Emerging infections and pregnancy: West Nile virus, monkeypox, severe acute respiratory syndrome, and bioterrorism

• Type of Material: Article
• Authors: Denise Jamieson, Emory University; Daniel B. Jernigan, Centers for Disease Control and Prevention; Jane Ellis, Emory University; Tracee A. Treadwell, Centers for Disease Control and Prevention
• Language: English
• Date: 2005-09-01
• Publisher: Elsevier Inc.
• Publication Version: Final Published Version
• Copyright Statement: © 2005 Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.clp.2005.04.008
• Title of Journal or Parent Work: Clinics in Peritinalogy
• Volume: 32
• Issue: 3
• Start Page: 765
• End Page: 776
• Keywords: OUTCOMES; Science & Technology; Pediatrics; BOTULISM; BIOLOGICAL WEAPON; Obstetrics & Gynecology; SARS; OUTBREAK; PNEUMONIA; SMALLPOX; ANTHRAX; Life Sciences & Biomedicine; WOMEN; CORONAVIRUS
• Research Categories: Health Sciences, Obstetrics and Gynecology

Abstract

As we face emerging and re-emerging health threats, we will need to understand how these novel diseases will affect pregnant women. In some cases, such as SARS, the hemorrhagic fevers, and smallpox, it appears that pregnant women may have more severe clinical courses compared with nonpregnant adults. In some cases, it appears that the rapid diagnosis of the disease may be delayed due to pregnancy. For example, in one of the reported anthrax cases, there was probably a delay in diagnosis of anthrax peritonitis because the pregnancy complicated the presenting clinical picture [41]. In terms of prophylaxis and treatment of emerging diseases, in many cases, such as anthrax, tularemia, and plague, first-line therapies and postexposure prophylaxis is similar in pregnant and nonpregnant adults. Although vaccinations such as those for smallpox and anthrax are not generally recommended for pregnant women, in some cases they may be used for postexposure prophylaxis. For example, for pregnant women exposed to monkeypox or smallpox, use of the vaccinia vaccine is recommended. In some cases, such as with ribavirin, which is generally contraindicated in pregnancy due to its teratogenic and embyrocidal effects, decisions about use in pregnancy need to be carefully weighed. In the case of SARS, where treatment is generally supportive and the effectiveness of ribavirin has not been convincingly demonstrated, use of ribavirin may not be indicated. By contrast, ribavirin has been shown to be effective treatment for some of the viral hemorrhagic fevers, such as Lassa fever, and despite the risks, treatment of pregnant women may be warranted given the severity of illness. In terms of perinatal transmission, there are cases of intrauterine transmission of West Nile virus, monkeypox, and smallpox virus reported in the literature. There are a growing number of new or newly recognized pathogens in the United States that threaten our health. As new disease threats emerge, it will be critical to evaluate and understand how these diseases affect pregnant women, so that reasonable response plans for diagnosis and treatment of pregnant women can be rapidly developed.