title: Rabies transmission risks during peripartum--Two cases and a review of the literature.
abstract: We report two cases of probable rabies in near-term/at-term pregnant women in sub-Saharan Africa and Asia. One baby was delivered by caesarean section and the other one vaginally. Both received post-exposure prophylaxis (PEP), including RIG and vaccine and both are alive and healthy, at 9 and 24 months, respectively. We found 14 other published cases of infants born from rabid mothers. One confirmed case of rabies transmission occurred. The other children born from rabid mothers, with or without caesarean section, did not acquire rabies, and were still healthy at the time of reporting, with or without post-exposure prophylaxis. Mother-to-child transmission of rabies is possible, but rare, because rabies virus is not present in blood and exposure of the baby's mucosa to maternal infectious fluids and tissue seems limited. A conservative approach should however, be adopted, and rabies PEP, including RIG, be administered as soon as possible to babies born from probably rabid mothers. Whether cesarean-section clearly provides prevention remains unclear. Rabies can be prevented in pregnant women by PEP administration. Rabies cell-culture vaccines are safe and effective and can be administered to pregnant and lactating women, as well as newborns. Efforts must focus on raising rabies awareness in the general population, as well as in healthcare workers.
authors.affiliation: Centre national hospitalier et universitaire Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Benin.
authors.forename: Christiane Tshabu
authors.initials: CT
authors.lastname: Aguèmon
authors.affiliation: Institut Pasteur du Cambodge, Epidemiology Unit, Phnom Penh, Cambodia. Electronic address: atarantola@pasteur-kh.org.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Tarantola
authors.affiliation: Centre national hospitalier et universitaire Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Benin.
authors.forename: Eugène
authors.initials: E
authors.lastname: Zoumènou
authors.affiliation: Institut Pasteur du Cambodge, Epidemiology Unit, Phnom Penh, Cambodia.
authors.forename: Sophie
authors.initials: S
authors.lastname: Goyet
authors.affiliation: Centre national hospitalier et universitaire Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Benin.
authors.forename: Pamphile
authors.initials: P
authors.lastname: Assouto
authors.affiliation: Institut Pasteur du Cambodge, Epidemiology Unit, Phnom Penh, Cambodia.
authors.forename: Sowath
authors.initials: S
authors.lastname: Ly
authors.affiliation: Centre national hospitalier et universitaire Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Benin.
authors.forename: Serge
authors.initials: S
authors.lastname: Mewanou
authors.affiliation: Institut Pasteur, Lyssavirus Dynamics and Host Adaptation Unit, National Reference Centre for Rabies, WHO Collaborating Centre for Reference and Research on Rabies, Paris, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Bourhy
authors.affiliation: Dodet Bioscience, Lyon, France.
authors.forename: Betty
authors.initials: B
authors.lastname: Dodet
authors.affiliation: Professeur d'anesthésie réanimation, membre AfroREB, président ONG Association béninoise contre la Rage, Cotonou, Benin.
authors.forename: Abdou-Rahmann
authors.initials: AR
authors.lastname: Aguèmon
mesh_terms: D000328:Adult; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D058725:Peripartum Period; D056990:Post-Exposure Prophylaxis; D011247:Pregnancy; D011818:Rabies / Q000517:prevention & control* / Q000628:therapy; D011819:Rabies Vaccines / Q000627:therapeutic use*
chemical_list: D011819:Rabies Vaccines
keywords: PEP; Peripartum transmission; Post-exposure prophylaxis; Rabies; Rabies prevention; Vertical transmission