RESUMO
BACKGROUND: Limited data on the impact of the coronavirus disease 2019 (COVID-19) during pregnancy on newborn outcomes are available. This study aimed to characterize and compare the clinical outcomes of newborns from women with and without the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection during late pregnancy. METHOD: This was a retrospective cohort study of women who were either infected or not infected with the SARS-CoV-2 virus during late pregnancy. The neonatal complications associated with COVID-19-positive pregnant women were investigated and analyzed. RESULTS: Among 2063 pregnant women over 28 weeks of gestation, 1.2%, 3.3%, and 18.7% of patients with multiple pregnancies, abnormal fetal positions, and lack of maternal or neonatal follow-up data, respectively, were excluded. Patients who were COVID-19-negative (60.6%) and -positive (16.2%) remained for further analysis. SARS-CoV-2 infection was significantly associated with higher SARS-CoV-2 infection rates in newborns (0% vs. 1.49%, P < 0.01) and longer duration of hospital stay (6.39 ± 2.2 vs. 4.92 ± 1.6, P < 0.01). However, comparing neonatal complications, including Apgar score, preterm birth, low birth weight, cesarean section rate, newborn hearing, neonatal congenital heart defects, and height and weight compliance rate of 6-month-old children, between non-infected and infected participants did not reach statistical significance. CONCLUSION: SARS-CoV-2 infection in late pregnancy has no significant impact on neonatal outcomes. After six months of follow-up of the neonates, we observed that SARS-CoV-2 infection in the third trimester of pregnancy did not affect their growth and development. Hopefully, these findings will guide management strategies and clinical practice.
Assuntos
COVID-19 , Complicações Infecciosas na Gravidez , Resultado da Gravidez , SARS-CoV-2 , Humanos , Feminino , Gravidez , COVID-19/complicações , COVID-19/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Recém-Nascido , Estudos Retrospectivos , Adulto , Resultado da Gravidez/epidemiologia , Terceiro Trimestre da Gravidez , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Nascimento Prematuro/epidemiologia , Cesárea/estatística & dados numéricos , Índice de ApgarRESUMO
BACKGROUND: Pregnancy is a critical time for women, making them more susceptible to infectious diseases like COVID-19. This study aims to determine the immunogenicity of COVID-19 in pregnant women who have been infected compared to those who have received the inactive COVID-19 vaccine. MATERIALS AND METHODS: In this retrospective cohort study, pregnant women who received the inactivated COVID-19 vaccine (Sinopharm) and those with a history of COVID-19 infection during pregnancy were studied. Participants who had experienced stillbirth, received different COVID-19 vaccines, or had intrauterine fetal death were excluded from the study. Overall, the study included 140 participants. The participants were divided into two groups of 70 participants - pregnant women who received the Sinopharm vaccine and pregnant women who had COVID-19 infection during pregnancy. Before delivery, blood samples were collected from all mothers to evaluate the maternal immunoglobulin G (IgG) level. Blood samples were also taken from the baby's umbilical cord during delivery to measure the newborn's IgG level. Additionally, blood samples were collected from babies whose mothers showed signs of acute infection to measure their IgM levels and evaluate vertical transmission. FINDINGS: The study found a significant relationship between the mean level of maternal IgG and umbilical cord IgG within the groups (P < 0.001). The highest levels of maternal IgG (2.50 ± 2.17) and umbilical cord IgG (2.43 ± 2.09) were observed in pregnant women with a previous COVID-19 infection and no history of vaccination (P < 0.001). Only one baby was born with a positive IgM, and this baby was born to a mother who showed signs of COVID-19 infection in the last five days of pregnancy. The mother was 28 years old, with a BMI of 33; it was her first pregnancy, and she gave birth to a male newborn at term. CONCLUSION: Administering an inactivated vaccine during pregnancy can generate immunity in both the mother and the child. However, the vaccine's immunity level may not be as potent as that conferred by COVID-19 infection during pregnancy. Nonetheless, the risk of vertical transmission of COVID-19 is considered minimal and can be classified as negligible.
Assuntos
Anticorpos Antivirais , Vacinas contra COVID-19 , COVID-19 , Imunoglobulina G , Complicações Infecciosas na Gravidez , SARS-CoV-2 , Humanos , Gravidez , Feminino , COVID-19/imunologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/imunologia , Vacinas contra COVID-19/administração & dosagem , Estudos Retrospectivos , Imunoglobulina G/sangue , Adulto , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/imunologia , SARS-CoV-2/imunologia , Anticorpos Antivirais/sangue , Vacinação , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Recém-Nascido , Vacinas de Produtos Inativados/imunologia , Vacinas de Produtos Inativados/administração & dosagem , Gestantes , Imunogenicidade da VacinaRESUMO
Maternal health remains a global priority, with particular emphasis on combating infectious diseases such as HIV and malaria during pregnancy. Despite significant progress in prevention and treatment efforts, both HIV and malaria continue to pose significant risks to maternal and fetal well-being, particularly in resource-limited settings. The prevention of mother-to-child transmission (PMTCT) programs for HIV and intermittent preventive treatment (IPTp) for malaria represent cornerstone strategies in mitigating the impact of these infections on pregnancy outcomes. PMTCT programs focus on early HIV diagnosis, antiretroviral therapy initiation, and promoting safe infant feeding practices to reduce the risk of mother-to-child transmission. Similarly, IPTp involves the administration of antimalarial medication to pregnant women in malaria-endemic regions to prevent maternal and fetal complications associated with malaria infection. Integration of HIV and malaria prevention and treatment services within existing maternal and child health programs is crucial for maximizing impact and minimizing healthcare system strain. Strengthening health systems, improving access to antenatal care services, and enhancing community engagement are essential components of comprehensive maternal health strategies. Furthermore, promoting awareness, education, and empowerment of pregnant women and communities are vital in fostering health-seeking behaviors and adherence to preventive measures against HIV and malaria. In conclusion, protecting maternal health from the dual threat of HIV and malaria requires a multifaceted approach that encompasses prevention, screening, treatment, and community engagement.
Assuntos
Infecções por HIV , Transmissão Vertical de Doenças Infecciosas , Malária , Complicações Infecciosas na Gravidez , Humanos , Gravidez , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Infecções por HIV/tratamento farmacológico , Malária/prevenção & controle , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Saúde Materna , Antimaláricos/uso terapêutico , Cuidado Pré-Natal/métodosRESUMO
Four infants potentially exposed to syphilis infection in utero, meeting World Health Organization surveillance criteria of congenital syphilis (CS), were diagnosed in Croatia between September 2020 and January 2024. We conducted a retrospective analysis of epidemiological, clinical and laboratory data of these cases to assess compliance with surveillance case definitions. As only one confirmed CS case has been reported in Croatia in over 2 decades, these reports signal an increased risk of syphilis vertical transmission and warrant strengthening antenatal screening.
Assuntos
Transmissão Vertical de Doenças Infecciosas , Complicações Infecciosas na Gravidez , Sífilis Congênita , Humanos , Croácia/epidemiologia , Feminino , Sífilis Congênita/epidemiologia , Sífilis Congênita/transmissão , Gravidez , Estudos Retrospectivos , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/diagnóstico , Recém-Nascido , Sífilis/epidemiologia , Sífilis/transmissão , Sífilis/diagnóstico , Masculino , Lactente , Diagnóstico Pré-Natal , Adulto , Sorodiagnóstico da Sífilis , Treponema pallidum/isolamento & purificaçãoRESUMO
BACKGROUND: Antiretroviral therapy (ART) use during pregnancy is essential to prevent vertical transmission of HIV, but it may also increase the risk of adverse birth outcomes. This study investigated the impact of both maternal HIV infection and the timing of ART initiation on birth outcomes in women living with HIV in South Africa. METHODS: This secondary data analysis examined the dataset from an earlier cohort study involving 1709 pregnant women living with HIV who delivered their babies at three major maternity centres in the Eastern Cape province of South Africa between September 2015 and May 2018. The associations between adverse birth outcomes (stillbirth, preterm birth, very preterm birth, and low birth weight) and the timing of maternal ART initiation, peripartum CD4 count, and HIV viral load were examined using logistic regression analysis. RESULTS: The observed rates of stillbirth, preterm birth, very preterm birth, and low birth weight were 1.4%, 33.5%, 5.4% and 18.0%, respectively. In the multivariable analysis, low birth weight was associated with ART initiated during the second trimester (adjusted odds ratio [aOR] 1.38; 95% confidence interval [CI], 1.03-1.85), low-level viraemia (21-999 copies/ml) (aOR, 1.62; 95% CI, 1.17-2.22), and high-level viraemia (≥1000 copies/ml) (aOR, 1.66; 95% CI, 1.66-2.38) during the peripartum period. Preterm birth was associated with low-level viraemia (aOR, 1.44; 95% CI, 1.16-1.79) and a CD4 count of less than 200 cells/mm3 (aOR, 1.35; 95% CI, 1.01-1.82). Very preterm birth was associated with detectable maternal viraemia. CONCLUSION: Adverse birth outcomes are common among pregnant women living with HIV, especially those with unsuppressed viraemia. Clinicians and programme managers should prioritise timeous ART initiation and virological suppression in all pregnant women living with HIV.
Assuntos
Infecções por HIV , Complicações Infecciosas na Gravidez , Resultado da Gravidez , Carga Viral , Humanos , Feminino , Gravidez , África do Sul/epidemiologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Adulto , Contagem de Linfócito CD4 , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/virologia , Recém-Nascido , Nascimento Prematuro/epidemiologia , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Adulto Jovem , Recém-Nascido de Baixo Peso , Fármacos Anti-HIV/uso terapêutico , Natimorto/epidemiologia , Análise de Dados SecundáriosRESUMO
BACKGROUND: Group B Streptococcus (GBS) is a major cause of sepsis and meningitis in newborns. The Centers for Disease Control and Prevention (CDC) recommends to pregnant women, between 35 and 37 weeks of gestation, universal vaginal-rectal screening for GBS colonization, aimed at intrapartum antibiotic prophylaxis (IAP). The latter is the only currently available and highly effective method against early onset GBS neonatal infections. Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, the preventive measures implemented to mitigate the effects of SARS-CoV-2 infection led to the reduction in the access to many health facilities and services, including the obstetric and perinatal ones. The purpose of the present study was to evaluate the prevalence of maternal GBS colonization, as well as use of IAP and incidence of episodes of neonatal GBS infection when antibiotic prophylaxis has not been carried out in colonized and/or at risk subjects, in a population of pregnant women during (years 2020-2021) and after (year 2022) the COVID-19 pandemic, also with the aim to establish possible epidemiological and clinical differences in the two subjects' groups. METHODS: We retrospectively analyzed the clinical data of pregnant women admitted to, and delivering, at the Gynaecology and Obstetrics Unit, Department of Sciences for Health Promotion and Mother and Child Care, of the University Hospital of Palermo, Italy, from 01.01.2020 to 31.12.2022. For each of them, we recorded pertinent socio-demographic information, clinical data related to pregnancy, delivery and peripartum, and specifically execution and status of vaginal and rectal swab test for GBS detection, along with eventual administration and modality of IAP. The neonatal outcome was investigated in all cases at risk (positive maternal swabs status for GBS, either vaginal or rectal, with or without/incomplete IAP, preterm labor and/or delivery, premature rupture of membranes ≥ 18 h, previous pregnancy ended with neonatal early onset GBS disease [EOD], urine culture positive for GBS in any trimester of current gestation, intrapartum temperature ≥ 38 °C and/or any clinical/laboratory signs of suspected chorioamnionitis). The data concerning mothers and neonates at risk, observed during the pandemic (years 2020-2021), were compared with those of both subjects' groups with overlapping risk factors recorded in the following period (year 2022). The chi squared test has been applied in order to find out the relationship between pregnant women with GBS colonization receiving IAP and outcome of their neonates. RESULTS: The total source population of the study consisted of 2109 pregnant women, in addition to their 2144 newborns. Our analysis, however, focused on women and neonates with risk factors. The vaginal-rectal swab for GBS was performed in 1559 (73.92%) individuals. The test resulted positive in 178 cases overall (11.42% of those undergoing the screening). Amongst our whole sample of 2109 subjects, 298 women had an indication for IAP (vaginal and/or rectal GBS colonization, previous pregnancy ended with neonatal GBS EOD, urine culture positive for GBS in any trimester of current gestation, and unknown GBS status at labor onset with at least any among delivery at < 37 weeks' gestation, amniotic membranes rupture ≥ 18 h and/or intrapartum temperature ≥ 38.0 °C), and 64 (21.48%) received adequate treatment; for 23 (7.72%) it was inadequate/incomplete, while 211 (70.8%) did not receive IAP despite maternal GBS colonization and/or the presence of any of the above mentioned risk factors. Comparing the frequency of performing vaginal-rectal swabs in the women admitted in the two time periods, the quote of those screened out of the total in the pandemic period (years 2020-2021) was higher than that of those undergoing GBS screening out of the total admitted in the year 2022 (75.65% vs. 70.38%, p = 0.009), while a greater number (not statistically significant, p = 0.12) of adequate and complete IAP was conducted in 2022, than in the previous biennium (26.36 vs. 18.62%). During the whole 3 years study period, as expected, none of the newborns of mothers with GBS colonization and/or risk factors receiving IAP developed EOD. Conversely, 13 neonates with EOD, out of 179 (7.3%) born to mothers with risk factors, were observed: 3 among these patients' mothers performed incomplete IAP, while the other 10 did not receive IAP. Neither cases of neonatal meningitis, nor deaths were observed. The incidence rate in the full triennium under investigation, estimated as the ratio between the number of babies developing the disease out of the total of 2144 newborns, was 6.06; among those born to mothers with risk factors, if comparing the two time periods, the incidence was 8.06% in the pandemic biennium, while 5.45% in the following year, evidencing thus no statistical significance (p = 0.53). CONCLUSIONS: The present study revealed in our Department an increased prevalence of pregnant women screened for, and colonized by GBS, in the last decade. However, an overall still low frequency of vaginal-rectal swabs performed for GBS, and low number of adequate and complete IAP despite the presence of risk factors have been found, which did not notably change during the two time periods. Moreover, significant EOD incidence rates have been reported among children of mothers carrying risk factors, although also in this case no statistically significant differences have been observed during and after the pandemic. Such data seem to be in contrast to those reported during the COVID-19, showing a decrease in the access to health facilities and increased mortality/morbidity rates also due to the restrictive measures adopted to mitigate the effects of the pandemic. These findings might be explained by the presence within the same metropolitan area of our Department of a COVID hospital and birthing center, which all the patients with SARS-CoV-2 infection referred to, and likely leading to a weaker concern of getting sick perceived by our patients. Although IAP is an easy procedure to implement, however adherence and uniformity in the management protocols are still not optimal. Therefore, the prophylactic measures adopted to date cannot be considered fully satisfactory, and should be improved. Better skills integration and obstetrical-neonatological collaboration, in addition to new effective preventive tools, like vaccines able to prevent invasive disease, may allow further reduction in morbidity and mortality rates related to GBS perinatal infection.
Assuntos
COVID-19 , Complicações Infecciosas na Gravidez , Infecções Estreptocócicas , Streptococcus agalactiae , Humanos , Feminino , Gravidez , COVID-19/epidemiologia , COVID-19/prevenção & controle , Estudos Retrospectivos , Recém-Nascido , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/prevenção & controle , Infecções Estreptocócicas/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/prevenção & controle , Streptococcus agalactiae/isolamento & purificação , Adulto , Antibioticoprofilaxia , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Itália/epidemiologia , Resultado da Gravidez , Pandemias , Incidência , SARS-CoV-2RESUMO
BACKGROUND: The principal route of HIV infection in children is vertical transmission. Thus, this study aimed to assess the incidence of mother-to-child transmission of HIV and predictors of positivity among HIV-exposed infants. METHOD: Institutions-based retrospective follow-up study was conducted in South Gondar Public hospitals, Northwest Ethiopia from December 2019 to November 2021. The data were taken from PMTCT logbooks and patient medical records, with death being the competing event. Data were entered in to Epi info version 7 and exported to STATA version 14 for final analysis. Both bivariable and multiple variable proportional subdistribution hazard analysis were conducted to identify predictors. P-value < 0.05 was level of significance. RESULT: A total of 469 exposed infant mother pairs records were included. The cumulative incidence rate at the end of the study period was 5.2 per 1000 person months (5.2; 95% CI: 3.4-8.0).Infants' absence of ARV prophylaxis at birth (aSHR = 3.7; 95% CI: 1.33-10.48), Mothers with no PMTCT intervention (aSHR = 5.1; 95% CI: 1.83-14.03), home delivery (aSHR = 4.1; 95%CI: 1.46-11.63) and maternal disclosure of HIV status to partner/families (aSHR = 2.9; 95% CI: 1.06-7.78) were predictors of HIV positivity. CONCLUSION: The study found that Infants' absence of ARV prophylaxis at birth, mothers without PMTCT intervention, home delivery and mothers who were not disclosing their HIV status to families were predictors of HIV positivity.
Assuntos
Infecções por HIV , Hospitais Públicos , Transmissão Vertical de Doenças Infecciosas , Humanos , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Etiópia/epidemiologia , Feminino , Infecções por HIV/transmissão , Infecções por HIV/epidemiologia , Infecções por HIV/diagnóstico , Incidência , Estudos Retrospectivos , Recém-Nascido , Lactente , Adulto , Gravidez , Masculino , Seguimentos , Complicações Infecciosas na Gravidez/epidemiologia , Fatores de Risco , Adulto JovemRESUMO
To gather national level data on Israeli neonatal HSV (NHSV) infection and to evaluate the distinct clinical characteristics of NHSV and neonatal enteroviral meningitis (NEM). Israeli NHSV patients, hospitalized between January 2015 and April 2022 in 22 medical centers were assessed, together with NEM patients, hospitalized at Sheba Medical Center during the same period. NHSV demographic and clinical characteristics were documented and compared to those of NEM. Eighty-five NHSV (73% males) and 130 NEM (62% males) patients were included. The incidence of NHSV was 5.9/100 000 live births, the common phenotype and HSV type were SEM (53%) and HSV1 (91%), respectively. Horizontal transmission was suspected in 50% cases (of which 67% underwent a Jewish ritual circumcision with direct wound sucking, 33% had relatives with highly suspicious herpetic lesions). Compared with NEM, NHSV tends to present with rash (14% vs. 60%, p-value < 0.01) and seizures (0% vs. 6%, p-value 0.02), while fever, irritability and poor feeding appear more frequently in NEM (94% vs. 18%, p-value < 0.01; 37% vs. 1%, p-value < 0.01; 25% vs. 1%, p-value < 0.01 respectively). Of NEM patients, 28% were treated with acyclovir. Our results mark a decrease in the incidence rate of NHSV in Israel and a prominent mode of horizontal infection acquisition. We underscore the unique localized phenotype of NHSV, in contrast to enterovirus, which tends to cause a systemic disease with constitutional symptoms. These findings should be considered when evaluating the need for comprehensive empirical treatment for HSV in the context of neonatal fever, or according to a certain clinical presentation.
Assuntos
Herpes Simples , Humanos , Israel/epidemiologia , Masculino , Herpes Simples/epidemiologia , Herpes Simples/transmissão , Feminino , Recém-Nascido , Incidência , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Infecções por Enterovirus/epidemiologia , Infecções por Enterovirus/virologia , Herpesvirus Humano 1 , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricosRESUMO
PURPOSE: The Rahima Moosa Mother and Child Hospital (RMMCH) maternal HIV cohort originated from data systems that were developed to support HIV-related birth care and track outcomes of a complete birth cohort of HIV-exposed infants at Rahima Moosa Hospital and their mothers living with HIV. PARTICIPANTS: Supported by the Empilweni Services and Research Unit, maternal and infant data from 13 654 pregnant women living with HIV who delivered their infants (and a subset also attended antenatal care) were collected at RMMCH in Johannesburg, South Africa since 2013. Maternal data were collected using counsellor-administered interviews and the 2013-2018 subset of this cohort was linked to the National Health Laboratory Services (NHLS) national HIV cohort-a longitudinal cohort of people living with HIV accessing care in the public sector antiretroviral therapy programme in South Africa that can observe national access to HIV care through laboratory testing data. FINDINGS TO DATE: Topics addressed by the cohort include antenatal care history, HIV treatment exposure, delivery/birth management, prophylaxis and maternal blood results relevant to HIV captured at delivery. The cohort was also one of the first to describe implementation of early infant diagnosis procedures in South Africa including evaluations of novel point-of-care testing strategies demonstrating improvements in uptake of HIV care among infants accessing point-of-care services. FUTURE PLANS: Annual linkage of infant delivery and testing data to longitudinal laboratory test data in the NHLS national HIV cohort is planned to allow for analysis of both infant continuity of care outcomes and as well as evaluation of maternal-infant pair treatment and mobility outcomes in the post partum and later period.
Assuntos
Infecções por HIV , Transmissão Vertical de Doenças Infecciosas , Complicações Infecciosas na Gravidez , Humanos , África do Sul/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/tratamento farmacológico , Feminino , Gravidez , Adulto , Complicações Infecciosas na Gravidez/epidemiologia , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Recém-Nascido , Lactente , Adulto Jovem , Cuidado Pré-Natal/estatística & dados numéricos , Estudos de Coortes , Estudos LongitudinaisRESUMO
PURPOSE: Prospective, multicentric observational cohort study in Switzerland investigating measures to prevent mother-to-child transmission in pregnant women with HIV (WWH) and assessing health and development of their exposed children as well as of children with HIV (CWH) in general. PARTICIPANTS: Between January 1986 and December 2022, a total of 1446 mother-child pairs were enrolled. During the same period, the study also registered 187 CWH and 521 HIV-exposed but uninfected children (HEU), for whom detailed maternal information was not available. Consequently, the cohort comprises a total of 2154 children. FINDINGS TO DATE: During these 37 years, research by the Swiss Mother and Child HIV Cohort Study (MoCHiV) and its international collaborators has strongly influenced the prevention of vertical transmission of HIV (eg, introduction and discontinuation of elective caesarean section, neonatal postexposure prophylaxis and breastfeeding). Contributions have also been made to the management of diagnostics (eg, p24 antigen assay) and the effects of antiretroviral treatment (eg, prematurity, growth) in HEU and CWH. FUTURE PLANS: Most children present within the cohort are now HEU, highlighting the need to investigate other vertically transmitted pathogens such as hepatitis B and C viruses, cytomegalovirus or Treponema pallidum. In addition, analyses are planned on the longitudinal health status of CWH (eg, resistance and prolonged exposure to antiretroviral therapy), on social aspects including stigma in CWH and HEU, and on interventions to further optimise antenatal and postpartum care in WWH.
Assuntos
Infecções por HIV , Transmissão Vertical de Doenças Infecciosas , Complicações Infecciosas na Gravidez , Humanos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Feminino , Suíça/epidemiologia , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Infecções por HIV/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Estudos Prospectivos , Recém-Nascido , Lactente , Adulto , Criança , Masculino , Pré-Escolar , Aleitamento Materno/estatística & dados numéricos , Estudos de CoortesRESUMO
BACKGROUND: While HIV testing and counselling play a crucial role in preventing mother-to-child transmission, numerous pregnant women did not receive these services. Understanding the spatial variation of HIV testing and counselling and its associated factors during antenatal care in Ethiopia remains limited. Thus, this study was aimed at assessing the spatial patterns and factors associated with HIV testing and counselling during antenatal care visits in Ethiopia. METHODS: A cross-sectional study design was employed with a two-stage stratified cluster sampling technique. A total of 2,789 women who gave birth in the two years prior to the survey and had at least one antenatal care visit were included in the study. Stata version 16 and ArcGIS version 10.8 software were used for analysis. A multilevel robust Poisson regression model was fitted to identify significantly associated factors since the prevalence of HIV testing and counselling was higher than 10%. A statistically significant association was declared based on multivariable multilevel robust Poisson regression analysis using an adjusted prevalence ratio with its 95% confidence interval at a p-value < 0.05. Spatial regression analysis was conducted, and the local coefficients of statistically significant spatial covariates were visualised. RESULTS: In Ethiopia, the overall prevalence of HIV testing and counselling during antenatal care visits was 29.5% (95% CI: 27.8%, 31.2%). Significant spatial clustering was observed (Global Moran's I = 0.138, p-value <0.001). In the spatial regression analysis, high and comprehensive knowledge related to HIV, and comprehensive knowledge on the prevention of mother-to-child transmission were significant explanatory variables for the spatial variation of HIV testing and counselling. In the multivariable multilevel robust Poisson regression analysis, education, household wealth, media exposure, number of antenatal care visits, comprehensive knowledge on mother-to-child transmission, comprehensive knowledge on prevention of mother-to-child transmission, and region were significantly associated factors. CONCLUSION: The prevalence of HIV testing and counselling during antenatal care visits was low. Empowering women through education, promoting mass media exposure, increasing numbers of antenatal care visits, and enhancing women's knowledge related to HIV and mother-to-child transmission by targeting cold spot areas could improve HIV testing and counselling service uptake among pregnant women in Ethiopia.
Assuntos
Aconselhamento , Infecções por HIV , Cuidado Pré-Natal , Humanos , Feminino , Etiópia/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Gravidez , Aconselhamento/estatística & dados numéricos , Infecções por HIV/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Estudos Transversais , Adulto Jovem , Adolescente , Teste de HIV/estatística & dados numéricos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , PrevalênciaRESUMO
Chagas disease, also known as American trypanosomiasis, is caused by a protozoan blood-borne pathogen called Trypanosoma cruzi. The World Health Organization (WHO) has classified Chagas as one of 21 neglected tropical diseases present in the world and estimates that 6-7 million people are currently infected with Chagas. Congenital transmission of Chagas disease contributes to a significant amount of new infections, especially in endemic areas where 22.5% of new infections are due to congenital transmission. In this paper, we investigate congenital transmission's impact on Chagas disease dynamics through a mathematical model. Specifically, we examine how treating a proportion of infants born to infected individuals impacts the progression and spread of Chagas disease. The influence of newborn therapy on the dynamics of the model is thoroughly investigated, both theoretically and numerically. The results illustrate the importance of treating a high proportion of newborns to reduce the number of infected cases of the disease. The findings show that the therapy given to newborns is necessary but not sufficient to curb the transmission of Chagas disease, and a comprehensive approach that includes vector and vertical transmission control strategies is essential for eradicating Chagas disease. We also observed that if vector transmission can be controlled, then at least 55% of the newborns need to be treated to eliminate the disease.
Assuntos
Doença de Chagas , Transmissão Vertical de Doenças Infecciosas , Doença de Chagas/transmissão , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Trypanosoma cruzi/patogenicidade , Modelos Teóricos , Animais , Feminino , Tripanossomicidas/uso terapêuticoRESUMO
BACKGROUND: Mother-to-child transmission of HIV during breastfeeding remains a challenge in low- and middle-income countries (LMIC). A prevention package was initiated during the highly attended 2nd visit of the Expanded Program of Immunisation (EPI-2) to identify the undiagnosed infants living with HIV and reduce the postnatal transmission of infant exposed to HIV. METHODS: PREVENIR-PEV is a non-randomized phase II clinical trial conducted at two health centres in Bobo Dioulasso (Burkina Faso). The study recruited mothers living with HIV aged 15 years and older with their singleton breastfed infants. During EPI-2 (at 8 weeks) and upon signature of the informed consent, a point-of-care early infant diagnosis (EID) was performed. HIV exposed uninfected (HEU) infants were followed-up until 12 months of age. High risk HEU infants (i.e., whose maternal viral load ≥ 1000 cp/mL at EPI-2 or M6) received an extended postnatal prophylaxis (PNP) with lamivudine until end of follow-up or the end of breastfeeding. RESULTS: Between 4 December 2019 and 4 December 2020, 118 mothers living with HIV-1 were identified, and 102 eligible mother/infant pairs had their infants tested for HIV EID. Six infants were newly diagnosed with HIV, and 96 HEU infants were followed-up for 10 months. Among the participants followed-up, all mothers were prescribed antiretrovirals. All 18 infants eligible for PNP at either EPI-2 or 6 months (M6) were initiated on lamivudine. No HIV transmission occurred, and no serious adverse events were reported in infants receiving lamivudine. CONCLUSIONS: The PREVENIR-PEV prevention package integrated into existing care is safe and its implementation is feasible in a LMIC with a low HIV prevalence. More research is needed to target mother/infant pairs not adhering to the intervention proposed in this trial. TRIAL REGISTRATION: NCT03869944; first registered on 11/03/2019.
Assuntos
Aleitamento Materno , Infecções por HIV , Transmissão Vertical de Doenças Infecciosas , Humanos , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Burkina Faso , Feminino , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Lactente , Adulto , Recém-Nascido , Adulto Jovem , Adolescente , Masculino , Fármacos Anti-HIV/uso terapêutico , Fármacos Anti-HIV/administração & dosagem , Carga Viral , Lamivudina/uso terapêutico , Lamivudina/administração & dosagem , MãesRESUMO
Oropouche virus (OROV) is an emerging arbovirus endemic in Latin America and the Caribbean that causes Oropouche fever, a febrile illness that clinically resembles some other arboviral infections. It is currently spreading through Brazil and surrounding countries, where, from 1 January to 1 August 2024, more than 8000 cases have been identified in Bolivia, Brazil, Columbia, and Peru and for the first time in Cuba. Travelers with Oropouche fever have been identified in the United States and Europe. A significant occurrence during this epidemic has been the report of pregnant women infected with OROV who have had miscarriages and stillborn fetuses with placental, umbilical blood and fetal somatic organ samples that were RT-PCR positive for OROV and negative for other arboviruses. In addition, there have been four cases of newborn infants having microcephaly, in which the cerebrospinal fluid tested positive for IgM antibodies to OROV and negative for other arboviruses. This communication examines the biology, epidemiology, and clinical features of OROV, summarizes the 2023-2024 Oropouche virus epidemic, and describes the reported cases of vertical transmission and congenital infection, fetal death, and microcephaly in pregnant women with Oropouche fever, addresses experimental animal infections and potential placental pathology findings of OROV, and reviews other bunyavirus agents that can cause vertical transmission. Recommendations are made for pregnant women travelling to the regions affected by the epidemic.
Assuntos
Infecções por Bunyaviridae , Transmissão Vertical de Doenças Infecciosas , Microcefalia , Orthobunyavirus , Placenta , Complicações Infecciosas na Gravidez , Natimorto , Gravidez , Feminino , Humanos , Microcefalia/virologia , Microcefalia/epidemiologia , Orthobunyavirus/genética , Orthobunyavirus/isolamento & purificação , Complicações Infecciosas na Gravidez/virologia , Complicações Infecciosas na Gravidez/epidemiologia , Placenta/virologia , Infecções por Bunyaviridae/transmissão , Infecções por Bunyaviridae/epidemiologia , Infecções por Bunyaviridae/virologia , Recém-Nascido , Feto/virologia , AnimaisRESUMO
Insect-specific viruses (ISVs) include viruses that are restricted to the infection of mosquitoes and are spread mostly through transovarial transmission. Despite using a distinct mode of transmission, ISVs are often phylogenetically related to arthropod-borne viruses (arboviruses) that are responsible for human diseases and able to infect both mosquitoes and vertebrates. ISVs can also induce a phenomenon called "superinfection exclusion", whereby a primary ISV infection in an insect inhibits subsequent viral infections of the insect. This has sparked interest in the use of ISVs for the control of pathogenic arboviruses transmitted by mosquitoes. In particular, insect-specific flaviviruses (ISFs) have been shown to inhibit infection of vertebrate-infecting flaviviruses (VIFs) both in vitro and in vivo. This has shown potential as a new and ecologically friendly biological approach to the control of arboviral disease. For this intervention to have lasting impacts for biological control, it is imperative that ISFs are maintained in mosquito populations with high rates of vertical transmission. Therefore, these strategies will need to optimise vertical transmission of ISFs in order to establish persistently infected mosquito lines for sustainable arbovirus control. This review compares recent observations of vertical transmission of arboviral and insect-specific flaviviruses and potential determinants of transovarial transmission rates to understand how the vertical transmission of ISFs may be optimised for effective arboviral control.
Assuntos
Culicidae , Infecções por Flavivirus , Flavivirus , Transmissão Vertical de Doenças Infecciosas , Mosquitos Vetores , Vertebrados , Animais , Flavivirus/fisiologia , Flavivirus/genética , Flavivirus/classificação , Mosquitos Vetores/virologia , Culicidae/virologia , Infecções por Flavivirus/transmissão , Infecções por Flavivirus/virologia , Humanos , Vertebrados/virologia , Arbovírus/fisiologia , Arbovírus/classificaçãoRESUMO
BACKGROUND: Uptake of HIV early infant diagnosis (HEID) among HIV-exposed infants is the key to timely initiation of Antiretroviral Treatment (ART). However, despite the availability of HEID services in Tanzania, its uptake is low. We aimed to determine predictors of mothers living with HIV' with HIV-exposed infants' uptake of HEID services in Iringa District, Tanzania. METHODS: A health facility-based cross-sectional study was conducted in Iringa District from May to June 2023. Mothers with HIV-exposed infants were recruited in the study through a multistage sampling technique and interviewed using pre-tested structured questions. Logistic regression analysis was employed to determine potential predictors of HEID uptake. RESULTS: A total of 309 mothers with HIV-exposed infants participated in the study. About 78.3% of the HIV-exposed infants had initial DNA PCR for HEID within 6 weeks of age and 86.1% within 8 weeks. Most mothers had high perceived benefits on uptake of HEID with a mean score of 4.3, high perceived self-efficacy with a mean score of 3.8 and 2.7 perceived risk of HIV infection on their HIV-exposed infants on the 5 scale Likert scale with 5 showing the highest perceived benefit, self-efficacy and risk. High perceived self-efficacy and being a businesswoman were the predictors of uptake of HEID. The odds of self-efficacy on the uptake of HEID by 2.4 times (aOR 2.4 95% CI 1.6-3.2) within 6 weeks of age and 1.9 (aOR 1.9 95% CI 1.3-2.7) within 8 weeks. The odds of being a businesswoman were 0.4 for 6 weeks and 0.3 for 8 weeks (aOR 0.4 95% CI 0.2-0.8) and (aOR 0.3 95% CI 0.1-0.8) respectively. CONCLUSION: Over three-quarters of the HIV-exposed infants had initial DNA PCR for HEID testing as recommended. Perceived self-efficacy was the main factor influencing HEID uptake. These findings highlight the need for strengthening HIV-positive mother's self-efficacy for improved uptake of HEID services.
Predictors of mothers living with HIV' uptake of HIV early infant diagnosis services in Iringa District, TanzaniaThis study aimed to find out the factors associated with the uptake of HIV early infant diagnosis (HEID) services among mothers living with HIV in Iringa District, Tanzania. The uptake of HEID in Tanzania is still below the 95% national and global target of ending AIDS as a public health by 2030 We employed a cross-sectional study design and collected data from May to June 2023 to determine predictors of mothers with HIV-exposed infants' uptake of HEID in Iringa District, Tanzania. The analysis was done by descriptive statistics and logistic regression analysis. A total of 309 mothers with HIV-exposed infants participated in the study. About 78.3% of the HIV-exposed infants had initial DNA PCR for HEID within 6 weeks of age and 86.1% within 8 weeks. Most mothers had high perceived benefits on uptake of HEID with a mean score of 4.3, high perceived self-efficacy with a mean score of 3.8 and 2.7 perceived risk of HIV infection on their HIV-exposed infants. High perceived self-efficacy was positively associated These findings highlight the need for strengthening HIV-positive mother's self-efficacy for improved uptake of HEID services.
Assuntos
Diagnóstico Precoce , Infecções por HIV , Transmissão Vertical de Doenças Infecciosas , Mães , Humanos , Tanzânia , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Feminino , Estudos Transversais , Adulto , Lactente , Mães/psicologia , Mães/estatística & dados numéricos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Adulto Jovem , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Recém-Nascido , Masculino , Conhecimentos, Atitudes e Prática em Saúde , Modelos Logísticos , GravidezRESUMO
The Chinese Clinical Practice Guidelines for the prevention and treatment of mother-to-child transmission of hepatitis B virus, developed by the Chinese Society of Infectious Diseases of the Chinese Medical Association in 2019, serves as a valuable reference for standardizing the process of preventing mother-to-child transmission in China. As new evidence emerges, it is crucial that timely and regular updates are made to the clinical practice guidelines so that to optimize guidance for clinical practice and research. To this end, the Infectious Disease Physician Branch of Chinese Medical Doctor Association and the Chinese Society of Infectious Diseases of Chinese Medical Association, in collaboration with multidisciplinary experts, have updated the guidelines based on the latest domestic and international research advancements and clinical practice, in order to provide guidance and reference for clinicians and maternal and child healthcare workers.
Assuntos
Hepatite B , Transmissão Vertical de Doenças Infecciosas , Humanos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Hepatite B/transmissão , Hepatite B/prevenção & controle , China , Feminino , Gravidez , Vírus da Hepatite B , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/terapia , Complicações Infecciosas na Gravidez/virologiaRESUMO
BACKGROUND: Maternal-foetal transmission of Chagas disease (CD) affects newborns worldwide. Although Benznidazole and Nifurtimox therapies are the standard treatments, their use during pregnancy is contra-indicated. The effectiveness of trypanocidal medications in preventing congenital Chagas Disease (cCD) in the offsprings of women diagnosed with CD was highly suggested by other studies. METHODS: We performed a systematic review and meta-analysis of studies evaluating the effectiveness of treatment for CD in women of childbearing age and reporting frequencies of cCD in their children. PubMed, Scopus, Web of Science, Cochrane Library, and LILACS databases were systematically searched. Statistical analysis was performed using Rstudio 4.2 using DerSimonian and Laird random-effects models. Heterogeneity was examined with the Cochran Q test and I2 statistics. A p-value of <0.05 was considered statistically significant. RESULTS: Six studies were included, comprising 744 children, of whom 286 (38.4%) were born from women previously treated with Benznidazole or Nifurtimox, trypanocidal agents. The primary outcome of the proportion of children who were seropositive for cCD, confirmed by serology, was signigicantly lower among women who were previously treated with no congenital transmission registered (OR 0.05; 95% Cl 0.01-0.27; p = 0.000432; I2 = 0%). In women previously treated with trypanocidal drugs, the pooled prevalence of cCD was 0.0% (95% Cl 0-0.91%; I2 = 0%), our meta-analysis confirms the excellent effectiveness of this treatment. The prevalence of adverse events in women previously treated with antitrypanocidal therapies was 14.01% (95% CI 1.87-26.14%; I2 = 80%), Benznidazole had a higher incidence of side effects than Nifurtimox (76% vs 24%). CONCLUSION: The use of trypanocidal therapy in women at reproductive age with CD is an effective strategy for the prevention of cCD, with a complete elimination of congenital transmission of Trypanosoma cruzi in treated vs untreated infected women.
Assuntos
Doença de Chagas , Transmissão Vertical de Doenças Infecciosas , Nifurtimox , Nitroimidazóis , Tripanossomicidas , Humanos , Feminino , Tripanossomicidas/uso terapêutico , Tripanossomicidas/efeitos adversos , Doença de Chagas/tratamento farmacológico , Doença de Chagas/prevenção & controle , Doença de Chagas/congênito , Doença de Chagas/transmissão , Gravidez , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Nifurtimox/uso terapêutico , Nifurtimox/efeitos adversos , Nitroimidazóis/uso terapêutico , Nitroimidazóis/efeitos adversos , Estudos Observacionais como Assunto , Recém-Nascido , Adulto , Trypanosoma cruzi/efeitos dos fármacos , Complicações Parasitárias na Gravidez/prevenção & controle , Complicações Parasitárias na Gravidez/tratamento farmacológicoRESUMO
BACKGROUND: Children born to women with HIV but who do not become HIV infected experience increased morbidity and mortality compared with children born to women without HIV. The basis of this increased vulnerability is unknown. The microbiome, specifically the infant gut microbiome, likely plays an important role in infant immune development. The human milk microbiome is thought to have an important role in the development of the infant gut and therefore, if perturbed, may contribute to this increased vulnerability. We investigated the effects of HIV and its therapies on the milk microbiome and possible changes in the milk microbiome before or after infant HIV infection. RESULTS: Seven-hundred fifty-six human milk samples were selected from three separate studies conducted over a 15-year period to investigate the role of HIV and its therapies on the human milk microbiome. Our data reveal that the milk microbiome is modulated by parity (R2 = 0.006, p = 0.041), region/country (R2 = 0.014, p = 0.007), and duration of lactation (R2 = 0.027-0.038, all p < 0.001). There is no evidence, however, using 16S rRNA V4 amplicon sequencing, that the human milk microbiome is altered by HIV infection (R2 = 0.003, p = 0.896), by combination antiretroviral therapy (R2 = 0.0009, p = 0.909), by advanced maternal disease (R2 = 0.003, p = 0.263), or in cases of infant infection either through isolated early mucosal (R2 = 0.003, p = 0.197) or early mucosal and breast milk transmission (R2 = 0.002, p = 0.587). CONCLUSIONS: The milk microbiome varies by stage of lactation, by parity, and by region; however, we found no evidence that the human milk microbiome is altered by maternal HIV infection, disease severity, or antiretroviral therapy. Additionally, we found no association between the milk microbiome and transmission of HIV to the infant. Investigations including higher resolution microbiome approaches or into other potential mechanisms to understand why the approximately one million children born annually to women with HIV escape infection, but do not escape harm, are urgently needed. Video Abstract.
Assuntos
Infecções por HIV , Leite Humano , RNA Ribossômico 16S , Humanos , Leite Humano/microbiologia , Leite Humano/virologia , Infecções por HIV/microbiologia , Infecções por HIV/virologia , Feminino , RNA Ribossômico 16S/genética , Gravidez , Transmissão Vertical de Doenças Infecciosas , Lactente , Microbiota , Microbioma Gastrointestinal , Recém-Nascido , Complicações Infecciosas na Gravidez/microbiologia , Complicações Infecciosas na Gravidez/virologia , Bactérias/classificação , Bactérias/isolamento & purificação , Bactérias/genética , Adulto , Aleitamento Materno , LactaçãoRESUMO
Globally, each year 1.3 million neonates acquire human immunodeficiency virus during pregnancy, labour, and breastfeeding time. Replacing breastfeeding with recommended safe infant feeding practices significantly reduces the risk of transmission, nearly eliminating it. This study aimed to assess Human immunodeficiency virus exposed child feeding among 314 mothers with infants under 24 months old. Participants were selected using a systematic random sampling technique, and data were collected through a semi-structured questionnaire. Bivariable and multivariable logistic regression analyses employed to identify determinants for safe infant feeding. During interviews, the mean age of women was 32.35 years (standard deviation±4.5), and infants were 10.8(±3.951) months. The overall safe infant feeding was 67.2% (95% CI: 61.7, 72.9), with a mean knowledge score. By the study's end, 9 infants (2.89%) were confirmed to be infected with virus based on dried blood sample test. Maternal promoting factors for safe infant practice included infant age 25-35 years (adjusted odd ratio (aOR) =2.9) completing high school education (adjusted odd ratio = 9.2), having a good knowledge score for infant feeding (adjusted odd ratio = 8.2), and urban residency (adjusted odd ratio = 2.2). On the other hand, being married made it 83% less likely for safe infant feeding practices (adjusted odd ratio = 0.17) compared to those never in a union. Two in three mothers practiced safe infant feeding for their HIV-exposed infants, with a mean knowledge score of 70.3%. Therefore, healthcare providers give accurate information and counselling services to make informed decisions about infant safe feeding.