission (PMTCT) of HBV is therefore critical in the global elimination strategy of viral hepatitis as we take lessons from PMTCT of HIV programs in Africa. We sought to create a network of multidisciplinary professional and civil society volunteers with the vision to promote cost-effective, country-driven initiatives to prevent the MTCT of HBV in Africa. In 2018, the Mother-Infant Cohort Hepatitis B Network (MICHep B Network) with members from Cameroon, Zimbabwe, and the United Kingdom and later from Chad, Gabon, and Central African Republic was created. The long-term objectives of the network are to organize capacity-building and networking workshops, create awareness among pregnant women, their partners, and the community, promote the operational research on MTCT of HBV, and extend the network activities to other African countries. The Network organized in Cameroon, two "Knowledge, Attitude and Practice" (KAP) surveys, one in-depth interview of 45 health care workers which revealed a high acceptability of the hepatitis B vaccine by families, two in-person workshops in 2018 and 2019, and one virtual in 2021 with over 190 participants, as well as two workshops on grant writing, bioethics, and biostatistics of 30 postgraduate students. Two HBV seroprevalence studies in pregnant women were conducted in Cameroon and Zimbabwe, in which a prevalence of 5.8% and 2.7%, respectively, was reported. The results and recommendations from the MICHep B Network activities could be implemented in countries of the MICHep B Network and beyond, with the goal of providing free birth dose vaccine against hepatitis B in Africa.
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Affiliation(s)
- Judith Ndongo Embola Torimiro
- Molecular Biology Laboratory, Chantal BIYA International Reference Center for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
- Department of Biochemistry, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Kerina Duri
- Department of Immunology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Nadège M. Goumkwa
- Molecular Biology Laboratory, Chantal BIYA International Reference Center for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
| | - Solange M. Atah
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Cindy Lobe
- Molecular Biology Laboratory, Chantal BIYA International Reference Center for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
- Department of Food Science and Nutrition, University of Ngaoundere, Ngaoundere, Cameroon
| | - Marielle Bouyou
- Department of Parasitology, Mycology and Tropical Medicine, University of Health Sciences, Libreville, Gabon
| | - Bénédicte Ndeboko
- Department of Cell and Molecular Biology-Genetics, Faculty of Medicine, University of Health Sciences, Libreville, Gabon
- Centre Hospitalier Universitaire Mère-Enfant de la Fondation Jeanne EBORI (CHUMEFJE), Libreville, Gabon
| | - Ali Mahamat Moussa
- Gastroenterology and Internal Medicine Unit, University Reference Hospital, Gamena, Chad
| | - Camengo Police
- Department of Hepato-Gastroenterology and Internal Medicine of “Amitié Sino Centrafraine”, University Hospital Center, Bangui, Central African Republic
| | - Patrick Awoumou
- Molecular Biology Laboratory, Chantal BIYA International Reference Center for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
- Department of Biochemistry, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Puinta Peyonga
- Department of Biochemistry, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Prisca V. Djivida
- Department of Biochemistry, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Assah Felix
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Godwin W. Nchinda
- Vaccinology Laboratory, Chantal BIYA International Reference Center for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
| | - Brigitte Wandji
- Yaoundé Gynaecology, Obstetrics and Pediatrics Hospital, Yaoundé, Cameroon
| | - Rachel K. Simo
- Clinical Diagnostic Laboratory, Chantal BIYA International Reference Center for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
| | - Sylvie Agnès Moudourou
- Medical Unit, Chantal BIYA International Reference Center for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
| | | | - Rosi Garcia
- Bikop Catholic Health Center, Bikop, Cameroon
| | | | - Evelyn Mah
- Yaoundé Gynaecology, Obstetrics and Pediatrics Hospital, Yaoundé, Cameroon
- Department of Paediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Sarah Rowland-Jones
- Molecular Biology Laboratory, Chantal BIYA International Reference Center for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
- Nuffield Department of Medicine, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Robinson Mbu
- Yaoundé Gynaecology, Obstetrics and Pediatrics Hospital, Yaoundé, Cameroon
- Department of Gynaecology and Obstetrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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Copiz GI, Ibañez C, Piñera C, Cordova L, Payá E, Leal P, Villena R. Outcome of Infants Born to Women with Chronic Hepatitis B: A Local Risk-Based Strategy in a Low Prevalence Country. Matern Child Health J 2024; 28:767-774. [PMID: 38358537 DOI: 10.1007/s10995-024-03909-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Chronic hepatitis-B virus (HBV) infection due to mother-to-child transmission (MTCT) during the perinatal period is an important global health concern. Chile is a low-prevalence country with an increasing migratory inflow from Latin- American countries, with intermediate to high endemic rates of HBV infection, and until 2021, there is no universal maternal screening. This study aimed to evaluate infant outcomes using a risk-based strategy of maternal screening to prevent MTCT of hepatitis B virus (HBV) in a low-prevalence country. METHODS This prospective study included infants born to HBsAg-positive women detected using a local risk-based strategy. The exposed infants received immunoprophylaxis (IP) and follow-up to evaluate their clinical outcomes and immune responses through post-serological vaccine testing (PSVT) after completing the three- dose schedule of the HBV vaccine. RESULTS A total of 99 HBsAg-positive mothers were detected. Seventy-six (82%) infants completed the follow-up and had PSVT between 9 and 12 months of age. 55.2% female, the median gestational age was 39 weeks (25-41) and the median birth weight was 3,130g (816-4,400 g). All patients received IP with recombinant HBV vaccine plus hepatitis-B virus immunoglobulin (HBIG) and three doses of the HBV vaccine. There were no cases of HBV infection, and 96% (72) responded to immunization with HBsAg antibodies (anti-HBsAg) >10 UI/ml, with a median level of 799 IU/ml. CONCLUSIONS A high-risk strategy can be implemented in countries with non-universal screening for VHB. Timely IP plus high-uptake VHB vaccination in infants born to HBsAg-positive mothers was associated with a high immunogenic response and absence of MTCT.
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Affiliation(s)
- Giannina Izquierdo Copiz
- Department of Pediatrics, Faculty of Medicine, Universidad de Chile, Santiago, Chile.
- Maternity Ward and Neonatal Intensive Care Unit, Complejo Asistencial Barros Luco, Santiago, Chile.
- Infectious Diseases Unit, Hospital de niños Dr. Exequiel González Cortés, Santiago, Chile.
| | - Carolina Ibañez
- Department of Pediatrics, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Department of Pediatrics, Hospital Dr. Luis Calvo Mackenna, Santiago, Chile
| | - Cecilia Piñera
- Department of Pediatrics, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Infectious Diseases Unit, Hospital de niños Dr. Exequiel González Cortés, Santiago, Chile
| | - Luis Cordova
- Department of Pediatrics, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Infectious Diseases Unit, Hospital de niños Dr. Exequiel González Cortés, Santiago, Chile
| | - Ernesto Payá
- Department of Pediatrics, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Infectious Diseases Unit, Hospital de niños Dr. Exequiel González Cortés, Santiago, Chile
| | - Paula Leal
- Infection Control Department, Hospital de niños Dr. Exequiel González Cortés, Santiago, Chile
| | - Rodolfo Villena
- Department of Pediatrics, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Infectious Diseases Unit, Hospital de niños Dr. Exequiel González Cortés, Santiago, Chile
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Badell ML, Prabhu M, Dionne J, Tita ATN, Silverman NS. Society for Maternal-Fetal Medicine Consult Series #69: Hepatitis B in pregnancy: updated guidelines. Am J Obstet Gynecol 2024; 230:B2-B11. [PMID: 38141870 DOI: 10.1016/j.ajog.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2023]
Abstract
More than 290 million people worldwide, and almost 2 million people in the United States, are infected with hepatitis B virus, which can lead to chronic hepatitis B, a vaccine-preventable communicable disease. The prevalence of chronic hepatitis B infection in pregnancy is estimated to be 0.7% to 0.9% in the United States, with >25,000 infants born annually at risk for chronic infection due to perinatal transmission. Given the burden of disease associated with chronic hepatitis B infection, recent national guidance has expanded both the indications for screening for hepatitis B infection and immunity and the indications for vaccination. The purpose of this document is to aid clinicians caring for pregnant patients in screening for hepatitis B infection and immunity status, discuss the perinatal risks of hepatitis B infection in pregnancy, determine whether treatment is indicated for maternal or perinatal indications, and recommend hepatitis B vaccination among susceptible patients. The following are the Society for Maternal-Fetal Medicine recommendations: (1) we recommend triple-panel testing (hepatitis B surface antigen screening, antibody to hepatitis B surface antigen, and total antibody to hepatitis B core antigen) at the initial prenatal visit if not previously documented or known to have been performed (GRADE 1C); (2) we recommend universal hepatitis B surface antigen screening alone at the initial prenatal care visit for all pregnancies where there has been a previously documented negative triple-panel test (GRADE 1B); (3) we recommend that individuals with unknown hepatitis B surface antigen screening status be tested on any presentation for care in pregnancy; we also recommend that those with clinical hepatitis or those with risk factors for acute hepatitis B infection be tested at the time of admission to a birthing facility when delivery is anticipated (GRADE 1B); (4) we do not recommend altering routine intrapartum care in individuals chronically infected with hepatitis B; administration of neonatal immunoprophylaxis is standard of care in these situations (GRADE 1B); (5) we do not recommend cesarean delivery for the sole indication of reducing perinatal hepatitis B virus transmission (GRADE 1B); (6) we recommend that individuals with HBV infection can breastfeed as long as the infant has received immunoprophylaxis at birth (GRADE 1C); (7) we suggest individuals with hepatitis B infection who desire invasive testing may have the procedure performed after an informed discussion on risks and benefits in the context of shared decision-making and in the context of how testing will affect clinical care (GRADE 2C); (8) in individuals with hepatitis viral loads >200,000 IU/mL (>5.3 log 10 IU/mL), we recommend antiretroviral therapy with tenofovir (tenofovir alafenamide at 25 mg daily or tenofovir disoproxil fumarate at 300 mg daily) in the third trimester (initiated at 28-32 weeks of gestation) as an adjunctive strategy to immunoprophylaxis to reduce perinatal transmission (GRADE 1B); (9) we recommend administering hepatitis B vaccine and hepatitis B immunoglobin within 12 hours of birth to all newborns of hepatitis B surface antigen-positive pregnant patients or those with unknown or undocumented hepatitis B surface antigen status, regardless of whether antiviral therapy has been given during the pregnancy to the pregnant patient (GRADE 1B); and (10) we recommend hepatitis B vaccination in pregnancy for all individuals without serologic evidence of immunity or documented history of vaccination (GRADE 1C).
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11
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Iwai C, Sasaki R, Yoshioka T. Toward the prevention of group B streptococcal early onset sepsis: the importance of defining target populations and second-line antimicrobials in line with current guideline recommendations. Am J Obstet Gynecol 2024; 230:e61. [PMID: 38128864 DOI: 10.1016/j.ajog.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Chikako Iwai
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Ryuji Sasaki
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Division of Pediatric Emergency and Transport Services, National Center for Child Health and Development, Tokyo, Japan
| | - Takashi Yoshioka
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
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12
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Ding F. Does maternal COVID-19 vaccination during pregnancy have a positive impact on neonatal outcomes? Pediatr Res 2024; 95:1166. [PMID: 38042948 DOI: 10.1038/s41390-023-02956-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/14/2023] [Indexed: 12/04/2023]
Affiliation(s)
- Fangrui Ding
- Department of Neonatology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, 300000, China.
- Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin, 300000, China.
- Department of Neonatology, Nankai University Maternity Hospital, Tianjin, 300000, China.
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13
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Adhikari EH. Update on syphilis in pregnancy: marrying basic science advances and clinical perseverance to solve an ancient public health problem. Curr Opin Obstet Gynecol 2024; 36:67-74. [PMID: 38205786 DOI: 10.1097/gco.0000000000000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
PURPOSE OF REVIEW While the clinical disease of syphilis, its consequences in pregnancy, and its sensitivity to penicillin treatment have remained relatively unchanged for a century or more, new technologies and basic discoveries in syphilis research have translated into tangible advances in clinical diagnosis, treatment, and prevention. The purpose of this review is to help the reader understand some of the recent relevant scientific publications on syphilis and its causative organism in a clinical obstetric context. RECENT FINDINGS Rates of adult and congenital syphilis have risen dramatically in the last decade despite public health efforts. Penicillin shortages and lack of screening or adequate treatment have all contributed to global disease burden. Advances in genomic and microbiological characterization of this spirochete have led to new developments in serologic and molecular diagnosis as well as evaluation of potential vaccine candidates. Until a syphilis vaccine is available, substance use disorders and lack of screening in pregnancy are associated with increased congenital syphilis, and these challenges will require novel solutions to fully address this public health crisis. SUMMARY Addressing the burden of congenital syphilis demands that obstetricians stay well informed of new tools and resources for diagnosis, treatment, and prevention of syphilis now and in the future.
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Affiliation(s)
- Emily H Adhikari
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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14
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Cremer M, Kaempfen S, Lapaire O, Hoesli IM, Heininger U. Interventional study to improve pertussis and influenza vaccination uptake in pregnant women. Eur J Obstet Gynecol Reprod Biol 2024; 295:201-209. [PMID: 38367393 DOI: 10.1016/j.ejogrb.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/07/2024] [Accepted: 02/07/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVES Pertussis and influenza are endemic infections and associated with relevant morbidity and mortality in newborns and young infants. The Swiss Federal Office of Public Health has recommended influenza vaccination since 2011 and pertussis vaccination in pregnancy (ViP) since 2013 and expanded to repetition in each pregnancy since 2017. ViP is safe and effective in preventing severe diseases, but implementation is a challenge. We hypothesized that the proportion of women receiving ViP is persistently low despite existing national recommendations. Our primary objective was to compare the proportion of pertussis and influenza vaccine recommendations for and its acceptance by pregnant women before and after an information campaign tailored to obstetricians. Secondly, we aimed to identify reasons for missing or declining ViP. STUDY DESIGN We conducted a prospective, single-center, single-arm implementation study in the maternity ward at the University Women's Hospital Basel. We performed standardized interviews with women hospitalized for postpartum care before (October to December 2019, Phase 1, n = 262) and after an information campaign (October to December 2020, Phase 2, n = 233) and compared categorical variables using chi-squared or Fisher's exact test and continuous variables using Whitney Mann U test. RESULTS We found no significant differences in the proportion of recommendation for pertussis ViP (80 % vs. 84 %, p = 0.25) and implementation (76 % vs. 78 %, p = 0.63) between Phase 1 and 2. Main reasons for missing or declining vaccinations were lack of recommendation (62.8 %) and safety concerns regarding the unborn child (17.7 %). In contrast, the proportion of recommendation for influenza ViP (45 % vs. 63 %, p < 0.001) and implementation (29 % vs. 43 %, p < 0.001) increased significantly. CONCLUSION Proactive recommendations by obstetricians play a key role in the implementation of ViP but is still insufficient in our setting. We believe that future efforts should aim to explore possible hurdles that impede recommendations by obstetricians for ViP. The focus should be on the needs and experiences of obstetricians in private practice, but also other health care professionals involved in care of pregnant women. Local campaigns do not seem effective enough, therefore national campaigns with new strategies are desirable.
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Affiliation(s)
- Martin Cremer
- University Children's Hospital (UKBB), Paediatric Infectious Diseases and Vaccinology Unit, Basel University of Basel, Spitalstrasse 33, 4056 Basel, Switzerland; Center for Congenital Heart Disease, Department of Cardiology, Pediatric Cardiology, Inselspital, Berne University Hospital, University of Berne, Freiburgstrasse 15, 3010 Berne, Switzerland.
| | - Siree Kaempfen
- University Children's Hospital (UKBB), Department of Neonatology, University of Basel, Spitalstrasse 33, 4056 Basel, Switzerland.
| | - Olav Lapaire
- Department of Obstetrics, University Women's Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland.
| | - Irene Mathilde Hoesli
- Department of Obstetrics, University Women's Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland.
| | - Ulrich Heininger
- University Children's Hospital (UKBB), Paediatric Infectious Diseases and Vaccinology Unit, Basel University of Basel, Spitalstrasse 33, 4056 Basel, Switzerland.
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15
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Low JM, Lee JH, Foote HP, Hornik CP, Clark RH, Greenberg RG. Throwing the spotlight on group B streptococcal early onset sepsis prevention: the importance of appropriate second-line antimicrobials. Am J Obstet Gynecol 2024; 230:e62-e63. [PMID: 38128866 DOI: 10.1016/j.ajog.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Jia Ming Low
- Department of Neonatology, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, Singapore; Department of Paediatrics, Yong Loo Lin School of Singapore, National University of Singapore, Singapore.
| | - Jan Hau Lee
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore; Singhealth-Duke NUS Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Henry P Foote
- Department of Pediatrics, Duke University, Durham, NC
| | - Christoph P Hornik
- Department of Pediatrics, Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | | | - Rachel G Greenberg
- Department of Pediatrics, Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC
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16
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Patel A, Puglisi JL, Patel S, Tarn DM. COVID-19 Vaccine Acceptance in Pregnant Women in the United States: A Systematic Review and Meta-Analysis. J Womens Health (Larchmt) 2024; 33:453-466. [PMID: 38112561 DOI: 10.1089/jwh.2023.0498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
Purpose: Pregnant women are vulnerable to Coronavirus Disease 2019 (COVID-19) complications, yet may hesitate to get vaccinated. It is important to identify racial/ethnic and other individual characteristics associated with COVID-19 vaccine acceptance in the United States during pregnancy. Methods: We searched PubMed, Embase, and Web of Science for articles published through January 2023 for keywords/terms related to immunization, COVID-19, and pregnancy, and performed a systematic review and meta-analysis to examine characteristics associated with vaccine acceptance. Results: Of 1,592 articles, 23 met inclusion criteria (focused on pregnant women in the United States, and their willingness or hesitation to vaccinate). Twenty-two of the studies examined receipt of ≥1 COVID-19 vaccine dose and/or intention to vaccinate, while one examined vaccine hesitancy. Vaccine acceptance rates ranged from 7% to 78.3%. Meta-analyses demonstrated that compared with Whites, Hispanics (odds ratios [OR] 0.72; 95% confidence interval [CI] 0.58-0.91) and Blacks (OR 0.44; 95% CI 0.30-0.63) had less COVID-19 vaccine acceptance, while Asians (OR 1.78; 95% CI 1.10-2.88) had greater vaccine acceptance. College graduation or more (OR 3.25; 95% CI 2.53-4.17), receipt or intention to receive the influenza vaccine (OR 3.46; 95% CI 2.22-5.41), and at least part-time employment (OR 2.12; 95% CI 1.66-2.72) were significantly associated with vaccine acceptance. Conclusions: COVID-19 vaccine nonacceptance in pregnant women is associated with Hispanic ethnicity and Black race, while acceptance is associated with Asian race, college education or more, at least part-time employment, and acceptance of the influenza vaccine. Future COVID-19 vaccination campaigns can target identified subgroups of pregnant women who are less likely to accept vaccination.
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Affiliation(s)
- Amy Patel
- College of Medicine, California Northstate University, Elk Grove, California, USA
| | - Jose L Puglisi
- Department of Basic Science, College of Medicine, California Northstate University, Elk Grove, California, USA
| | - Seeta Patel
- College of Letters and Sciences, University of California, Los Angeles, Los Angeles, California, USA
| | - Derjung M Tarn
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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McCormack S, Thompson C, Nolan M, Imcha M, Dee A, Saunders J, Philip RK. Maternal awareness, acceptability and willingness towards respiratory syncytial virus (RSV) vaccination during pregnancy in Ireland. Immun Inflamm Dis 2024; 12:e1257. [PMID: 38661110 PMCID: PMC11044221 DOI: 10.1002/iid3.1257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 04/01/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the world's leading cause of viral acute lower respiratory infections (ALRI) in infants. WHO has identified maternal RSV vaccination a priority and candidate vaccines are in development; however, vaccine hesitancy remains an impediment to successful implementation of maternal immunization. This study, the largest antenatal survey conducted to-date, aimed to examine maternal RSV awareness, likely acceptance of RSV vaccination in pregnancy, and attitudes to maternal vaccination. METHODS Pregnant women of all gestations attending antenatal clinic of a university maternity hospital in Ireland were invited to participate. An information leaflet provided, consent obtained, and survey administered examining RSV awareness, willingness to avail of antenatal RSV vaccination, factors influencing acceptability and preferred sources of assistance. Research Ethics Committee (REC) approval obtained, and general data protection regulation (GDPR) guidelines followed. RESULTS 528 women completed the survey. A large proportion (75.6%) had never heard of RSV, yet 48.5% would still avail of a vaccine, 45.8% were undecided and only 5.3% would not. The main factor making vaccination acceptable to women (76.4%) was that it protects their infant from illness (p < .001, CV 0.336 for association with acceptance) and general practitioner (GP) was the preferred guidance source in decision-making (57.7%). CONCLUSIONS Despite low levels of maternal awareness of RSV, pregnant women in Ireland are open to availing of antenatal vaccination. Maternal immunization strategies need to focus on infant's protection from RSV-associated ALRI along with vaccine safety, and build on an interdisciplinary collaboration of maternal, neonatal, primary care and public health services.
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Affiliation(s)
- Siobhan McCormack
- Division of Neonatology, Department of PaediatricsUniversity Maternity Hospital LimerickLimerickIreland
| | - Claire Thompson
- Division of Neonatology, Department of PaediatricsUniversity Maternity Hospital LimerickLimerickIreland
| | - Miriam Nolan
- Department of MidwiferyUniversity Maternity Hospital LimerickLimerickIreland
| | - Mendinaro Imcha
- Department of Obstetrics and GynaecologyUniversity Maternity Hospital LimerickLimerickIreland
| | - Anne Dee
- Department of Public Health MedicineHealth Service ExecutiveLimerickIreland
| | - Jean Saunders
- Claddagh Statistical Consulting Services (CSCS), Shannon & LimerickLimerickIreland
| | - Roy K Philip
- Division of Neonatology, Department of PaediatricsUniversity Maternity Hospital LimerickLimerickIreland
- University of Limerick School of MedicineLimerickIreland
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Álvarez Aldeán J, José Álvarez García F, de la Calle Fernández-Miranda M, Figueras Falcón T, Iofrío de Arce A, López Rojano M, Rivero Calle I, Suy Franch A. Vaccination in pregnancy. Consensus document of the CAV-AEP and the SEGO. An Pediatr (Barc) 2024; 100:268-274. [PMID: 38565447 DOI: 10.1016/j.anpede.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 04/04/2024] Open
Abstract
During pregnancy, physiological changes in the immune response make pregnant women more susceptible to serious infection, increasing the risk for the mother as well as the foetus, newborn and infant. All women should be correctly and fully vaccinated as they enter their reproductive years, especially against diseases such as tetanus, hepatitis B, measles, rubella and varicella. In addition to the recommended vaccines, in risk situations, inactivated vaccines could be administered to women who were not correctly vaccinated before, while attenuated vaccines are contraindicated. Despite the fact that vaccination during pregnancy is a very important preventive measure and the existing recommendations from public health authorities, scientific societies and health professionals, the vaccination coverage could clearly be improved, especially against influenza and SARS-CoV-2, so any health professional involved in the care of pregnant women should proactively recommend these vaccines. The Spanish Association of Pediatrics (AEP), through its Advisory Committee on Vaccines, and the Spanish Society of Gynaecology and Obstetrics (SEGO) recommend vaccination against the following diseases during pregnancy: against influenza and COVID-19, in any trimester of pregnancy and during the postpartum period (up to 6 months post birth) in women not vaccinated during pregnancy; against pertussis, with the Tdap vaccine, between weeks 27 and 36 of gestation (in the CAV-AEP recommendations, preferably between weeks 27 and 28); and against RSV, with RSVPreF, between weeks 24 and 36 of gestation, preferably between weeks 32 and 36.
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Affiliation(s)
- Javier Álvarez Aldeán
- Servicio de Pediatría, Hospital Costa del Sol, Asociación Española de Pediatría (CAV-AEP), Marbella, Málaga, Spain
| | - Francisco José Álvarez García
- Centro de Salud de Llanera, Asturias Departamento de Medicina. Universidad de Oviedo. Asociación Española de Pediatría (CAV-AEP), Oviedo, Spain.
| | - Maria de la Calle Fernández-Miranda
- Sección de Obstetricia, Hospital Universitario la Paz, Facultad de Medicina, Universidad Autónoma de Madrid, Sociedad Española de Ginecología y Obstetricia, Madrid, Spain
| | - Tatiana Figueras Falcón
- Unidad Medicina Materno Fetal, Servicio de Obstetricia y Ginecologia, Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas, Sociedad Española de Ginecología y Obstetricia, Las Palmas de Gran Canaria, Spain
| | - Antonio Iofrío de Arce
- Centro de Salud El Ranero, Comité Asesor de Vacunas de la Asociación Española de Pediatría (CAV-AEP), Murcia, Spain
| | - Marta López Rojano
- Servicio de Medicina Maternofetal, BCNatal-Centro de Medicina Maternofetal y Neonatal de Barcelona (Hospital Clínic de Barcelona y Hospital Sant Joan de Déu), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Sociedad Española de Ginecología y Obstetricia, Barcelona, Spain
| | - Irene Rivero Calle
- Sección de Pediatría Clínica, Infectológica y Traslacional, Hospital Clínico Universitario de Santiago de Compostela, Sociedad Española de Infectología Pediátrica (SEIP), Grupo Genética, Vacunas, Infecciones y Pediatría (GENVIP). Asociación Española de Pediatría (CAV-AEP), Santiago de Compostela, A Coruña, Spain
| | - Anna Suy Franch
- Sección de Obstetricia, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Sociedad Española de Ginecología y Obstetricia, Barcelona, Spain
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19
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Nagarakanti S, Vegunta S, Nagarakanti S. Optimal Delivery Choices for Pregnant Patients Living with HIV: A Comprehensive Decision-Making Guide. J Womens Health (Larchmt) 2024; 33:551-552. [PMID: 38170181 DOI: 10.1089/jwh.2023.0946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Affiliation(s)
| | - Suneela Vegunta
- Divisions of Women's Health-Internal Medicine, Mayo Clinic, Phoenix, Arizona, USA
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Tartaglia S, Di Ilio C, Romanzi F, Moresi S, Nardi E, Bevilacqua E, Arena V, Lanzone A. Effects of SARS-Cov-2 mRNA vaccine on placental histopathology: Comparison of a population of uncomplicated COVID-19 positive pregnant women. Placenta 2024; 149:64-71. [PMID: 38527377 DOI: 10.1016/j.placenta.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 03/05/2024] [Accepted: 03/13/2024] [Indexed: 03/27/2024]
Abstract
1. INTRODUCTION This study investigates the impact of SARS-CoV-2 infection on placental histopathology in pregnant women, comparing outcomes between vaccinated and non-vaccinated individuals. Despite known adverse pregnancy outcomes linked to SARS-CoV-2 infection, the specific effects on the placenta remain unclear. Although vaccination has demonstrated a substantial reduction in infection severity, its impact on placental health requires more insight. 2. METHODS Between March 2021 and July 2022, 387 COVID-19-positive women were admitted for delivery. Of these, 98 with non-severe symptoms were analyzed: 35 vaccinated during pregnancy, and 63 non-vaccinated. Two independent pathologists evaluated all placental specimens. 3. RESULTS The only differing obstetrical characteristic between groups was the mode of delivery (p 0.047), lacking clinical implications. Over 85% of placentas exhibited microscopic abnormalities, predominantly maternal vascular supply disorders (vaccinated 89.1%; unvaccinated 85.5%). Comparing vaccinated and unvaccinated groups revealed statistically significant differences, notably in increased focal perivillous fibrin deposits (IFPFD) [17.1% vs. 33.3% (p 0.04)] and avascular fibrotic villi (AFV) [0% vs. 11.1% (p 0.04)]. Binomial logistic regression confirmed the vaccine's protective role against IFPFD (aOR 0.36; 95%CI 013-0.99) and AVF (aOR 0.06, 95% CI 0.003-0.98). A sub-analysis in vaccinated women showed a positive correlation between the timing of the first dose and IFPFD presence (p 0.018). 4. DISCUSSION The lower incidence of maternal and fetal vascular malperfusion placental features in vaccinated women, coupled with the timing correlation, supports the vaccine's protective effect on placental tissue in COVID-19-infected pregnant patients. Notably, no side effects were reported post-vaccination, emphasizing the vaccine's safety and advocating for its secure administration in pregnant populations.
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Affiliation(s)
- Silvio Tartaglia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienza della Salute della Donna e del Bambino e di Sanità Pubblica, 00168, Rome, Italy; Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.
| | - Chiara Di Ilio
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Federica Romanzi
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sascia Moresi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienza della Salute della Donna e del Bambino e di Sanità Pubblica, 00168, Rome, Italy
| | - Eleonora Nardi
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Elisa Bevilacqua
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienza della Salute della Donna e del Bambino e di Sanità Pubblica, 00168, Rome, Italy
| | - Vincenzo Arena
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, unità di Gineco-patologia e Patologia Mammaria, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, 00168, Rome, Italy
| | - Antonio Lanzone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienza della Salute della Donna e del Bambino e di Sanità Pubblica, 00168, Rome, Italy; Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
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Zels G, Colpaert C, Leenaerts D, Nailis H, Verheecke M, De Catte L, Richter J, Baldewijns M. COVID-19 vaccination protects infected pregnant women from developing SARS-CoV-2 placentitis and decreases the risk for stillbirth. Placenta 2024; 148:38-43. [PMID: 38359600 DOI: 10.1016/j.placenta.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/03/2024] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION The impact of COVID-19 infection in pregnant women remained unclear for a long time. Previous research showed that SARS-CoV-2 virus is able to infect the placenta, potentially causing significant lesions leading to placental insufficiency. The impact of maternal vaccination status on the prevalence of SARS-CoV-2 placentitis remains unclear. We characterized placental lesions in SARS-CoV-2 infected pregnant women and studied the impact of vaccination on placental involvement. METHODS We retrospectively studied 180 placentas sent to the Department of Pathology in UZ Leuven or AZ Turnhout between January 2020 and August 2022, from non-vaccinated and vaccinated mothers suffering a SARS-CoV-2 proven infection during pregnancy. All reports and hematoxylin-eosin stained sections were revised by two pathologists to determine the presence of histopathological lesions that have been described in SARS-CoV-2 infection. SARS-CoV-2 immunostainings were available for a subgroup of 109 placentas. We gathered clinical data: date of delivery, date of positive serologic test result, vaccination status, SARS-CoV-2 variant and outcome of the pregnancy. RESULTS Of the 180 placentas, 37,2% showed histopathological lesions and in 12,8% an immunohistochemically proven SARS-CoV-2 placentitis was present. SARS-CoV-2 immunohistochemical positivity was only seen in non-vaccinated mothers. The risk of fetal demise was more than 5 times higher for non-vaccinated mothers and their placentas showed significantly more syncytiotrophoblast necrosis and chronic histiocytic intervillositis compared to vaccinated mothers (both p < 0,001). DISCUSSION Maternal vaccination was associated with a reduced risk of SARS-CoV-2 placentitis and stillbirth. This study provides new evidence of the protective effect of vaccination on the placenta.
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Affiliation(s)
- Gitte Zels
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium.
| | - Cecile Colpaert
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium; Department of Pathology, AZ Turnhout, Turnhout, Belgium
| | - Dorien Leenaerts
- Department of Laboratory Medicine, AZ Turnhout, Turnhout, Belgium; Department of Pharmaceutical Sciences, University of Antwerp, Antwerp, Belgium
| | - Heleen Nailis
- Department of Laboratory Medicine, AZ Turnhout, Turnhout, Belgium
| | - Magali Verheecke
- Department of Gynecology and Obstetrics, AZ Turnhout, Turnhout, Belgium
| | - Luc De Catte
- Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Jute Richter
- Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
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22
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Wong LP, Alias H, Lee HY, AbuBakar S, Lin Y, Hu Z. Has Zika been forgotten? A qualitative exploration of knowledge gaps, perceived risk and preventive practices in pregnant women in Malaysia. BMC Womens Health 2024; 24:190. [PMID: 38515067 PMCID: PMC10956172 DOI: 10.1186/s12905-024-02999-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/26/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Although Zika virus infection is rarely reported now, continuous prevention is needed to achieve sustained eradication. This study aimed to explore the knowledge gaps, risk perception and preventive measures against Zika virus infection (ZIKV) in pregnant women in Malaysia. METHODS We conducted in-depth virtual interviews with pregnant women between February and April 2022. The interviews were recorded and transcribed, and data were analyzed by content analysis. RESULTS The majority of the participants demonstrated a commendable level of awareness regarding the signs and symptoms associated with ZIKV infection. They also exhibited a clear understanding of preventive measures, particularly emphasizing the importance of avoiding mosquito bites to minimize the risk of ZIKV transmission. However, a noteworthy gap in knowledge surfaced as a subset of participants remained uninformed about the potential for sexual transmission of ZIKV, which could lead to congenital ZIKV in pregnant women. Even among women who were cognizant of ZIKV and its potential negative health outcomes, associated with the infection, many of them did not perceive themselves to be at risk, mainly because ZIKV infection is infrequently discussed or heard of, leading to a sense of infections' rarity. While the adoption of preventive measures such as mosquito bite prevention during pregnancy was a common practice, however, prevention of sexually transmitted infections (STIs) including mosquito-borne diseases such as Zika is low. A minority of women express concerns about the sensitivity surrounding discussions and prevention of STIs within the context of marriage. Most of the participants were supportive of the provision of awareness of ZIKV infection in women during pregnancy and the involvement of men, especially in initiatives aimed at preventing transmission through sexual contact. CONCLUSION This study uncovered gaps in both knowledge and practices pertaining ZIKV infection among pregnant women in the aftermath of the ZIKV pandemic. The insights gleaned from our research are valuable for shaping future interventions geared towards preventing the resurgence or facilitating the sustainable eradication of ZIKV.
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Affiliation(s)
- Li Ping Wong
- Fujian Key Laboratory of Environmental Factors and Cancer, Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, 350122, Fujian Province, China.
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Haridah Alias
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Hai Yen Lee
- Tropical Infectious Diseases Research and Educational Centre (TIDREC), Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Sazaly AbuBakar
- Tropical Infectious Diseases Research and Educational Centre (TIDREC), Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Yulan Lin
- Fujian Key Laboratory of Environmental Factors and Cancer, Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, 350122, Fujian Province, China.
| | - Zhijian Hu
- Fujian Key Laboratory of Environmental Factors and Cancer, Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, 350122, Fujian Province, China.
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23
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Sancken CL, Tannis A, Amouzou SA, Burkel V, Carlson JM, Newton S, Gilboa SM, Gonzalez M, Valencia D, Tong VT, Ospina M. Zika virus prevention behaviors and knowledge among male partners of pregnant people and lack of condom use as a prevention behavior from the Zika en Embarazadas y Niños (ZEN) prospective cohort study, Colombia. BMC Res Notes 2024; 17:87. [PMID: 38515162 PMCID: PMC10956169 DOI: 10.1186/s13104-024-06702-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/23/2024] [Indexed: 03/23/2024] Open
Abstract
OBJECTIVE Zika virus (ZIKV) infection in pregnancy can cause brain and eye abnormalities and neurodevelopmental sequelae. In the absence of medical countermeasures, behavioral interventions were recommended to prevent mosquito bites and sexual transmission of ZIKV. This report uses data from the Zika en Embarazadas y Niños (ZEN) prospective cohort study in Colombia to describe the knowledge, attitudes, and behaviors (KAB) related to ZIKV prevention in male partners compared to those of their pregnant partners at study enrollment during February 2017-2018. RESULTS Most male partners reported wearing protective clothing such as long pants (97.6%) and long sleeves (72.8%), as well as covering ankles and feet (89.1%) to prevent ZIKV infection. When comparing the preventive behavior of condom use between male and pregnant partners, 26 pairs (10.0%) both responded that they performed the behavior. Overall, 25.1% of male partners and 18.9% of pregnant people reported any condom use during the three months before enrolling in ZEN. When comparing other preventive behaviors between male and pregnant partners, the behavior which was most frequently reported by both partners was wearing long pants (85.4%), and the least frequently reported by both partners was using condoms after finding out about a partner's pregnancy (3.4%).
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Affiliation(s)
| | - Ayzsa Tannis
- Eagle Global Scientific, LLC, San Antonio, TX, USA
| | - Sandra A Amouzou
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - Suzanne Newton
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Suzanne M Gilboa
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Diana Valencia
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Van T Tong
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Martha Ospina
- Instituto Nacional de Salud de Colombia, Bogotá, Colombia
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Sun HZ, Li XQ, Yang LL, Duan QN, Xiao L, Zhao C, Xian JC. [Discussion on several issues with regard to managing the prevention and treatment of pregnancy-related conditions in the guidelines for the prevention and treatment of chronic hepatitis B (2022 version)]. Zhonghua Gan Zang Bing Za Zhi 2024; 32:255-256. [PMID: 38584110 DOI: 10.3760/cma.j.cn501113-20231108-00186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Affiliation(s)
- H Z Sun
- Obstetrics and Gynecology, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou 225300, China
| | - X Q Li
- Department of Hepatology, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou 225300, China
| | - L L Yang
- Obstetrics and Gynecology, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou 225300, China
| | - Q N Duan
- Pediatrics Department, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou 225300, China
| | - L Xiao
- Department of Hepatology, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou 225300, China
| | - C Zhao
- Department of Hepatology, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou 225300, China
| | - J C Xian
- Department of Hepatology, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou 225300, China
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Kristinsdottir I, Haraldsson A, Thors V. Influenza vaccination in pregnant women in Iceland 2010-2020 and the burden of influenza in pregnant women and their infants. Vaccine 2024; 42:2051-2058. [PMID: 38413277 DOI: 10.1016/j.vaccine.2024.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 02/29/2024]
Abstract
INTRODUCTION Influenza vaccinations are recommended in pregnancy to protect both the pregnant woman and the unborn baby. The aim of this study was to assess the influenza vaccine uptake among pregnant women in Iceland in ten influenza seasons and to estimate the influenza disease burden on pregnant women and their infants. METHODS This was a retrospective, descriptive study on influenza vaccine uptake among pregnant women and the burden of influenza and influenza-like illness (ILI) among pregnant women and their infants in ten influenza seasons. All women attending a 20-week ultrasound at Landspitali University Hospital in Reykjavik in August-April each influenza season 2010-2020 were included in the study. Data on influenza vaccinations and influenza/ILI diagnoses was collected from central national databases. RESULTS The influenza vaccine uptake increased from 6.2 % in 2011-2012 to 37.5 % in 2019-2020. The incidence rate of influenza/ILI among pregnant women ranged from 5.5 to 22.1/1000 person-years. The estimated vaccine effectiveness in the ten influenza seasons was 34-100 %. The incidence rate of influenza/ILI among infants < 12 months of age was 0-13.4/1000 person-years. Influenza vaccinations in pregnancy are protective against influenza/ILI in pregnant women (IRR 0.36, 95 % CI 0.22-0.58), infants in the season of vaccination (IRR 0.40, 95 % CI 0.17-0.97) and probably for infants < 6 months of age (IRR 0.51, 95 % CI 0.22-1.21). CONCLUSIONS Influenza vaccine coverage in pregnancy is suboptimal. Influenza vaccinations in pregnancy provide significant protection against influenza/ILI for pregnant women and infants in the season of vaccination. Initiatives to improve maternal vaccination coverage are needed.
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Affiliation(s)
- Iris Kristinsdottir
- Faculty of Medicine, University of Iceland, Iceland; Children's Hospital Iceland, Landspitali University Hospital, Iceland
| | - Asgeir Haraldsson
- Faculty of Medicine, University of Iceland, Iceland; Children's Hospital Iceland, Landspitali University Hospital, Iceland
| | - Valtyr Thors
- Faculty of Medicine, University of Iceland, Iceland; Children's Hospital Iceland, Landspitali University Hospital, Iceland.
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Jurga J, Mierzwa G, Kuciel JA, Kołak M, Jaworowski A, Huras H. Maternal Vaccination in Pregnancy: An Assessment of Influenza, Pertussis, and COVID-19 Vaccination Rates in Cracow, Poland. Med Sci Monit 2024; 30:e943304. [PMID: 38525559 PMCID: PMC10944008 DOI: 10.12659/msm.943304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 12/17/2023] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Maternal vaccination during pregnancy reduces the risk of severe course and complications from infections both for the mother and her child. As information regarding immunization status of pregnant women with recommended vaccines in Poland is scarce, this questionnaire-based study aimed to identify influenza, pertussis (whooping cough), and COVID-19 vaccination in 205 pregnant women in Cracow, Poland, between February and April 2023. Another objective was to assess whether any of the maternal factors might influence women's decision to inoculate during pregnancy. MATERIAL AND METHODS An anonymous and self-reported questionnaire developed specifically for this study was disseminated among postpartum women, who gave birth and were hospitalized at the Department of Obstetrics and Perinatology of the University Hospital in Cracow, Poland, between February and April 2023. Study participants were asked about their basic sociodemographic and obstetric data, as well as their immunization status regarding influenza, pertussis, and COVID-19 during their most recent pregnancy. RESULTS Only 12.2% and 23.4% of study participants received influenza and pertussis vaccinations, respectively, during pregnancy, while 61.5% of pregnant women reported vaccination with at least 2 doses of the mRNA COVID-19 vaccine. Features including type of occupation, place of residence, gravidity, and parity were statistically significant (P.
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Hatami D, Habibelahi A, Changizi N, Heidarzadeh M, Nojomi M, Rast M, Ansari K, Tehrani-Banihashemi A. Perinatal outcomes and sinopharm BBIBP-CorV vaccination during pregnancy. BMC Pregnancy Childbirth 2024; 24:190. [PMID: 38468216 PMCID: PMC10926583 DOI: 10.1186/s12884-024-06389-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/04/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND After the outbreak of COVID-19, a huge part of the health care services was dedicated to preventing and treating this disease. In case of COVID-19 infection, severe COVID-19 is reported more in pregnant individuals. Afterward, Vaccination against SARS-CoV-2 became a hot topic due to known effects in preventing severe COVID-19 during pregnancy. Vaccination of pregnant individuals started in August 2021 with the Sinopharm vaccine in Iran. The aim of current study was to determine the incidence of perinatal outcomes in women who were vaccinated during pregnancy. METHOD This retrospective cohort study included 129,488 singleton births from March 21, 2021, until March 21, 2022, in Tehran, Iran. The data was obtained from the Iranian Maternal and Neonatal (IMaN) Network and the Maternal Vaccination Registry. Adverse perinatal outcomes investigated in this study include preterm birth, extremely preterm birth, low birth weight, very low birth weight, intrauterine growth restriction, stillbirth, neonatal intensive care unit admission, congenital anomaly, neonatal death and low 5-minute Apgar score. The risk of all perinatal outcomes was evaluated using multiple logistic regression. The analysis was done using STATA version 14. RESULTS Of all 129,488 singleton births included in this study, 17,485 (13.5%) were vaccinated against SARS-CoV-2 (all with Sinopharm (BBIBP-CorV)). The exposure to the Sinopharm vaccine during pregnancy caused a significant decrease in the incidence of preterm birth (P =0.006, OR=0.91 [95% CI, 0.85 to 0.97]), extremely preterm birth (P =<0.001,OR=0.55 [95% CI, 0.45 to 0.66]), and stillbirth (P =<0.001, OR=0.60 [95% CI, 0.47 to 0.76]). Exposure to vaccination during the first trimester was associated with an increased risk of preterm birth (P =0.01, OR=1.27 [95% CI, 1.04 to 1.55]) Maternal vaccination during pregnancy was not associated with an increased risk of other adverse perinatal outcomes included in this study. CONCLUSION The finding of this population-based study indicated no adverse pregnancy outcome due to vaccination with the Sinopharm vaccine during the second and third trimesters of pregnancy. Overall risk of adverse pregnancy outcomes were lower in the vaccinated individuals compared to the unvaccinated group. Also, vaccination during the first trimester was associated with an increased risk of preterm birth.
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Affiliation(s)
- Donya Hatami
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Habibelahi
- Neonatal Health Office, Ministry of Health and Medical Education, Tehran, Iran
| | - Nasrin Changizi
- Maternal Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Heidarzadeh
- Department of Neonatology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Marzieh Nojomi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Moein Rast
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Kiarash Ansari
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Arash Tehrani-Banihashemi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Santimano AJ, Al-Zoubi RM, Al-Qudimat AR, Al Darwish MB, Ojha LK, Rejeb MA, Hamad Y, Elrashid MA, Ruxshan NM, El Omri A, Bawadi H, Al-Asmakh MA, Yassin A, Aboumarzouk OM, Zarour A, Al-Ansari AA. Efficacy and Clinical Outcomes of mRNA COVID-19 Vaccine in Pregnancy: A Systematic Review and Meta-Analysis. Intervirology 2024; 67:40-54. [PMID: 38432215 PMCID: PMC11006275 DOI: 10.1159/000538135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/23/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The world has witnessed one of the largest pandemics, dubbed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As of December 2020, the USA alone reported 98,948 cases of coronavirus disease 2019 (COVID-19) infection during pregnancy, with 109 related maternal deaths. Current evidence suggests that unvaccinated pregnant women infected with SARS-CoV-2 are at a higher risk of experiencing complications related to COVID-19 compared to nonpregnant women. This review aimed to provide healthcare workers and non-healthcare workers with a comprehensive overview of the available information regarding the efficacy of vaccines in pregnant women. SUMMARY We performed a systematic review and meta-analysis following PRISMA guidelines. The search through the database for articles published between December 2019 and October 2021 was performed. A comprehensive search was performed in PubMed, Scopus, and EMBASE databases for research publications published between December 2019 and October 2021. We focused on original research, case reports, case series, and vaccination side effect by authoritative health institutions. Phrases used for the Medical Subject Heading [MeSH] search included ("COVID-19" [MeSH]) or ("Vaccine" [MeSH]) and ("mRNA" [MeSH]) and ("Pregnant" [MeSH]). Eleven studies were selected and included, with a total of 46,264 pregnancies that were vaccinated with mRNA-containing lipid nanoparticle vaccine from Pfizer/BioNTech and Moderna during pregnancy. There were no randomized trials, and all studies were observational (prospective, retrospective, and cross-sectional). The mean maternal age was 32.2 years, and 98.7% of pregnant women received the Pfizer COVID-19 vaccination. The local and systemic adverse effects of the vaccination in pregnant women were analyzed and reported. The local adverse effects of the vaccination (at least 1 dose) such as local pain, swelling, and redness were reported in 32%, 5%, and 1%, respectively. The systemic adverse effects such as fatigue, headaches, new onset or worsening of muscle pain, chills, fever, and joint pains were also reported in 25%, 19%, 18%, 12%, 11%, and 8%, respectively. The average birthweight was 3,452 g. Among these pregnancies, 0.03% were stillbirth and 3.68% preterm (<37 weeks) births. KEY MESSAGES The systemic side effect profile after administering the COVID-19 mRNA vaccine to pregnant women was similar to that in nonpregnant women. Maternal and fetal morbidity and mortality were lowered with the administration of either one or both the doses of the mRNA COVID-19 vaccination.
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Affiliation(s)
- Antonio J. Santimano
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Raed M. Al-Zoubi
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- Department of Biomedical Sciences, College of Health Sciences, QU-Health, Qatar University, Doha, Qatar
- Department of Chemistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Ahmad R. Al-Qudimat
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed B. Al Darwish
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Laxmi Kumari Ojha
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Amine Rejeb
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Yasser Hamad
- Department of Quality and Patients Safety, Rehabilitation Institute, Hamad Medical Corporation, Doha, Qatar
| | - Malaz A. Elrashid
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Noorah M. Ruxshan
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Abdelfatteh El Omri
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Hiba Bawadi
- Department of Nutrition, College of Health Sciences, QU-Health, Qatar University, Doha, Qatar
| | - Maha A. Al-Asmakh
- Department of Biomedical Sciences, College of Health Sciences, QU-Health, Qatar University, Doha, Qatar
- Biomedical Research Centre, Qatar University, Doha, Qatar
| | - Aksam Yassin
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- Center of Medicine and Health Sciences, Dresden International University, Dresden, Germany
| | - Omar M. Aboumarzouk
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- School of Medicine, Dentistry and Nursing, The University of Glasgow, Glasgow, UK
| | - Ahmad Zarour
- Acute Care Surgery Division, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Abdulla A. Al-Ansari
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
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Hookham L, Cantrell L, Cose S, Freyne B, Gadama L, Imede E, Kawaza K, Lissauer S, Musoke P, Nankabirwa V, Sekikubo M, Sommerfelt H, Voysey M, Le Doare K. Seroepidemiology of SARS-CoV-2 in a cohort of pregnant women and their infants in Uganda and Malawi. PLoS One 2024; 19:e0290913. [PMID: 38427691 PMCID: PMC10906847 DOI: 10.1371/journal.pone.0290913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/24/2023] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Data on SARS-CoV-2 infection in pregnancy and infancy has accumulated throughout the course of the pandemic, though evidence regarding asymptomatic SARS-CoV-2 infection and adverse birth outcomes are scarce. Limited information is available from countries in sub-Saharan Africa (SSA). The pregnant woman and infant COVID in Africa study (PeriCOVID Africa) is a South-South-North partnership involving hospitals and health centres in five countries: Malawi, Uganda, Mozambique, The Gambia, and Kenya. The study leveraged data from three ongoing prospective cohort studies: Preparing for Group B Streptococcal Vaccines (GBS PREPARE), SARS-CoV-2 infection and COVID-19 in women and their infants in Kampala and Mukono (COMAC) and Pregnancy Care Integrating Translational Science Everywhere (PRECISE). In this paper we describe the seroepidemiology of SARS-CoV-2 infection in pregnant women enrolled in sites in Uganda and Malawi, and the impact of SARS-CoV-2 infection on pregnancy and infant outcomes. OUTCOME Seroprevalence of SARS-CoV-2 antibodies in maternal blood, reported as the proportion of seropositive women by study site and wave of COVID-19 within each country. METHODS The PeriCOVID study was a prospective mother-infant cohort study that recruited pregnant women at any gestation antenatally or on the day of delivery. Maternal and cord blood samples were tested for SARS-CoV-2 antibodies using Wantai and Euroimmune ELISA. In periCOVID Uganda and Malawi nose and throat swabs for SARS-Cov-2 RT-PCR were obtained. RESULTS In total, 1379 women were enrolled, giving birth to 1387 infants. Overall, 63% of pregnant women had a SARS-CoV-2 positive serology. Over subsequent waves (delta and omicron), in the absence of vaccination, seropositivity rose from 20% to over 80%. The placental transfer GMR was 1.7, indicating active placental transfer of anti-spike IgG. There was no association between SARS-CoV-2 antibody positivity and adverse pregnancy or infancy outcomes.
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Affiliation(s)
- Lauren Hookham
- Institute for Infection and Immunity, St George’s, University of London, London, United Kingdom
| | - Liberty Cantrell
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Stephen Cose
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Bridget Freyne
- Malawi Liverpool Wellcome Trust, Blantyre, Malawi
- Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Liverpool, United Kingdom
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Luis Gadama
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Esther Imede
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | | | - Samantha Lissauer
- Malawi Liverpool Wellcome Trust, Blantyre, Malawi
- Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Liverpool, United Kingdom
| | - Phillipa Musoke
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - Victoria Nankabirwa
- Department of Epidemiology & Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Musa Sekikubo
- Department of Obstetrics & Gynaecology Makerere University, Kampala, Uganda
| | - Halvor Sommerfelt
- Centre for Intervention Science in Maternal and Child Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Institute of Public Health, Bergen, Norway
| | - Merryn Voysey
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Kirsty Le Doare
- Institute for Infection and Immunity, St George’s, University of London, London, United Kingdom
- Makerere University, John’s Hopkins University, Kampala, Uganda
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Rodríguez-Muñoz MF, Martín-Martín C, Kovacheva K, Olivares ME, Izquierdo N, Pérez-Romero P, García-Ríos E. Hygiene-based measures for the prevention of cytomegalovirus infection in pregnant women: a systematic review. BMC Pregnancy Childbirth 2024; 24:172. [PMID: 38424481 PMCID: PMC10905865 DOI: 10.1186/s12884-024-06367-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/23/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Human Cytomegalovirus (HCMV) is the most frequent congenital infection worldwide causing important sequelae. However, no vaccine or antiviral treatments are currently available, thus interventions are restricted to behavioral measures. The aim of this systematic review was to assess evidence from available intervention studies using hygiene-based measures to prevent HCMV infection during pregnancy. METHODS Studies published from 1972 to 2023 were searched in Medline, PsycInfo, and Clinical Trials (PROSPERO, CRD42022344840) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Methodological quality was assessed by two authors, using ROBE-2 and MINORS. RESULTS After reviewing 6 selected articles, the outcome analysis suggested that implementation of hygiene-based interventions during pregnancy prevent, to some extent, the acquisition of congenital HCMV. CONCLUSIONS However, these conclusions are based on limited and low-quality evidence available from few studies using this type of intervention in clinical practice. Thus, it would be necessary to perform effective and homogeneous intervention studies using hygiene-based measures, evaluated in high-quality randomized controlled trials (RCTs).
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Affiliation(s)
| | - Clara Martín-Martín
- National Centre for Microbiology, Instituto de Salud Carlos III (ISCIII), Carretera Majadahonda - Pozuelo km. 2, Majadahonda, Madrid, 28220, Spain
| | - Katina Kovacheva
- Faculty of Psychology, Universidad Nacional de Educación a Distancia, (UNED), Madrid, Spain
| | | | - Nuria Izquierdo
- Department of Gynecology and Obstetrics, Hospital Clínico San Carlos, Madrid, Spain
| | - Pilar Pérez-Romero
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Estéfani García-Ríos
- National Centre for Microbiology, Instituto de Salud Carlos III (ISCIII), Carretera Majadahonda - Pozuelo km. 2, Majadahonda, Madrid, 28220, Spain.
- Department of Food Biotechnology, Instituto de Agroquimica y Tecnologia de los Alimentos (IATA), CSIC, Agustín Escardino 7, Paterna, Valencia, 46980, Spain.
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Hayes K, Janssen P, Payne BA, Jevitt C, Johnston W, Johnson P, Butler M. Oral Probiotic Supplementation in Pregnancy to Reduce Group B Streptococcus Colonisation (OPSiP trial): study protocol for a double-blind parallel group randomised placebo trial. BMJ Open 2024; 14:e076455. [PMID: 38316588 PMCID: PMC10860072 DOI: 10.1136/bmjopen-2023-076455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 01/16/2024] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION Group B streptococcus (GBS), or Streptococcus agalactiae, remains a leading cause of neonatal morbidity and mortality. Canadian guidelines advise universal maternal screening for GBS colonisation in pregnancy in conjunction with selective antibiotic therapy. This results in over 1000 pregnant individuals receiving antibiotic therapy to prevent one case of early-onset neonatal GBS disease, and over 20 000 pregnant individuals receiving antibiotic therapy to prevent one neonatal death. Given the growing concern regarding the risk of negative sequela from antibiotic exposure, it is vital that alternative approaches to reduce maternal GBS colonisation are explored.Preliminary studies suggest some probiotic strains could confer protection in pregnancy against GBS colonisation. METHODS AND ANALYSIS This double-blind parallel group randomised trial aims to recruit 450 pregnant participants in Vancouver, BC, Canada and will compare GBS colonisation rates in those who have received a daily oral dose of three strains of probiotics with those who have received a placebo. The primary outcome will be GBS colonisation status, measured using a vaginal/rectal swab obtained between 35 weeks' gestation and delivery. Secondary outcomes will include maternal antibiotic exposure and urogenital infections. Analysis will be on an intention-to-treat basis. PATIENT OR PUBLIC INVOLVEMENT There was no patient or public involvement in the design of the study protocol. ETHICS AND DISSEMINATION This study protocol received ethics approval from the University of British Columbia's Clinical Research Ethics Board, Dublin City University and Health Canada. Findings will be presented at research rounds, conferences and in peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT03407157.
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Affiliation(s)
- Kelly Hayes
- BCCHR, The University of British Columbia, Vancouver, British Columbia, Canada
- School of Nursing, Faculty of Science and Health, Dublin City University, Dublin, Ireland
| | - Patricia Janssen
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Beth A Payne
- Paediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Research, Women's Health Research Institute, Vancouver, BC, Canada
| | - Cecilia Jevitt
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Will Johnston
- The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Michelle Butler
- Faculty of Science and Health, Dublin City University, Dublin, Ireland
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Chatzakis C, Shahar-Nissan K, Faure-Bardon V, Picone O, Hadar E, Amir J, Egloff C, Vivanti A, Sotiriadis A, Leruez-Ville M, Ville Y. The effect of valacyclovir on secondary prevention of congenital cytomegalovirus infection, following primary maternal infection acquired periconceptionally or in the first trimester of pregnancy. An individual patient data meta-analysis. Am J Obstet Gynecol 2024; 230:109-117.e2. [PMID: 37473793 DOI: 10.1016/j.ajog.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE Recent studies have shown that a dosage of 8 g/d of oral valacyclovir reduces substantially the vertical transmission rate of cytomegalovirus in women with primary cytomegalovirus infection acquired periconceptionally or during the first trimester of pregnancy. This individual patient data meta-analysis aimed to assess the effectiveness and safety of valacyclovir treatment in the secondary prevention of congenital cytomegalovirus infection. DATA SOURCES MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, the US registry of clinical trials (www. CLINICALTRIALS gov), and gray literature sources were searched from inception to March 2023. STUDY ELIGIBILITY CRITERIA Randomized controlled trials and quasi-randomized studies administering 8 g/d of oral valacyclovir in pregnant women with primary cytomegalovirus infection acquired periconceptionally or during the first trimester of pregnancy were included. METHODS All corresponding authors of the eligible studies were contacted. Cochrane's Risk of Bias 2 and Risk Of Bias In Non-randomised Studies - of Interventions tools were used for the risk of bias assessment. The result of amniocentesis was the primary outcome of interest. A 1-stage individual patient data meta-analysis was performed, using a generalized linear mixed model, clustered by the different trials. A subgroup analysis was performed, assessing separately the effect of valacyclovir in the periconceptional period and first trimester of pregnancy. RESULTS Overall, 3 studies were included in the analysis (n=527 women). Valacyclovir reduced the vertical transmission rate of cytomegalovirus (adjusted odds ratio, 0.34; 95% confidence interval, 0.18-0.61). This reduction was apparent for both periconceptional period (adjusted odds ratio, 0.34; 95% confidence interval, 0.12-0.96) and first-trimester (adjusted odds ratio, 0.35; 95% confidence interval, 0.16-0.76) infections. Moreover, valacyclovir reduced the rate of neonatal infection (adjusted odds ratio, 0.30; 95% confidence interval, 0.19-0.47), in both periconceptional period (adjusted odds ratio, 0.30; 95% confidence interval, 0.14-0.61) and first-trimester (adjusted odds ratio, 0.30; 95% confidence interval, 0.17-0.54) infections. Furthermore, valacyclovir reduced the rate of termination of pregnancy because of cytomegalovirus-associated severe fetal findings (adjusted odds ratio, 0.23; 95% confidence interval, 0.22-0.24). The gestational age at the initiation of treatment has a positive correlation with all outcomes. The overall prevalence of severe side effects was 2.1%. CONCLUSION A dosage of 8 g/d of oral valacyclovir reduced the vertical transmission rates of cytomegalovirus following primary maternal infection acquired periconceptionally or in the first trimester of pregnancy, with a low incidence of side effects.
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Affiliation(s)
- Christos Chatzakis
- Department of Obstetrics, Fetal-Medicine, and Surgery, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France; Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Karen Shahar-Nissan
- Department of Pediatrics "C," Schneider Children's Medical Center of Israel, Petach Tikvah, Israel; Sackler Faculty of Medicine, Department of Pediatric Infectious Diseases, Tel Aviv University, Tel Aviv, Israel
| | - Valentine Faure-Bardon
- Department of Obstetrics, Fetal-Medicine, and Surgery, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Olivier Picone
- Department of Obstetrics and Gynecology, Hospital Paul Brousse, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Eran Hadar
- Sackler Faculty of Medicine, Department of Pediatric Infectious Diseases, Tel Aviv University, Tel Aviv, Israel; Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikvah, Israel
| | - Jacob Amir
- Sackler Faculty of Medicine, Department of Pediatric Infectious Diseases, Tel Aviv University, Tel Aviv, Israel; Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikvah, Israel
| | - Charles Egloff
- Department of Obstetrics and Gynecology, Hospital Paul Brousse, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Alexandre Vivanti
- Department of Obstetrics and Gynecology, DMU Santé des Femmes et des Nouveau-nés, Hôpital Antoine Béclère, Paris Saclay University, AP-HP, Clamart, France
| | - Alexandros Sotiriadis
- Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marianne Leruez-Ville
- Virology Laboratory, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yves Ville
- Department of Obstetrics, Fetal-Medicine, and Surgery, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France.
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Jahn LS, Kengonzi A, Kabwama SN, Rubaihayo J, Theuring S. Preventing HIV Infection in Pregnant Women in Western Uganda Through a Comprehensive Antenatal Care-Based Intervention: An Implementation Study. Arch Sex Behav 2024; 53:745-756. [PMID: 37943471 PMCID: PMC10844405 DOI: 10.1007/s10508-023-02726-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/07/2023] [Accepted: 10/12/2023] [Indexed: 11/10/2023]
Abstract
We implemented and assessed a comprehensive, antenatal care (ANC)-embedded strategy to prevent HIV seroconversions during pregnancy in Uganda. HIV-negative first-time ANC clients were administered an HIV risk assessment tool and received individual risk counseling. Those attending ANC without partners obtained formal partner invitation letters. After three months, repeat HIV testing was carried out; non-attending women were reminded via phone. We analyzed uptake and acceptance, HIV incidence rate, and risk behavior engagement. Among 1081 participants, 116 (10.7%) reported risk behavior engagement at first visit; 148 (13.7%) were accompanied by partners. At the repeat visit (n = 848), 42 (5%, p < 0.001) reported risk behavior engagement; 248 (29.4%, p < 0.001) women came with partners. Seroconversion occurred in two women. Increased odds for risk behavior engagement were found in rural clients (aOR 3.96; 95% CI 1.53-10.26), women with positive or unknown partner HIV-status (2.86; 1.18-6.91), and women whose partners abused alcohol (2.68; 1.15-6.26). Overall, the assessed HIV prevention strategy for pregnant women seemed highly feasible and effective. Risk behavior during pregnancy was reduced by half and partner participation rates in ANC doubled. The observed HIV incidence rate was almost four times lower compared to a pre-intervention cohort in the same study setting.
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Affiliation(s)
- Lisa S Jahn
- Institute of International Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Agnes Kengonzi
- School of Health Sciences, Mountains of the Moon University, Fort Portal, Uganda
| | | | - John Rubaihayo
- School of Health Sciences, Mountains of the Moon University, Fort Portal, Uganda
| | - Stefanie Theuring
- Institute of International Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
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Craig AM, Pavon CG, Byrd A, Weaver K, Swamy GK, Fouda G, Hughes BL. Delta variant neutralizing antibody response following maternal COVID-19 vaccination. Am J Infect Control 2024; 52:252-254. [PMID: 37689124 DOI: 10.1016/j.ajic.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 09/11/2023]
Abstract
The Delta pandemic wave saw increased maternal morbidity and mortality compared to prior viral strains. COVID-19 vaccination in pregnancy elicits detectable levels of neutralizing antibodies to SARS-CoV-2 wild type and SARS-CoV-2 Delta variants in both maternal and neonatal samples at delivery. Our results demonstrate the effectiveness of vaccination which confers an immunological response against newer, and potentially more dangerous, viral variants.
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Affiliation(s)
- Amanda M Craig
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Duke University, Durham, NC.
| | | | - Alliyah Byrd
- Duke Human Vaccine Institute, Duke University, Durham, NC
| | - Kristin Weaver
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Duke University, Durham, NC
| | - Geeta K Swamy
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Duke University, Durham, NC
| | | | - Brenna L Hughes
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Duke University, Durham, NC
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Zuber MJ, Miller A, Poehling KA. Influenza Vaccination in Pregnancy-Rolling Up Sleeves for Pregnant Persons and Infants. JAMA Pediatr 2024; 178:115-116. [PMID: 38109106 DOI: 10.1001/jamapediatrics.2023.5630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Affiliation(s)
- Matthew J Zuber
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Center for Vaccines at the Extremes of Aging, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - April Miller
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Katherine A Poehling
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Center for Vaccines at the Extremes of Aging, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Innovation Quarter, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Yin X, Wang W, Chen H, Mao Q, Han G, Yao L, Gao Q, Gao Y, Jin J, Sun T, Qi M, Zhang H, Li B, Duan C, Cui F, Tang W, Chan P, Liu Z, Hou J. Real-world implementation of a multilevel interventions program to prevent mother-to-child transmission of HBV in China. Nat Med 2024; 30:455-462. [PMID: 38297093 PMCID: PMC10878969 DOI: 10.1038/s41591-023-02782-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/19/2023] [Indexed: 02/02/2024]
Abstract
Reducing hepatitis B virus (HBV) mother-to-child transmission (MTCT) is a fundamental step toward the HBV elimination goal. The multicentred, multilevel SHIELD program aimed to use an intense intervention package to reduce HBV MTCT in China. This study was conducted in diverse health settings across China, encompassing 30,109 pregnant women from 178 hospitals, part of the interim analysis of stage II of the SHIELD program, and 8,642 pregnant women from 160 community-level health facilities in stage III of the SHIELD program. The study found that the overall MTCT rate was 0.23% (39 of 16,908; 95% confidence interval (CI): 0.16-0.32%) in stage II and 0.23% (12 of 5,290; 95% CI: 0.12-0.40%) in stage III. The MTCT rate was lower among participants who were compliant with the interventions (stage II: 0.16% (95% CI: 0.10-0.26%); stage III: 0.03% (95% CI: 0.00-0.19%)) than among those who were noncompliant (3.16% (95% CI: 1.94-4.85%); 1.91% (95% CI: 0.83-3.73%); P < 0.001). Our findings demonstrate that the comprehensive interventions among HBV-infected pregnant women were feasible and effective in dramatically reducing MTCT.
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Affiliation(s)
- Xueru Yin
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
- State Key Laboratory of Organ Failure Research; Key Laboratory of Infectious Diseases Research in South China, Ministry of Education; Guangdong Provincial Key Laboratory of Viral Hepatitis Research; Guangdong Provincial Clinical Research Center for Viral Hepatitis; Guangdong Institute of Hepatology, Guangzhou, China
| | - Wei Wang
- Department of Health Care, Shenzhen Bao'an Women's and Children's Hospital, Shenzhen, China
| | - Hui Chen
- Department of Hepatology, Hepatobiliary Hospital of Jilin, Changchun, China
| | - Qing Mao
- Department of Infectious Diseases, Southwest Hospital, Army Medical University, Chongqing, China
| | - Guorong Han
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of the Southeast University, Nanjing, China
| | - Lyufeng Yao
- Department of Hepatology, Mengchao Hepatobiliary Hospital, Fujian Medical University, Fuzhou, China
| | - Qingwei Gao
- Department of Hepatology, The Sixth People's Hospital of Dalian, Dalian, China
| | - Yunfei Gao
- Department of Gynecology and Obstetrics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jie Jin
- Department of Infectious Disease, The First People's Hospital of Hangzhou, Hangzhou, China
| | - Tong Sun
- Department of Hepatology, The Fifth People's Hospital of Wuxi, Wuxi, China
| | - Minghua Qi
- Department of Infectious Diseases, Peking University Shenzhen Hospital, Shenzhen, China
| | - Hua Zhang
- Department of Gynecology and Obstetrics, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Baijun Li
- Department of Hepatology, The Sixth People's Hospital of Shenyang, Shenyang, China
| | - Chongyang Duan
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Fuqiang Cui
- School of Public Health, Peking University, Beijing, China
| | - Weiming Tang
- Dermatology Hospital of South Medical University, Guangzhou, China
- University of North Carolina Project-China, Guangzhou, China
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Polin Chan
- World Health Organization South-East Asia Regional Office, New Delhi, India
| | - Zhihua Liu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.
- State Key Laboratory of Organ Failure Research; Key Laboratory of Infectious Diseases Research in South China, Ministry of Education; Guangdong Provincial Key Laboratory of Viral Hepatitis Research; Guangdong Provincial Clinical Research Center for Viral Hepatitis; Guangdong Institute of Hepatology, Guangzhou, China.
| | - Jinlin Hou
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.
- State Key Laboratory of Organ Failure Research; Key Laboratory of Infectious Diseases Research in South China, Ministry of Education; Guangdong Provincial Key Laboratory of Viral Hepatitis Research; Guangdong Provincial Clinical Research Center for Viral Hepatitis; Guangdong Institute of Hepatology, Guangzhou, China.
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Kuitunen I, Kekki M, Renko M. Intrapartum azithromycin to prevent maternal and neonatal sepsis and deaths: A systematic review with meta-analysis. BJOG 2024; 131:246-255. [PMID: 37691261 DOI: 10.1111/1471-0528.17655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/12/2023] [Accepted: 08/18/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES A systematic review with met-analysis was performed to summarise the evidence on the effect of intrapartum azithromycin on maternal and neonatal infections and deaths. SEARCH STRATEGY PubMed, Scopus and Web of Science databases were searched in March 2023. SELECTION CRITERIA Randomised controlled trials comparing intrapartum single-dose of azithromycin with placebo. DATA COLLECTION AND ANALYSIS Maternal infections, maternal mortality, neonatal sepsis, neonatal mortality. We used the random-effects Mantel-Haenszel method to calculate risk ratios (RR) with 95% confidence intervals (95% CI). We assessed risk of bias of the included studies and estimated the evidence certainty using the GRADE approach. MAIN RESULTS After screening 410 abstracts, five studies with 44 190 women and 44 565 neonates were included. The risk of bias was low in four and had some concerns in one of the studies. The risk of endometritis was 1.5% in the azithromycin group and 2.3% in the placebo group (RR 0.64, 95% CI 0.55-0.75), and the evidence certainty was high. The respective risk for chorioamnionitis was 0.05% and 0.1% (RR 0.50, 95% CI 0.22-1.18; evidence certainty moderate). The wound infection rate was lower in the azithromycin group (1.6%) than in the placebo group (2.5%), RR 0.52 (95% CI 0.30-0.89; moderate certainty evidence). The maternal sepsis rate was 1.1% in the azithromycin group and 1.7% in the placebo group (RR 0.66, 95% CI 0.56-0.77; evidence certainty high). Mortality rates did not show evidence of a difference (0.09% versus 0.08%; RR 1.26, 95% CI 0.65-2.42; moderate certainty evidence). The neonatal mortality rate was 0.7% in the azithromycin group and 0.8% in the placebo group (RR 0.94, 95% CI 0.76-1.16; moderate certainty evidence). The neonatal sepsis rate was 7.6% in the azithromycin group and 7.4% in the placebo group (RR 1.02, 95% CI 0.96-1.09; moderate certainty evidence). CONCLUSIONS Intrapartum administration of azithromycin to the mother reduces maternal postpartum infections, including sepsis. Impact on maternal mortality remains undecided. Azithromycin does not reduce neonatal sepsis or mortality rates.
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Affiliation(s)
- Ilari Kuitunen
- Department of Paediatrics, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Paediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Maiju Kekki
- Department of Obstetrics, Tampere University Hospital, Tampere, Finland
- Tampere Centre for Child and Maternal Health Research, Tampere University, Tampere, Finland
| | - Marjo Renko
- Department of Paediatrics, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Paediatrics, Kuopio University Hospital, Kuopio, Finland
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Influenza in Pregnancy: Prevention and Treatment: ACOG Committee Statement No. 7. Obstet Gynecol 2024; 143:e24-30. [PMID: 38016152 DOI: 10.1097/AOG.0000000000005479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Pregnant and postpartum individuals are at significantly higher risk of serious complications related to seasonal and pandemic influenza infections compared with nonpregnant people. The Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists (ACOG) recommend that all adults receive an annual influenza vaccine and that individuals who are or will be pregnant during influenza season receive an inactivated or recombinant influenza vaccine as soon as it is available. Although the influenza vaccine significantly lowers the risk of severe disease, it will not prevent all infections. Obstetrician-gynecologists and other obstetric health care professionals should consider both influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection for pregnant individuals who present with symptoms of respiratory illness. Antiviral treatment should not be delayed while awaiting respiratory infection test results, and a patient's vaccination status should not affect the decision to treat. Obstetrician-gynecologists and other obstetric care professionals can help reduce disparities in influenza vaccination rates as well as severe outcomes related to influenza infection by strongly recommending influenza vaccination to all patients.
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Yang JS, Sovann S, Shimakawa Y, Nhoueng S, Dim B, Vong C, Sann C, Guillebaud J, Vann D, Touch B, Chea H, Phirum WPC, Rosenthal E, Paul C, Khun L, Yay C, Laurent D, Chhun S, Borand L, Segeral O. Simplified Criteria to Assess Long-Term Antiviral Treatment Indication in Chronic HBV-Infected Pregnant Women in Cambodia. Viruses 2024; 16:194. [PMID: 38399970 PMCID: PMC10891875 DOI: 10.3390/v16020194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
Pregnant women identified to carry hepatitis B surface antigen (HBsAg) should be linked to care for the determination of the need for long-term antiviral therapy (LTT). We assessed the performance of simplified criteria, free from HBV DNA quantification, to select women eligible for LTT using different international guidelines as a reference. A retrospective analysis of HBV-infected pregnant women enrolled in the phase 4 ANRS TA-PROHM study was conducted in Cambodia. Sensitivity, specificity, and AUROC were computed to compare three simplified criteria (TREAT-B, HBcrAg/ALT, and TA-PROHM) with the American (AASLD) and European (EASL) guidelines as a reference. An additional assessment was performed at 6 months postpartum. Of 651 HBsAg-positive women, 209 (32%) received peripartum antiviral prophylaxis using tenofovir disoproxil fumarate (TDF). During pregnancy, 9% and 12% of women were eligible for LTT according to AASLD and EASL guidelines, respectively; 21% and 24% of women were eligible for prophylactic TDF and 2% and 5% in those ineligible (p < 0.001). Using the AASLD guidelines, the AUROC of TREAT-B, HBcrAg/ALT, and TA-PROHM scores were 0.88 (95%CI, 0.85-0.90), 0.90 (95%CI, 0.87-0.92), and 0.76 (95%CI, 0.73-0.80), respectively. Using the EASL guidelines, the AUROCs were lower: 0.73 (95%CI, 0.69-0.76), 0.76 (95%CI, 0.73-0.80), and 0.71 (95%CI, 0.67-0.74), respectively. Among those ineligible for prophylactic TDF, only 2% to 6% present an indication for LTT at 24 weeks postpartum. Few pregnant women are eligible for LTT, and the use of simplified criteria could represent an efficient triage option in decentralized areas to identify those negative for whom there is no urgent indication for LTT and focus on those positive for whom other exams must be conducted to confirm LTT indication.
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Affiliation(s)
- Jee-Seon Yang
- Institut Pasteur du Cambodge, Phnom Penh 12201, Cambodia; (J.-S.Y.); (J.G.)
- Sorbonne Université, 75013 Paris, France
- Service de Pédiatrie Générale et Aval des Urgences, Hôpital Armand Trousseau, 75012 Paris, France
| | - Saren Sovann
- Institut Pasteur du Cambodge, Phnom Penh 12201, Cambodia; (J.-S.Y.); (J.G.)
| | - Yusuke Shimakawa
- Institut Pasteur, Unité d’Épidémiologie des Maladies Émergentes, Université Paris Cité, 75015 Paris, France
| | - Sovann Nhoueng
- Institut Pasteur du Cambodge, Phnom Penh 12201, Cambodia; (J.-S.Y.); (J.G.)
| | - Bunnet Dim
- Institut Pasteur du Cambodge, Phnom Penh 12201, Cambodia; (J.-S.Y.); (J.G.)
| | | | - Channa Sann
- Calmette Hospital, Phnom Penh 12201, Cambodia
| | - Julia Guillebaud
- Institut Pasteur du Cambodge, Phnom Penh 12201, Cambodia; (J.-S.Y.); (J.G.)
| | - Darapolin Vann
- Jayavarman VII Hospital, Siem Reap 17259, Cambodia (B.T.)
| | - Bunrith Touch
- Jayavarman VII Hospital, Siem Reap 17259, Cambodia (B.T.)
| | - Hyna Chea
- Jayavarman VII Hospital, Siem Reap 17259, Cambodia (B.T.)
| | | | - Eric Rosenthal
- ANRS|Maladies Infectieuses Emergentes, 75000 Paris, France; (E.R.)
- Internal Medicine Department, Université Côte d’Azur, 06000 Nice, France
| | - Christelle Paul
- ANRS|Maladies Infectieuses Emergentes, 75000 Paris, France; (E.R.)
| | | | - Chantana Yay
- Jayavarman VII Hospital, Siem Reap 17259, Cambodia (B.T.)
| | - Denis Laurent
- Direction Department, Foundation Children’s Hospital Kantha Bopha, Phnom Penh 12000, Cambodia
| | | | - Laurence Borand
- Institut Pasteur du Cambodge, Phnom Penh 12201, Cambodia; (J.-S.Y.); (J.G.)
- Center for Tuberculosis Research, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Olivier Segeral
- ANRS|Maladies Infectieuses Emergentes, 75000 Paris, France; (E.R.)
- HIV Unit, Infectious Diseases Department, Geneva University Hospital, 1205 Geneva, Switzerland
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Elgalib A, Lau R, Al-Habsi Z, Shah S, Al-Rawahi B, Al-Abri S. Oman eliminates mother-to-child transmission of HIV and syphilis. East Mediterr Health J 2024; 30:5-6. [PMID: 38415331 DOI: 10.26719/emhj.23.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/25/2023] [Indexed: 02/29/2024]
Affiliation(s)
- Ali Elgalib
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Richard Lau
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Zeyana Al-Habsi
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Samir Shah
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Bader Al-Rawahi
- Directorate General for Disease Surveillance and Control, Muscat, Oman
| | - Seif Al-Abri
- Directorate General for Disease Surveillance and Control, Muscat, Oman
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Bednarek A, Laskowska M. Vaccination Guidelines for Pregnant Women: Addressing COVID-19 and the Omicron Variant. Med Sci Monit 2024; 30:e942799. [PMID: 38229424 PMCID: PMC10802082 DOI: 10.12659/msm.942799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/06/2023] [Indexed: 01/18/2024] Open
Abstract
Vaccinations are an essential element of public health programs around the world, which have a major impact on morbidity, mortality, and costs of the health care system. In recent years, with a better understanding of the effectiveness and safety of vaccinations, many recommendations have been developed for administering vaccines to adults. Countless physiological changes occur during pregnancy, including those affecting the immune system. Pregnant women are at increased risk of developing infections and resulting complications. According to research, vaccines are immunogenic and safe for pregnant women. Pregnancy is not an absolute contraindication to vaccination. After administration of vaccines to pregnant women, the concentration of antibodies increases, which can be transferred to the child in the second and third trimesters of pregnancy and provide protection in the first months of life. The Advisory Committee on Immunization Practices (ACIP), guidelines of the Centers for Disease Control and Prevention (CDC), and the American College of Obstetrics and Gynecology (ACOG) unanimously recommend vaccination of pregnant women if a safe vaccine is available and there is a risk of exposure of the woman to a disease that threatens herself or her developing baby. In everyday clinical practice, medical professionals should provide their patients with the necessary information on vaccinations, which may contribute to greater awareness and implementation of vaccinations. This article aims to review current global recommendations for the vaccination of pregnant and breastfeeding women, including against the Omicron variants of SARS-CoV-2.
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Affiliation(s)
- Anna Bednarek
- Department of Health Promotion, Chair of Nursing Development, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
| | - Marzena Laskowska
- Department of Obstetrics and Perinatology, Medical University of Lublin, Lublin, Poland
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Foles AI, Eiras Dias M, Figueiredo M, Marçal M. Congenital syphilis: the re-emergence of a forgotten disease. BMJ Case Rep 2024; 17:e257694. [PMID: 38233003 PMCID: PMC10806924 DOI: 10.1136/bcr-2023-257694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
A preterm newborn presented at birth with generalised oedema, disseminated bullous and desquamative exanthema with palmoplantar involvement and hepatomegaly, admitted to the neonatal intensive care unit with severe multisystemic disease, haemodynamic instability and respiratory distress. The mother had a history of treated latent syphilis before pregnancy. Venereal Disease Research Laboratory screening was negative in the first trimester, titre 1:2 in second trimester and 1:32 in the third trimester, a result only available to the medical team at birth. The mother's rapid plasma reagin (RPR) titre was 1:64 at birth. The newbon's RPR titre was 1:256, confirming the diagnosis of early congenital syphilis. The newborn was treated with aqueous penicillin G, with clinical and laboratorial progressive recovery. Congenital syphilis is a preventable disease, but despite prenatal screening programmes, it remains a significant public health issue worldwide with high morbidity and mortality.
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Affiliation(s)
- Ana Isabel Foles
- Neonatology, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
| | - Mariana Eiras Dias
- Neonatology, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
| | - Melissa Figueiredo
- Neonatology, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
| | - Mónica Marçal
- Neonatology, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
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Deng H, Jin Y, Sheng M, Liu M, Shen J, Qian W, Zou G, Liao Y, Liu T, Ling Y, Fan X. Safety and efficacy of COVID-19 vaccine immunization during pregnancy in 1024 pregnant women infected with the SARS-CoV-2 Omicron virus in Shanghai, China. Front Immunol 2024; 14:1303058. [PMID: 38292486 PMCID: PMC10826606 DOI: 10.3389/fimmu.2023.1303058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024] Open
Abstract
Background Large sample of pregnant women vaccinated with COVID-19 vaccine has not been carried out in China. The objective of this study was to evaluate the safety and effectiveness of COVID-19 inactivated vaccine in pregnant women infected with the SARS-CoV-2 Omicron variant. Methods A total of 1,024 pregnant women and 120 newborns were enrolled in this study. 707 pregnant women received one to three doses of the inactivated COVID-19 vaccine, and 317 unvaccinated patients served as the control group. A comparison was made between their clinical and laboratory data at different stages of pregnancy. Results The incidence rate of patients infected with Omicron variant in the first, the second, and the third trimesters of pregnancy was 27.5%, 27.0%, and 45.5% in patients during, respectively. The corresponding length of hospital stay was 8.7 ± 3.3 days, 9.5 ± 3.3 days, and 11 ± 4.3 days, respectively. The hospitalization time of pregnant women who received 3 doses of vaccine was (8.8 ± 3.3) days, which was significantly shorter than that of non-vaccinated women (11.0 ± 3.9) days. (P<0.0001). The positive rate of SARS-CoV-2 IgG in patients in the early stage of pregnancy was 28.8%, while that in patients in the late stage of pregnancy was 10.3%. However, three-doses of vaccination significantly increased the SARS-CoV-2 IgG positive rate to 49.5%. The hospitalization time of SARS-CoV-2 IgG-positive patients was shorter than that of negative patients (9.9 ± 3.5 days), which was 7.4 ± 2.0 days. 12.2% of vaccinated women experienced mild adverse reactions, manifested as fatigue (10.6%) and loss of appetite (1.6%). The vaccination of mother did not affect her choice of future delivery mode and the Apgar score of their newborn. All newborns tested negative for SARS-CoV-2 nucleic acid, as well as for IgG and IgM antibodies. Conclusions Women in the third trimester of pregnancy are highly susceptible to infection with the Omicron strain. The vaccination of pregnant women with COVID-19 vaccine can accelerate the process of eliminating SARS-CoV-2 virus, and is considered safe for newborns. The recommended vaccination includes three doses.
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Affiliation(s)
- Hongmei Deng
- Department of Gynecology and Obstetrics, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yinpeng Jin
- Liver Disease Center, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Minmin Sheng
- Department of Gynecology and Obstetrics, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Min Liu
- Department of Gynecology and Obstetrics, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Jie Shen
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Wei Qian
- International Peace Maternity & Child Health Hospital Affiliated to Jiaotong University, Shanghai, China
| | - Gang Zou
- Department of Fetal Medicine & Prenatal Diagnosis Center, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yixin Liao
- Scientific Research Center, Shanghai Public Health Clinical Center, Shanghai, China
| | - Tiefu Liu
- Scientific Research Center, Shanghai Public Health Clinical Center, Shanghai, China
| | - Yun Ling
- Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Xiaohong Fan
- Department of Respiratory, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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Chirombo J, Majamanda A, Gunsaru V, Yosefe S, Ozituosauka W, Mchoma C, Morroni C, Chipeta E, MacPherson P, Freyne B. The prevalence of gestational syphilis in Malawi between 2014 and 2022: spatiotemporal modeling of population-level factors. Front Public Health 2024; 11:1242870. [PMID: 38292384 PMCID: PMC10825961 DOI: 10.3389/fpubh.2023.1242870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/20/2023] [Indexed: 02/01/2024] Open
Abstract
Background Mother-to-child transmission of syphilis remains high especially in the WHO AFRO region with a prevalence of 1.62%, resulting in a congenital syphilis rate of 1,119 per 100,000 live births. Elimination efforts can be supported by an understanding of the spatial and temporal changes in disease over time, which can identify priority areas for targeted interventions aimed at reducing transmission. Methods We collated routine surveillance data from health facilities and covariate data from demographic and health surveys conducted in Malawi between 2014 and 2022. We fitted a Bayesian hierarchical mixed model with spatial and temporally structured random effects to model the district-level monthly counts of maternal syphilis notifications as a function of individual- and district-level predictors. We then generated district-level spatiotemporally explicit risk profiles to estimate the effect of individual- and district-level covariates on maternal syphilis notifications and to identify hotspot areas. Results Overall, the national prevalence of maternal syphilis increased from 0.28% (95% CI: 0.27-0.29%) in 2014 to peaking in 2021 at 1.92% (95% CI: 1.89-1.96%). Between 2020 and 2022, there was a decline in prevalence, with the most significant decline seen in Zomba District (1.40, 95% CI: 1.12-1.66%). In regression models, a one percentage point increase in district-level antenatal HIV prevalence was associated with increased maternal syphilis (prevalence ratio [PR]: 1.15, 95% credible interval [CrI]: 1.10-1.21). There was also an increased prevalence of maternal syphilis associated with an increased district-level mean number of sex partners (PR: 1.05, 95% CrI: 0.80-1.37). The number of districts with a high prevalence of maternal syphilis also increased between 2014 and 2022, especially in the southern region, where most had a high probability (approaching 100%) of having high maternal syphilis (defined as relative risk >1 compared to the standard population of women aged 15-49 years) in 2022. Conclusion Maternal syphilis prevalence in Malawi shows an increasing upward trend, with an estimated six times relative increase between 2014 and 2022 (0.28% to 1.73%) and strong associations with higher district-level HIV prevalence. Controlling syphilis depends on reaching vulnerable populations at the sub-national level, which may be disproportionately affected. Our findings support the move to integrate the elimination of mother-to-child transmission (EMTCT) of syphilis programs with existing prevention of mother-to-child transmission (PMTCT) of HIV programs.
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Affiliation(s)
- James Chirombo
- Statistical Support Unit, Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Vester Gunsaru
- Statistical Support Unit, Malawi Liverpool Wellcome Programme, Blantyre, Malawi
| | - Simeon Yosefe
- Digital Health Department, Ministry of Health, Lilongwe, Malawi
| | | | - Christina Mchoma
- Reproductive Health Department, Ministry of Health of Malawi, Lilongwe, Malawi
| | - Chelsea Morroni
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Effie Chipeta
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Peter MacPherson
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bridget Freyne
- Department of Paediatric Infectious Diseases, Children’s Health Ireland, Dublin, Ireland
- Division of Women and Children’s Health, School of Medicine, University College Dublin, Dublin, Ireland
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
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45
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Zhang C, Huang Y, Ji L, Zhu Q, Wang L, Wang J. Effectiveness of health management team program to enhance prevention of mother-to-child transmission of hepatitis B virus in Ningxia, China. BMC Public Health 2024; 24:67. [PMID: 38166770 PMCID: PMC10763679 DOI: 10.1186/s12889-023-17550-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Hepatitis B mother-to-child transmission interruption (PMTCT) poses a formidable challenge in underdeveloped regions of China. This study aims to evaluate the effectiveness of PMTCT and the health management team (HMT) model in Ningxia, China, as well as the risk factors for adverse outcomes. METHODS The PMTCT + HMT model was established, and 360 pregnant women diagnosed with HBV infection in 2020-2022 were selected and divided into the control and the study groups based on different intervention modes. HBV serum markers and HBV DNA levels were assessed, the indicators of compliance behaviors and adverse outcomes were compared, and the factors influencing adverse outcomes were analyzed. RESULTS The majority of subjects were residents of the local city, married, with secondary school or higher education, and employees of public sectors. The proportion of ethnic minorities was 40.8% and 34.2% in the control group and study group. HBeAg positivity was 23.3% and 26.3%, and the proportion with HBV DNA levels ≥ 2 × 105 IU/mL was 9.2% and 7.1%. Compared with the control group (PMTCT alone), the PMTCT + HMT model led to improved maternal knowledge (17.5% vs. 57.1%), voluntary counseling (34.2% vs. 63.3%), and testing (37.5% vs. 70.4%). The incidence of adverse pregnancy outcomes ((including miscarriage, preterm birth) decreased significantly (17.5% vs. 6.2%), as did adverse neonatal outcomes (low birth weight and congenital HBV) (26.9% vs. 10.5%). Adverse outcomes were associated with low educational attainment, non-locals, unmarried status, and ethnic minority identity. Additionally, HBeAg positivity and HBV DNA levels ≥ 2 × 105 IU/mL were risk factors for adverse outcomes. CONCLUSIONS The PMTCT + HMT model demonstrates significant effectiveness in preventing mother-to-child transmission of hepatitis B in Ningxia. The unique demographic structure of Ningxia region is closely linked to poor outcomes, emphasizing the importance of monitoring HBeAg status and HBV DNA viral load level.
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Affiliation(s)
- Chenglei Zhang
- Medical Laboratory, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750003, China
| | - Yongxiang Huang
- Medical Laboratory, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750003, China
| | - Liying Ji
- Department of laboratory, Yinchuan women and children healthcare hospital, Yinchuan, Ningxia, 750001, China
| | - Qian Zhu
- Medical Laboratory, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750003, China
| | - Lixin Wang
- Medical Laboratory, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750003, China
| | - Jingjiao Wang
- Department of Periodontics, Stomatological Hospital, General Hospital of Ningxia Medical University, 804 Shengli South Street, Xingqing District, Yinchuan, Ningxia, 750003, China.
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Luo YL, Gao S, Zhang QF, Liu X, Lv DY, Chen JH, Wang W. Eliminating mother-to-child transmission of hepatitis B virus: practice and progress in Baoan, a national pilot district of China. BMC Public Health 2024; 24:58. [PMID: 38166939 PMCID: PMC10763428 DOI: 10.1186/s12889-023-17500-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND While mother-to-child transmission (MTCT) of hepatitis B virus (HBV) remains a significant challenge in China, research investigating the effectiveness of the September 2017 pilot program to eliminate MTCT of HIV, syphilis, and HBV is limited. Baoan district, which has a higher-than-average rate of hepatitis B infection among pregnant women and strong support from the government, was one of six national pilot districts selected for the program. Therefore, this study aims to assess the progress and implementation of the elimination of MTCT of HBV in Baoan district over a period of 5 years. METHODS Data was collected from the national information system for the prevention of MTCT, registration forms, and follow-up forms of pregnant women and their live births from 2018 to 2022. Joinpoint models were used to analyze changing trends over time, calculating annual percentage change (APC) and the corresponding 95% confidence interval (95%CI). Multivariate logistic regression models were used to analyze risk factors for HBV MTCT. RESULTS From 2018 to 2022, the coverage of HBV screening during pregnancy increased from 98.29 to 99.55% (APC = 0.30, P = 0.012). The coverage of HBV early screening within 13 gestational weeks increased from 40.76 to 86.42% (APC = 18.88, P = 0.033). The prevalence of maternal HBV infection declined by an APC of - 3.50 (95% CI -6.28 ~ - 0.63). The coverage of antiviral therapy among high-risk pregnant women increased from 63.59 to 90.04% (APC = 11.90, P = 0.031). Coverage for timely administration of hepatitis B immunoglobulin, hepatitis B birth dose vaccine, and three-dose hepatitis B vaccination remained consistently above 97.50%. The coverage of post-vaccination serological testing (PVST) in high-risk infants was 56.15% (1352/2408), and the MTCT rate of HBV was 0.18%. Mothers with high-school education or below (OR = 3.76, 95% CI 1.04 ~ 13.60, P = 0.04) and hepatitis B e antigen (HBeAg) positivity (OR = 18.89, 95% CI 1.98 ~ 18.50, P = 0.01) had increased MTCT risk. CONCLUSIONS The implementation of comprehensive prevention strategies in Baoan district, including screening, treatment, and immunoprophylaxis, has proven effective in maintaining the MTCT of HBV at an extremely low level. However, it remains crucial to raise public awareness, specifically on the importance of improving the coverage of PVST for infants exposed to HBV.
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Affiliation(s)
- Ya-Li Luo
- Department of Health Care, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, Guangdong, China
| | - Shuang Gao
- Department of Maternal Health Care, Guangdong Women and Children's Hospital and Health Institue, Guangzhou, Guangdong, China
| | - Quan-Fu Zhang
- Office of Hospital Director, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, Guangdong, China
| | - Xian Liu
- Department of Anesthesiology and Surgery, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, Guangdong, China
| | - Ding-Yan Lv
- Department of Health Care, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, Guangdong, China
| | - Jia-Hong Chen
- Department of Health Care, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, Guangdong, China
| | - Wei Wang
- Department of Health Care, Shenzhen Baoan Women's and Children's Hospital, Shenzhen, Guangdong, China.
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Pérez Cavazos S, Molina de la Garza JF, Rodríguez Saldivar MM, Espinosa Villaseñor F, Vaquera Aparicio DN, Castillo Bejarano JI, Mascareñas de Los Santos AH, Pérez Barragán E. Clinical-Demographic and Laboratory Profile of the Mother-Child Binomial With Syphilis in a Tertiary-Level Hospital in Mexico. Sex Transm Dis 2024; 51:11-14. [PMID: 37889942 DOI: 10.1097/olq.0000000000001878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
BACKGROUND Congenital syphilis (CS) remains a major public health problem, and its incidence is increasing worldwide. METHODS Retrospective, observational, and descriptive study of cases with CS and their mothers at a tertiary-level hospital in Mexico from 2017 to 2022. Medical records of patients with CS and a structured collection of epidemiological, clinical, and laboratory data were analyzed and classified in the Centers for Disease Control scenarios as confirmed, probable, less probable, or unlikely. RESULTS One hundred eighty cases were diagnosed with a compatible definition of congenital syphilis, and we identified 43 (21.21%) confirmed proven. Among those proven cases, 15.6% had hematological, 13.3% skin, 12.2% liver, 6.7% pulmonary, 6.6% neurological, 5.8% eye, 5.6% bone, and 0.6% hearing involvements. According to the clinical stages of maternal syphilis, 119 (66.1%) were in the late latent phase, 49 (27.2%) in the early latent phase, 7 (3.9%) in the secondary stage, and 5 (2.8%) in the primary stage. Mothers with tertiary syphilis were not detected. CONCLUSION Regardless of negative antenatal screening, health care workers should consider the diagnosis of congenital syphilis. Infants are still undiagnosed at birth, and only a tiny percentage exhibits symptoms. The wide range of clinical manifestations of this preventable infection can be misdiagnosed for various other diseases, causing diagnostic delays that can have serious consequences.
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Affiliation(s)
- Samantha Pérez Cavazos
- From the Department of Pediatrics/Infectious Diseases Service, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - Juan Francisco Molina de la Garza
- From the Department of Pediatrics/Infectious Diseases Service, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - María Mayela Rodríguez Saldivar
- From the Department of Pediatrics/Infectious Diseases Service, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - Fernando Espinosa Villaseñor
- From the Department of Pediatrics/Infectious Diseases Service, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - Denisse Natalie Vaquera Aparicio
- From the Department of Pediatrics/Infectious Diseases Service, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - José Iván Castillo Bejarano
- From the Department of Pediatrics/Infectious Diseases Service, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | | | - Edgar Pérez Barragán
- Infectious Diseases Department/Infectious Diseases Hospital, Centro Médico Nacional "La Raza"/Ciudad de México, Mexico City, Mexico
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Wynn A, Morroni C, Klausner JD. Further Considerations Regarding Molecular Screening and Treatment of Bacterial Vaginosis. JAMA Pediatr 2024; 178:94-95. [PMID: 37930708 DOI: 10.1001/jamapediatrics.2023.4755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Adriane Wynn
- Division of Infectious Diseases and Global Public Health, University of California, San Diego
| | - Chelsea Morroni
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
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Sohn Y, Choi HK, Yun J, Kim EH, Kim YK. Clinical Characteristics and Risk of Hypoxemia Development in Women Infected with SARS-CoV-2 during Pregnancy. Yonsei Med J 2024; 65:27-33. [PMID: 38154477 PMCID: PMC10774648 DOI: 10.3349/ymj.2023.0270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 12/30/2023] Open
Abstract
PURPOSE There is limited information on the clinical characteristics and prognosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy. The clinical features and risk factors for hypoxemia development were investigated in pregnant women with coronavirus disease-2019 (COVID-19). MATERIALS AND METHODS From August 2020 to February 2022, we performed a retrospective cohort study of 410 pregnant women with COVID-19. The clinical characteristics and prognoses were compared between pregnant COVID-19 patients requiring oxygen and those who did not. RESULTS Of 410 patients, 100 (24.4%) required oxygen therapy. Among them, fever [163 (52.6%) vs. 81 (81.0%), p<0.001] and cough [172 (56.4%) vs. 73 (73.0%), p=0.003] were more frequently observed than in non-oxygen group. The proportion of unvaccinated women was higher in oxygen group than in non-oxygen group [264 (85.2%) vs. 98 (98.0%), p=0.003]. During the Omicron wave, patients were more likely to have no oxygen requirement [98 (31.6%) vs. 18 (18.0%), p=0.009]. The risk of hypoxemic respiratory difficulty increased if SARS-CoV-2 infection occurred during the third trimester [adjusted odds ratio (aOR) 5.083, 95% confidence interval (CI): 1.095-23.593, p=0.038] and C-reactive protein (CRP) was elevated (≥1.0 mg/dL) at admission (aOR 5.878, 95% CI: 3.099-11.146, p<0.001). The risk was higher in unvaccinated patients (aOR 5.376, 95% CI: 1.193-24.390, p=0.028). However, the risk was lower in patients during the Omicron wave (aOR 0.498, 95% CI: 0.258-0.961, p=0.038). CONCLUSION A quarter of SARS-CoV-2-infected women developed hypoxemic respiratory difficulty during pregnancy. SARS-CoV-2 infection during the third trimester, CRP elevation at admission, and no vaccination increased the risk of hypoxemia in pregnant women.
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Affiliation(s)
- Yujin Sohn
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hee Kyoung Choi
- Department of Infectious Diseases, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jisun Yun
- Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Eui Hyeok Kim
- Department of Obstetrics and Gynecology, CHA Ilsan Medical Center, CHA University School of Medicine, Goyang, Korea.
| | - Young Keun Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
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Vital Signs: Missed Opportunities for Preventing Congenital Syphilis-United States, 2022. Pediatr Infect Dis J 2023; 43:39. [PMID: 38048643 DOI: 10.1097/INF.0000000000004202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
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