Atypical clinical presentation of Ebola virus disease in pregnancy: Implications for clinical and public health management

Boris I Pavlin,Andrew Hall,Jan Hajek,Muhammad Ali Raja,Vikas Sharma,Otim Patrick Ramadan,Sharmistha Mishra,Audrey Rangel,Aileen Kitching,Katrina Roper,Tim O’Dempsey,Judith Starkulla,Amy Elizabeth Parry,Rashida Kamara,Alie H Wurie

doi:10.1016/j.ijid.2020.05.064

Abstract

BackgroundBetween December 2013 and June 2016, West Africa experienced the largest Ebola virus disease (EVD) outbreak in history. Understanding EVD in pregnancy is important for EVD clinical screening and infection prevention and control. MethodsWe conducted a review of medical records and EVD investigation reports from three districts in Sierra Leone. We report the clinical presentations and maternal and fetal outcomes of six pregnant women with atypical EVD, and subsequent transmission events from perinatal care. ResultsThe six women (ages 18–38) were all in the third trimester. Each presented with signs and symptoms initially attributed to pregnancy. None met EVD case definition; only one was known at presentation to be a contact of an EVD case. Five women died, and all six fetuses/neonates died. These cases resulted in at least 35 additional EVD cases. ConclusionsThese cases add to the sparse literature focusing on pregnant women with EVD, highlighting challenges and implications for outbreak control. Infected newborns may also present atypically and may shed virus while apparently asymptomatic. Pregnant women identified a priori as contacts of EVD cases require special attention and planning for obstetrical care.

Highlights

Between December 2013 and June 2016, West Africa experienced the largest Ebola virus disease (EVD) outbreak in history
Between December 2013 and June 2016, West Africa experienced the largest outbreak of Ebola virus disease (EVD) in history, with at least 28,646 cases and 11,323 deaths (WHO, 2019)
We are aware of four previous reports each involving a single pregnant woman with EVD who presented in labour without fever or typical symptoms of EVD (Akerlund et al, 2015; Okoror et al, 2018; Bower et al, 2016; Dunn et al, 2016)

Summary

Introduction

Between December 2013 and June 2016, West Africa experienced the largest Ebola virus disease (EVD) outbreak in history. Few reports describe the clinical outcomes in pregnant women infected with EVD, and their newborns (Piot et al, 1978; World Health and Organization, 1978; Bwaka et al, 1999; Mupapa et al, 1999; Caluwaerts et al, 2016, 2018; Baize et al, 2014; Caluwaerts, 2017; Chiu et al, 2018; Henwood et al, 2017; Lyman et al, 2018; Mpofu et al, 2019; Nelson et al, 2016; Oduyebo et al, 2015; UNFPA, 2020). We are aware of four previous reports each involving a single pregnant woman with EVD who presented in labour without fever or typical symptoms of EVD (Akerlund et al, 2015; Okoror et al, 2018; Bower et al, 2016; Dunn et al, 2016)

Methods

Discussion

Conclusion