Last two
decades have seen epidemics of several infectious diseases which were previously not
so prevalent worldwide. Pregnant mothers are especially prone to many infections
because of anatomical and physiological changes that accompany pregnancy. The
immune tolerance to semiallogenic fetus is because of down regulation of
immunity, which puts the pregnant women at high risk of other infectious
diseases reports a paper published in May 2017 issue of Journal Obstetrics and
Gynecology.
The world
has seen epidemics of four major and other minor emerging infectious diseases in
the last two decades such as severe acute respiratory syndrome, the 2009 H1N1
pandemic influenza, Ebola virus, and, most recently, the Zika virus. Each of this
infection has unique implications in pregnant women that are distinctly
different from general population.
Each of this
infectious disease has different clinical course, complications and future implications
when occurring in pregnant women and requires special technique and skills and
coordination at national and international levels to contain the outbreak, some
basic principles are common to all for diagnosing and limiting the spread of
these diseases.
A number of
epidemiological factors have contributed towards emergence and widespread occurrence
of these infection in pregnant women like global travel, development of
microbial resistance and barriers towards vaccinations in pregnant women in-spite
of increasing evidence of distinct benefits to mother and fetus.
Although the
general principles of disease containment are common to all, some disease
specific measures for treatment and prevention of individual infections in
pregnancy are:
SARS: During
the severe acute respiratory syndrome (SARS) outbreak by coronavirus in 2003,
standard non-pharmaceutical measures were applied, and global containment was achieved
in 5 months.
Influenza:
All pregnant women should get influenza vaccine every year as soon as it is
available and should not wait for the unpredictable influenza season to start. It
is safe in all the trimester. The rapid influenza tests currently available has
low sensitivity resulting in many false negative results. Hence, to err on the
side of safety it is always recommended to prescribe oseltamivir as precaution
and is recommended both by Centers for Disease Control and Prevention (CDC) and
the American College of Obstetricians and Gynecologists.
Ebola virus:
Women are always at high risk for contracting Ebola during an epidemic as they
are the primary caregivers to other infectious family members. Women who are
pregnant with the virus during acute Ebola epidemic usually transmit virus to the
fetus, leading to intrauterine fetal death, stillbirth, or neonatal death. Ebola
virus is also excreted in breast milk.
They also transmit
the virus to healthcare providers and caregivers during labor or abortion.
Standard precaution including the use of personal protective equipment (PPE)
during labor and delivery for protection against blood and body fluids should
be used along with rigorous hand hygiene, appropriate waste, sharps and laundry
management and cleaning and decontamination.
WHO states
that women who get pregnant after having being recovered from Ebola infection
are not infectious but standard precautions and use of PPE should be
implemented all the time during handling such patients.
Zika virus: Zika
virus is a flavivirus that has potential for sexual and vector born transmission
by Aedes (Stegomyia) species of mosquitoes. It was declared as
a public health emergency by the World Health Organization from 2016. A
pregnant woman is susceptible to Zika virus in all three trimesters. Maternal
Zika infection is associated with a range of adverse neonatal complications,
most important of which is microcephaly. Peripartum transmission is also known
to occur.
In absence
of antiviral vaccine, CDC recommends that all pregnant women should postpone
their travel to Zika infected areas and those who are in such areas should
avoid mosquito bite especially during the day.
Pregnant
women with laboratory-confirmed Zika virus infection can be offered
amniocentesis to test for Zika virus RNA by RT-PCR after 15 weeks of gestation.
Deliveries
of mothers with positive Zika infection should take place at specialized
center.
No specific
antiviral treatment is available.
Media courtesy:
InfectiousDiseaseAdvisor and Coherent news.
