Current Tropical Medicine Reports

, Volume 6, Issue 4, pp 186–196 | Cite as

Viral Hemorrhagic Fevers in Pregnant Women and the Vaccine Landscape: Comparisons Between Yellow Fever, Ebola, and Lassa Fever

  • Carleigh B. KrubinerEmail author
  • David A. Schwartz
Vaccines in Pregnant Women & Infants (DA Schwartz and C Krubiner, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Vaccines in Pregnant Women & Infants


Purpose of Review

As research efforts have advanced to understand the pathophysiology of viral hemorrhagic fevers (VHF) and other epidemic viral infections and develop medical countermeasures such as vaccines, pregnant women have remained an underexamined subgroup. To better understand the implications of future outbreaks of VHF for pregnant women amidst an evolving vaccine landscape, we examine three pathogens—yellow fever, Ebola, and Lassa fever—each with different levels of evidence and understanding of disease in pregnancy and at varying stages of vaccine development.

Recent Findings

There are very limited data available on yellow fever disease in pregnancy and the current live-attenuated 17D yellow fever vaccine is recommended for pregnant women at high risk of exposure. Evidence on Ebola virus disease in pregnancy shows very high case fatality rates (CFRs) among pregnant women and their infants, with mixed evidence on whether mortality is higher in pregnant women than non-pregnant adults. The replication-competent rVSV-ZEBOV vaccine is currently being offered to at-risk pregnant women in the Democratic Republic of the Congo after a revision to an earlier protocol that excluded them. For Lassa fever, there is evidence that CFR is higher in pregnant individuals than non-pregnant adults, especially later in gestation, with high rates of fetal or perinatal loss associated with infection. There are currently no Lassa fever vaccine candidates that have been tested in humans.


More evidence is needed to fully understand the implications of infection in pregnancy, but the existing data underscore the serious maternal and fetal health risks associated with each viral infection. It will also be critical to generate evidence on the safety profile of vaccine candidates as they advance through the pipeline to ensure timely and appropriate access for pregnant women at risk of infection. It is important that pregnant women be considered in the design and clinical trial phases of future vaccines.


Ebola Lassa fever Yellow fever Vaccines Pregnancy Maternal immunization 


Funding Information

One of the authors [CBK] received support from the Wellcome Trust under grant 203160/Z/16/Z.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    World Health Organization (WHO). An R&D blueprint for action to prevent epidemic - plan of action May 2016. 2016.Google Scholar
  2. 2.
    Pigott DM, Deshpande A, Letourneau I, Morozoff C, Reiner RC Jr, Kraemer MU, et al. Local, national, and regional viral haemorrhagic fever pandemic potential in Africa: a multistage analysis. Lancet. 2017;390(10113):2662–72.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    World Health Organization (WHO). Guidance for managing ethical issues in infectious disease outbreaks. World Health Organization. 2016. Accessed August 1, 2018. Available from:
  4. 4.
    Bloom DE, Black S, Rappuoli R. Emerging infectious diseases: a proactive approach. Proc Natl Acad Sci. 2017;7:201701410.Google Scholar
  5. 5.
    •• Gomes MF, de la Fuente-Núñez V, Saxena A, Kuesel AC. Protected to death: systematic exclusion of pregnant women from Ebola virus disease trials. Reprod Health. 2017;14:172. an overview of the systematic exclusion of pregnant women from trials conducted during the West African Outbreak. CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Beigi RH. Emerging infectious diseases in pregnancy. Obstet Gynecol. 2017;129(5):896–906.PubMedCrossRefGoogle Scholar
  7. 7.
    •• Krubiner CB, Faden RR, Karron RA, Little MO, Lyerly AD, Abramson JS, et al. Pregnant women & vaccines against emerging epidemic threats: ethics guidance for preparedness, research, and response. Vaccine. 2019. Available from: Accessed 18 July 2019. Provides guidance of the ethical inclusion of pregnant women in epidemic vaccine research and deployment campaigns.
  8. 8.
    •• Bebell LM, Oduyebo T, Riley LE. Ebola virus disease and pregnancy: a review of the current knowledge of Ebola virus pathogenesis, maternal, and neonatal outcomes. Birth Defects Res. 2017;109:353–62 Provides a thorough review of state of knowledge on Ebola in pregnancy. CrossRefGoogle Scholar
  9. 9.
    FIGO. Pregnancy and vaccination. April 24, 2019. Available from: Accessed 20 July 2019.
  10. 10.
    Plotkin SA, Mahmoud AAF, Farrar J. Establishing a global vaccine-development fund. N Engl J Med. 2015;373:297–300.PubMedCrossRefGoogle Scholar
  11. 11.
    Røttingen JA, Gouglas D, Feinberg M, Plotkin S, Raghavan KV, Witty A, et al. New vaccines against epidemic infectious diseases. N Engl J Med. 2017.Google Scholar
  12. 12.
    Jamieson DJ, Theiler RN, Rasmussen SA. Emerging infections and pregnancy. Emerg Infect Dis. 2006 Nov;12(11):1638–43.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Kourtis AP, Read JS, Jamieson DJ: Pregnancy and infection. N Engl J Med 2014; 370:2211–2218PubMedCrossRefGoogle Scholar
  14. 14.
    Silasi M, Cardenas I, Kwon JY, Racicot K, Aldo P, Mor G. Viral infections during pregnancy. Am J Reprod Immunol. 2015;73(3):199–213.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Soma-Pillay P, Catherine NP, Tolppanen H, Mebazaa A, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovasc J Afr. 2016;27(2):89–94.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Theiler RN, Rasmussen SA, Treadwell TA, Jamieson DJ. Emerging and zoonotic infections in women. Infect Dis Clin N Am. 2008;22(4):755–72.CrossRefGoogle Scholar
  17. 17.
    Nigeria Centre for Disease Control (NCDC). Disease situation reports: an update of Lassa fever outbreak in Nigeria. 2019 Lassa fever outbreak situation report. 8 September 2019 Available from: https://ncdcgovng/themes/common/files/sitreps/2298ace1545cc7da74ce4d565bbfee77pdf Accessed 20 September 2019.
  18. 18.
    Nigeria Centre for Disease Control (NCDC). Disease situation reports: an update of yellow fever outbreak in Nigeria. Situation report of cluster of yellow fever outbreak in Bauchi State. 11 September 2019. Available from: Accessed 20 September 2019.
  19. 19.
    Nigeria Demographic and Health Survey. 2018. Key indicators report. Available from: Accessed 20 September 2019.
  20. 20.
    Assaf S, Wang W. Regional disparities in fertility preferences and demand satisfied for family planning by modern methods across levels of poverty. DHS Analytical Studies No. 71. Rockville, Maryland, USA: ICF. August 2019. Available from: Accessed 20 September 2019.
  21. 21.
    World Health Organization. Addressing sex and gender in epidemic-prone infectious diseases. 2007. Available from: Accessed 20 September 2019.
  22. 22.
    Ravi SJ, Gauldin EM. Sociocultural dimensions of the Ebola virus disease outbreak in Liberia. Biosecur Bioterror. 2014;12(6):301–5.PubMedCrossRefGoogle Scholar
  23. 23.
    WHO Africa. Mothers survive Ebola while pregnant against the odds in the Democratic Republic of the Congo. 2 October 2019. Available from: Accessed 3 October 2019.
  24. 24.
    Mupapa K, Mukundu W, Bwaka MA, Kipasa M, De Roo A, Kuvula K, et al. Ebola hemorrhagic fever and pregnancy. J Infect Dis. 1999;179(Supplement_1):S11–2.CrossRefGoogle Scholar
  25. 25.
    Lang J. Ebola in the maternity ward. The New Yorker. 2014 Oct 19:1–9. Available from:
  26. 26.
    Schwartz DA. Clinical trials and administration of Zika virus vaccine in pregnant women: lessons (that should have been) learned from excluding immunization with the Ebola vaccine during pregnancy and lactation. Vaccines (Basel). 2018;6(4). Available from: Scholar
  27. 27.
    Faden R, Karron R, Krubiner C. An ‘indefensible’ decision: not vaccinating pregnant and lactating women in an Ebola outbreak. STAT News, August 27, 2018. Available from: Accessed 1 July 2019.
  28. 28.
    Schwartz DA. Maternal and infant survival following Ebola infection –their exclusion from treatment and vaccine trials and “Primum non nocere”. In: Pregnant in the time of Ebola: women and their children in the 2013-2015 West African epidemic. D.A. Schwartz, J.A. Anoko, S. Abramowitz, eds. Springer Nature, New York and Berlin Pgs. 147-155. Website:, 2019
  29. 29.
    Rasmussen SA, Watson AK, Kennedy ED, Broder KR, Jamieson DJ. Vaccines and pregnancy: past, present, and future. Semin Fetal Neonatal Med. 2014;19(3):161–9. Scholar
  30. 30.
    Ryan ET. Yellow fever. UpToDate. 2018. Available from: Accessed 17 July 2019.
  31. 31.
    Garske T, Van Kerkhove MD, Yactayo S, Ronveaux O, Lewis RF, Staples JE, et al. Yellow fever in Africa: estimating the burden of disease and impact of mass vaccination from outbreak and serological data. PLoS Med. 2014;11(5):e1001638 Available from: Accessed 3 August 2019.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    WHO. Yellow fever fact sheet. 2019. Available from: https://wwwwhoint/en/news-room/fact-sheets/detail/yellow-fever Accessed 16 July 2019.
  33. 33.
    Monath TP. Treatment of yellow fever. Antivir Res. 2008;78(1):116–24.PubMedCrossRefGoogle Scholar
  34. 34.
    WHO. Yellow fever – Brazil. 2018. Available from: Accessed 15 July 2019.
  35. 35.
    Ribeiro CF, Soares ACG, Lopes VGS, Brasil P, De Filippis AMB, Nunes PCG. Maternal and fetal death after dengue infection: insights on dengue diagnosis. J Infect Dis Epi. 2017;3(2). Available from: Accessed 1 August 2019.
  36. 36.
    Pouliot SH, Xiong X, Harville E, Paz-Soldan V, Tomashek KM, Breart G. Maternal dengue and pregnancy outcomes: a systematic review. Obstet Gynecol Surv. 2010;65:107–18.PubMedGoogle Scholar
  37. 37.
    Schwartz DA. The origin and emergence of Zika virus, the newest TORCH infection - what’s old is new again. Arch Pathol Lab Med. 2017;141(1):18–25. Available from: Accessed 15 July 2019.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Marinho PS, Cunha AJ, Junior JA, Prata-Barbosa A. A review of selected arboviruses during pregnancy. Matern Health Neonatol Perinatol. 2017;3:17 Available from: Accessed 20 July 2019.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Bentlin MR, Almeida RA, Coelho KI, Ribeiro AF, Siciliano MM, Suzuki A, et al. Perinatal transmission of yellow fever, Brazil, 2009. Emerg Infect Dis. 2011;17(9):1779–80. Available from: https://wwwnccdcgov/eid/article/17/9/11-0242_article Accessed 10 August 2019.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Frierson JG. The yellow fever vaccine: a history. Yale J Biol Med. 2010;83(2):77–85 Available from: Accessed 3 August 2019.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Collins ND, Barrett ADT. Live attenuated yellow fever 17D vaccine: a legacy vaccine still controlling outbreaks in modern day. Curr Infect Dis Rep. 2017;19(3):14. Available from: Accessed 12 July 2019.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    • Beck AS, Barrett ADT. Current status and future prospects of yellow fever vaccines. Expert Rev Vaccines. 2015;14(11):1479–92. Available from: Accessed 3 August 2019. Provides an update of new yellow fever vaccines in development. CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Bassi MR, Larsen MA, Kongsgaard M, Rasmussen M, Buus S, Stryhn A, et al. Vaccination with replication deficient adenovectors encoding YF-17D antigens induces long-lasting protection from severe yellow fever virus infection in mice. PLoS Negl Trop Dis. 2016;10(2):e0004464. Scholar
  44. 44.
    Yang H, Yang H, Li Z, Liu L, Wang W, He T, et al. Japanese encephalitis virus/yellow fever virus chimera is safe and confers full protection against yellow fever virus in intracerebrally challenged mice. Vaccine. 2018;36(18):2450–5.PubMedCrossRefGoogle Scholar
  45. 45.
    WHO. 2014. Safety of immunization during pregnancy. A review of the evidence. Available from: https://wwwwhoint/vaccine_safety/publications/safety_pregnancy_nov2014pdf Accessed 20 July 2019.
  46. 46.
    World Health Organization. Vaccines and vaccination against yellow fever: WHO position paper—June 2013. Vaccine. 2015;33(1):76–7. Scholar
  47. 47.
    •• Schwartz DA, Anoko JN, Abramowitz S, editors. Pregnant in the time of Ebola: women and their children in the 2013–2015 West African Epidemic: Springer; 2019. –New York and Berlin. [ISBN-13: 978-3319976365] [ISBN-10: 3319976362]. Provides an anthology with several relevant chapters on various aspects of Ebola and pregnancy. Google Scholar
  48. 48.
    Schwartz DA. Maternal filovirus infection and death from Marburg and Ravn viruses: highly lethal to pregnant women and their fetuses similar to Ebola Virus. In: Okware SI, editor. Re-Emerging Filovirus Diseases: IntechOpen; 2019. ISBN: 978-1-78985-550-0. Available from: https://wwwintechopencom/online-first/maternal-filovirus-infection-and-death-from-marburg-and-ravn-viruses-highly-lethal-to-pregnant-women Accessed 15 August 2019.
  49. 49.
    Callaghan WM, Creanga AC, Jamieson DJ. Pregnancy-related mortality resulting from influenza in the United States during the 2009–2010 pandemic. Obstet Gynecol. 2015;126(3):486–90. Available from: Accessed 8 August 2019.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Patra S, Kumar A, Trivedi SS, Puri M, Sarin SK. Maternal and fetal outcomes in pregnant women with acute hepatitis E virus infection. Ann Intern Med. 2007;147(1):28–33.PubMedCrossRefGoogle Scholar
  51. 51.
    •• Okogbenin S, Okoeguale J, Akpede G, Colubri A, Barnes KG, Mehta S, et al. Retrospective cohort study of Lassa fever in pregnancy, southern Nigeria. Emerg Infect Dis. 2019;25(8). Available from: Accessed 15 August 2019. Provides one of the few analyses of maternal and fetal outcome with Lassa fever infection. PubMedCentralCrossRefPubMedGoogle Scholar
  52. 52.
    Nasidi A, Monath TP, Vandenberg J, Tomori O, Calisher CH, Hurtgen X, et al. Yellow fever vaccination and pregnancy: a four-year prospective study. Trans R Soc Trop Med Hyg. 1993;87(3):337–9.PubMedCrossRefGoogle Scholar
  53. 53.
    Tsai TF, Paul R, Lynberg MC, Letson GW. Congenital yellow fever virus infection after immunization in pregnancy. J Infect Dis. 1993;168(6):1520–3. Scholar
  54. 54.
    Thomas RE, Lorenzetti DL, Spragins W, Jackson D, Williamson T. The safety of yellow fever vaccine 17D and 17DD in children, pregnant women, HIV+ individuals, and older persons: systematic review. Am J Trop Med Hyg. 2012;86(2):359–72. Available from: Accessed 1 August 2019.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Malvy D, McElroy AK, de Clerck H, Günther S, van Griensven J. Ebola virus disease. Lancet. 2019. Scholar
  56. 56.
    CDC. Ebola virus disease distribution map: cases of Ebola virus disease in africa since 1976. Updated 19 June 2019. Available from: Accessed 2 October 2019.
  57. 57.
    WHO. Ebola virus disease - Democratic Republic of the Congo: external situation report 61. 1 October 2019. Available from: Accessed 2 October 2019.
  58. 58.
    Diallo B, Sissoko D, Loman NJ, Bah HA, Bah H, Worrell MC, et al. Resurgence of Ebola virus disease in Guinea linked to a survivor with virus persistence in seminal fluid for more than 500 days. Clin Infect Dis. 2016;63(10):1353–6.PubMedPubMedCentralCrossRefGoogle Scholar
  59. 59.
    Chertow DS, Kleine C, Edwards JK, Scaini R, Giuliani R, Sprecher A. Ebola virus disease in West Africa—clinical manifestations and management. N Engl J Med. 2014;371(22):2054–7.PubMedCrossRefGoogle Scholar
  60. 60.
    Haddad LB, Jamieson DJ, Rasmussen SA. Pregnant women and the Ebola crisis. N Engl J Med. 2018;379(26):2492–3.PubMedCrossRefGoogle Scholar
  61. 61.
    Bebell LM. Ebola virus disease and pregnancy: perinatal transmission and epidemiology. In: Schwartz D, Anoko J, Abramowitz S, editors. Pregnant in the Time of Ebola. Global Maternal and Child Health (Medical, Anthropological, and Public Health Perspectives). Cham: Springer; 2019. p. 53–65.Google Scholar
  62. 62.
    Mupapa K, Mukundu W, Bwaka MA, Kipasa M, De Roo A, Kuvula K, Kibadi K, Massamba M, Ndaberey D, Colebunders R, Muyembe-Tamfum JJ. Ebola hemorrhagic fever and pregnancy. The Journal of infectious diseases. 1999 Feb 1;179(Supplement_1):S11-2.PubMedCrossRefGoogle Scholar
  63. 63.
    Akerlund E, Prescott J, Tampellini L. Shedding of Ebola virus in an asymptomatic pregnant woman. N Engl J Med. 2015;372(25):2467–9.PubMedCrossRefGoogle Scholar
  64. 64.
    Baggi FM, Taybi A, Kurth A, Van Herp M, Di Caro A, Wolfel R, Gunther S, Decroo T, Declerck H, Jonckheere S. Management of pregnant women infected with Ebola virus in a treatment centre in Guinea, June 2014.Google Scholar
  65. 65.
    Bower H, Grass JE, Veltus E, Brault A, Campbell S, Basile AJ, et al. Delivery of an Ebola virus-positive stillborn infant in a rural community health center, Sierra Leone, 2015. Am J Trop Med Hyg. 2016;94(2):417–9.PubMedPubMedCentralCrossRefGoogle Scholar
  66. 66.
    Henwood PC, Bebell LM, Roshania R, Wolfman V, Mallow M, Kalyanpur A, et al. Ebola virus disease and pregnancy: a retrospective cohort study of patients managed at 5 Ebola treatment units in West Africa. Clin Infect Dis. 2017;65(2):292–9. Scholar
  67. 67.
    Caluwaerts S, Van Herp M, Cuesta JG, Crestani R, Ronsse A, Lagrou D, et al. Pregnancy and Ebola: survival outcomes for pregnant women admitted to MSF Ebola treatment centres in the West Africa outbreak. [Meeting Abstract; not peer reviewed]. F1000Res. 2018;7:945. Scholar
  68. 68.
    Oduyebo T, Bennett SD, Nallo AS, Jamieson DJ, Ellington S, Souza K, et al. Stillbirths and neonatal deaths surveillance during the 2014–2015 Ebola virus disease outbreak in Sierra Leone. Int J Gynecol Obstet. 2019;144(2):225–31.CrossRefGoogle Scholar
  69. 69.
    Dörnemann J, Burzio C, Ronsse A, Sprecher A, De Clerck H, Van Herp M, et al. First newborn baby to receive experimental therapies survives Ebola virus disease. J Infect Dis. 2017;215(2):171–4.PubMedPubMedCentralGoogle Scholar
  70. 70.
    WHO. Healthy baby born to mother who survived Ebola. 15 December 2018. Available from: Accessed 29 September 2019.
  71. 71.
    Gulland A. Meet Nubia: the only baby ever to have survived Ebola. The Telegraph. 1 June 2018. Available from: Accessed 29 September 2019.
  72. 72.
    •• Venkatraman N, Silman D, Folegatti PM, Hill AV. Vaccines against Ebola virus. Vaccine. 2018;36(36):5454–9. a thorough overview of various Ebola vaccine candidates. CrossRefPubMedGoogle Scholar
  73. 73.
    Wang Y, Li J, Hu Y, Liang Q, Wei M, Zhu F. Ebola vaccines in clinical trial: the promising candidates. Hum Vaccines Immunother. 2017;13(1):153–68.CrossRefGoogle Scholar
  74. 74.
    Sridhar S. Clinical development of Ebola vaccines. Ther Adv Vaccines. 2015;3(5–6):125–38. Scholar
  75. 75.
    WHO Strategic Advisory Group of Experts (SAGE) on Immunisation. Update with the development of Ebola vaccines and implications of emerging evidence to inform future policy recommendations – background paper for SAGE deliberations. October 2018. Available from: Accessed 3 October 2019.
  76. 76.
    Henao-Restrepo AM, Preziosi MP, Wood D, Moorthy V, Kieny MP. On a path to accelerate access to Ebola vaccines: the WHO’s research and development efforts during the 2014–2016 Ebola epidemic in West Africa. Curr Opin Virol. 2016;17:138–44.PubMedPubMedCentralCrossRefGoogle Scholar
  77. 77.
    Regules JA, Beigel JH, Paolino KM, Voell J, Castellano AR, Hu Z, et al. A recombinant vesicular stomatitis virus Ebola vaccine. N Engl J Med. 2017;376(4):330–41.PubMedCrossRefGoogle Scholar
  78. 78.
    Henao-Restrepo AM, Camacho A, Longini IM, Watson CH, Edmunds WJ, Egger M, et al. Efficacy and effectiveness of an rVSV-vectored vaccine in preventing Ebola virus disease: final results from the Guinea ring vaccination, open-label, cluster-randomised trial (Ebola Ca Suffit!). Lancet. 2017;389(10068):505–18.CrossRefGoogle Scholar
  79. 79.
    INRB, WHO. Preliminary results on the efficacy of rVSV-ZEBOV-GP Ebola vaccine using the ring vaccination strategy in the control of an Ebola outbreak in the Democratic Republic of the Congo: an example of integration of research into epidemic response. 12 April 2019. Available from: Accessed 3 October 2019.
  80. 80.
    Merck. FDA Accepts Merck’s biologics license application (BLA) and grants priority review for V920, the company’s investigational vaccine for Ebola Zaire virus [press release] (2019 Sept 17) [cited 2019 Oct 5]. Available from:
  81. 81.
    Kennedy SB, Bolay F, Kieh M, Grandits G, Badio M, Ballou R, et al. Phase 2 placebo-controlled trial of two vaccines to prevent Ebola in Liberia. N Engl J Med. 2017;377(15):1438–47.PubMedPubMedCentralCrossRefGoogle Scholar
  82. 82.
    Samai M, Seward JF, Goldstein ST, Mahon BE, Lisk DR, Widdowson MA, et al. The Sierra Leone trial to introduce a vaccine against Ebola: an evaluation of rVSV∆ G-ZEBOV-GP vaccine tolerability and safety during the West Africa Ebola outbreak. J Infect Dis. 2018;217(suppl_1):S6–15.PubMedPubMedCentralCrossRefGoogle Scholar
  83. 83.
    Suder E, Furuyama W, Feldmann H, Marzi A, de Wit E. The vesicular stomatitis virus-based Ebola virus vaccine: from concept to clinical trials. Hum Vaccine Immunother. 2018;14(9):2107–13. Scholar
  84. 84.
    Lévy Y, Lane C, Piot P, Beavogui AH, Kieh M, Leigh B, et al. Prevention of Ebola virus disease through vaccination: where we are in 2018. Lancet. 2018;392(10149):787–90.PubMedPubMedCentralCrossRefGoogle Scholar
  85. 85.
    Schopper D, Ravinetto R, Schwartz L, Kamaara E, Sheel S, Segelid MJ, et al. Research ethics governance in times of Ebola. Public Health Ethics. 2016.
  86. 86.
    Edmunds J, Jarvis C. Benefits risk analysis of vaccination of pregnant women with rVSV-ZEBOV as part of expanded access programme. Presentation to WHO SAGE. October 2018. Available from:
  87. 87.
    WHO WER. Report of the Strategic Advisory Group of Experts (SAGE) on immunization. October 2018. Available from: Accessed 5 Oct 2019.
  88. 88.
    Amid SL. Ebola surge, experts don’t give nod to vaccine in pregnancy. CIDRAP News. 2018 Oct 26. Available from: Accessed 5 Oct 2019.
  89. 89.
    Personal Communication. 28 Jan 2019.Google Scholar
  90. 90.
    Branswell H. Ebola vaccine will be provided to women who are pregnant, marking reversal in policy. STAT News. 2019. Available from: Accessed 24 September 2019.
  91. 91.
    WHO SAGE. SAGE Interim recommendations on vaccination against Ebola virus disease (EVD). 2019. Available from: Accessed 3 Oct 2019.
  92. 92.
    Bedford J, Gercama I, Bardosh K. Social science and behavioural data compilation – November 2018. Social science in humanitarian action. November 2018 Available from: https://reliefwebint/sites/reliefwebint/files/resources/SSHAP%20data%20compilation%20brief%20November%202018pdf. Accessed 17 July 2019.
  93. 93.
    Bedford J, et al. Social science and behavioural data compilation, DRC Ebola outbreak, November 2018–February 2019. Social science in humanitarian action. March 2019 Available from: https://wwwsocialscienceinactionorg/updates-dr-congo-ebola-outbreak-2019. Accessed 3 Oct 2019.
  94. 94.
    Higgins A. Pregnant women in DRC finally receive Ebola vaccine. Devex. 28 June 2019. Available from: Accessed 3 Oct 2019.
  95. 95.
    Rasmussen SA, Jamieson DJ. Ebola vaccine for pregnant women: one step closer but still more to go. STAT News. 13 June 2019. Available from: Accessed 3 Oct 2019.
  96. 96.
    Personal Communication, 2019 Oct 6.Google Scholar
  97. 97.
    Uganda Medical Research Council. Uganda starts Ebola Vaccine Trial among Healthcare and Frontline Workers in Mbarara. 5 Aug 2019. Available from:
  98. 98.
    WHO. Second Ebola vaccine to complement “ring vaccination” given green light in DRC. 23 Sept 2019. Available from: Accessed 24 September 2019.
  99. 99.
    Frame JD, Baldwin JM Jr, Gocke DJ, Troup JM. Lassa fever, a new virus disease of man from West Africa. Am J Trop Med Hyg. 1970;19(4):670–6.PubMedCrossRefGoogle Scholar
  100. 100.
    Monath TP. A short history of Lassa fever: the first 10–15 years after discovery. Curr Opin Virol. 2019;37:77–83.PubMedCrossRefGoogle Scholar
  101. 101.
    Ilori EA, Frank C, Dan-Nwafor CC, Ipadeola O, Krings A, Ukponu W, et al. Increase in Lassa fever cases in Nigeria, January-March 2018. Emerg Infect Dis. 2019;25(5):1026–7. Scholar
  102. 102.
    Ilori EA, Furuse Y, Ipadeola OB, Dan-Nwafor CC, Abubakar A, Womi-Eteng OE, et al. Epidemiologic and clinical features of Lassa fever outbreak in Nigeria, January 1-May 6, 2018. Emerg Infect Dis. 2019;25(6):1066–74. Scholar
  103. 103.
    Hallam HJ, Hallam S, Rodriguez SE, Barrett AD, Beasley DW, Chua A, et al. Baseline mapping of Lassa fever virology, epidemiology and vaccine research and development. NPJ Vaccines. 2018;3(1):11.PubMedPubMedCentralCrossRefGoogle Scholar
  104. 104.
    WHO (2019). Lassa Fever fact sheet. Available from: Accessed 21 Sep 2019.
  105. 105.
    Nigerian CDC. 2019 Lassa fever outbreak situation report. Serial No 31 4 August 2019 Available from: https://ncdcgovng/themes/common/files/sitreps/dd05ce463fb792c9b2fc3850bfe9ad73pdf. Accessed 19 August 2019.
  106. 106.
    Mateer EJ, Huang C, Shehu NY, Paessler S. Lassa fever–induced sensorineural hearing loss: a neglected public health and social burden. PLoS Negl Trop Dis. 2018;12(2):e0006187.PubMedPubMedCentralCrossRefGoogle Scholar
  107. 107.
    • Price ME, Fisher-Hoch SP, Craven RB, McCormick JB. A prospective study of maternal and fetal outcome in acute Lassa fever infection during pregnancy. BMJ. 1988;297(6648):584–7 Provides only prospective assessment of maternal and fetal outcomes with Lassa fever infection. PubMedPubMedCentralCrossRefGoogle Scholar
  108. 108.
    Bello OO, Akinajo OR, Odubamowo KH, Oluwasola TA. Lassa fever in pregnancy: report of 2 cases seen at the University College Hospital, Ibadan. Case Rep Obstet Gynecol. 2016;2016:9673683.PubMedPubMedCentralGoogle Scholar
  109. 109.
    Dan-Nwafor C. on behalf of team at Nigeria Centre for Disease Control (NCDC). Personal communication. Email sent to: Carleigh B. Krubiner. 19 August 2019.Google Scholar
  110. 110.
    World Health Organization. WHO Target Product Profile for Lassa virus Vaccine. 2017. Available from: Accessed 23 September 2019.
  111. 111.
    CEPI. Our Portfolio. Available from: Accessed 23 September 2019.
  112. 112.
    Salami K, Gouglas D, Schmaljohn C, Saville M, Tornieporth N. A review of Lassa fever vaccine candidates. Curr Opin Virol. 2019 Aug 1;37:105–11.PubMedCrossRefGoogle Scholar
  113. 113.
    Inovio. Inovio first to advance Lassa fever candidate vaccine into a clinical trial. 21 May 2019. Available from: Accessed 24 September 2019.
  114. 114.
    Karron R, Krubiner C, Faden R. As the world prepares to fight Lassa fever, the interests of pregnant women must be part of the planning. STAT. 15 January 2019. Available from: Accessed 24 September 2019.
  115. 115.
    • Faherty LJ, Rasmussen SA, Lurie N. A call for science preparedness for pregnant women during public health emergencies. Am J Obstet Gynecol. 2017;216(1):34-e1 Provides an approach for greater data collection on pregnancy-specific indicators and outcomes. CrossRefGoogle Scholar
  116. 116.
    Hirsch AJ, Roberts VH, Grigsby PL, Haese N, Schabel MC, Wang X, et al. Zika virus infection in pregnant rhesus macaques causes placental dysfunction and immunopathology. Nat Commun. 2018;9(1):263.PubMedPubMedCentralCrossRefGoogle Scholar
  117. 117.
    Vermillion MS, Lei J, Shabi Y, Baxter VK, Crilly NP, McLane M, et al. Intrauterine Zika virus infection of pregnant immunocompetent mice models transplacental transmission and adverse perinatal outcomes. Nat Commun. 2017;8:14575.PubMedPubMedCentralCrossRefGoogle Scholar
  118. 118.
    Krauer F, Riesen M, Reveiz L, Oladapo OT, Martinez-Vega R, Porgo TV, et al. WHO Zika Causality Working Group. Zika virus infection as a cause of congenital brain abnormalities and Guillain–Barré syndrome: systematic review. PLoS Med. 2017;14(1):e1002203.PubMedPubMedCentralCrossRefGoogle Scholar
  119. 119.
    Schwartz DA. Viral infection, proliferation, and hyperplasia of Hofbauer cells and absence of inflammation characterize the placental pathology of fetuses with congenital Zika virus infection. Arch Gynecol Obstet. 2017;295(6):1361–8.PubMedPubMedCentralCrossRefGoogle Scholar
  120. 120.
    Kourtis AP, Read JS, Jamieson DJ. Pregnancy and infection. N Engl J Med. 2014;370:2211–8.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Center for Global DevelopmentWashingtonUSA
  2. 2.Johns Hopkins Berman Institute of BioethicsBaltimoreUSA
  3. 3.Medical College of GeorgiaAugusta UniversityAugustaUSA

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