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Labor and Delivery
Ebola Readiness and Protocols
John P Horton, M.D.
Associate Director of Operations
Division of General OB/GYN
Dept of Gynecology and Obstetrics
�BACKGROUND
• Sparse data of patient outcomes
• Historical data is set in low a resource environment
• Little has been published on healthcare worker
safety techniques in regard to labor and delivery
• No previous published protocols on pregnancy
�HISTORY
• Outbreaks with Pregnancy data collection
– Yambuku, 1976
•
•
•
•
•
•
High Percentage of Infected, 46%
Related to Injection Contamination
Mortality Rate of Pregnant 89%
Overall Patient Mortality 88%
19 abortions among 82 women
11 neonates born, all died within 19 days
�HISTORY
• Kikwit, 1996
– Of 105 identified patient, 15 were Pregnant
– 14 die, Mortality Rate 95.5%
– Overall Mortality Rate, 77%
– 10 women ended with abortion
• 3 had Curettage was performed
• Gloves, mask, plastic apron
�HISTORY
• Kikwit, 1996
– 1 woman survives
• 32 yo, curettage for Incomplete Ab
– 1 woman had stillbirth with a 32 wk Delivery
– 4 were in 3rd Trimester, all died
– 1 delivered a live term infant
• Mother developed fever 4 days before
• Neonate died 3 days later
�SYMPTOMS
• At Kikwit 100% of
pregnant patients had:
–
–
–
–
–
–
–
–
Fever
Severe Genital Hemorrhage
Abdominal Pain
Diarrhea
Arthralgia
Hiccups
Dysphagia
Neuro Psych
• Other symptoms
– Melina
– Vomiting
– Nausea
– Hematuria
�CURRENT UPDATE
• Baggi et al
– 2 pregnant patients from Guinea
– Both recovered and were subsequently induced
at seven months with fetal demise
– Amniocentesis confirmed high concentration of
Ebola Virus
�CURRENT UPDATE
• Asymptomatic Shedding
– Pregnant patient may present differently
• Delivery after Infection
– Pregnant Survivors
– Pregnancy after resolved infection
�ASSESS YOUR RESOURCES
• Gather the team
– Nursing
– Doctors
– Infection Control
– Facilities
�PATH
• Where does a patient present
• Where will the go
• How will they get there
�SCHEMATICS
�SCHEMATICS
�DIFFERENCES
• Pain
• Dramatic Bleeding
• Secondary Patient
�PRESENTATION PROTOCOL
�PRESENTATION PROTOCOL
�PRESENTATION PROTOCOL
�PRESENTATION PROTOCOL
�LABORING PROTOCOL
�LABORING PROTOCOL
�LABORING PROTOCOL
�VAGINAL EXAM DONNING
• Over Full coverage PPE
– 1. Remove outer glove
– 2. Sanitize
– 3. Place surgical sleeve over protective outerwear
sleeve
– 4. Sanitize
– 5. Replace outer glove insuring glove over the sleeve
cuff
• At all times one should have clear visualization of the
outer glove cuff edge, and a buddy system used to
monitor.
�PRACTICE
�PRACTICE
�VAGINAL EXAM DOFFING
• Over Full coverage PPE
– 1. Wipe off heavy soil
– 2. Remove Sleeve From Shoulder pulling downward
– 3. Sanitize
– 4. Remove Outer Glove
– 5. Sanitize
– 6. Replace outer glove
• At all times one should have clear visualization of the
outer glove cuff edge, and a buddy system used to
monitor.
�DELIVERY PROTOCOL
�DELIVERY PROTOCOL
�FULL GEAR
�DELIVERY PROTOCOL
�GREAT QUESTIONS
• No protocol can cover all situations
– Does Delivery Improves
• Preeclampsia (Assuming you can Dx)
• Simply to improve outcome
– Lassa
�START YOUR PLAN
•
•
•
•
•
•
Collaborate Collaborate Collaborate
Nursing – Beverly Green
Ethics
Admin
CDC
Data is hopefully coming from the amazing health
workers in Africa
��
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Labor and Delivery Ebola Readiness and Protocols
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Treatment & Care
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NETEC past class slides 2015-2016
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NETEC
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John P Horton, M.D.
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2016
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2025-09-27
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2022-09-27 - general asset review - Treatment & Care group
Ebola
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Labor and Delivery
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SYNOPSIS
Pregnancy, Labor, and
Delivery after Ebola Virus Disease
and Implications for Infection
Control in Obstetric Services,
United States
Amanda Kamali, Denise J. Jamieson, Julius Kpaduwa, Sarah Schrier, Moon Kim, Nicole M. Green,
Ute Ströher, Atis Muehlenbachs, Michael Bell, Pierre E. Rollin, Laurene Mascola
Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing
clinicians the opportunity to earn CME credit.
This activity has been planned and implemented in accordance with the Essential Areas and policies of the
Accreditation Council for Continuing Medical Education through the joint providership of Medscape, LLC and
Emerging Infectious Diseases. Medscape, LLC is accredited by the ACCME to provide continuing medical education
for physicians.
Medscape, LLC designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1
Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal
CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the
post-test with a 75% minimum passing score and complete the evaluation at http://www.medscape.org/journal/eid; (4)
view/print certificate.
Release date: May 19, 2016; Expiration date: May 19, 2017
Learning Objectives
Upon completion of this activity, participants will be able to:
•
•
•
•
Assess the potential for Ebola virus to complicate pregnancy
Analyze obstetric interventions and outcomes of a case of a pregnant woman with a history of Ebola
virus diseases (EVD)
Evaluate precautions taken during labor and delivery involving this patient with a history of EVD
Distinguish laboratory testing results for Ebola virus among the mother and infant in the current case.
CME Editor
Claudia Chesley, Technical Writer/Editor, Emerging Infectious Diseases. Disclosure: Claudia Chesley has disclosed
no relevant financial relationships.
CME Author
Charles P. Vega, MD, Clinical Professor of Family Medicine, University of California, Irvine. Disclosure: Charles P.
Vega, MD, has disclosed the following financial relationships: served as an advisor or consultant for Allergan, Inc.;
McNeil Consumer Healthcare; served as a speaker or a member of a speakers bureau for Shire Pharmaceuticals.
Authors
Disclosures: Amanda Kamali, MD, has disclosed the following relevant financial relationships: owns stock, stock
options, or bonds from Pfizer. Denise J. Jamieson, MD, MPH; Julius Kpaduwa, MD; Sarah Schrier, RNC-OB,
MSN; Moon Kim, MD, MPH; Nicole M. Green, PhD; Ute Ströher; Atis Muehlenbachs, MD, PhD; Michael Bell,
MD; and Pierre E. Rollin, MD, have disclosed no relevant financial relationships. Laurene Mascola, MD, MPH,
has disclosed the following relevant financial relationships: served as a speaker or a member of a speakers bureau
for Merck.
Author affiliations: Centers for Disease Control and Prevention,
Atlanta, Georgia, USA (A. Kamali, D.J. Jamieson, U. Ströher,
A. Muehlenbachs, M. Bell, P.E. Rollin); Los Angeles County
Department of Public Health, Los Angeles, California, USA
1156
(A. Kamali, M. Kim, N.M. Green, L. Mascola); Greater El Monte
Community Hospital, South El Monte, California, USA
(J. Kpaduwa, S. Schrier)
DOI: http://dx.doi.org/10.3201/eid2207.160269
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 22, No. 7, July 2016
�EVD and Infection Control in Obstetric Services
Many of the survivors of the 2014–2015 epidemic of Ebola
virus disease (EVD) in West Africa were women of childbearing age. Limited clinical and laboratory data exist that
describe these women’s pregnancies and outcomes. We
report the case of an EVD survivor who became pregnant
and delivered her child in the United States, and we discuss implications of this case for infection control practices
in obstetric services. Hospitals in the United States must be
prepared to care for EVD survivors.
T
he 2014–2015 epidemic of Ebola virus disease (EVD),
which was centered in West Africa, is the largest EVD
epidemic in history. Vertical transmission of Ebola virus
from mother to fetus can occur during acute Ebola infection,
leading to intrauterine fetal death, stillbirth, or neonatal death
(1–5). Little is known about the risk for vertical transmission of Ebola virus from women to their neonates outside
of the acute infectious period. Ebola virus (EBOV) has been
found in breast milk during acute disease (6), and a study
documenting 2 discordant mother–child pairs postulated that
breast feeding of 1 infant may have led to infection of the
infant (7). EBOV has been found in immune-privileged sites,
ocular fluid and semen, many months after onset of infection
(8–13), and it is possible that other immune-privileged sites,
such as the central nervous system (CNS), may also contain
EBOV many months after onset of infection. In addition,
acutely infected pregnant women have had high amounts of
Ebola viral nucleic acid persist in the amniotic fluid following clearance of viremia; however, it is not known whether
this amniotic fluid is infectious (2). Some theoretical concern
exists that during labor and delivery or obstetric anesthetic
procedures (e.g., spinal anesthesia), contact with products of
conception or cerebrospinal fluid from EVD survivors may
pose an infectious risk (6,14–18).
As of March 9, 2016, an estimated 17,323 persons
worldwide have survived EVD, and among them are
≈5,000 women of childbearing age (19). Survivors will require medical care for routine illnesses, surgical services,
dental work, and management of disease sequelae (20,21).
In addition, many of the female survivors who are of reproductive age will require obstetric care. Some of these
survivors may come to the United States, and hospitals
and healthcare workers must be prepared to provide care
in a manner that promotes patient dignity and comfort, prevents stigmatization, and ensures that all patients receive
appropriate, high-quality medical care (22–24). However,
limited preparations have been made for follow-up care
for EVD survivors, including those needing obstetric care.
We describe the case of an EVD survivor who delivered
a healthy neonate in a community hospital in the United
States 14 months after acute EBOV infection, and we discuss the implications of the findings from this case for infection control in obstetric services.
Clinical Course
Ebola Virus Disease Course
A 29-year-old physician from West Africa became ill
with EVD in late July 2014. She had contracted the virus
from an EVD patient whom she had cared for from July
20th until his death on July 25. On July 29, the woman began feeling unwell, noting arthralgia and myalgia, which
she self-treated with antimalarial medications. On August
1, she had fever, and on August 3, she began vomiting and
had diarrhea. The woman was admitted to an Ebola treatment center (ETC) and isolated after results of an EBOV
real-time reverse transcription PCR (rRT-PCR) were positive for EBOV RNA (cycle threshold unknown). According to the woman, she spent 13 days in the ETC, where
she was treated with oral rehydration fluids, acetaminophen, and a second course of antimalarial medications.
She was discharged from the ETC on August 16, after
showing negative results on 2 EBOV rRT-PCRs. After
her recovery, the woman noted some fatigue, anorexia,
arthralgia, and alopecia; she did not report any sleep disturbances, headaches, or vision problems. Symptoms resolved 2–3 months later.
Pregnancy, Labor, and Delivery
Eight months before her EVD diagnosis, the patient had
had a spontaneous abortion at 10 weeks’ gestation. In January 2015, twenty-two weeks after her last negative EBOV
rRT-PCR, she became pregnant again. For this second
pregnancy, the estimated date of delivery was established
on the basis of an 11.5-week ultrasound that was consistent with the patient’s last menstrual period. The patient
received routine prenatal care in West Africa, and at 25
weeks’ gestation, she traveled to Kern County, California,
USA, and a detailed anatomy ultrasound was performed in
Los Angeles County, California, and demonstrated normal
fetal development.
The hospital identified staff members who were willing to assist during labor and delivery for the patient, and at
40 weeks and 1 day of gestation, labor was induced to ensure that those staff members were present. The patient was
given 2 vaginal doses of misoprostol, and oxytocin was administered, and labor progressed normally. The patient was
given epidural anesthesia for pain control and had a normal
vaginal delivery of a female neonate (weight 4,128 g) with
Apgar scores of 8 and 9 at 1 and 5 min of age, respectively.
The patient had a second-degree perineal laceration, which
was repaired.
The patient and her neonate were discharged from
the hospital at 36 h postpartum. They returned for routine
follow-up 7 days postpartum and were monitored for 6
weeks following delivery, after which they traveled home
to West Africa.
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 22, No. 7, July 2016
1157
�SYNOPSIS
Infection Control and Personal Protective Equipment,
Public Health Response
Two weeks before the patient’s delivery date, her US
obstetrician contacted the California Department of Public Health (DPH; Richmond, CA, USA) and the Centers
for Disease Control and Prevention (CDC; Atlanta, GA,
USA) to determine if there were any special precautions
needed for infection control; the California DPH notified
the Los Angeles County DPH (Los Angeles, CA, USA).
Because the patient was healthy and had fully recovered
from EVD ≈4 months before becoming pregnant, all public health agencies agreed that she presented an extremely
low risk for transmission of Ebola virus. Nevertheless, it
was deemed appropriate that public health officials play an
active role assessing and guiding management of the patient. The Los Angeles County DPH and CDC collaborated
with the hospitals healthcare providers, nursing directors,
laboratory director, environmental services staff, anesthesiologists, and hospital administration to address concerns
and review the care plan, including plans for any complications, such as the need for cesarean delivery or the development of peripartum fever.
Hospital infection control procedures were reviewed in
person with hospital staff. In review of these policies, no additional precautions were recommended above the standard
precautions and policies currently used for all deliveries at
the hospital. Several hospital staff members not directly involved in patient care expressed discomfort about working
while an EVD survivor was admitted. To reassure these staff
members, the patient was kept in 1 room during labor and
delivery and after delivery. No changes were made to the
policies for environmental cleaning or waste disposal.
Hospital staff raised concerns about the possibility of
EBOV being harbored in immune-privileged sites (e.g.,
cerebrospinal fluid) in EVD survivors and, thus, expressed
their concerns about a theoretical risk for EBOV transmission (6,14–17). This patient did not show signs or symptoms
of CNS involvement during her acute illness or during her
pregnancy, which likely indicated a decreased risk of any
latent EBOV reservoir in her CNS; thus, it was considered
likely that epidural or spinal anesthesia for this patient would
not pose an infectious risk to staff. Hospital staff also noted
the often imperfect adherence to use of personal protective
equipment (PPE) during labor and delivery; thus, they voiced
concern over this patient’s history of EVD because large volumes of blood and amniotic fluid are often encountered in
typical, uncomplicated vaginal deliveries (25). As a result of
these concerns, many discussions were held regarding what
PPE should be used during labor and delivery. Standard precautions should always be applied in all medical settings,
including labor and delivery; however, neither CDC nor the
American College of Obstetricians and Gynecologists had
tailored recommendations for PPE specifically for vaginal
or cesarean deliveries for any patients. Thus, CDC and Los
Angeles County DPH developed a preliminary set of recommendations for the patient’s providers regarding the use
of PPE (Tables 1, 2) during and after labor and delivery to
ensure that standard precautions were implemented. These
PPE recommendations were discussed with the providers in
the days before the delivery, and staff members were able to
ask for clarification and ensure that materials were readily
available. These PPE recommendations did not differ from
standard precautions, but they explicitly discussed which
PPE to use for casual contact, vaginal examinations, labor
and delivery, anesthesia, and postpartum care. Routine hand
hygiene, the use of barriers for mucous membrane protection, and the use of double gloves for procedures that involve
sharps were emphasized.
Table 1. Recommendations for use of personal protective equipment by healthcare workers during labor and delivery for a woman
who became pregnant after surviving Ebola virus disease, United States, 2015*
Personal protective equipment
Gown
Fluid-resistant,
Gloves
midcalf boot
Face Face
Fluid-resistant or
covers
mask shield Isolation impermeable†
Potential exposure
Single Double
Casual contact with patient
Performing duties for patient with intact
No
No
No
No
No
No
No
membranes (e.g., delivering food or water,
talking with patient, adjusting external monitors)
Performing duties for patient with ruptured
No
No
No
No
No
No
No
membranes; no touching of patient or bedding
Noncasual contact with patient
Touching patient with ruptured membranes or
No
No
Yes
No
Yes
No
No
bedding of patient with ruptured membranes
Administering epidural
Yes
Yes
Yes
No
No
Yes
Yes‡
Performing vaginal examination
Yes
Yes
No
Yes
Yes
No
Yes‡
Performing obstetric procedures§
Yes
Yes
No
Yes
Yes
Yes
Yes
*These personal protective equipment recommendations were developed for this particular patient and do not represent a formal recommendation.
†Impermeable indicates that the material and construction have demonstrated resistance to synthetic blood and simulated bloodborne pathogens; fluidresistant indicates demonstrated resistance to water (http://www.cdc.gov/niosh/npptl/topics/protectiveclothing/default.html).
‡To be used if membranes were ruptured.
§Procedures include placement of fetal scalp electrode or intrauterine pressure catheter; manual removal of placenta; bimanual massage of uterine.
1158
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 22, No. 7, July 2016
�EVD and Infection Control in Obstetric Services
Table 2. Recommendations for use of personal protective equipment by healthcare workers during postpartum care of a woman who
became pregnant after surviving Ebola virus disease and during care of her neonate, United States, 2015*
Gown
Gloves
Fluid-resistant,
midcalf boot
Fluid-resistant or
covers
Level of care
Face mask Face shield Isolation
impermeable†
Single
Double
While caring for mother
Before bedding/gown change
Yes
Yes
No
Yes
Yes
No
Yes
After bedding/gown change
No, unless No, unless
Yes
No
Yes
No
No
(vaginal exam, perineal care)
splash likely splash likely
While caring for neonate
Before bathing
Yes
Yes
No
Yes
Yes
No
Yes
After bathing
No
No
No
No
Yes‡
No
No
*These personal protective equipment recommendations were developed for this particular patient and do not represent a formal recommendation.
†Impermeable indicates that the material and construction have demonstrated resistance to synthetic blood and simulated bloodborne pathogens; fluidresistant indicates demonstrated resistance to water (http://www.cdc.gov/niosh/npptl/topics/protectiveclothing/default.html).
‡To be used if exposure to fluids is likely.
Laboratory Assessment
One week before delivery, EBOV rRT-PCR testing was
performed on the patient’s blood by the Los Angeles County DPH laboratory and the CDC Viral Special Pathogens
Branch; both results were negative. As expected, Ebola
serum antibodies were detected by ELISA (IgG >1:1600,
IgM negative).
After obtaining written informed consent from the
patient, healthcare staff obtained the following during and
after delivery: vaginal secretions, amniotic fluid (vaginal
pool), cord blood, placenta, umbilical cord, breast milk
(colostrum collected 16 h after delivery), and oral and ear
swab samples from the neonate. Cord blood, colostrum,
amniotic fluid, and swab samples were kept refrigerated
until processed or frozen on dry ice for shipment to CDC.
A placental sample was frozen in a sterile specimen cup
and samples of placenta and umbilical cord were placed
in buffered formalin and shipped at room temperature to
CDC. EBOV rRT-PCR testing was performed on all of
these specimens at the Los Angeles County DPH and CDC
laboratories by using assays specific for nucleoprotein and
viral protein 40 genes.
Placenta, amniotic fluid, and cord blood samples and
ear and oral swab samples from the neonate were negative
by EBOV rRT-PCR. Attempts were made to recover virus
from placenta, amniotic fluid, cord blood, and colostrum
at CDC, but no virus was recovered (Table 3). Amniotic
fluid, cord blood, and colostrum were tested by ELISA for
IgM and IgG against Ebola virus antigens (26). Cord blood
was negative for IgM and had an IgG titer of >1:1600.
Amniotic fluid and colostrum were negative for IgM and
IgG. The placenta and umbilical cord were histologically
normal, and no Ebola virus antigen was detected by immunohistochemistry (27), including in maternal and fetal
endothelial cells and leukocytes.
Conclusions
We describe the delivery of a healthy baby to an EVD survivor who became pregnant 22 weeks after clearance of
viremia and resolution of post-EVD sequelae (i.e., fatigue,
anorexia, arthralgia). At 6 weeks follow-up, before returning to West Africa, the mother and baby were doing well.
Given that the mother did not exhibit any signs or symptoms of post-EVD sequelae during her pregnancy, we did
not expect to find any EBOV by rRT-PCR in any specimens
obtained, and none was detected. It is somewhat surprising
that we did not detect Ebola IgG in the colostrum; however,
studies of antibodies for other infections have found that
levels of IgG and IgM in colostrum are much lower than
in serum (28), and this might also be true for antibodies
against EBOV.
Although we did not detect EBOV RNA in this patient
during pregnancy, women who are pregnant during acute
EBOV infection usually transmit virus to the fetus and may
pose an infectious risk to healthcare providers and others
during delivery or abortion (3). EBOV can readily cross the
placenta, and pathologic examination of placental tissues
of patients with confirmed EVD have demonstrated EBOV
antigen in the trophoblasts, syncytiotrophoblasts, and circulating maternal macrophages (4). EBOV RNA has been
demonstrated in amniotic fluid; fetal meconium; vaginal
secretions; umbilical cord; buccal swab samples from neonates; and peripheral blood samples from neonates, including those of mothers with cleared viremia (29,30).
The immune effects of pregnancy in the context of
EVD have not been well documented (3); however, alterations in the immune system do occur during pregnancy
(31), which during acute EBOV infection likely increases
the risk for a poor outcome, including spontaneous abortion and neonatal death. Unlike the CNS, eye, and male
testis, the genital tract of a nongravid female is not traditionally considered an immune-privileged site (32–34).
Laboratory data that demonstrate the absence of EBOV
or the presence of antibodies in post-EVD pregnancies
are lacking; however, on the basis of epidemiological evidence in the field of multiple uneventful deliveries in West
Africa and of the laboratory-analyzed case reported here,
no evidence currently exists that Ebola virus can persist
in the female genital tract. Any perceived risk must be
mitigated to ensure that patients are not stigmatized and
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 22, No. 7, July 2016
Page 1 of 1
1159
�SYNOPSIS
Table 3. Laboratory test results for a woman who became pregnant after surviving Ebola virus disease and for her neonate, United
States, 2015*
Source
Time of sample collection
rRT-PCR
Ebola antibodies
Immunohistochemistry
Maternal blood
1 week before delivery
Negative
IgG (1:1,600); IgM not detected
NA
Cord blood
At delivery
Negative
IgG (1:1,600); IgM not detected
NA
Amniotic fluid
At delivery
Negative
IgG; IgM not detected
NA
Vaginal swab sample
At delivery
Negative
NA
NA
Neonate ear swab sample
At delivery
Negative
NA
NA
Neonate oral swab sample
At delivery
Negative
NA
NA
Placenta
At delivery
Negative
NA
Negative for Ebola antigen
Umbilical cord
At delivery
NA
NA
Negative for Ebola antigen
Colostrum
1 day after delivery
Negative
IgG and IgM not detected
NA
*NA, not applicable; rRT-PCR, real-time reverse transcription PCR.
receive appropriate care. The authors concur with current
guidelines by the World Health Organization, which state
that women who have recovered from EVD are not infectious and should receive routine prenatal care, and their
labor and delivery should be performed using standard
PPE for protection against blood and body fluids (35).
The normal pregnancy for the patient described in
this study and her delivery of a healthy neonate offer reassurance that women who become pregnant after recovery from EVD pose little risk for transmission of EBOV
to the baby or others. Many more EVD survivors will
become pregnant and deliver, and some may do so in the
United States. Many other survivors will require routine
medical care, including care for post-EVD syndrome.
Lessons learned from this patient, specifically those addressing concerns about potential risks for virus transmission, may be applied to future patients. However,
each survivor who seeks medical care will likely need to
be assessed individually to determine possible risks for
transmitting virus (16,18). Over the course of the public health involvement in this case, it became evident
that, although standard precautions should routinely be
used in all labor and delivery settings, written guidelines
for labor and delivery may be useful, given the heightened concern for a theoretical disease transmission risk.
We hope that the preliminary recommendations for
PPE use during labor and delivery in the case discussed
here will provide a template for other professional organizations to create guidelines for use in all labor and
delivery settings.
Acknowledgments
We thank Cheryl Starling, Benjamin Schwartz, and Claudia
Jonah for assistance in coordinating care for the patient; Clara
Tyson, Geri Braddock, Juliet Bugante, Elizabeth Traub, and
Dawn Terashita for assistance in ensuring appropriate hospital
infection control procedures were in place; Viviana Torres,
Nicholas Miranda, Robert Tran, Julio Ramirez, Carlos
Garcia, Sascha Ellington, Aridth Gibbons, Shelley Brown, and
Ketan Patel for performing laboratory testing; Stanley Toy for
administrative leadership; Stella Kpaduwa for clinical care of
1160
the neonate; and Inger Damon, Dana Meaney-Delman, Oliver
Morgan, Maleeka Glover, Timothy Uyeki, and Jana M. Ritter
for guidance and assistance with personal protective equipment
recommendations.
Dr. Kamali, an Epidemic Intelligence Service Officer in the
Center for Surveillance, Epidemiology and Laboratory
Services, Centers for Disease Control and Prevention, is based
at the Los Angeles County Department of Public Health as
a physician specializing in infectious diseases. Her interests
include emerging infectious diseases, antimicrobial resistance,
and stewardship.
References
1. Akerlund E, Prescott J, Tampellini L. Shedding of Ebola virus in an
asymptomatic pregnant woman. N Engl J Med. 2015;372:2467–9.
http://dx.doi.org/10.1056/NEJMc1503275
2. Baggi FM, Taybi A, Kurth A, Van Herp M, Di Caro A, Wolfel R,
et al. Management of pregnant women infected with Ebola
virus in a treatment centre in Guinea, June 2014. Euro Surveill.
2014;19:20983. http://dx.doi.org/10.2807/1560-7917.
ES2014.19.49.20983
3. Black BO, Caluwaerts S, Achar J. Ebola viral disease and
pregnancy. Obstet Med. 2015;8:108–13. http://dx.doi.org/10.1177/
1753495X15597354
4. Muehlenbachs A, de la Rosa Vazquez O, Bausch DG, Schafer IJ,
Paddock CD, Bergeron E, et al. Ebola virus disease in pregnancy:
histopathologic and immunohistochemical findings. Presented
at: Abstracts of the American Society of Tropical Medicine and
Hygiene 64th Annual Meeting; 2015 Oct 25–29; Philadelphia, PA,
USA. Abstract LB-5108.
5. 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(Suppl 1):S11–2. http://dx.doi.org/10.1086/514289
6. Bausch DG, Towner JS, Dowell SF, Kaducu F, Lukwiya M,
Sanchez A, et al. Assessment of the risk of Ebola virus
transmission from bodily fluids and fomites. J Infect Dis.
2007;196(Suppl 2):S142–7. http://dx.doi.org/10.1086/520545
7. Moreau M, Spencer C, Gozalbes JG, Colebunders R, Lefevre A,
Gryseels S, et al. Lactating mothers infected with Ebola virus:
EBOV RT-PCR of blood only may be insufficient.
Euro Surveill. 2015;20:21017. http://dx.doi.org/10.2807/
1560-7917.ES2015.20.3.21017
8. Deen GF, Knust B, Broutet N, Sesay FR, Formenty P, Ross C, et al.
Ebola RNA persistence in semen of Ebola virus disease
survivors—preliminary report. N Engl J Med. Epub 2015 Oct 14.
9. Mate SE, Kugelman JR, Nyenswah TG, Ladner JT, Wiley MR,
Cordier-Lassalle T, et al. Molecular evidence of sexual
transmission of Ebola virus. N Engl J Med. 2015. Epub 2015 Oct 14.
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 22, No. 7, July 2016
Page 1 of 1
�EVD and Infection Control in Obstetric Services
10. Varkey JB, Shantha JG, Crozier I, Kraft CS, Lyon GM, Mehta AK,
et al. Persistence of Ebola virus in ocular fluid during
convalescence. N Engl J Med. 2015;372:2423–7. http://dx.doi.org/
10.1056/NEJMoa1500306
11. Fischer WA II, Wohl DA. Confronting Ebola as a sexually
transmitted infection. Clin Infect Dis. Epub 2016 Mar 1.
12. Howlett P, Brown C, Helderman T, Brooks T, Lisk D, Deen G,
et al. Ebola virus disease complicated by late-onset encephalitis
and polyarthritis, Sierra Leone. Emerg Infect Dis. 2016;22:150–2.
http://dx.doi.org/10.3201/eid2201.151212
13. Rowe AK, Bertolli J, Khan AS, Mukunu R, Muyembe-Tamfum JJ,
Bressler D, et al. Clinical, virologic, and immunologic follow-up
of convalescent Ebola hemorrhagic fever patients and their
household contacts, Kikwit, Democratic Republic of the Congo.
Commission de Lutte contre les Epidémies à Kikwit.
J Infect Dis. 1999;179(Suppl 1):S28–35. http://dx.doi.org/10.1086/
514318
14. Barkhordarian A, Thames AD, Du AM, Jan AL, Nahcivan M,
Nguyen MT, et al. Viral immune surveillance: toward a TH17/TH9
gate to the central nervous system. Bioinformation. 2015;11:47–54.
http://dx.doi.org/10.6026/97320630011047
15. Brainard J, Pond K, Hooper L, Edmunds K, Hunter P.
Presence and persistence of Ebola or Marburg virus in patients
and survivors: a rapid systematic review. PLoS Negl Trop Dis.
2016;10:e0004475. http://dx.doi.org/10.1371/journal.pntd.0004475
16. Sonnenberg P, Field N. Sexual and mother-to-child transmission
of Ebola virus in the postconvalescent period. Clin Infect Dis.
2015;60:974–5. http://dx.doi.org/10.1093/cid/ciu981
17. Farge E, Giahyue JH. Female survivor may be cause of Ebola flare-up
in Liberia. Reuters. 2015 Dec 17. In: Kaye D. 15 March news.
Clin Infect Dis. 2016;62:i–ii. http://dx.doi.org/10.1093/cid/civ1211
18. Centers for Disease Control and Prevention. Interim guidance for
management of survivors of Ebola virus disease in US healthcare
settings. 2016 [cited 2016 Mar 18]. http://www.cdc.gov/vhf/ebola/
healthcare-us/evaluating-patients/guidance-for-management-ofsurvivors-ebola.html
19. World Health Organization. Ebola data and statistics: situation
summary 09, March 2016. 2016 Mar 11 [cited 2016 Mar 18].
http://apps.who.int/gho/data/view.ebola-sitrep.ebola-summary20160309?lang=en
20. Bausch DG. Sequelae after Ebola virus disease: even when it’s over
it’s not over. Lancet Infect Dis. 2015;15:865–6. http://dx.doi.org/
10.1016/S1473-3099(15)70165-9
21. Clark DV, Kibuuka H, Millard M, Wakabi S, Lukwago L,
Taylor A, et al. Long-term sequelae after Ebola virus disease in
Bundibugyo, Uganda: a retrospective cohort study.
Lancet Infect Dis. 2015;15:905–12. http://dx.doi.org/10.1016/
S1473-3099(15)70152-0
22 Kupferschmidt K. Infectious diseases. Surviving Ebola survival.
Science. 2015;348:1406–7. http://dx.doi.org/10.1126/
science.348.6242.1406
23. Minkoff H, Ecker J. Physicians’ obligations to patients infected
with Ebola: echoes of acquired immune deficiency syndrome.
Am J Obstet Gynecol. 2015:212;456.e1–4.
24. Sprecher A. Handle survivors with care. N Engl J Med. Epub 2015
Oct 14.
25. Magann EF, Bass JD, Chauhan SP, Young RA, Whitworth NS,
Morrison JC. Amniotic fluid volume in normal singleton
pregnancies. Obstet Gynecol. 1997;90:524–8. http://dx.doi.org/
10.1016/S0029-7844(97)00351-7
26. Ksiazek TG, West CP, Rollin PE, Jahrling PB, Peters CJ. ELISA
for the detection of antibodies to Ebola viruses. J Infect Dis.
1999;179(Suppl 1):S192–8. http://dx.doi.org/10.1086/514313
27. Martines RB, Ng DL, Greer PW, Rollin PE, Zaki SR. Tissue and
cellular tropism, pathology and pathogenesis of Ebola and Marburg
viruses. J Pathol. 2015;235:153–74. http://dx.doi.org/10.1002/
path.4456
28. Wheeler TT, Hodgkinson AJ, Prosser CG, Davis SR. Immune
components of colostrum and milk—a historical perspective.
J Mammary Gland Biol Neoplasia. 2007;12:237-47.
29. 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, January 2015.
Am J Trop Med Hyg. 2016;94:417–9. http://dx.doi.org/10.4269/
ajtmh.15-0619
30. Oduyebo T, Pineda D, Lamin M, Leung A, Corbett C, Jamieson DJ.
A pregnant patient with Ebola virus disease. Obstet Gynecol.
2015;126:1273–5. http://dx.doi.org/10.1097/
AOG.0000000000001092
31. Kourtis AP, Read JS, Jamieson DJ. Pregnancy and infection.
N Engl J Med. 2014;371:1077.
32. Clark GF, Schust DJ. Manifestations of immune tolerance in the
human female reproductive tract. Front Immunol. 2013;4:26.
http://dx.doi.org/10.3389/fimmu.2013.00026
33. Mital P, Hinton BT, Dufour JM. The blood–testis and blood–
epididymis barriers are more than just their tight junctions.
Biol Reprod. 2011;84:851–8. http://dx.doi.org/10.1095/
biolreprod.110.087452
34. Muldoon LL, Alvarez JI, Begley DJ, Boado RJ, Del Zoppo GJ,
Doolittle ND, et al. Immunologic privilege in the central nervous
system and the blood–brain barrier. J Cereb Blood Flow Metab.
2013;33:13–21. http://dx.doi.org/10.1038/jcbfm.2012.153
35. World Health Organization. Interim guidance: Ebola virus disease
in pregnancy: screening and management of Ebola cases, contacts
and survivors. 2015 Sep 4 [cited 2015 Nov 11]. http://apps.who.int/
iris/bitstream/10665/184163/1/WHO_EVD_HSE_PED_15.1_eng.
pdf?ua=1
Address for correspondence: Amanda Kamali, Los Angeles County
Department of Public Health, 313 N Figueroa St, Ste 212, Los Angeles,
CA 90012-2602, USA; email: ydh3@cdc.gov
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Title
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<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
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<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
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<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
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Kamali, Amanda, Denise J. Jamieson, Julius Kpaduwa, Sarah Schrier, Moon Kim, Nicole M. Green, Ute Ströher, Atis Muehlenbachs, Michael Bell, Pierre E. Rollin, and Laurene Mascola. 2016. "Pregnancy, Labor, and Delivery after Ebola Virus Disease and Implications for Infection Control in Obstetric Services, United States." Emerging infectious diseases 22 (7):1156-61.
Abstract
Many of the survivors of the 2014–2015 epidemic of Ebola virus disease (EVD) in West Africa were women of childbearing age. Limited clinical and laboratory data exist that describe these women’s pregnancies and outcomes. We report the case of an EVD survivor who became pregnant and delivered her child in the United States, and we discuss implications of this case for infection control practices in obstetric services. Hospitals in the United States must be prepared to care for EVD survivors.
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4918171/
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Pregnancy, Labor, and Delivery after Ebola Virus Disease and Implications for Infection Control in Obstetric Services, United States
Subject
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Infection Control
Description
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Many of the survivors of the 2014–2015 epidemic of Ebola virus disease (EVD) in West Africa were women of childbearing age.
Creator
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Kamali, Amanda, Denise J. Jamieson, Julius Kpaduwa, Sarah Schrier, Moon Kim, Nicole M. Green, Ute Ströher, Atis Muehlenbachs, Michael Bell, Pierre E. Rollin, and Laurene Mascola.
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CDC
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2016-07
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2022-11-07 - Clayton, Treatment & Care group general asset review (1 year)
2022-01-10 by PPE group Shawn Gibbs (3 years)
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2023-11-07
Ebola
Infection Prevention and Control
Labor and Delivery
Neonates
Personal Protective Equipment (PPE)
R-SP
Survivors
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3f501528330a5195fcab9cad4e0bb714
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<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
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<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
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Bebell, Lisa M., Titilope Oduyebo, and Laura E. Riley. 2017. "Ebola virus disease and pregnancy: A review of the current knowledge of Ebola virus pathogenesis, maternal, and neonatal outcomes." Birth Defects Res 109 (5):353-62.
Abstract
The 2014-2016 Ebola virus disease (EVD) outbreak in West Africa devastated local health systems and caused thousands of deaths. Historical reports from Zaire ebolavirus outbreaks suggested pregnancy was associated with an increased risk of severe illness and death, with mortality rates from 74-100%. In total, 111 cases of pregnant patients with EVD are reported in the literature, with an aggregate maternal mortality of 86%. Pregnancy-specific data published from the recent outbreak include four small descriptive cohort studies and five case reports. Despite limitations including reporting bias and small sample size, these studies suggest mortality in pregnant women may be lower than previously reported, with five of 13(39%) infected women dying. Optimal treatments for pregnant women, and differences in EVD course between pregnant women and non-pregnant individuals are major scientific gaps that have not yet been systematically addressed. Ebola virus may be transmitted from mother to baby in utero, during delivery, or through contact with maternal body fluids after birth including breast milk. EVD is almost universally fatal to the developing fetus, and limited fetal autopsy data prevent inferences on risk of birth defects. Decisions about delivery mode and other obstetric interventions should be individualized. WHO recommends close monitoring of survivors who later become pregnant, but does not recommend enhanced precautions at subsequent delivery. Though sexual transmission of Ebola virus has been documented, birth outcomes among survivors have not been published and will be important to appropriately counsel women on pregnancy outcomes and inform delivery precautions for healthcare providers.
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Author manuscript free on PubMed; final article through Wiley
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5407292/
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Ebola virus disease and pregnancy - A review of the current knowledge of Ebola virus pathogenesis, maternal and neonatal outcomes
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The 2014-2016 Ebola virus disease (EVD) outbreak in West Africa devastated local health systems and caused thousands of deaths.
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Bebell, Lisa M., Titilope Oduyebo, and Laura E. Riley.
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2017-03-15
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2022-07 by Kari, Special Populations Treatment & Care group
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2024-07-31
Labor and Delivery
Outcomes
R-Res&Pub
R-SP
Vaccine Study
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3f501528330a5195fcab9cad4e0bb714
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Title
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<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
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Citation
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Haddad, Lisa B., John Horton, Bruce S. Ribner, and Denise J. Jamieson. 2018. "Ebola Infection in Pregnancy: A Global Perspective and Lessons Learned." Clinical obstetrics and gynecology 61 (1):186-96.
Abstract
<h2 class="head no_bottom_margin ui-helper-clearfix">Abstract</h2>
<div>
<p id="P1" class="p p-first-last">The 2014-2016 Ebola outbreak primarily based in 3 West African countries, had far-reaching global effects. Importantly, the crisis highlighted large gaps in reproductive health services in affected countries and inadequate healthcare system preparedness for obstetrical patients in the setting of highly contagious infectious diseases. We aim to review Ebola virus effects with a focus on the obstetrical implications in the context of this recent Ebola outbreak, discuss the lessons learned following this outbreak and propose current measures specific to obstetrics that should be considered in preparation for the next concerning emergent infectious disease.</p>
</div>
<div class="sec"><strong class="kwd-title">Keywords: </strong><span class="kwd-text">Ebola, obstetrics, pregnancy, haemorrhagic fever</span></div>
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Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Author manuscript free on PubMedCentral.
URL
https://www.ncbi.nlm.nih.gov/pubmed/29351152
Read Online
Online location of the resource.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5776722/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Ebola Infection in Pregnancy
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
The 2014-2016 Ebola outbreak primarily based in 3 West African countries, had far-reaching global effects.
Creator
An entity primarily responsible for making the resource
Haddad, Lisa B., John Horton, Bruce S. Ribner, and Denise J. Jamieson.
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-03
Type
The nature or genre of the resource
Publication
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-09-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group (3 yr)
2022-07 - general asset review - Clayton, SP Treatment & Care group (1 yr - went with T&C)
Ebola
Labor and Delivery
R-Res&Pub
R-SP
R-T&C
Viral Hemorrhagic Fever
-
https://repository.netecweb.org/files/original/84ca03c4be00e1f9e6cdfcf23a699a76.png
700012660d4898bcf6c588d95d719479
Dublin Core
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Title
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Develop
Description
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<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
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Objectives
<div class="card-body bg-gray-l3">
<p><strong>Who this is for:</strong> Healthcare providers working in emergency departments and labor and delivery units in U.S. hospitals.</p>
<p><strong>What this is for:</strong> Guidance on how to screen pregnant women for Ebola virus disease (EVD) and how to care for pregnant women as patients under investigation (PUIs) for or with confirmed EVD, including considerations for pregnant healthcare workers.</p>
<p><strong>How to use:</strong> This guidance is intended to help U.S. hospitals develop a plan for screening and treating pregnant PUIs or patients with confirmed EVD.</p>
</div>
URL
https://www.cdc.gov/vhf/ebola/clinicians/evd/pregnant-women.html
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Guidance for Screening and Caring for Pregnant Women with Ebola Virus Disease for Healthcare Providers in U.S. Hospitals
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
<h2>Key Points</h2>
<ul><li>Healthcare providers caring for pregnant women in U.S. hospitals should be prepared to screen patients for EVD and have a plan in place to triage these patients.</li>
<li>Obstetric management of pregnant women with EVD, particularly decisions about mode of delivery for women in labor, needs to consider risks to the woman, risks of exposure for healthcare providers, and potential benefits to the neonate.</li>
<li>Healthcare workers who are pregnant should not care for patients with EVD.</li>
<li>Pregnant PUIs or patients with confirmed EVD should be hospitalized, and CDC guidance for hospitalized PUIs or patients with confirmed EVD should be followed.</li>
</ul>
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-05-30
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-09-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
Relation
A related resource
Y
Ebola
Labor and Delivery
R-SP
R-T&C
-
https://repository.netecweb.org/files/original/78cee186cf2c178d2f7c095465050d06.png
3f501528330a5195fcab9cad4e0bb714
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Haddad, Lisa B., Denise J. Jamieson, and Sonja A. Rasmussen. 2018. "Pregnant Women and the Ebola Crisis." New England Journal of Medicine 379 (26):2492-3.
Accessibility
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Read online on Journal website
URL
https://www.ncbi.nlm.nih.gov/pubmed/30485156
Read Online
Online location of the resource.
https://www.nejm.org/doi/full/10.1056/NEJMp1814020
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Pregnant Women and the Ebola Crisis
Subject
The topic of the resource
Treatment & Care
Creator
An entity primarily responsible for making the resource
Haddad, Lisa B., Denise J. Jamieson, and Sonja A. Rasmussen.
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-12-27
Type
The nature or genre of the resource
Publication
Description
An account of the resource
On August 1, 2018, the Ministry of Health of the Democratic Republic of Congo (DRC) reported the emergence of another Ebola virus outbreak, the 10th in the DRC since the virus was discovered in 1976. As of November 13, 2018, there were 341 cases and 215 deaths, making this the world’s third-largest Ebola outbreak to date. The public health community learned several lessons when West Africa experienced the largest-ever Ebola outbreak beginning in 2014, which ultimately included 28,000 cases and caused 11,000 deaths. Current prevention and control measures have benefited from these lessons and are directed toward a coordinated response, including improvements in cross-border surveillance, laboratory capacity, case management, infection control at health facilities, culturally sensitive safe burials, and psychosocial care, as well as inclusion of vaccination as a control measure. However, according to available documents, issues related to pregnant women have been largely ignored in these efforts.
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-09-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group (3 yr)
2022-07 - general asset review - Clayton, SP Treatment & Care group
Contact Transmission
Ebola
Epidemiology
Infection Prevention and Control
Labor and Delivery
Neonates
Outbreaks
R-Res&Pub
R-SP
R-T&C
Vaccine Study
-
https://repository.netecweb.org/files/original/f49f01cc54c5c9d2e5a0de305a902d74.pdf
105a922fad9575f2cd808b5e624ba62e
PDF Text
Text
PREGNANT WOMEN &
VACCINES AGAINST
EMERGING EPIDEMIC
THREATS
Ethics Guidance for
Preparedness, Research,
and Response
The PREVENT
Working Group
�Johns Hopkins Berman Institute of Bioethics
The Pregnancy Research Ethics for Vaccines, Epidemics, and New Technologies
(PREVENT) Project
This work is a product of The PREVENT Working Group. PREVENT is a grant-funded
project led by faculty at Johns Hopkins University alongside co-investigators at
Georgetown University and the University of North Carolina at Chapel Hill, with
external contributions from Working Group Members.
The PREVENT Project is funded by the Wellcome Trust (203160/Z/16/Z).
The recommendations, interpretations, and conclusions expressed in this work
do not necessarily reflect the views of the institutions with which Working Group
members are affiliated.
Suggested citation:
The PREVENT Working Group. Pregnant Women & Vaccines Against Emerging
Epidemic Threats: Ethics Guidance for Preparedness, Research, and Response.
Baltimore, MD: September 2018.
* Corresponding Author: Carleigh B. Krubiner (ckrubiner@cgdev.org)
Available at: vax.pregnancyethics.org
RIGHTS AND PERMISSIONS
The material in this work is subject to copyright with a Creative Commons
Attribution-Non-Commercial-NoDerivs 3.0 IGO (CC BY-NC-ND 3.0 IGO) license.
Because the PREVENT Project encourages dissemination of its knowledge, this
work may be reproduced, in whole or in part, for non-commercial purposes as long
as full attribution to this work is given and changes are indicated. If you remix,
transform, or build upon the material, you must distribute your contributions under
the same license as the original.
�EXECUTIVE SUMMARY
Recent epidemics, including Zika virus, Lassa
Fever, Ebola, and H1N1 influenza, have
highlighted the ways in which infectious disease
outbreaks can severely—and at times uniquely—
affect the health interests of pregnant women
and their offspring.i For some pathogens,
pregnant women are at significantly higher
risk of serious disease and death. Infection
in pregnancy can also result in pregnancy
loss or severe congenital harms. Even if the
disease caused by the pathogen is no worse in
pregnancy, the harms of infection in pregnant
women can potentially affect two lives.
These serious and often disproportionate risks
underscore the critical need to proactively
consider the interests of pregnant women and
their offspring in efforts to combat epidemic
threats. This is especially true for vaccines,
essential tools in the public health response to
infectious diseases. Despite increasing support
of maternal immunization strategies and
efforts to develop certain vaccines specifically
targeted to pregnant women, the vast majority
of new vaccine products are rarely designed
with pregnant women in mind. Moreover,
widespread failure to appropriately include
pregnant women in vaccine research means
that evidence about safety and efficacy in
pregnancy has been limited and late in coming.
As a result, in numerous outbreaks and
epidemics, pregnant women have been denied
opportunities to receive vaccines that would
have protected them and their offspring from
the ravages of these diseases.
This way of treating pregnant women in
vaccine research and deployment is
not acceptable. Business as usual can
no longer continue.
To ensure that the needs of pregnant women
and their offspring are fairly addressed, new
approaches to public health preparedness,
vaccine research and development (R&D),
and vaccine delivery are required. This
Guidance provides a roadmap for the ethically
responsible, socially just, and respectful
inclusion of the interests of pregnant women in
the development and deployment of vaccines
against emerging pathogens. The Guidance is
a product of the Pregnancy Research Ethics for
Vaccines, Epidemics, and New Technologies
(PREVENT) Working Group—a multidisciplinary,
international team of 17 experts specializing in
bioethics, maternal immunization, maternal-fetal
medicine, obstetrics, pediatrics, philosophy,
public health, and vaccine research and policy—
in consultation with a variety of external experts
and stakeholders.
We recognize the recommendations contained
in this Guidance will not always be easy to
follow. For some, it will require a new way of
thinking about pregnant women and vaccines.
For many, it will require a commitment of
will and of financial resources. Addressing
inequities in biomedical research and public
health rarely comes cheaply or without hard
work. In terms of the lives saved and the
suffering averted, the resources and the effort
needed to ensure that pregnant women and
their offspring are treated fairly will be more
than worth it.
i We use the term “women” throughout this document, and while we appreciate that individuals who do not identify as women can
still become pregnant, transgender and gender non-conforming individuals face different (though also substantial and problematic)
barriers to participating in clinical research and having their health needs met that lie beyond the scope of this work. We use the term
“offspring” throughout this report to broadly refer to fetuses as well as any persons born whose interests may be affected by in utero
exposures to pathogens or vaccine administrations.
Pregnant Women & Vaccines Against Emerging Epidemic Threats
Executive Summary | 1
�VISION
The guidance aims to realize a world in which:
Pregnant women
are not unjustifiably
excluded from participating
in vaccine studies.
Pregnant women and their
offspring benefit from advances in
vaccine technologies and are
not left behind as new vaccine
products are developed.
Pregnant women
have access to safe and effective
vaccines to protect them and their
offspring against emerging
and re-emerging pathogenic
threats.
2 | Executive Summary
Pregnant Women & Vaccines Against Emerging Epidemic Threats
�RECOMMENDATIONS
PUBLIC HEALTH EMERGENCY PREPAREDNESS
RECOMMENDATION 1
Health information systems and infectious
disease surveillance systems should be
strengthened and integrated to ensure
that data relevant to maternal, obstetric,
and newborn health outcomes can inform
scientific and public health responses to
emerging pathogenic threats.
RECOMMENDATION 2
Evidence-based strategies to promote
confidence about vaccination in pregnancy
should be developed and implemented
ahead of outbreaks, including stakeholder
engagement with health care providers,
women, their families, and their
communities.
. DIRECTED TO: public health authorities; the
World Health Organization (WHO) and regional
health organizations; developers and users of
routine health information and global health
security systems, including organizations with a
focus on maternal and child health outcomes;
organizations developing innovative approaches
to data collection and surveillance; funders and
sponsors of maternal health studies and global
health surveillance
. DIRECTED TO: public health authorities; health
care providers; professional medical associations;
medical and health training programs; community
leaders; civil society organizations and vaccine
advocacy groups; research institutes; funders and
sponsors; the media
Routine health information systems and
infectious disease surveillance systems are
both essential to an appropriate and rapid
response to emerging pathogenic threats.
Collecting baseline data on maternal,
obstetric, and newborn health can advance
the interests of pregnant women and their
offspring by enabling detection of increases in
adverse events that may signal the presence
of infectious disease threats. These baseline
rates are also needed to help interpret whether
adverse events surrounding pregnancy have
any causal link to vaccination. Infectious
disease surveillance systems should routinely
include pregnancy status and maternal,
obstetric, and newborn outcomes in case
reports. These data, when integrated with
baseline rates from health information systems,
can help determine whether a circulating
pathogen causes additional or more severe
harms in pregnancy.
For immunization programs to be successful,
it is critical that populations have confidence
in the benefits of a vaccine and its safety, and
in the health benefits of vaccination more
broadly. Inadequate confidence in vaccines can
be especially pronounced among pregnant
women and those who care for them. Evidence
about safety in pregnancy is limited because
of the historic absence of vaccine trials in
pregnant women. Moreover, pregnant women
and health care providers are understandably
concerned about fetal harm, and they are
frequently bombarded with mixed messages
about what may or may not be harmful in
pregnancy. Working now to better understand
and address the various sources and drivers of
vaccine confidence among pregnant women
and their communities will be critical to ensure
appropriate vaccine uptake by pregnant
women during outbreaks and epidemics.
Pregnant Women & Vaccines Against Emerging Epidemic Threats
Executive Summary | 3
�RECOMMENDATION 3
Communication plans should be developed
for clear, balanced, and contextualized
dissemination of vaccine study findings,
recommendations for vaccine use in
pregnancy, and any pregnancy-specific
adverse events.
.
DIRECTED TO: clinical investigators; scientific
journal editors; funders and sponsors; public health
authorities; global, regional, and local vaccine
advisory groups; professional medical associations;
regulatory authorities; civil society organizations
and vaccine advocacy groups; the media
Because pregnant women, health providers,
and the public often overestimate potential
fetal harms associated with medications
and biologics, effective communication in
vaccine development and delivery is critical. In
research studies, the required timely reporting
of clinically relevant signals and findings on
vaccine safety and efficacy in pregnancy to
regulatory authorities is not enough. Effective
communication to the public and to clinicians
through a variety of channels, including
traditional and social media, is essential. In
an epidemic response that recommends
vaccination in pregnancy, communication
plans must be clear about any known risks to
pregnant women and their offspring, and why
the anticipated benefits of vaccination outweigh
these risks. When immunization in pregnancy is
not recommended, communication plans should
be sensitive to fears and concerns about the
pathogenic threat that pregnant women share
with the rest of the population, and provide
them with information about what alternatives,
if any, are available to them. In both research
and epidemic responses, one best practice for
communicating reports of adverse pregnancy
or birth outcomes is to present the findings
alongside the best available information about
the baseline rates of these adverse events, and
to acknowledge that many of them have no
known cause.
4 | Executive Summary
RECOMMENDATION 4
Research efforts that aim to advance vaccine
development by using new technologies
to study human immune system function
and response should include investigations
specific to pregnant women and their
offspring.
. DIRECTED TO: clinical investigators; basic
research scientists; funders
Because pregnancy can alter immune
response and because both maternal and
fetal immune responses may change over the
course of gestation, it is important that these
foundational studies examine the distinctive
characteristics of maternal and fetal immune
systems. Understanding these differences
could critically inform the development and
identification of new vaccines that are safe and
effective in pregnancy.
RECOMMENDATION 5
Mechanisms for incentivizing vaccine
development for emerging and re-emerging
infections and mitigating existing
disincentives should include and address
pregnancy-specific concerns of vaccine
developers.
. DIRECTED TO: policymakers; regulatory
authorities; funders and sponsors; vaccine
developers; civil society organizations and
those who are positioned to influence vaccine
research, adoption, and delivery, including WHO,
the World Economic Forum, and the Coalition
for Epidemic Preparedness Innovations (CEPI)
Vaccine developers and manufacturers face
significant market challenges and uncertainties
in pursuing products targeting emerging and
re-emerging pathogens. These challenges
can become even more complicated when
vaccine products are studied in and ultimately
offered to pregnant women—for whom
there may be heightened concerns of legal
and financial liability. Current mechanisms
in place to encourage development of
Pregnant Women & Vaccines Against Emerging Epidemic Threats
�beneficial biomedical products and protect
developers and manufacturers against liability
concerns—as well as new incentive programs
being explored for vaccines against epidemic
threats—need to be intentionally inclusive of
the needs and interests of pregnant women.
RECOMMENDATION 6
To help ensure systematic and enduring
change in the treatment of pregnant women
in global vaccine policy and practices, the
World Health Organization should convene
a consultation of relevant stakeholders and
experts. The Consultation should identify
specific strategies to establish for pregnant
women the presumption of inclusion in both
vaccine research and deployment, including
whether a dedicated, standing expert group
is needed.
Throughout this Guidance we make multiple
recommendations to help ensure that pregnant
women and their offspring can fairly benefit
from the protection that vaccines offer
against emerging epidemic threats. These
recommendations outline specific actions that
need to be taken, but institutional change
at every level—globally, regionally, and
nationally—will be required to operationalize
these new approaches and move advisory
and decision-making bodies toward the
new default of presumptive inclusion of
pregnant women. To seed this institutional
change and explore specific strategies for the
Institutional change
at every level will be
required to establish
a new default of
presumptive inclusion
of pregnant women.
The Presumptive Inclusion of
Pregnant Women
“Presumption of inclusion” does not
entail the automatic or absolute inclusion
of pregnant women in every vaccine
study or every vaccine campaign. Instead,
a presumption of inclusion changes
the default position. It normalizes the
position that pregnant women are
to be included in vaccine deployment
programs and vaccine R&D. With
inclusion of pregnant women as the
default position, the burden of proof,
both scientific and ethical, falls on those
who want to argue for their exclusion.
There will certainly be cases where the
exclusion of pregnant women from
a particular vaccine trial or vaccine
campaign will be justified, but starting
from a presumption of inclusion helps
instantiate and maintain a fundamental
shift in the way pregnancy and pregnant
women are viewed in the field of
vaccines.
systematic consideration of pregnant women in
international policies and practices governing
vaccine research and delivery, WHO should
convene a multi-day, global Consultation of
relevant stakeholders. The Consultation should
provide a critical opportunity to discuss and
determine the best strategies to systematically
integrate consideration of the interests
of pregnant women and their offspring
throughout all relevant WHO-supported
activities, including whether a dedicated,
standing group of relevant and diverse experts
is needed. The Consultation should also
consider ways to support regional and national
public health authorities who may wish to
establish similar expert groups.
Pregnant Women & Vaccines Against Emerging Epidemic Threats
Executive Summary | 5
�VACCINE RESEARCH & DEVELOPMENT
RECOMMENDATION 7
Suitability for use in pregnancy should be
a strong consideration in development and
investment decisions for vaccines against
emerging pathogenic threats.
. DIRECTED TO: CEPI, U.S. Biomedical Advanced
Research and Development Authority (BARDA),
and other funders and sponsors; WHO emergency
response teams, R&D Blueprint teams and
TPP Working Groups; vaccine developers
If pregnant women, and the offspring they
carry, are among those threatened by an
emerging pathogen, then suitability for use
during pregnancy should be an important
vaccine development priority. Organizations
investing in the vaccine pipeline against
emerging pathogenic threats should try to
ensure that, among candidates prioritized for
development, at least some use platforms
and adjuvants that would make them suitable
for use in pregnancy. Early investment in
options that are most likely to be acceptable
in pregnancy can pave the way for pregnant
women and their offspring to realize benefits
from vaccine candidates that ultimately prove
successful—and help ensure that they, like
other population groups, will be protected
against emerging infectious diseases. For
pathogens that pose significantly greater
threats in pregnancy—of fetal harm, maternal
harm, or both—funding calls should designate
greater investment priority to candidates
likely to be suitable for use in pregnancy.
When pregnant women or their offspring are
at higher risk of harm, it would be particularly
unjust for their needs not to be included in
vaccine development priorities.
6 | Executive Summary
RECOMMENDATION 8
When pathogens pose a risk of severe harm
to pregnant women or their offspring and
the most promising vaccine candidates are
likely to be contraindicated for routine use
in pregnancy, investments should be made in
alternative vaccine candidates that could be
more readily used in pregnancy.
. DIRECTED TO: CEPI, BARDA, and other
funders; vaccine developers
It is possible that the vaccine candidates
that move most rapidly through the R&D
pipeline are found to be problematic for use
in pregnancy. Unless other vaccines with more
favorable profiles for use in pregnancy are
then prioritized, it is possible that pregnant
women and their offspring will end up without
any vaccine protection against the emerging
pathogenic threat. This prospect is particularly
dire when the target pathogen has more
severe consequences in pregnancy. When
pregnant women and their offspring suffer
disproportionately compared with other
population groups from an emerging infectious
disease threat, justice calls for the vaccine
enterprise to make every reasonable effort to
bring to market a safe and effective product
that pregnant women can use.
Pregnant women
need to be on the
agenda when decisions
about investment and
funding are made.
Pregnant Women & Vaccines Against Emerging Epidemic Threats
�RECOMMENDATION 9
Non-clinical studies that are a prerequisite
for clinical trials in pregnant women, such as
developmental toxicology studies, should be
initiated early in the clinical development of
promising vaccine candidates, before efficacy
trials are planned.
. DIRECTED TO: CEPI, BARDA, and other
funders and sponsors; vaccine developers;
national regulatory authorities
Current regulatory guidance often requires
that certain non-clinical studies must be
completed prior to including pregnant women
in clinical trials. Because pregnant women
should be able to participate in large-scale
efficacy studies conducted during outbreaks
whenever the benefits outweigh the risks
(see Recommendation 11), any non-clinical
studies required prior to clinical evaluation
in pregnant women should be conducted as
soon as promising vaccine candidates move
from phase 1 to phase 2 clinical trials.
RECOMMENDATION 10
Studies to assess immune responses to
vaccines in pregnancy should be conducted
before or between outbreaks whenever
scientifically possible and ethically and
legally acceptable.
. DIRECTED TO: CEPI, BARDA, and other
funders and sponsors; vaccine developers;
clinical investigators
Although much of the work to evaluate vaccines
in pregnancy will be done during outbreaks and
epidemics (see Recommendation 11), there will
be some cases in which it will be both beneficial
and feasible to generate immunogenicity data
in pregnancy before or between outbreaks.
Because immune system functioning is altered
in pregnancy, it is possible that a vaccine will be
less immunogenic or induce atypical immune
responses in pregnant women, with potential
implications for its effectiveness as well as the
dosing and frequency required in pregnancy
to generate sufficient protection. Such
immunogenicity studies would be particularly
valuable if a correlate of protection for the
vaccine has already been established. In the
absence of an outbreak or epidemic, it may be
difficult to demonstrate that studies to assess
immune response in pregnant women have a
favorable risk-benefit profile. However, there
may be instances in which the future exposure
to a pathogen among a particular population
is likely enough to conclude that the potential
benefits of being protected would outweigh
the risks associated with a particular candidate
vaccine.
RECOMMENDATION 11
Clinical development plans for investigational
vaccines against emerging and re-emerging
pathogens should include studies designed
to evaluate vaccines in pregnancy. Pregnant
women should have opportunities to enroll in
vaccine studies conducted during outbreaks
and epidemics whenever the prospect of
benefit outweighs the risks to pregnant
women, their offspring, or both.
. DIRECTED TO: CEPI, BARDA, and other
funders and sponsors; vaccine developers;
clinical investigators and trial implementation
partners; research ethics committees;
national regulatory authorities
This recommendation rests on two claims
of justice about the importance of treating
pregnant women and their offspring fairly in the
conduct of research on vaccines for emerging
and re-emerging infections. The first of these
justice claims pertains to pregnant women as
a class: as a matter of equity, as well as public
health, the evidence base for pregnant women
should be as good as possible and generated as
contemporaneously as possible to the evidence
for the general population. The second,
independent reason motivated by justice is that
pregnant women, as the moral equals of others,
Pregnant Women & Vaccines Against Emerging Epidemic Threats
Executive Summary | 7
�should have fair access to the prospect of
direct benefit that may ensue from receiving
an experimental vaccine. For both of these
reasons, it is critical that vaccine research
conducted during outbreaks include
appropriate plans for research with pregnant
women when there is a reasonable judgment
that the prospective benefits of enrollment
outweigh the risks.
RECOMMENDATION 12
Vaccine studies that include women
of childbearing potential should have
plans to systematically collect data on
immunogenicity and pregnancy-specific
indicators of safety from participants who
are unknowingly pregnant at the time
of exposure or become pregnant within
a relevant window following vaccine
administration.
. DIRECTED TO: CEPI, BARDA, and other funders
and sponsors; vaccine developers; clinical
investigators and trial implementation partners;
research ethics committees; national regulatory
authorities
In trials enrolling women of childbearing
potential, including vaccine trials conducted in
outbreak contexts, it is predictable that some
women not known to be pregnant at the time
of enrollment will nevertheless be pregnant at
enrollment, or become pregnant in the course
of the trial. Historically, data from inadvertent
exposures during pregnancy have been a key
source of information regarding the safety
profiles of vaccines in pregnancy. Having a
plan to systematically generate evidence from
participants who are unknowingly pregnant
at the time of administration also enables
capturing data from vaccine exposures earlier
in pregnancy than would be likely in trials
prospectively enrolling pregnant women.
Wherever possible, systematic observational
studies that are designed to capture
inadvertent exposures to vaccine during
pregnancy should also include longitudinal
8 | Executive Summary
evaluation of safety, immunogenicity, and other
relevant outcomes. Data from inadvertent
exposures during pregnancy should be
collected using standardized methods and case
definitions and must be cautiously interpreted,
particularly when adverse events occur in early
pregnancy, as these very commonly occur
unrelated to vaccine exposure.
RECOMMENDATION 13
Women participating in vaccine trials who
become aware of a pregnancy during the
trial should be guaranteed the opportunity,
through a robust re-consent process, to
remain in the trial and complete the vaccine
schedule when the prospect of direct benefit
from completing the schedule can reasonably
be judged to outweigh the incremental risks
of receiving subsequent doses.
. DIRECTED TO: clinical investigators and
trial implementation partners; vaccine developers;
research ethics committees; national regulatory
authorities
In vaccine trials that include prospectively
enrolled pregnant women, participants who
become pregnant after enrollment should
be provided the opportunity to continue to
receive vaccine doses after a renewed consent
process. In trials that exclude pregnant women
from prospective enrollment, determinations
about continued dosing should be based on
assessment of the potential benefits and harms
specific to the circumstances of the pregnant
participant, including possible risks associated
with receiving an incomplete vaccination series
and the risks already incurred from the first
vaccination. In both cases, a robust re-consent
process will be essential to allowing pregnant
women to determine whether they want to
receive additional doses. Regardless of whether
they choose or are permitted to continue with
the vaccine schedule, participants who become
pregnant should be provided all study-related
benefits and ancillary care to which they would
otherwise be entitled.
Pregnant Women & Vaccines Against Emerging Epidemic Threats
�RECOMMENDATION 14
When a pregnant woman of legal standing
to consent is judged eligible to enroll or
continue in a vaccine trial, her voluntary and
informed consent should be sufficient to
authorize her participation.
. DIRECTED TO: clinical investigators and trial
implementation partners; research ethics
committees; national authorities in charge of
governance and oversight of human subjects
research
As a matter of respect, and as a key aspect of
ensuring fair access to investigational vaccines,
the consent of pregnant women who are
judged eligible to participate in or continue
receiving doses in a vaccine trial should be
sufficient for participation. Pregnant women
are the moral equals of other self-governing
adults. Further, requiring the consent of
additional actors can present a material
barrier to the benefits research may offer to
the offspring. At the same time, researchers
should support pregnant women who wish to
involve partners, family members, and other
personal supports in decisions to join or remain
in vaccine trials.
RECOMMENDATION 15
Experts in maternal and perinatal health,
pediatrics, and research ethics should be
involved in decisions about funding; trial
design; research ethics oversight; and the
generation, analysis, and evaluation of
evidence on vaccine use in pregnancy.
. DIRECTED TO: funders and sponsors; vaccine
developers; clinical investigators; research ethics
committees; national health authorities in charge
of research governance and regulations; data
safety monitoring boards
Pregnant women deserve that decisions
affecting them will be made in careful,
thoughtful, and evidence-based ways, involving
the most informed experts possible. Experts
in obstetrics and gynecology, maternalfetal medicine, pediatrics, and neonatology,
especially those who have experience with
infectious diseases, immunology, and maternal
immunization, have specialized knowledge
that is critical to properly identifying and
addressing the needs and interests of pregnant
women and their offspring in research and
development.
RECOMMENDATION 16
Whenever possible, the perspectives of
pregnant women should be taken into
account in designing and implementing
vaccine studies in which pregnant women
are enrolled or in which women enrolled may
become pregnant.
. DIRECTED TO: clinical investigators; vaccine
developers; research ethics committees;
community advisory boards; funders and sponsors;
public health authorities
Community engagement and participatorybased approaches to biomedical research
have been increasingly recognized as good
practice in the design and conduct of human
subjects research. In the context of vaccine
studies enrolling pregnant women, soliciting
the perspectives of pregnant women from
the communities in which the research will
be conducted offers a way to demonstrate
respect, and can be critical to the success of
a study. The perspectives of pregnant women
can improve various aspects of study design
by, for example, determining what information
and outcomes are most important to pregnant
women, ascertaining culturally relevant
considerations for the consent process, and
establishing the appropriate frequency and
location of study visits based on the daily
demands on women’s lives throughout
pregnancy and after delivery.
Pregnant Women & Vaccines Against Emerging Epidemic Threats
Executive Summary | 9
�VACCINE DELIVERY DURING THE EPIDEMIC RESPONSE
RECOMMENDATION 17
Pregnant women should be offered vaccines
as part of an outbreak or epidemic response.
Pregnant women should only be excluded
if a review of available evidence by relevant
experts concludes that the risks to pregnant
women and their offspring from the vaccine
are demonstrably greater than the risks of
not being vaccinated.
. DIRECTED TO: public health authorities;
national immunization programs; recommending
and advisory bodies, including professional
medical associations, SAGE, and other relevant
WHO advisory committees; teams overseeing
the epidemic response, such as Public Health
Emergency Operations Centers and incident
management teams; organizations involved
in vaccine delivery in the outbreak response,
including UNICEF, MSF, and International
Federation of Red Cross
Because pregnant women are the moral equals
of others, and because there is nothing about
being pregnant that would make them or
their offspring less susceptible to the harms
of emerging pathogenic threats, the default
position of advisory bodies and public health
authorities should be that pregnant women
are offered vaccines alongside other affected
populations during an epidemic response.
Any recommendations or decisions not to use
vaccines in pregnancy during an outbreak or
epidemic requires justification of exclusion
based on a reasonable determination that the
risks to pregnant women and their offspring
from vaccination are demonstrably greater
than the likely benefits of being protected
from the pathogen. This determination should
be made by relevant experts, including those
in maternal, perinatal, and pediatric health.
The absence of evidence and the mere
theoretical or even documented risk of fetal
harm is generally not sufficient to justify
10 | Executive Summary
denying pregnant women access to a vaccine
in an outbreak or epidemic. Even when the
risk of fetal harm from the vaccine is significant,
if the likelihood and severity of harms from
the pathogen are high enough for pregnant
women and their offspring, then the benefits of
vaccination may still outweigh the risks.
RECOMMENDATION 18
When there is a limited supply of
vaccine against a pathogenic threat that
disproportionately affects pregnant women,
their offspring, or both, or when only one
vaccine among several is appropriate for use
in pregnancy, then pregnant women should
be among the priority groups to be offered
the vaccine.
. DIRECTED TO: public health authorities; national
immunization programs; teams overseeing
the epidemic response, such as Public Health
Emergency Operations Centers and incident
management teams; WHO; organizations
involved in vaccine delivery as part of the
outbreak response, including UNICEF, MSF, and
International Federation of Red Cross
It is not uncommon in outbreak and epidemic
settings for vaccine demand to exceed supply.
For some pathogenic threats, pregnant women
and their offspring may be among the hardest
hit groups; in these cases, as with any other
high-risk group, they should be a priority
in the allocation of a vaccine that is in short
supply. Additionally, even when the threat is
no worse for pregnant women than it is for
other affected population groups, vaccinating
a pregnant woman protects not only the
pregnant woman but also her offspring.
Particularly for high-consequence pathogens
with significant mortality rates, there may be
considerable additional benefit in vaccinating
pregnant women.
Pregnant Women & Vaccines Against Emerging Epidemic Threats
�During an epidemic,
the default should
be to offer vaccines
to pregnant women
alongside other
affected populations.
RECOMMENDATION 19
When vaccines are offered to pregnant
women during outbreaks or epidemics,
prospective observational studies should be
conducted with pregnant women and their
offspring to further advance the evidence
base for use in pregnancy.
. DIRECTED TO: vaccine manufacturers; public
health and regulatory authorities; national
immunization programs; organizations involved in
vaccine delivery as part of the outbreak response,
including UNICEF, MSF, and International
Federation of Red Cross; researchers; funders;
groups that oversee research with human subjects,
including research ethics committees
Implementing prospective observational
studies in pregnant women and their
offspring who receive the vaccine as part of
the outbreak or epidemic response provides
an important opportunity to narrow the
evidence gap between pregnant women and
other population groups. If such studies are
not conducted, decision-makers in future
outbreaks and epidemics will be faced with
the same evidence gap as current decision
makers—an unacceptable outcome from both
an equity and a public health perspective.
Moreover, safety data obtained from
evaluating a vaccine derived using a novel
platform in pregnant women may inform future
decision-making regarding the suitability of
that platform for development of vaccines
against other pathogens.
RECOMMENDATION 20
When vaccines are offered to pregnant
women during outbreaks and epidemics,
the consent of the pregnant woman should
be sufficient to authorize administration
whenever the pregnant woman is of legal
standing to consent to medical care.
. DIRECTED TO: public health authorities; national
immunization programs; teams overseeing
the epidemic response, such as Public Health
Emergency Operations Centers and incident
management teams; organizations involved in
vaccine delivery as part of the outbreak response,
including UNICEF, MSF, and International
Federation of Red Cross; clinicians and
obstetricians; pregnant women and communities
As a matter of respect, and as a key aspect
of ensuring fair access to vaccines during
an outbreak or epidemic, when vaccines
are offered to pregnant women, their
consent should be sufficient to authorize
administration. Women should be presumed
to have authority for decisions about their
own medical care. Women are no different
from men in this respect, and pregnant
women are no different than women who
are not pregnant. All adults, regardless of
gender or pregnancy status, have rights of
self-determination over decisions that affect
their bodies and their health. Pregnant women
who wish to engage or consult with their
partners or other family or friends in making
their decisions about vaccination should be
supported in doing so.
Pregnant Women & Vaccines Against Emerging Epidemic Threats
Ensuring that pregnant
women have vaccines to
protect them and their
offspring will require
generation of evidence
from pregnant women.
Executive Summary | 11
�RECOMMENDATION 21
When evidence supports a determination
that the risk of serious maternal or fetal
harm from the vaccine outweighs the
vaccine’s benefits, pregnant women should
be a priority group for access to alternative
preventative or treatment measures.
. DIRECTED TO: public health authorities; teams
overseeing the epidemic response, such as
Public Health Emergency Operations Centers
and incident management teams; organizations
involved in vaccine delivery as part of the
outbreak response, including UNICEF, MSF, and
International Federation of Red Cross; providers
Despite the best possible research and
development efforts, the available vaccine
for a given outbreak or epidemic may have
sufficiently severe pregnancy-specific risks,
even compared with the risks posed by the
pathogen, that it is not made available to
pregnant women. The moral objective remains,
however, of giving pregnant women and
their offspring as close to an equal chance of
avoiding the harms of infection as the rest of
the population. If they cannot be protected
by immunization, then pregnant women,
along with any other population group that
cannot receive the vaccine, should be given
preferential access to alternative preventive
interventions and treatments.
12 | Executive Summary
RECOMMENDATION 22
When vaccines against emerging pathogens
are not recommended for use in pregnancy,
inadvertent vaccine exposures during
pregnancy should be anticipated and
mechanisms put in place for the collection
and analysis of data from pregnant women
and their offspring on relevant indicators and
outcomes.
. DIRECTED TO: public health and regulatory
authorities; vaccine manufacturers; national
immunization programs; funders and sponsors
Even when pregnant women are intentionally
excluded from the vaccine response effort, it is
reasonable to expect that some of the women
who are vaccinated will be unknowingly
pregnant at the time of vaccine administration,
or will become pregnant within a relevant
window of its administration. Collecting data
about outcomes in these women and their
offspring in the midst of an active outbreak
or epidemic will be difficult and costly, but
there are two sets of ethical and public health
reasons why it is critically important to do
so. First, collecting data from unintentional
exposures to vaccine in pregnancy during an
outbreak or epidemic affords an important
opportunity to gather evidence about novel
vaccine technologies and thus to help ensure
that pregnant women are not left behind
as vaccine technology advances. Second,
research and public health communities have
a responsibility to pursue evidence about the
likelihood and nature of any associated risks
pregnant women and their offspring face from
these unintended exposures to inform personal
and clinical decision-making.
Pregnant Women & Vaccines Against Emerging Epidemic Threats
�MEMBERS OF THE PREVENT WORKING GROUP
Ruth Faden
Principal Investigator
Johns Hopkins Berman
Institute of Bioethics
Carleigh Krubiner
Co-Principal Investigator
Johns Hopkins Berman
Institute of Bioethics
Ruth Karron
Co-Principal Investigator
Johns Hopkins Bloomberg
School of Public Health
Margaret Little
Co-Investigator
Georgetown University
Kennedy Institute of Ethics
Anne Lyerly
Co-Investigator
University of North Carolina
Center for Bioethics
Jon Abramson
Wake Forest University
School of Medicine
Richard Beigi
Magee-Womens Hospital of
University of Pittsburgh Medical Center
Alejandro Cravioto
Universidad Nacional Autónoma de México
Faculty of Medicine
Anna Durbin
Johns Hopkins Bloomberg
School of Public Health
Bruce Gellin
Sabin Vaccine Institute
Swati Gupta
International AIDS Vaccine Initiative (IAVI)
David C. Kaslow
PATH Essential Medicines
Sonali Kochhar
Global Healthcare Consulting
Florencia Luna
FLACSO-Argentina Bioethics Program
& CONICET
Carla Saenz
Pan American Health Organization
Regional Program on Bioethics
Jeanne Sheffield
Johns Hopkins University
School of Medicine
Paulina Tindana
Navrongo Health
Research Centre
��
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Deploy
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<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
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Citation
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Krubiner, Carleigh B., Ruth R. Faden, Ruth A. Karron, Margaret O. Little, Anne D. Lyerly, Jon S. Abramson, Richard H. Beigi, Alejandro R. Cravioto, Anna P. Durbin, Bruce G. Gellin, Swati B. Gupta, David C. Kaslow, Sonali Kochhar, Florencia Luna, Carla Saenz, Jeanne S. Sheffield, and Paulina O. Tindana. 2019. "Pregnant women & vaccines against emerging epidemic threats: Ethics guidance for preparedness, research, and response." Vaccine.
Abstract
<div class="Abstracts u-font-serif">
<div class="abstract author">
<h2 class="section-title u-h3 u-margin-l-top u-margin-xs-bottom">Abstract</h2>
<div>
<p id="sp0005">Zika virus, influenza, and Ebola have called attention to the ways in which infectious disease outbreaks can severely – and at times uniquely – affect the health interests of pregnant women and their offspring. These examples also highlight the critical need to proactively consider pregnant women and their offspring in vaccine research and response efforts to combat emerging and re-emerging infectious diseases. Historically, pregnant women and their offspring have been largely excluded from research agendas and investment strategies for vaccines against epidemic threats, which in turn can lead to exclusion from future vaccine campaigns amidst outbreaks. This state of affairs is profoundly unjust to pregnant women and their offspring, and deeply problematic from the standpoint of public health. To ensure that the needs of pregnant women and their offspring are fairly addressed, new approaches to public health preparedness, vaccine research and development, and vaccine delivery are required. This Guidance offers 22 concrete recommendations that provide a roadmap for the ethically responsible, socially just, and respectful inclusion of the interests of pregnant women in the development and deployment of vaccines against emerging pathogens. The Guidance was developed by the Pregnancy Research Ethics for Vaccines, Epidemics, and New Technologies (PREVENT) Working Group – a multidisciplinary, international team of 17 experts specializing in bioethics, maternal immunization, maternal-fetal medicine, obstetrics, pediatrics, philosophy, public health, and vaccine research and policy – in consultation with a variety of external experts and stakeholders.</p>
</div>
</div>
</div>
<div class="Keywords u-font-serif">
<div class="keywords-section">
<h2 class="section-title u-h3 u-margin-l-top u-margin-xs-bottom">Keywords</h2>
<div class="keyword"><span>Epidemics</span></div>
<div class="keyword"><span>Pregnancy</span></div>
<div class="keyword"><span>Emerging infectious diseases</span></div>
<div class="keyword"><span>Maternal immunization</span></div>
<div class="keyword"><span>Public health ethics</span></div>
<div class="keyword"><span>Research ethics</span></div>
<div class="keyword"><span>Vaccines</span></div>
<div class="keyword"><span>Research & development</span></div>
</div>
</div>
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Open source - CC-BY-NC-ND
URL
https://www.sciencedirect.com/science/article/pii/S0264410X19300453?via%3Dihub
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https://www.sciencedirect.com/science/article/pii/S0264410X19300453?via%3Dihub
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Title
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Pregnant Women and Vaccines Against Emerging Epidemic Threats: Ethics Guidance for Preparedness, Research, and Response
Description
An account of the resource
<div class="sqs-block html-block sqs-block-html">
<div class="sqs-block-content">
<h2 style="white-space:pre-wrap;">PREVENT Guidance</h2>
<p style="white-space:pre-wrap;">This Guidance provides a roadmap for the ethically responsible, socially just, and respectful inclusion of the interests of pregnant women in the development and deployment of vaccines against emerging pathogens. The Guidance is a product of the Pregnancy Research Ethics for Vaccines, Epidemics, and New Technologies (PREVENT) Working Group—a multidisciplinary, international team of 17 experts specializing in bioethics, maternal immunization, maternal-fetal medicine, obstetrics, pediatrics, philosophy, public health, and vaccine research and policy— in consultation with a variety of external experts and stakeholders.</p>
<p style="white-space:pre-wrap;">The Guidance begins by setting forth an aspirational vision and makes the case for its moral importance. We then specify 22 concrete recommendations, organized around three key areas: public health preparedness, R&D, and vaccine delivery.</p>
<p style="white-space:pre-wrap;">The recommendations are directed at a range of actors, including global and national policymakers, regional and national regulatory authorities, funders and sponsors, vaccine manufacturers, research institutions, trial networks and research groups, individual researchers, oversight bodies, ethics review committees, community advisory boards, and civil society organizations.</p>
<p style="white-space:pre-wrap;">The Guidance is also now available in Vaccine: <a href="https://doi.org/10.1016/j.vaccine.2019.01.011">https://doi.org/10.1016/j.vaccine.2019.01.011</a></p>
</div>
</div>
Creator
An entity primarily responsible for making the resource
Johns Hopkins Berman Institute of Bioethics, The Pregnancy Research Ethics for Vaccines, Epidemics, and New Technologies (PREVENT) Project
Source
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Krubiner, Carleigh B., Ruth R. Faden, Ruth A. Karron, Margaret O. Little, Anne D. Lyerly, Jon S. Abramson, Richard H. Beigi, Alejandro R. Cravioto, Anna P. Durbin, Bruce G. Gellin, Swati B. Gupta, David C. Kaslow, Sonali Kochhar, Florencia Luna, Carla Saenz, Jeanne S. Sheffield, and Paulina O. Tindana.
Date
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2019-05-03
Type
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Publication
Subject
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Research
Contributor
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2022-11-07 Clayton, Treatment & Care general asset review
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-11-07
Epidemic
Ethics
Labor and Delivery
Neonates
Pediatrics
Public Health
R-Res&Pub
R-SP
Research
Treatment and Care
Vaccine Study
-
https://repository.netecweb.org/files/original/8b5c756e6403ce4443b2642583f48f1d.png
ffa8193d03702a0b82a1a1ca19b763a4
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Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
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<p><strong>Date:</strong> Thursday, March 12, 2020</p>
<p><strong>Time:</strong> 2:00 P.M. – 3:00P.M. (Eastern Time)</p>
Event Type
COCA Call webinar, will be recorded.
URL
https://emergency.cdc.gov/coca/calls/2020/callinfo_031220.asp
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Coronavirus Disease 2019 (COVID-19) Update—Information for Clinicians Caring for Children and Pregnant Women
Subject
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Infection Control
Description
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During this COCA Call, presenters will focus on current information about COVID-19 as it relates to children and pregnant women. Topics will include infection prevention and control measures in inpatient obstetric healthcare settings (<a href="https://emergency.cdc.gov/coca/calls/2020/callinfo_031220.asp">CDC’s Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings</a>) and resources available to care for pediatric patients.
Creator
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CDC
Date
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2020-03-12
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Clayton, Treatment & Care group - Archive - Would replace with links to current CDC/ACOG guidelines: https://www.covid19treatmentguidelines.nih.gov/special-populations/pregnancy/ - (In SPORSA No Archive)
2023-08-24 - general ongoing review IPC - Caroline and Trish
2023-12-15 by Clayton Mowrer, Special Populations Treatment & Care group - move to SP for next review (timed with IPC for now)
Relation
A related resource
Y
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-08-24
2019-nCoV
CDC
Coronavirus
COVID-19
Infection Prevention and Control
Labor and Delivery
Neonates
Patient Care
Pediatrics
R-SP
-
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Martinez-Portilla, Raigam J., Anna Goncé, Ameth Hawkins-Villarreal, and Francesc Figueras. 2020. "A Spanish-translated clinical algorithm for management of suspected SARS-CoV-2 infection in pregnant women." The Lancet Infectious Diseases.
Abstract
No standardised guidelines for treating pregnant woman with SARS-CoV-2 infection are currently available in Spanish, a language with 537 million native speakers worldwide.<sup></sup>Thus, we feel there is an urgent need to share the valuable information provided by Favre and colleagues to all countries where SARS-CoV-2 is spreading, especially Latin America. We feel this algorithm can be adequately adapted to Spanish-speaking countries where such information is urgently needed.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site
URL
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30285-1/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/cms/10.1016/S1473-3099(20)30285-1/attachment/9bb157ea-3ba1-42cd-8638-48cb5bfd79c5/mmc1.pdf
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
A Spanish-translated clinical algorithm for management of suspected SARS-CoV-2 infection in pregnant women
Subject
The topic of the resource
Elementos en Español
Description
An account of the resource
Translation of the algorithm from the following paper to spanish:<br /><br />
<ul>
<li>Favre, Guillaume, Léo Pomar, Xiaolong Qi, Karin Nielsen-Saines, Didier Musso, and David Baud. 2020. "Guidelines for pregnant women with suspected SARS-CoV-2 infection." The Lancet Infectious Diseases.</li>
</ul>
Creator
An entity primarily responsible for making the resource
Martinez-Portilla, Raigam J., Anna Goncé, Ameth Hawkins-Villarreal, and Francesc Figueras.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-04-09
Type
The nature or genre of the resource
Publication
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
Coronavirus
COVID-19
Español
Labor and Delivery
Neonates
R-Res&Pub
R-SP
Spanish
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Sutton, Desmond, Karin Fuchs, Mary D’Alton, and Dena Goffman. 2020. "Universal Screening for SARS-CoV-2 in Women Admitted for Delivery." New England Journal of Medicine.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online
URL
https://www.nejm.org/doi/full/10.1056/NEJMc2009316
Read Online
Online location of the resource.
https://www.nejm.org/doi/full/10.1056/NEJMc2009316
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Universal Screening for SARS-CoV-2 in Women Admitted for Delivery
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
In recent weeks, Covid-19 has rapidly spread throughout New York City. The obstetrical population presents a unique challenge during this pandemic, since these patients have multiple interactions with the health care system and eventually most are admitted to the hospital for delivery.
Creator
An entity primarily responsible for making the resource
Sutton, Desmond, Karin Fuchs, Mary D’Alton, and Dena Goffman.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-04-13
Type
The nature or genre of the resource
Publication
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-09-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
2022-07 by Clayton, Special Populations Treatment & Care group
2023-12-15 by Clayton Mowrer, Special Populations Treatment & Care group - note "new asset to replace"
Relation
A related resource
Y
2019-nCoV
Coronavirus
COVID-19
Labor and Delivery
Laboratory Testing
Not updated
R-Res&Pub
R-SP
R-T&C
-
https://repository.netecweb.org/files/original/254a7e22bf141859ef644784c4bae0ac.pdf
221dd909f51b1938443df3c255083260
PDF Text
Text
NETEC COVID-19 Webinar Series:
Caring for COVID-19 Labor and Delivery Patients
�Content Outline (TOC)
Welcome
Sonia Bell
�Overview
Welcome: Sonia Bell
Caring for COVID-19 Labor and Delivery Patients: Dr. John P Horton, MD
Topics to discuss:
Planning
Screening
Testing
Personal Protective Equipment
Medical Course:
• Antepartum
• Intrapartum
• Postpartum
• Environment:
• Visitors
• Cleaning
•
•
•
•
•
NETEC Resources: Sonia Bell
Questions and Answers with NETEC
Topics not discussed:
• Viral Information
• Emerging Technology
• Vaccines
• Curative Therapies
�Welcome
National Emerging Special Pathogens
Training and Education Center
Mission
To increase the capability of the United States public health and
health care systems to safely and effectively manage individuals
with suspected and confirmed special pathogens
For more information
Please visit us at www.netec.org
or email us at info@netec.org
�NETEC Overview
Assessment
Education
Technical Assistance
Research Network
Empower hospitals to gauge
their readiness using
Provide self-paced education
through
Onsite & Remote
Guidance
Online Repository
Self-Assessment
Measure facility and
healthcare worker readiness
using
Metrics
Meet Fred
Online Trainings
Deliver didactic and hands-on
simulation training via
In-Person Courses
Compile
Online Repository
of tools and resources
Develop customizable
Exercise Templates
based on the HSEEP model
Provide direct feedback to
hospitals via
On-Site Assessment
Provide
Emergency On-Call
Mobilization
Cross-Cutting, Supportive Activities
Built for rapid implementation
of clinical research protocols
Develop Policies,
Procedures and Data
Capture Tools
to facilitate research
Create infrastructure for a
Specimen
Biorepository
�Content Outline (TOC)
Caring for COVID-19
Labor and Delivery Patients
Dr. John P. Horton
Division Director of General OB/Gyn, Emory Healthcare
�Caring for COVID-19 Labor and Delivery Patients
Planning
You are likely here
Because we all are
Resources
Fear
Simulation
Staff
Patients
�Caring for COVID-19 Labor and Delivery Patients
Planning
Everyone needs an overall ID policy
Umbrella policy
Specifics
• Area
• Provider type
• Lab plan
• Patient flow
• Patient location
�Caring for COVID-19 Labor and Delivery Patients
Players
In this emergency, who do we need:
Nursing
Respiratory
Environmental Services
Anesthesia
Infection Prevention
MFN
Infectious Disease
Neonatal
Internal Medicine
OB
Pulmonary Critical Care
�Caring for COVID-19 Labor and Delivery Patients
Places
Isolation of patients
• Conversion of units
• Redeploying staff
• PUI goes in a room
• They stay in that room
�Caring for COVID-19 Labor and Delivery Patients
Screening
Best Offense…
Symptoms
Recent Positive COVID testing
�Caring for COVID-19 Labor and Delivery Patients
Testing
•
•
•
•
•
What kinds do you have?
How many can your facility run?
How many testing supplies are there?
Who do you test?
Pregnancy and Co-morbidities
�Caring for COVID-19 Labor and Delivery Patients
Testing
Testing all patients Vs targeted testing
• Primary planning
• How? Who?
• What are the down stream effects
• PPE
• Co-rooming
• Breastfeeding
• Visitors
• Location challenges
Antibody testing
�Caring for COVID-19 Labor and Delivery Patients
Personal Protective Equipment (PPE)
Is using more than one layer better?
What if it was used for extended times?
What if the were thicker to filter out more?
�Caring for COVID-19 Labor and Delivery Patients
Personal Protective Equipment (PPE)
Is using more than one layer better?
What if it was used for extended times?
What if the were thicker to filter out more?
�Caring for COVID-19 Labor and Delivery Patients
PPE: Mass Mask Confusion
It is a physical representation of safety
• Acknowledge and respect
N95 respirators
• Better for extended use
• Better for repeat use
Surgical masks
• Repetitive use not recommended
• Most cannot be cleaned
�Caring for COVID-19 Labor and Delivery Patients
PPE: Hand Hygiene
• There is no greater good in time of pandemic
• Personal habituation
• I can’t stop touching my face
PPE: Eye Protection
• Shields preferred
• in procedural/surgical areas
• Especially when using extended N95 wear
• Goggles
�Caring for COVID-19 Labor and Delivery Patients
PPE: In Translation
Triage
Laboring
C-section
Vaginal delivery
Emergent
• Anesthesia techniques
• Neonatal response and
positioning
Scheduled
�Caring for COVID-19 Labor and Delivery Patients
PPE: Aerosol Generating Procedures
Intubation
Nitrous?
• Maybe but not recommended
Oxygen
• Worth a discussion of effectiveness
• Data that says it is not helpful
• Some societies still recommend
Delivery method
• Mask versus nasal cannula
�Caring for COVID-19 Labor and Delivery Patients
Medical Practice: Antepartum
Decreased physical visits
Telemedicine
• Blood pressure cuff
• Doppler versus Fetal movement
Steroids for fetal maturity
Anticoagulation
�Caring for COVID-19 Labor and Delivery Patients
Medical Practice: Intrapartum
Cohort
Fluids
Magnesium
Azithromycin
Communication
• Nursing
• Anesthesia
�Caring for COVID-19 Labor and Delivery Patients
Medical Practice: Postpartum
Co-rooming
Breast feeding
Follow up timing
�Caring for COVID-19 Labor and Delivery Patients
Medical Practice: ICU Care
Steroids
Equipment
Staff
Response
Transit
�Caring for COVID-19 Labor and Delivery Patients
Anticipate
Create Plan
• It’s a draft
• Anyone add/subtract
• Change is inevitable
THE NEXT
Create a communication tool
How do you rally your team
Results:
Results:
Decreased Fear
Decreased Confusion
�Content Outline (TOC)
NETEC Resources
Sonia Bell
�Resources
Arentz, Matt, Eric Yim, Lindy Klaff, Sharukh Lokhandwala, Francis X. Riedo, Maria Chong, and Melissa Lee. “Characteristics and Outcomes of 21 Critically Ill Patients With
COVID-19 in Washington State.” JAMA, March 19, 2020. https://doi.org/10.1001/jama.2020.4326.
Boelig, Rupsa C., Tracy Manuck, Emily A. Oliver, Daniele Di Mascio, Gabriele Saccone, Federica Bellussi, and Vincenzo Berghella. “Labor and Delivery Guidance for
COVID-19.” American Journal of Obstetrics & Gynecology MFM, March 2020, 100110. https://doi.org/10.1016/j.ajogmf.2020.100110.
Boelig, Rupsa C., Gabriele Saccone, Federica Bellussi, and Vincenzo Berghella. “MFM Guidance for COVID-19.” American Journal of Obstetrics & Gynecology MFM,
March 2020, 100106. https://doi.org/10.1016/j.ajogmf.2020.100106.
Bourne, T., C. Kyriacou, A. Coomarasamy, M. Al-Memar, M. Leonardi, E. Kirk, C. Landolfo, et al. “ISUOG Consensus Statement on Rationalization of Early-Pregnancy Care
and Provision of Ultrasonography in Context of SARS-CoV-2: ISUOG Consensus Statement on Rationalization of Early-Pregnancy Care and Provision of Ultrasonography
in Context of SARS-CoV-2.” Ultrasound in Obstetrics & Gynecology, April 8, 2020. https://doi.org/10.1002/uog.22046.
Di Mascio, Daniele, Asma Khalil, Gabriele Saccone, Giuseppe Rizzo, Danilo Buca, Marco Liberati, Jacopo Vecchiet, et al. “Outcome of Coronavirus Spectrum Infections
(SARS, MERS, COVID 1 -19) during Pregnancy: A Systematic Review and Meta-Analysis.” American Journal of Obstetrics & Gynecology MFM, March 2020, 100107.
https://doi.org/10.1016/j.ajogmf.2020.100107.
Langrish, Jeremy P, Nicholas L Mills, Julian KK Chan, Daan LAC Leseman, Robert J Aitken, Paul HB Fokkens, Flemming R Cassee, et al. “Beneficial Cardiovascular Effects of
Reducing Exposure to Particulate Air Pollution with a Simple Facemask.” Particle and Fibre Toxicology 6, no. 1 (2009): 8. https://doi.org/10.1186/1743-8977-6-8.
Rasmussen, Sonja A., John C. Smulian, John A. Lednicky, Tony S. Wen, and Denise J. Jamieson. “Coronavirus Disease 2019 (COVID-19) and Pregnancy: What Obstetricians
Need to Know.” American Journal of Obstetrics and Gynecology, February 2020, S0002937820301976. https://doi.org/10.1016/j.ajog.2020.02.017.
Sutton, Desmond, Karin Fuchs, Mary D’Alton, and Dena Goffman. “Universal Screening for SARS-CoV-2 in Women Admitted for Delivery.” New England Journal of
Medicine 0, no. 0 (April 13, 2020): null. https://doi.org/10.1056/NEJMc2009316.
“Weekly U.S. Influenza Surveillance Report | CDC.” Accessed April 12, 2020. https://www.cdc.gov/flu/weekly/#ClinicalLaboratories.
�Resources: NETEC
NETEC is Here to Help
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
Ask for help!
Send questions to info@netec.org - they will be answered by NETEC
SMEs
Submit a Technical Assistance request at NETEC.org
�Questions
and
Answers
�Contact
NETEC eLearning Center
NETEC Skill videos
courses.netec.org
youtube.com/thenetec
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Repository
Email
netec.org
repository.netecweb.org
info@netec.org
���
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Thursday, April 16, 2020 | 3:00 PM CDT
Event Type
Webinar, register at the link below.
URL
https://youtu.be/wYo0h32bN4A
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Care of Labor and Delivery Patients webinar" src="https://www.youtube.com/embed/wYo0h32bN4A?autoplay=0" frameborder="0"></iframe>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
NETEC COVID-19 Webinar Series (4/16/20)/Online Course: Care of Labor and Delivery Patients
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
Approach to care for pregnant COVID patients and those under investigation for labor and delivery, pregnancy, and childbirth.<br /><br />Webinar slides attached.<br />
<h2>Get continuing education credit through the related <a href="https://repository.netecweb.org/items/show/1205">online course on COVID-19 and Labor and Delivery patients</a>.</h2>
<br />See the related <a href="https://repository.netecweb.org/items/show/1204">flyer on COVID-19 and Labor and Delivery patients</a>.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-04-16
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-04-27 = note says "Course removed" but link works? Please review
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
2023-12-15 by Clayton Mowrer, Special Populations Treatment & Care group - "course removed"
Type
The nature or genre of the resource
Webinar and Online Course
2019-nCoV
Coronavirus
COVID-19
Labor and Delivery
Not updated
R-SP
R-T&C
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Kang, Yin, Longjiao Deng, Dengwen Zhang, Yuehong Wang, Gang Wang, Li Mei, Guobin Zhou, and Haihua Shu. 2020. "A practice of anesthesia scenario design for emergency cesarean section in patients with COVID-19 infection based on the role of standard patient." BioScience Trends advpub.
Abstract
The new coronavirus (COVID-19) has been characterized as a world pandemic by WHO since March 11, 2020. Although it is likely that COVID-19 transmission is primarily via droplets and close contact, airborne transmission and fecal-oral route remains a possibility. The medical staff working in the operating room, such as anesthesiologists, surgeons and nurses, are at high risk of exposure to virus due to closely contacting patients. The perioperative management is under great challenge while performing surgeries for patients suffering COVID-19, including emergency cesarean section, which is one of the most common surgeries under such circumstances. How to prevent medical staff from cross-infection is an issue of great concern. In this article, we give a practice of anesthesia scenario design for emergency cesarean section in a supposed standard patient suffering COVID-19, aimed to optimize the work flow and implement the protective details through simulation of a real operation scenario, which may be useful for training and clinical practice of anesthesia management for patients suffering COVID-19 or other fulminating infectious diseases.<br /><br />Keywords: COVID-19, SARS-CoV-2, anesthesia management, cesarean section, scenario design
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Advance publication pdf available online
URL
https://www.jstage.jst.go.jp/article/bst/advpub/0/advpub_2020.03066/_article/-char/en
Read Online
Online location of the resource.
https://www.jstage.jst.go.jp/article/bst/advpub/0/advpub_2020.03066/_article/-char/en
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
A practice of anesthesia scenario design for emergency cesarean section in patients with COVID-19 infection based on the role of standard patient
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
The new coronavirus (COVID-19) has been characterized as a world pandemic by WHO since March 11, 2020. Although it is likely that COVID-19 transmission is primarily via droplets and close contact, airborne transmission and fecal-oral route remains a possibility.
Creator
An entity primarily responsible for making the resource
Kang, Yin, Longjiao Deng, Dengwen Zhang, Yuehong Wang, Gang Wang, Li Mei, Guobin Zhou, and Haihua Shu.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-04-21
Type
The nature or genre of the resource
Publication
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-04-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
2022-07 by Clayton, Special Populations Treatment & Care group
2023-12-15 by Clayton Mowrer, Special Populations Treatment & Care group - skipped, bump for next review.
Relation
A related resource
Y
2019-nCoV
Coronavirus
COVID-19
Example
Labor and Delivery
R-Res&Pub
R-SP
R-T&C
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Foeller, Megan E., Carolina Carvalho Ribeiro do Valle, Timothy M. Foeller, Olufemi T. Oladapo, Elin Roos, and Anna E. Thorson. 2020. "Pregnancy and breastfeeding in the context of Ebola: a systematic review." The Lancet Infectious Diseases.
Abstract
<h2 class="top" id="seccestitle10"><span class="top__text">Summary</span></h2>
<div class="section-paragraph">
<div class="section-paragraph">The outbreaks of Ebola virus between 2014 and 2020 have drawn attention to knowledge gaps related to Ebola virus disease in pregnant women. The aim of this study was to systematically evaluate available data on pregnant and lactating women with acute Ebola virus disease or following recovery. We searched MEDLINE, Embase, Cochrane Library (CENTRAL), Web of Science Core Collection, CINAHL, POPLINE, Global Health, and WHO Global Index Medicus, in addition to grey literature, for relevant articles. Studies of all types and published between database inception and Aug 19, 2019, were eligible (PROSPERO 129335). We identified 1060 records, of which 52 studies met our inclusion criteria. Overall, mortality in 274 pregnant women with Ebola virus disease was 72% (197 women died); mortality for pregnant women with Ebola virus disease were not higher than those in the general population of patients with Ebola virus disease. Nearly all women with Ebola virus disease had adverse pregnancy outcomes. Among survivors, Ebola virus RNA was detected by RT-PCR in amniotic fluid up to 32 days after maternal clearance of Ebola virus from the blood and in breastmilk 26 days after symptom onset. A risk of transmission of Ebola virus from pregnancy-related fluids and breastmilk probably exists, and precautions should be taken.</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30194-8/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30194-8/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Pregnancy and breastfeeding in the context of Ebola: a systematic review
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
The outbreaks of Ebola virus between 2014 and 2020 have drawn attention to knowledge gaps related to Ebola virus disease in pregnant women. The aim of this study was to systematically evaluate available data on pregnant and lactating women with acute Ebola virus disease or following recovery.
Creator
An entity primarily responsible for making the resource
Foeller, Megan E., Carolina Carvalho Ribeiro do Valle, Timothy M. Foeller, Olufemi T. Oladapo, Elin Roos, and Anna E. Thorson.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-05-06
Type
The nature or genre of the resource
Publication
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-09-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
2022-07 by Clayton, Special Populations Treatment & Care group (3 yr)
Relation
A related resource
Y
Ebola
Labor and Delivery
Neonates
R-Res&Pub
R-SP
R-T&C
Viral Hemorrhagic Fever
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Thorson, Anna E., Megan E. Foeller, Severine Caluwaerts, Carolina Ribeiro do Valle, Ian Crozier, Gibrilla Deen, Devika Dixit, Chrissy Godwin, Pius Okong, Rachel Esteves Soeiro, João Paulo Sousa, Michel van Herp, Maurice Bucagu, Alejandro Costa, Megan Foeller, Pierre Formenty, Roopan Gill, Caron Kim, Brigitte Kini, Anais Legand, Olufemi Oladapo, Leopold Ouedraogo, Mark Perkins, Anne Thorson, and Patricia Titulaer. 2020. "New WHO guidelines on the management of pregnancy and breastfeeding in the context of Ebola." The Lancet Infectious Diseases.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30375-3/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30375-3/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
New WHO guidelines on the management of pregnancy and breastfeeding in the context of Ebola
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
Providing care for pregnant and breastfeeding women with Ebola virus disease is complex and requires expertise in infectious diseases, obstetrics, and gynaecology.
Creator
An entity primarily responsible for making the resource
Thorson, Anna E., Megan E. Foeller, Severine Caluwaerts, Carolina Ribeiro do Valle, Ian Crozier, Gibrilla Deen, Devika Dixit, Chrissy Godwin, Pius Okong, Rachel Esteves Soeiro, João Paulo Sousa, Michel van Herp, Maurice Bucagu, Alejandro Costa, Megan Foeller, Pierre Formenty, Roopan Gill, Caron Kim, Brigitte Kini, Anais Legand, Olufemi Oladapo, Leopold Ouedraogo, Mark Perkins, Anne Thorson, and Patricia Titulaer.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-05-06
Type
The nature or genre of the resource
Publication
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-09-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group (3 yr)
2022-07 by Kari, Special Populations Treatment & Care group (1 yr - went with T&C)
Relation
A related resource
Y - D0.1Tx/D0.2Tx Qualtrics # 826
Ebola
Guidance Document
Labor and Delivery
Neonates
R-Res&Pub
R-SP
R-T&C
Viral Hemorrhagic Fever
-
https://repository.netecweb.org/files/original/c58a77ff915bbcb55d5c8d1fb43f1520.png
963952f0a88126b5dd744cf7405311df
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Online Course
Access portal to an online course.
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
<strong>Self-paced </strong> <br /><strong> 1 credit </strong>
Objectives
<p><strong>TARGET AUDIENCE</strong></p>
<p>This enduring material is intended primarily for healthcare workers and teams which may include but are not limited to, medical and nursing staff, administration, education/training leadership, and infection control leadership. Staff specializing in emergency management, communications, specialized clinical areas, laboratory, facilities management and environmental services are also welcome.</p>
<p><strong>EDUCATIONAL OBJECTIVES</strong></p>
<p>At the conclusion of this enduring material, the participant should be better able to:</p>
<ol>
<li>Identify techniques to plan for appropriate PPE response</li>
<li>Discuss testing and the causality of testing for COVID-19 on labor and delivery</li>
<li>Describe the essential modifications necessary in medical practice for care of COVID-19 during antepartum, intrapartum, and postpartum</li>
<li>Development of a communication plan with patients and families</li>
</ol>
<p><strong>REQUIREMENTS FOR SUCCESSFUL COMPLETION</strong> </p>
<p>In order to receive CME/CNE credit, you must complete these steps prior to the activity expiration date.</p>
<ol>
<li>View the entire presentation</li>
<li>Complete the post-test with a score of 2 out of 3 or better</li>
<li>Complete the online evaluation</li>
<li>Submit the Completion Attestation</li>
</ol>
<p><strong>CREDIT</strong></p>
<p>The University of Nebraska Medical Center, Center for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.</p>
<p>The University of Nebraska Medical Center, Center for Continuing Education designates this enduring material for a maximum of 1 <em>AMA PRA Category 1 Credit</em>™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.</p>
<p>This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of University of Nebraska Medical Center, Center for Continuing Education and National Emerging Special Pathogen Training and Education Center.</p>
<p>The University of Nebraska Medical Center College of Nursing Continuing Nursing Education is accredited with distinction as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation. This activity is provided for <strong>1.0</strong> contact hour under ANCC criteria.</p>
<p>This enduring material has been planned and implemented in accordance with the accreditation requirements and policies of the American Nurses Credentialing Center’s Commission on Accreditation (ANCC) through the joint providership of the University of Nebraska Medical Center College of Nursing Continuing Nursing Education (UNMC CON CNE) (provider), University of Nebraska Medical Center, Center for Continuing Education (UNMC CCE), and National Emerging Special Pathogen Training and Education Center.</p>
<p><strong>DISCLOSURE DECLARATION</strong></p>
<p>As a provider accredited by ACCME, the University of Nebraska Medical Center, Center for Continuing Education, the University of Nebraska Medical Center, College of Nursing Continuing Nursing Education, and the American Nurses Credentialing Center’s Commission on Accreditation must ensure balance, objectivity, independence, and scientific rigor in its educational activities. Faculty are encouraged to provide a balanced view of therapeutic options by utilizing either generic names or the trade names of several to ensure impartiality.</p>
<p>All speakers, planning committee members and others in a position to control continuing medical education content participating in a University of Nebraska Medical Center, Center for Continuing Education, University of Nebraska Medical Center, College of Nursing Continuing Nursing Education, and American Nurses Credentialing Center’s Commission on Accreditation activity are required to disclose relationships with commercial interests. A commercial interest is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Disclosure of these commitments and/or relationships is included in these course materials so that participants in the activity may formulate their own judgments in interpreting its content and evaluating its recommendations.</p>
<p>This enduring material may include presentations in which faculty may discuss off-label and/or investigational use of pharmaceuticals or instruments not yet FDA-approved. Participants should note that the use of products outside currently FDA-approved labeling should be considered experimental and are advised to consult current prescribing information for FDA-approved indications.</p>
<p>All materials are included with the permission of the authors. The opinions expressed are those of the authors and are not to be construed as those of the University of Nebraska Medical Center, Center for Continuing Education, University of Nebraska Medical Center, College of Nursing Continuing Nursing Education, or American Nurses Credentialing Center’s Commission on Accreditation.</p>
<p>The following indicates the disclosure declaration information and the nature of those commercial relationships.</p>
<p><strong>FACULTY AND PLANNING COMMITTEE DISCLOSURES</strong></p>
<p>The following faculty** and planning committee members have no financial relationships to disclose.</p>
<ul>
<li>Sarah Anderson-Fiore, MPH, CHES</li>
<li>Sonia Bell, BS</li>
<li>John P. Horton, MD**</li>
<li>Heidi Keeler, PhD, RN</li>
<li>Benjamin Mattson, MS Ed</li>
<li>Jason Noble, BA, BFA</li>
<li>Renee Paulin, MSN, RN, CWOCN</li>
<li>Brenda Ram, CMP, CHCP</li>
<li>Michelle Schwedhelm, MSN, RN, NEA-BC</li>
<li>Sharon Vanairsdale, DNP, APRN, ACNS-BC, NP-C, CEN. FAEN, FAAN</li>
<li>Sami Vasistha, MS</li>
</ul>
<p><strong>FINANCIAL SUPPORT</strong></p>
<p>This program is funded by ASPR & CDC</p>
URL
https://courses.netec.org/courses/20-web-ld
Access
Description of access information (e.g. itunes).
Free online with free account
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Caring for COVID-19 Labor and Delivery Patients
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
Get continuing education credit, and cover the approach to care for COVID patients and those under investigation for labor and delivery.<br /><br />See the related <a href="https://repository.netecweb.org/exhibits/show/ppe-cons/item/946">webinar on COVID-19 and Labor and Delivery patients</a>.<br /><br />See the related <a href="https://repository.netecweb.org/items/show/1204">flyer on COVID-19 and Labor and Delivery patients</a>.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-06-16
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-03-03
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
2022-07 by Kari, Special Populations Treatment & Care group - tagged Archive - no more reviews
2023-03-03 - un-mark archive - in SPORSA
Relation
A related resource
Y - D0.1Tx/D0.2Tx Qualtrics # 826
Type
The nature or genre of the resource
Online Course
2019-nCoV
Coronavirus
COVID-19
Labor and Delivery
R-SP
R-T&C
Training
-
https://repository.netecweb.org/files/original/83496a89e330e33749d8cbaa7483e5ed.pdf
9c02cc3314162e78db89e665aa90c756
PDF Text
Text
07-02-20
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
COVID-19 Considerations for Labor & Delivery Patients
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
Planning, screening, testing, and medical practice considerations for pregnant, birth, labor and delivery patients.<br /><br />See the related <a href="https://repository.netecweb.org/exhibits/show/ppe-cons/item/946">webinar on COVID-19 and Labor and Delivery patients</a>.<br /><br />Get continuing education credit through the related <a href="https://repository.netecweb.org/items/show/1205">online course on COVID-19 and Labor and Delivery patients</a>.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-07-02
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-03-03
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
2022-07 by Kari, Special Populations Treatment & Care group - Tag archived - no more reviews
2023-03-03 un-mark archive - in SPORSA
Relation
A related resource
Y - D0.1Tx/D0.2Tx Qualtrics # 826
2019-nCoV
Archived
Coronavirus
COVID-19
Labor and Delivery
R-SP
R-T&C
-
https://repository.netecweb.org/files/original/8f5bcc6f0785195057e85011ce7daa0e.pdf
2f4aae3628c068475ac9e04cac120345
PDF Text
Text
Cuidados durante COVID-19 sobre
pacientes de partos laborales
Consideraciones en
cuanto enfermedades
infecciosas
Cuidado sobre sondeos
y examenes
• Examina a pacientes y visitantes por síntomas o exposición
• Decide que porción de la normatividad de
enfermedades infecciosa de las instalaciones
medicas cubre partos laborales.
• Infórmate sobre la manera en que las instalaciones
medicas maneja pruebas.
• Identifica los principales participantes en el plan de
parto (enfermedades, obstetra, neonatal, etc.) con
quien comunicar planes específicos sobre COVID-19.
o Examinan a todas las pacientes embarazadas?
o De que manera alocan habitaciones, EPP, y otros
recursos si algun paciente resulta positivo?
• Completa un recorrido de cada área de tu unidad la
cual un paciente o medico pueda tocar o entrar.
o Cual es las normas generales de visitantes para
pacientes que resultan positivos?
Ciudado sobre practicas medicas
Anteparto
Intraparto
• Decide como agrupar a pasientes
que resultan Confirma el tiempo
inicio de fluidos
intravenosos.positivos.
• Usa telemedicina si es posible
para disminuir visitas medicas.
• Comunícate con equipos de
infecciones contagiosas y
pulmonares para determinar si,
dependiendo de la fecha de
parto, pacientes positivos con el
COVID-19 necesitan
esteroides o anticoagulantes,
dependiendo en la fecha de
parto.
• Determina si pacientes positivos
ante el COVID-19 deben recibir
magnesio.
• Confirma el suministro de
azitromicina y detemina si va a ser
utilizado profilácticamente.
• Mantiene un claro plan de
comunicaciónes con todos los
equipos.
Posparto
• Estarás en una habitación
compartida con otras
madres y sus neonatales
con apariencia saludable?
• Como educaras y
proveerás EPP a
pacientes para
amamantar y bombear
leche materna?
Cuidados intensivos
• Planea y ejecuta
simulaciones de
partos ocurridos
fuera de la unidad de
partos.
• Decide de que
manera es posible
desplegar
eficientemente
personal y equipo a
áreas fuera de la
unidad de partos.
07-02-20
�
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Cuidados durante COVID-19 sobre pacientes de partos laborales
Subject
The topic of the resource
Elementos en Español
Description
An account of the resource
<a href="https://repository.netecweb.org/items/show/1204">COVID-19 Considerations for Labor & Delivery Patients</a> in Spanish.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-07-02
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
Coronavirus
COVID-19
Español
Labor and Delivery
Laboratory Testing
Postpartum
Pregnancy
R-SP
Spanish
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Khalil, A., P. von Dadelszen, T. Draycott, A. Ugwumadu, P. O'Brien, and L. Magee. 2020. "Change in the Incidence of Stillbirth and Preterm Delivery During the COVID-19 Pandemic." Jama 324 (7):705-6.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on JAMA and Lancet.
URL
https://pubmed.ncbi.nlm.nih.gov/32648892/
Read Online
Online location of the resource.
https://jamanetwork.com/journals/jama/fullarticle/2768389
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Change in the Incidence of Stillbirth and Preterm Delivery During the COVID-19 Pandemic
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
High rates of preterm birth and cesarean delivery have been reported in women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, studies have inadequate power to assess uncommon outcomes like stillbirth (fetal death ≥24 weeks’ gestation).<br /><br />The authors published a follow up to this article:<br />
<ul>
<li>Khalil, Asma, Peter von Dadelszen, Erkan Kalafat, Mercede Sebghati, Shamez Ladhani, Austin Ugwumadu, Tim Draycott, Pat O'Brien, and Laura Magee. 2020. "<a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30779-9/fulltext" target="_blank" rel="noreferrer noopener">Change in obstetric attendance and activities during the COVID-19 pandemic.</a>" The Lancet Infectious Diseases.<br /><br /><br /></li>
</ul>
Creator
An entity primarily responsible for making the resource
Khalil, A., P. von Dadelszen, T. Draycott, A. Ugwumadu, P. O'Brien, and L. Magee.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-07-10
Type
The nature or genre of the resource
Publication
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-09-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
2023-12-15 by Clayton Mowrer, Special Populations Treatment & Care group - 3 years - note "New asset to replace"
2019-nCoV
Clinical Care
Coronavirus
COVID-19
Labor and Delivery
Neonates
Not updated
Pregnancy
R-Res&Pub
R-SP
R-T&C
SARS-CoV-2
-
https://repository.netecweb.org/files/original/64c50f01f5416aac379037dbc4ea7d66.png
f4a4f48ef9e079fa45404c12852ebe1d
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Video
A video iframed into the item.
Player
Field for the html for a video player.
<br /><iframe width="600" height="336" title="Vaccines and maternal health QandA" src="https://www.facebook.com/plugins/video.php?href=https://www.facebook.com/EmoryUniversity/videos/283185166802377/&show_text=0&amp;width=640"></iframe>
URL
https://www.facebook.com/EmoryUniversity/videos/283185166802377
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Vaccines and maternal health Q&A: Dr. Denise Jamieson
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
Are vaccines safe for women who are pregnant? Hope to be pregnant? Join Emory infectious diseases and OB-GYN expert Dr. Denise Jamieson for a live discussion with Emory public health expert Dr. Jodie Guest
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2021-05-12
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-09-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
2022-07 by Kari, Special Populations Treatment & Care group (both 1 yr)
2023-12-15 by Clayton Mowrer, Special Populations Treatment & Care group
2019-nCoV
Coronavirus
COVID-19
Labor and Delivery
Neonates
Not updated
Pregnancy
R-SP
R-T&C
Vaccine Study