Abstract
Abstract
Purpose of Review
Ebola virus infection has one of the highest overall case fatality rates of any viral disease. It has historically had an especially high case mortality rate among pregnant women and infants—greater than 90% for pregnant women in some outbreaks and close to 100 % in fetuses and newborns. The Merck recombinant vaccine against Ebola virus, termed rVSV-ZEBOV, underwent clinical trials during the 2013–2015 West Africa Ebola epidemic where it was found to be 100% efficacious. It was subsequently used during the 2018 DRC Équateur outbreak and in the 2018 DRC Kivu Ebola which is still ongoing, where its efficacy is 97.5 %. Pregnant and lactating women and their infants have previously been excluded from the design, clinical trials, and administration of many vaccines and drugs. This article critically examines the development of the rVSV-ZEBOV vaccine and its accessibility to pregnant and lactating women and infants as a life-saving form of prevention through three recent African Ebola epidemics—West Africa, DRC Équateur, and DRC Kivu.
Recent Findings
Pregnant and lactating women and their infants were excluded from participation in the clinical trials of rVSV-ZEBOV conducted during the West Africa epidemic. This policy of exclusion was continued with the occurrence of the DRC Équateur outbreak in 2018, in spite of calls from the public health and global maternal health communities to vaccinate this population. Following the onset of the DRC Kivu epidemic, the exclusion persisted. Eventually, the policy was reversed to include vaccination of pregnant and lactating women. However, it was not implemented until June 2019, 10 months after the start of the epidemic, placing hundreds of women and infants at risk for this highly fatal infection.
Summary
The historical policy of excluding pregnant and lactating women and infants from vaccine design, clinical trials, and implementation places them at risk, especially in situations of infectious disease outbreaks. In the future, all pregnant women, regardless of trimester, breastfeeding mothers, and infants, should have access to the Ebola vaccine.
Publisher
Springer Science and Business Media LLC
Subject
Infectious Diseases,Immunology and Allergy
Reference63 articles.
1. Schwartz DA. Maternal filovirus infection and death from Marburg and Ravn viruses: Highly lethal to pregnant women and their fetuses similar to Ebola Virus. In: Okware SI, editor. Re-emerging filovirus diseases. London: IntechOpen; 2019. ISBN: 978-1-78985-550-0. Available from: https://www.intechopencom/online-first/maternal-filovirus-infection-and-death-from-marburg-and-ravn-viruses-highly-lethal-to-pregnant-women. Accessed 20 August 2019.
2. Bebell LM. Ebola virus disease and pregnancy: Perinatal transmission and epidemiology. In: Schwartz DA, Anoko JN, Abramowitz S, editors. Pregnant in the time of Ebola: Women and their children in the 2013–2015 West African epidemic. New York: Springer Nature; 2019. p. 53–65. ISBN-13: 978–3319976365.
3. • Breman JG, Heymann DL, Lloyd G, McCormick JB, Miatudila M, Murphy FA, et al. Discovery and description of Ebola Zaire virus in 1976 and relevance to the west African epidemic during 2013–2016. J Infect Dis. 2016;214(Suppl 3): S93–101. Doi: https://doi.org/10.1093/infdis/jiw207 available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5050466/. accessed 25 July 2019. A detailed description of the initial outbreak of Ebola virus disease in 1976 in Yambuku, DRC and its relation to the West Africa Ebola epidemic.
4. WHO/International Study Team. Ebola haemorrhagic fever in Sudan, 1976. Report of a WHO/International Study Team. Bull World Health Organ. 1978;56(2):247–70 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2395561/. Accessed 1 September 2019.
5. CDC. Ebola virus disease distribution map: Cases of Ebola virus disease in Africa Since 1976. 2019. Available from: https://www.cdc.gov/vhf/ebola/history/distribution-map.html. Accessed 27 July 2019.
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