The Ebola outbreaks in 2014 and 2016 resulted in high mortality; however, many people who were infected recovered. Studies have demonstrated that after recovery Ebola virus can persist throughout the body in the eyes, brain, semen, human milk, and vaginal secretions. One study found that viral RNA could be detected in human milk over a year after recovery. Given this, understanding the persistence of Ebola virus post infection is a critical women’s health issue, particularly in individuals of child-bearing potential. This study assessed viral persistence or reactivation in pregnancy, pregnancy outcomes, and infant growth and development.
An observational cohort study was conducted in a subgroup of individuals who were enrolled in the PREVAIL III (Partnership for Research on Ebola Virus in Liberia) longitudinal survival study that was launched in 2015. Participants self-reported pregnancies and two groups were compared: seropositive individuals who had recovered from Ebola virus disease and seronegative individuals who had close contact with people infected with Ebola. Of the 1,566 participants enrolled between 2015 and 2017, 639 became pregnant (215 seropositive, 424 seronegative), and 589 reported their pregnancy outcomes. Rates of livebirths and other pregnancy measures were assessed in both study groups, and PCR testing was conducted in samples of placenta, parental and cord blood, human milk, and vaginal secretions from those in the seropositive group. The children born in the seropositive group were assessed every 6 months for 2 years on markers of growth and neurodevelopment.
The results of the study demonstrated low risk of Ebola virus reactivation peripartum and postpartum and low risk of adverse birth outcomes. Ebola survivors can have safe and successful pregnancies, especially when conception occurs over a year after recovery from acute infection. Because reactivation during the peripartum period was unlikely, seropositive individuals were therefore unlikely to transmit Ebola virus to their infants, contacts, or caregivers. Neonates of those who have recovered from Ebola virus disease had high concentrations of transplacental Ebola antibodies, suggesting robust immune response and early protection from Ebola virus. These findings indicate that healthcare and support can be offered without infection risk to providers.
References:
Fallah, MP et al. Pregnancy, pregnancy outcomes, and infant growth and development after recovery from Ebola virus disease in Liberia: an observational cohort study. Lancet Glob Health. DOI 10.1016/S2214-109X(23)00210-3