Choléra et grossesse: aspects épidémiologiques, cliniques et évolutifs

Diop, Sylvie Audrey; Manga, N.M.; Dia, N. M.; Gaye, S.; Ndour, C.T.; Seydi, Moussa; Soumare, M.; Diop, Bernard Marcel; Sow, Papa Salif

doi:10.1016/j.medmal.2007.05.010

Cited by 20 publications

(24 citation statements)

References 8 publications

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“…In a study done in the 1960s in Bangladesh, 18 half of pregnant patients with cholera lost their fetuses in the third trimester of pregnancy. Fetal losses among women with cholera in their second or third trimester of pregnancy have varied in later studies, from 6% in two different studies in Peru in 1991,19, 20 to 12% in Senegal in 2006 2 , to 8% in a more recent study in Haiti 1 . In our study, we noted 23 pregnancy losses among women exposed to oral cholera vaccine and 18 pregnancy losses among women not exposed to the vaccine.…”

Section: Discussionsupporting

confidence: 44%

“…However, the potential additional risk of pregnancy loss associated with vaccine was very small (<1%). This hypothetical risk needs to be considered in the context of substantial risk of disease for the mother during an outbreak and a high risk of pregnancy loss (6–12%) if cholera does occur 1, 2, 19, 20…”

Section: Discussionmentioning

confidence: 99%

“…Pregnant women with cholera are at risk of complications, leading to fetal losses in 2–36% of cases if not treated promptly 1, 2. Killed, whole-cell, oral cholera vaccines are recommended by WHO to reduce the risk of cholera.…”

Section: Introductionmentioning

confidence: 99%

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Safety of a killed oral cholera vaccine (Shanchol) in pregnant women in Malawi: an observational cohort study

Ali

Nelson

Luquero

et al. 2017

The Lancet Infectious Diseases

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SummaryBackgroundPregnancy increases the risk of harmful effects from cholera for both mothers and their fetuses. A killed oral cholera vaccine, Shanchol (Shantha Biotechnics, Hydrabad, India), can protect against the disease for up to 5 years. However, cholera vaccination campaigns have often excluded pregnant women because of insufficient safety data for use during pregnancy. We did an observational cohort study to assess the safety of Shanchol during pregnancy.MethodsThis observational cohort study was done in two adjacent districts (Nsanje and Chikwawa) in Malawi. Individuals older than 1 year in Nsanje were offered oral cholera vaccine during a mass vaccination campaign between March 30 and April 30, 2015, but no vaccines were administered in Chikwawa. We enrolled women who were exposed to oral cholera vaccine during pregnancy in Nsanje district, and women who were pregnant in Chikwawa district (and thus not exposed to oral cholera vaccine) during the same period. The primary endpoint of our analysis was pregnancy loss (spontaneous miscarriage or stillbirth), and the secondary endpoints were neonatal deaths and malformations. We evaluated these endpoints using log-binomial regression, adjusting for the imbalanced baseline characteristics between the groups. This study is registered with ClinicalTrials.gov, number NCT02499172.FindingsWe recruited 900 women exposed to oral cholera vaccine and 899 women not exposed to the vaccine between June 16 and Oct 10, 2015, and analysed 835 in each group. 361 women exposed to the vaccine and 327 not exposed to the vaccine were recruited after their pregnancies had ended. The incidence of pregnancy loss was 27·54 (95% CI 18·41–41·23) per 1000 pregnancies among those exposed to the vaccine and 21·56 (13·65–34·04) per 1000 among those not exposed. The adjusted relative risk for pregnancy loss among those exposed to oral cholera vaccine was 1·24 (95% CI 0·64–2·43; p=0·52) compared with those not exposed to the vaccine. The neonatal mortality rate was 11·78 (95% CI 5·92–23·46) per 1000 livebirths for infants whose mothers were exposed to oral cholera vaccine versus 8·91 (4·02–19·77) per 1000 livebirths for infants whose mothers were not exposed to the vaccine (crude relative risk 1·32, 95% CI 0·46–3·84; p=0·60). Only three newborn babies had malformations, two in the vaccine exposure group and one in the no-exposure group, yielding a relative risk of 2·00 (95% CI 0·18–22·04; p=0·57), although this estimate is unreliable because of the small number of outcomes.InterpretationOur study provides evidence that fetal exposure to oral cholera vaccine confers no significantly increased risk of pregnancy loss, neonatal mortality, or malformation. These data, along with findings from two retrospective studies, support use of oral cholera vaccine in pregnant women in cholera-affected regions.FundingBill & Melinda Gates Foundation.

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Section: Discussionsupporting

confidence: 44%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Safety of a killed oral cholera vaccine (Shanchol) in pregnant women in Malawi: an observational cohort study

Ali

Nelson

Luquero

et al. 2017

The Lancet Infectious Diseases

View full text Add to dashboard Cite

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“…Cholera in the third trimester has previously been significantly associated with an increased severity of diarrhoeal disease, as indicated by severe dehydration on admission to hospital, as compared with non-pregnant controls [19]. Several studies also suggest an association between fetal loss and the degree of dehydration and hypovolemia [19–21]. Independent of the dehydration status, severe vomiting was also found to be another risk factor for fetal death [12].…”

Section: Discussionmentioning

confidence: 99%

Cholera in pregnancy: Clinical and immunological aspects

Khan

Chowdhury

Leung

et al. 2015

International Journal of Infectious Diseases

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Background The objective of this study was to examine the clinical and immunological features of cholera in pregnancy. Methods Women of reproductive age presenting to the icddr,b Dhaka hospital with cholera, and enrolled as part of a larger cohort study, were tested for pregnancy on admission. We compared initial clinical features and immune responses of pregnant patients with non-pregnant female patients at days 2, 7 and 21 after infection. Results Among reproductive age women enrolled between January 2001 and May 2006, 9.7% (14/144) were pregnant. The duration of diarrhea prior to admission tended to be higher in pregnant compared to non-pregnant patients (p=0.08), but other clinical characteristics did not differ. Antibody responses to cholera toxin B subunit (CtxB), toxin-coregulated pilus A (TcpA), Vibrio cholerae lipopolysaccharide (LPS), and serum vibriocidal antibody responses, were comparable between pregnant and non-pregnant patients. There were no deaths among the pregnant cases or non-pregnant controls, and no adverse fetal outcomes, including stillbirths, during 21 days of follow up of pregnant cases. Conclusions To our knowledge, this is the first report of immune responses in pregnant women with cholera. We found that pregnant woman early in pregnancy has comparable clinical illness and subsequent immune responses compared to non-pregnant women. These findings suggest that the evaluation of safety and immunogenicity of oral cholera vaccines in pregnancy should be an area of future investigations.

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“…Moreover, cholera during pregnancy has been associated with abortion, premature childbirth and maternal death [2], [3], [4]. Thus, prevention of cholera in pregnancy constitutes an important public health priority.…”

Section: Introductionmentioning

confidence: 99%