ABSTRACT
BACKGROUND: Rift Valley fever virus is an emerging mosquito-borne virus that causes infections in animals and human beings in Africa and the Arabian Peninsula. Outbreaks of Rift Valley fever lead to mass abortions in livestock, but such abortions have not been identified in human beings. Our aim was to investigate the cause of miscarriages in febrile pregnant women in an area endemic for Rift Valley fever. METHODS: Pregnant women with fever of unknown origin who attended the governmental hospital of Port Sudan, Sudan, between June 30, 2011, and Nov 17, 2012, were sampled at admission and included in this cross-sectional study. Medical records were retrieved and haematological tests were done on patient samples. Presence of viral RNA as well as antibodies against a variety of viruses were analysed. Any association of viral infections, symptoms, and laboratory parameters to pregnancy outcome was investigated using Pearson's χ2 test. FINDINGS: Of 130 pregnant women with febrile disease, 28 were infected with Rift Valley fever virus and 31 with chikungunya virus, with typical clinical and laboratory findings for the infection in question. 15 (54%) of 28 women with an acute Rift Valley fever virus infection had miscarriages compared with 12 (12%) of 102 women negative for Rift Valley fever virus (p<0·0001). In a multiple logistic regression analysis, adjusting for age, haemorrhagic disease, and chikungunya virus infection, an acute Rift Valley fever virus infection was an independent predictor of having a miscarriage (odds ratio 7·4, 95% CI 2·7-20·1; p<0·0001). INTERPRETATION: This study is the first to show an association between infection with Rift Valley fever virus and miscarriage in pregnant women. Further studies are warranted to investigate the possible mechanisms. Our findings have implications for implementation of preventive measures, and evidence-based information to the public in endemic countries should be strongly recommended during Rift Valley fever outbreaks. FUNDING: Schlumberger Faculty for the Future, CRDF Global (31141), the Swedish International Development Cooperation Agency, the County Council of Västerbotten, and the Faculty of Medicine, Umeå University.
Subject(s)
Abortion, Spontaneous/etiology , Rift Valley Fever/complications , Rift Valley fever virus , Abortion, Spontaneous/virology , Animals , Cross-Sectional Studies , Disease Outbreaks , Female , Fever/etiology , Fever/virology , Humans , Logistic Models , Mosquito Vectors , Odds Ratio , Pregnancy , Pregnancy Outcome , Rift Valley Fever/transmission , Rift Valley Fever/virology , Rift Valley fever virus/pathogenicity , SudanABSTRACT
During 4 months (November 2010-March 2011) of an outbreak of hepatitis E virus (HEV), 39 pregnant women presented at Port Sudan Hospital, Sudan, with various symptoms of viral hepatitis. The diagnosis of viral hepatitis was confirmed by serology using ELISA anti-HEV IgG and IgM. The mean (SD) maternal age and gestational age were 24·0 (4·2) years and 33·6 (3·7) weeks, respectively. Eight (20·5%) women were primigravidae. There were 11 (28·2%) maternal deaths, 14 (36·0%) intrauterine fetal deaths, and eight (20·5%) cases of postpartum haemorrhage. There were nine (23·0%) cases of preterm (<37 weeks of gestation) deliveries. Fulminant hepatitis with hepatic encephalopathy was the most common cause of death among these patients. Nine of these women died before delivery and the other two died immediately following the delivery due to severe haemorrhage. There were no significant differences in clinical and biochemical data between the women who died (11) and those who survived.
Subject(s)
Disease Outbreaks , Fetal Death/epidemiology , Hepatic Encephalopathy/mortality , Hepatitis E virus/isolation & purification , Hepatitis E/mortality , Malnutrition/epidemiology , Postpartum Hemorrhage/mortality , Pregnancy Complications, Infectious/mortality , Adult , Enzyme-Linked Immunosorbent Assay , Female , Fetal Death/prevention & control , Gestational Age , Hepatic Encephalopathy/epidemiology , Hepatic Encephalopathy/immunology , Hepatic Encephalopathy/prevention & control , Hepatitis Antibodies/blood , Hepatitis E/epidemiology , Hepatitis E/prevention & control , Hepatitis E virus/immunology , Humans , Immunocompromised Host , Infant, Newborn , Maternal Mortality , Parity , Postpartum Hemorrhage/prevention & control , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/immunology , Pregnancy Complications, Infectious/prevention & control , Prevalence , RNA, Viral , Sudan/epidemiologyABSTRACT
AIM: To investigate maternal and perinatal outcomes (maternal death, preterm delivery, low birth weight and perinatal mortality) of dengue at PortSudan and Elmawani hospitals in the eastern Sudan. METHOD: This was a retrospective Cohort study where medical files of women with dengue were reviewed. RESULTS: There were 10820 deliveries and 78 (0.7%) pregnant women with confirmed dengue IgM serology at the mean (SD) gestational age of 29.4(8.2) weeks. While the majority of these women had dengue fever (46, 58.9%), hemorrhagic fever and dengue shock syndrome were the presentations in 18 (23.0%) and 12, (15.3%) of these women, respectively. There were 17(21.7%) maternal deaths. Fourteen (17.9%) of these 78 women had preterm deliveries and 19 (24.3%) neonates were admitted to neonatal intensive care unit. Nineteen (24.3%) women gave birth to low birth weight babies. There were seven (8.9%) perinatal deaths. Eight (10.2%) patients delivered by caesarean section due to various obstetrical indications. CONCLUSION: Thus dengue has poor maternal and perinatal outcomes in this setting. Preventive measures against dengue should be employed in the region, and more research on dengue during pregnancy is needed.
