Characteristics of patients included in the study.

<p>Characteristics of patients included in the study.</p

The Ebola virus disease epidemic in the Conakry area, Guinea, March 2014 to February 2015.

<p>(A) Map of the study area, which consists of Conakry and the surrounding prefectures of Boffa, Coyah, Dubreka, Forecariah, Fria, Kindia, and Telimele (for which diagnoses were mostly performed by the IPD-LFHP laboratory) (the administrative boundaries were taken from the GADM database; <a href="http://www.gadm.org/" target="_blank">http://www.gadm.org/</a>). (B) Number of cases by month of symptom onset. The total number of probable and confirmed cases in the study area that were hospitalized is indicated in grey. The number of those that were diagnosed by reverse transcription PCR (RT-PCR) by the IPD-LFHP laboratory is in blue.</p

Viremia and the probability of death.

<p>(A) Mean viremia as a function of the time from symptom onset to sample collection. (B) Mean viremia by gender. (C) Mean viremia by age group. (D) Probability of death as a function of viremia, when viremia was measured in the week following symptom onset. Three viremia groups are defined: low (<i>V</i> < 10^4.4 copies/ml), intermediate (10^4.4 ≤ <i>V</i> < 10^5.2 copies/ml), and high (<i>V</i> ≥ 10^5.2 copies/ml) viremia. The probability of death according to viremia group is represented as dotted line. The grey line corresponds to the predictions of the univariable logistic regression model. (E) Probability of death (dot: observed mean; thick line: 95% CI) as a function of the time from symptom onset to sample collection and the viremia group. Mean predicted values obtained with the multivariable logistic regression (triangle) and the bootstrap prediction intervals (thin lines) are also provided.</p

Variation of CFR and viremia over time.

<p>(A) Observed CFR by month (black) and predictions obtained from multivariable logistic regression (orange) and from the simple univariable logistic regression model that relies only on viremia (violet). Lines provide 95% CI. The shaded area indicates the bootstrap prediction interval. (B) Mean viremia by month. (C) Proportion of patients in the low (red; <i>V</i> < 10^4.4 copies/ml), intermediate (green; 10^4.4 ≤ <i>V</i> < 10^5.2 copies/ml), and high (blue; <i>V</i> ≥ 10^5.2 copies/ml) viremia groups by month.</p

Pregnancy Outcomes after a Mass Vaccination Campaign with an Oral Cholera Vaccine in Guinea: A Retrospective Cohort Study

<div><p>Introduction</p><p>Since 2010, WHO has recommended oral cholera vaccines as an additional strategy for cholera control. During a cholera episode, pregnant women are at high risk of complications, and the risk of fetal death has been reported to be 2–36%. Due to a lack of safety data, pregnant women have been excluded from most cholera vaccination campaigns. In 2012, reactive campaigns using the bivalent killed whole-cell oral cholera vaccine (BivWC), included all people living in the targeted areas aged ≥1 year regardless of pregnancy status, were implemented in Guinea. We aimed to determine whether there was a difference in pregnancy outcomes between vaccinated and non-vaccinated pregnant women.</p><p>Methods and Findings</p><p>From 11 November to 4 December 2013, we conducted a retrospective cohort study in Boffa prefecture among women who were pregnant in 2012 during or after the vaccination campaign. The primary outcome was pregnancy loss, as reported by the mother, and fetal malformations, after clinical examination. Primary exposure was the intake of the BivWC vaccine (Shanchol) during pregnancy, as determined by a vaccination card or oral history. We compared the risk of pregnancy loss between vaccinated and non-vaccinated women through binomial regression analysis. A total of 2,494 pregnancies were included in the analysis. The crude incidence of pregnancy loss was 3.7% (95%CI 2.7–4.8) for fetuses exposed to BivWC vaccine and 2.6% (0.7–4.5) for non-exposed fetuses. The incidence of malformation was 0.6% (0.1–1.0) and 1.2% (0.0–2.5) in BivWC-exposed and non-exposed fetuses, respectively. In both crude and adjusted analyses, fetal exposure to BivWC was not significantly associated with pregnancy loss (adjusted risk ratio (aRR = 1.09 [95%CI: 0.5–2.25], p = 0.818) or malformations (aRR = 0.50 [95%CI: 0.13–1.91], p = 0.314).</p><p>Conclusions</p><p>In this large retrospective cohort study, we found no association between fetal exposure to BivWC and risk of pregnancy loss or malformation. Despite the weaknesses of a retrospective design, we can conclude that if a risk exists, it is very low. Additional prospective studies are warranted to add to the evidence base on OCV use during pregnancy. Pregnant women are particularly vulnerable during cholera episodes and should be included in vaccination campaigns when the risk of cholera is high, such as during outbreaks.</p></div

Timeline of the cholera vaccination campaign and field surveys in Boffa prefecture, Guinea, 2012 and 2013.

<p>Timeline of the cholera vaccination campaign and field surveys in Boffa prefecture, Guinea, 2012 and 2013.</p

Enrollment of study participants for the primary analysis and the bias-indicator analysis, Boffa prefecture, Guinea, 2013.

<p>Enrollment of study participants for the primary analysis and the bias-indicator analysis, Boffa prefecture, Guinea, 2013.</p