Online Program

Clinical presentation of pregnant women at isolation centers for Ebola Virus Disease in Sierra Leone, 2014

Monday, November 2, 2015 : 12:55 p.m. - 1:20 p.m.

Jonetta Johnson, PhD, MPH, Division of Reproductive Health, CDC National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA
William Callaghan, MD, MPH, Division of Reproductive Health, CDC National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA
Hayfa Elamin, MD, MPH, Govt Central Medical Stores Compound, Freetown, Sierra Leone
Sascha Ellington, MSPH, CPH, Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
Samuel Sheku Kargbo, MD, MPH, DMed (Leeds), Health Systems Planning, Policy and Information, Ministry of Health and Sanitation, Freetown, Sierra Leone
Alimamy Philip (AP) Koroma, MD, Princess Christian Maternity Hospital, Freetown, Sierra Leone
Meghan Lyman, MD, Division of Healthcare Quality and Promotion, Centers for Disease Control and Prevention, Atlanta, GA
Diane Morof, MD, MSc, Emergency Response and Recovery Branch, Centers for Disease Control and Prevention, Atlanta, GA
Fatma Soud, PhD RN/M, Centers for Disease Control & Prevention (CDC)|
Background: Limited evidence suggests that Ebola virus disease (EVD) is more severe in pregnant women. Identification of EVD in pregnant women may be difficult due to an overlap in symptoms of pregnancy/labor and EVD.

Objective: To examine EVD symptom prevalence and EVD status among pregnant women in EVD isolation units in Sierra Leone.

Methods: We abstracted data for pregnant women suspected of EVD in isolation units from July-December, 2014. Suspect cases were defined as pregnant women with fever (temperature>38ºC) and/or symptoms suggestive of EVD. We examined associations between EVD status and symptoms using chi-square tests and multivariate logistic regression.

Results: Of 192 pregnant women isolated, 36% (n=67) were EVD positive. Women testing EVD-positive were significantly more likely to have fever (89% vs 65% ), fatigue/weakness (84% vs 57% ), vomiting (69% vs 42% ), headache (69% vs 32%), muscle/joint pain (58% vs 32%), chest pain (41% vs 21%), vaginal bleeding (38% vs 14%), unexplained bleeding (19% vs 6%), sore throat (25% vs 3%) and cough (11% vs 2%)  compared to EVD-negative women (p-value <0.05 for all comparisons). After adjusting for age and the above listed symptoms, only vomiting (OR:2.5 95%CI:1.0-6.0) , headache (OR:2.9 95%CI:1.2-6.8), vaginal bleeding (OR:2.9 95%CI:1.0-7.9), and sore throat (OR:11.7 95%CI:1.2-116.9) were associated with  higher odds of positive EVD status.

Discussion: Our sample represents the largest collection of symptomology data from pregnant women with suspected EVD. Some symptoms were more common in EVD-positive than negative women. Our results highlight challenges associated with screening pregnant women for EVD.

Learning Areas:

Protection of the public in relation to communicable diseases including prevention or control
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines
Public health or related research

Learning Objectives:
Describe the symptomatology of EVD among a select group of pregnant women during the 2014-2015 EVD epidemic in Sierra Leone. Identify challenges associated with data collection, sampling, and logistics with a vulnerable population during an infectious disease epidemic.

Keyword(s): Vulnerable Populations, Maternal and Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was involved in the design and collection of data for this study while working in Freetown, Sierra Leone for the Centers for Disease Control and Prevention (CDC) on the Infection Prevention and Control Team during the 2014-2015 Ebola outbreaks. I am an Epidemiologist in the Division of Reproductive Health at CDC. I am also a member of a multidisciplinary workgroup of clinicians and epidemiologists working on maternal health issues and Ebola at CDC.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.