Cholera in pregnancy: Clinical and immunological aspects

Abstract

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.

Cholera rages in Africa and the Middle East: A narrative review on challenges and solutions

“…Despite early research suggesting a high risk of fetal death linked to cholera during pregnancy (up to 50% during the third trimester), more recent research has revealed a decreased but still high risk (~8%). 114 , 121 , 122 , 123 According to one study from Guinea, most pregnant women affected by a 2012 cholera outbreak were in their third trimester. The classic clinical manifestations were associated with obstetric difficulties and maternal‐fetal hazards.…”

“…Cholera is particularly dangerous to pregnant women and their fetuses. Despite early research suggesting a high risk of fetal death linked to cholera during pregnancy (up to 50% during the third trimester), more recent research has revealed a decreased but still high risk (~8%) 114,121–123 . According to one study from Guinea, most pregnant women affected by a 2012 cholera outbreak were in their third trimester.…”