Association of Rift Valley fever virus infection with miscarriage in Sudanese women

a cross-sectional study

Maria Baudin, Ammar M. Jumaa, Huda J.E. Jomma, Mubarak S. Karsany, Göran Bucht, Jonas Näslund, Clas Ahlm, Magnus Evander, Nahla Mohamed

Research output: Contribution to journalArticleResearchpeer-review

27 Citations (Scopus)

Abstract

Background Rift Valley fever virus is an emerging mosquito-borne virus that causes infections in animals and human beings in Africa and the Arabian Peninsula. Outbreaks of Rift Valley fever lead to mass abortions in livestock, but such abortions have not been identified in human beings. Our aim was to investigate the cause of miscarriages in febrile pregnant women in an area endemic for Rift Valley fever. Methods Pregnant women with fever of unknown origin who attended the governmental hospital of Port Sudan, Sudan, between June 30, 2011, and Nov 17, 2012, were sampled at admission and included in this cross-sectional study. Medical records were retrieved and haematological tests were done on patient samples. Presence of viral RNA as well as antibodies against a variety of viruses were analysed. Any association of viral infections, symptoms, and laboratory parameters to pregnancy outcome was investigated using Pearson's χ2 test. Findings Of 130 pregnant women with febrile disease, 28 were infected with Rift Valley fever virus and 31 with chikungunya virus, with typical clinical and laboratory findings for the infection in question. 15 (54%) of 28 women with an acute Rift Valley fever virus infection had miscarriages compared with 12 (12%) of 102 women negative for Rift Valley fever virus (p<0·0001). In a multiple logistic regression analysis, adjusting for age, haemorrhagic disease, and chikungunya virus infection, an acute Rift Valley fever virus infection was an independent predictor of having a miscarriage (odds ratio 7·4, 95% CI 2·7–20·1; p<0·0001). Interpretation This study is the first to show an association between infection with Rift Valley fever virus and miscarriage in pregnant women. Further studies are warranted to investigate the possible mechanisms. Our findings have implications for implementation of preventive measures, and evidence-based information to the public in endemic countries should be strongly recommended during Rift Valley fever outbreaks. Funding Schlumberger Faculty for the Future, CRDF Global (31141), the Swedish International Development Cooperation Agency, the County Council of Västerbotten, and the Faculty of Medicine, Umeå University.

Original languageEnglish
Pages (from-to)e864-e871
JournalThe Lancet Global Health
Volume4
Issue number11
DOIs
Publication statusPublished - 1 Nov 2016

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Rift Valley fever virus
Spontaneous Abortion
Virus Diseases
Cross-Sectional Studies
Rift Valley Fever
Pregnant Women
Sudan
Disease Outbreaks
Fever
Chikungunya virus
Laboratory Infection
Viral Antibodies
Fever of Unknown Origin
International Cooperation
Viral RNA
Hematologic Tests
Livestock
Pregnancy Outcome
Culicidae
Medical Records

Cite this

Baudin, Maria ; Jumaa, Ammar M. ; Jomma, Huda J.E. ; Karsany, Mubarak S. ; Bucht, Göran ; Näslund, Jonas ; Ahlm, Clas ; Evander, Magnus ; Mohamed, Nahla. / Association of Rift Valley fever virus infection with miscarriage in Sudanese women : a cross-sectional study. In: The Lancet Global Health. 2016 ; Vol. 4, No. 11. pp. e864-e871.
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title = "Association of Rift Valley fever virus infection with miscarriage in Sudanese women: a cross-sectional study",
abstract = "Background Rift Valley fever virus is an emerging mosquito-borne virus that causes infections in animals and human beings in Africa and the Arabian Peninsula. Outbreaks of Rift Valley fever lead to mass abortions in livestock, but such abortions have not been identified in human beings. Our aim was to investigate the cause of miscarriages in febrile pregnant women in an area endemic for Rift Valley fever. Methods Pregnant women with fever of unknown origin who attended the governmental hospital of Port Sudan, Sudan, between June 30, 2011, and Nov 17, 2012, were sampled at admission and included in this cross-sectional study. Medical records were retrieved and haematological tests were done on patient samples. Presence of viral RNA as well as antibodies against a variety of viruses were analysed. Any association of viral infections, symptoms, and laboratory parameters to pregnancy outcome was investigated using Pearson's χ2 test. Findings Of 130 pregnant women with febrile disease, 28 were infected with Rift Valley fever virus and 31 with chikungunya virus, with typical clinical and laboratory findings for the infection in question. 15 (54{\%}) of 28 women with an acute Rift Valley fever virus infection had miscarriages compared with 12 (12{\%}) of 102 women negative for Rift Valley fever virus (p<0·0001). In a multiple logistic regression analysis, adjusting for age, haemorrhagic disease, and chikungunya virus infection, an acute Rift Valley fever virus infection was an independent predictor of having a miscarriage (odds ratio 7·4, 95{\%} CI 2·7–20·1; p<0·0001). Interpretation This study is the first to show an association between infection with Rift Valley fever virus and miscarriage in pregnant women. Further studies are warranted to investigate the possible mechanisms. Our findings have implications for implementation of preventive measures, and evidence-based information to the public in endemic countries should be strongly recommended during Rift Valley fever outbreaks. Funding Schlumberger Faculty for the Future, CRDF Global (31141), the Swedish International Development Cooperation Agency, the County Council of V{\"a}sterbotten, and the Faculty of Medicine, Ume{\aa} University.",
author = "Maria Baudin and Jumaa, {Ammar M.} and Jomma, {Huda J.E.} and Karsany, {Mubarak S.} and G{\"o}ran Bucht and Jonas N{\"a}slund and Clas Ahlm and Magnus Evander and Nahla Mohamed",
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Baudin, M, Jumaa, AM, Jomma, HJE, Karsany, MS, Bucht, G, Näslund, J, Ahlm, C, Evander, M & Mohamed, N 2016, 'Association of Rift Valley fever virus infection with miscarriage in Sudanese women: a cross-sectional study', The Lancet Global Health, vol. 4, no. 11, pp. e864-e871. https://doi.org/10.1016/S2214-109X(16)30176-0

Association of Rift Valley fever virus infection with miscarriage in Sudanese women : a cross-sectional study. / Baudin, Maria; Jumaa, Ammar M.; Jomma, Huda J.E.; Karsany, Mubarak S.; Bucht, Göran; Näslund, Jonas; Ahlm, Clas; Evander, Magnus; Mohamed, Nahla.

In: The Lancet Global Health, Vol. 4, No. 11, 01.11.2016, p. e864-e871.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Association of Rift Valley fever virus infection with miscarriage in Sudanese women

T2 - a cross-sectional study

AU - Baudin, Maria

AU - Jumaa, Ammar M.

AU - Jomma, Huda J.E.

AU - Karsany, Mubarak S.

AU - Bucht, Göran

AU - Näslund, Jonas

AU - Ahlm, Clas

AU - Evander, Magnus

AU - Mohamed, Nahla

PY - 2016/11/1

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N2 - Background Rift Valley fever virus is an emerging mosquito-borne virus that causes infections in animals and human beings in Africa and the Arabian Peninsula. Outbreaks of Rift Valley fever lead to mass abortions in livestock, but such abortions have not been identified in human beings. Our aim was to investigate the cause of miscarriages in febrile pregnant women in an area endemic for Rift Valley fever. Methods Pregnant women with fever of unknown origin who attended the governmental hospital of Port Sudan, Sudan, between June 30, 2011, and Nov 17, 2012, were sampled at admission and included in this cross-sectional study. Medical records were retrieved and haematological tests were done on patient samples. Presence of viral RNA as well as antibodies against a variety of viruses were analysed. Any association of viral infections, symptoms, and laboratory parameters to pregnancy outcome was investigated using Pearson's χ2 test. Findings Of 130 pregnant women with febrile disease, 28 were infected with Rift Valley fever virus and 31 with chikungunya virus, with typical clinical and laboratory findings for the infection in question. 15 (54%) of 28 women with an acute Rift Valley fever virus infection had miscarriages compared with 12 (12%) of 102 women negative for Rift Valley fever virus (p<0·0001). In a multiple logistic regression analysis, adjusting for age, haemorrhagic disease, and chikungunya virus infection, an acute Rift Valley fever virus infection was an independent predictor of having a miscarriage (odds ratio 7·4, 95% CI 2·7–20·1; p<0·0001). Interpretation This study is the first to show an association between infection with Rift Valley fever virus and miscarriage in pregnant women. Further studies are warranted to investigate the possible mechanisms. Our findings have implications for implementation of preventive measures, and evidence-based information to the public in endemic countries should be strongly recommended during Rift Valley fever outbreaks. Funding Schlumberger Faculty for the Future, CRDF Global (31141), the Swedish International Development Cooperation Agency, the County Council of Västerbotten, and the Faculty of Medicine, Umeå University.

AB - Background Rift Valley fever virus is an emerging mosquito-borne virus that causes infections in animals and human beings in Africa and the Arabian Peninsula. Outbreaks of Rift Valley fever lead to mass abortions in livestock, but such abortions have not been identified in human beings. Our aim was to investigate the cause of miscarriages in febrile pregnant women in an area endemic for Rift Valley fever. Methods Pregnant women with fever of unknown origin who attended the governmental hospital of Port Sudan, Sudan, between June 30, 2011, and Nov 17, 2012, were sampled at admission and included in this cross-sectional study. Medical records were retrieved and haematological tests were done on patient samples. Presence of viral RNA as well as antibodies against a variety of viruses were analysed. Any association of viral infections, symptoms, and laboratory parameters to pregnancy outcome was investigated using Pearson's χ2 test. Findings Of 130 pregnant women with febrile disease, 28 were infected with Rift Valley fever virus and 31 with chikungunya virus, with typical clinical and laboratory findings for the infection in question. 15 (54%) of 28 women with an acute Rift Valley fever virus infection had miscarriages compared with 12 (12%) of 102 women negative for Rift Valley fever virus (p<0·0001). In a multiple logistic regression analysis, adjusting for age, haemorrhagic disease, and chikungunya virus infection, an acute Rift Valley fever virus infection was an independent predictor of having a miscarriage (odds ratio 7·4, 95% CI 2·7–20·1; p<0·0001). Interpretation This study is the first to show an association between infection with Rift Valley fever virus and miscarriage in pregnant women. Further studies are warranted to investigate the possible mechanisms. Our findings have implications for implementation of preventive measures, and evidence-based information to the public in endemic countries should be strongly recommended during Rift Valley fever outbreaks. Funding Schlumberger Faculty for the Future, CRDF Global (31141), the Swedish International Development Cooperation Agency, the County Council of Västerbotten, and the Faculty of Medicine, Umeå University.

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