Blood, birthing and body fluids: Kailahun, 2014 °BBC, 2014 Blood, birthing and body fluids: Delivering and staying alive in an Ebola Management Centre Séverine Caluwaerts, Daphne Lagrou, Patricia Lledo Weber, Benjamin Black, Tom Decroo, Alseny Modet Camara, Michel Van Herp

1. Introduction 2014/2015 West-Africa Ebola epidemic How to care for Ebola-infected pregnant patients? What are the implications of pregnant Ebola survivors? Limited data in literature: 1976: 9/82 (11%) maternal survivors Foetal/neonatal mortality 100% Lack of adequate guidelines Medical staff anxious when caring for pregnant Ebola patients Blood birthing and body fluids Séverine Caluwaerts

Introduction AIM of the research: Describe specific adapted management protocol for caring for pregnant Ebola virus disease (EVD) patients Describe the characteristics of pregnant/postpartum EVD survivors and neonates Blood birthing and body fluids Séverine Caluwaerts

Methods Teams in MSF Ebola Management Centres (EMCs) were contacted and asked to report on pregnant Ebola patients 8 study sites reported (Guéckédou, Donka, Freetown, Kissy, Bo, Kailahun, Foya, Monrovia) from 1/04/2014 until 25/04/2015 This retrospective descriptive analysis met the MSF Ethics Review Board criteria for exemption from ethics review Blood birthing and body fluids Séverine Caluwaerts

Results - management protocol Meanwhile 4 updates -initially main emphasis on protection of health care workers (HCW): no invasive procedures, no suturing, strict waste management protocols -preference for oral drugs (misoprostol instead of oxytocin for prevention of postpartum haemorrhage) -later possibility of life-saving blood transfusion (3 patients transfused), MgSO4 treatment (1 patient treated) -importance of family planning/condom use Blood birthing and body fluids Séverine Caluwaerts

Results - pregnant survivors 33 pregnant survivors in MSF EMCs 9 (27%) in first trimester (probably underreporting, initially no systematic pregnancy testing at admission) (2 first trimester patients arrived already blood PCR negative) 15 (45%) in second 9 (27%) in third trimester Median age: 22 years [range 16-35] Sierra Leone Sept 2014 °Ruth Kauffman, 2014 Blood birthing and body fluids Séverine Caluwaerts

Results - foetuses 33/34 (97%) stillbirths/miscarriages (1 pregnancy was twin pregnancy) One baby born alive (Guéckédou, Guinea) good Apgars, lived 2 days °BBC, 2014 Blood birthing and body fluids Séverine Caluwaerts

Results: PCR from 15 deliveries Pt Site Month admission Pregn. Trim. Days between blood negativation and delivery Sample from PCR : CT values (+;++;+++) 1 Guéck June 14 3rd 4 Amniotic fluid 21,41 (+++) 2 24,10 (+++) 3 Oct 14 2nd 32 22,29 (+++) (+++) 5 Donka Nov 14 Placenta (mat) 6 Dec 2014 9 Placenta/amniotic fluid 25 (+++), 28 (++) 7 Jan 15 (++) 8 Kailahun Sept 14 10 23 (+++) Buccal swab 21 (+++) 22 (+++) 11 Kissy 21,3 (+++) 12 Feb 15 1rst 4 (blood PCR neg at entrance) Miscarriage 16 (+++) 13 April 15 31 Placenta 19,2 (+++) 14 Freetown 24 (+++) 15 Foya July 14 Foetus ‘positive’ 15/15 +ve 13/15 CT <25 (+++)

Conclusion Limitations: no systematic data-collection Pregnant woman can survive Ebola Need for pregnancy tests at admission Adapt management and monitoring Foetal/neonatal mortality 100% No HCW infections registered when caring for pregnant Ebola patients PCR amniotic fluid highly positive up to 32 days after negativation of the blood of the mother Pregnant survivor possibly infective after cure Urgent need for viral culture! => Every pregnant Ebola survivor needs to deliver in an EMC Blood birthing and body fluids Séverine Caluwaerts

Thanks to Everyone who reported data and cared for the patients (Floribert Lomboto , Furaha Walumpumpu, Maya Vergara, Ruth Kauffman, Benjamin Black, Patricia Lledo, Nelly Staderini ,Michel Moreau, Modet Camara, Maud Santantonio, Axelle Ronsse, Aicha Taybi, Jeff Edwards, Lucie, Fernanda Baggi and many more) and the field teams from Liberia, Guinea and Sierra Leone Luxor operational research unit Blood birthing and body fluids Séverine Caluwaerts °MSF, 2014