Cholera in pregnancy: Clinical and immunological aspects.
BACKGROUND
The objective of this study was to examine the clinical and immunological features of cholera in pregnancy.


METHODS
Women of reproductive age presenting to the icddr,b Dhaka hospital with cholera, and enrolled as part of a larger cohort study, were tested for pregnancy on admission. We compared initial clinical features and immune responses of pregnant patients with non-pregnant female patients at days 2, 7 and 21 after infection.


RESULTS
Among reproductive age women enrolled between January 2001 and May 2006, 9.7% (14/144) were pregnant. The duration of diarrhoea prior to admission tended to be higher in pregnant compared to non-pregnant patients (p=0.08), but other clinical characteristics did not differ. Antibody responses to cholera toxin B subunit (CtxB), toxin-coregulated pilus A (TcpA), Vibrio cholerae lipopolysaccharide (LPS), and serum vibriocidal antibody responses, were comparable between pregnant and non-pregnant patients. There were no deaths among the pregnant cases or non-pregnant controls, and no adverse foetal outcomes, including stillbirths, during 21 days of follow up of pregnant cases.


CONCLUSIONS
To our knowledge, this is the first report of immune responses in pregnant women with cholera. We found that pregnant woman early in pregnancy has comparable clinical illness and subsequent immune responses compared to non-pregnant women. These findings suggest that the evaluation of safety and immunogenicity of oral cholera vaccines in pregnancy should be an area of future investigations.
Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Ashraful I
AI
Khan
Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Fahima
F
Chowdhury
Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Division of Infectious Diseases, University of Utah, Salt Lake City, UT, USA.
Daniel T
DT
Leung
Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
Regina C
RC
Larocque
Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
Jason B
JB
Harris
Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA.
Edward T
ET
Ryan
Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Microbiology and Immunobiology, Harvard Medical School, Boston, MA, USA.
Stephen B
SB
Calderwood
Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh. Electronic address: fqadri@icddrb.org.
Firdausi
F
Qadri
D000293:Adolescent; D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood; D001459:Bangladesh; D002771:Cholera / Q000175:diagnosis / Q000276:immunology*; D002772:Cholera Toxin / Q000276:immunology; D015331:Cohort Studies; D005260:Female; D036781:Fimbriae Proteins / Q000276:immunology; D006801:Humans; D008070:Lipopolysaccharides / Q000276:immunology; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000276:immunology*; D011446:Prospective Studies; D014734:Vibrio cholerae / Q000276:immunology; D055815:Young Adult
D000907:Antibodies, Bacterial; D008070:Lipopolysaccharides; C085807:TcpA protein, Vibrio cholerae; D036781:Fimbriae Proteins; D002772:Cholera Toxin
Cholera; Immune response; Pregnancy