Amid Ebola surge, experts don't give nod to vaccine in pregnancy

In the latest Ebola developments, the Democratic Republic of the Congo (DRC) today reported six more cases in Beni, the outbreak's current epicenter, and the World Health Organization's (WHO's) vaccine advisory group said there's still not enough evidence to recommend Ebola vaccination for pregnant women.

Officials probe 47 suspected cases

The 6 new illnesses in Beni, part of a steady stream of cases from the region, bring the outbreak total to 257 cases, which includes 222 confirmed and 35 probable infections.

Two more deaths were reported, one from Beni and the other from Butembo, the city that continues to report cases and deaths. So far 164 people have died in the DRC's latest outbreak, which is affecting North Kivu and Ituri provinces in the northeast part of the country.

Another 47 suspected Ebola cases are under investigation.

The number of people reached with the ring vaccination campaign continues to increase, with 22,811 immunized so far, about half of them in Beni.

In another response development, the DRC's health ministry said the capacity of the Ebola treatment center in Mangina, the earlier outbreak hot spot, had been reduced by 16 beds, while the one in Beni has been increased to 60 beds to allow for the best quality of care given the high volume of suspected and confirmed cases in that health zone.

Vaccine data lacking for pregnant women

Ebola vaccine was among the topics that the WHO Strategic Advisory Group of Experts (SAGE) on Immunizations discussed this week at its meeting in Geneva.

At a media telebriefing today, the group's chair Alejandro Cravioto, MD, with the National Autonomous University of Mexico, said the group examined data on using Ebola vaccine in pregnant women. The VSV-EBOV vaccine contains live virus, which typically isn't recommended for use in pregnant women. He said health officials are following a small number of women who didn't know they were pregnant when they received the VSV-EBOV vaccine and some who were inadvertently vaccinated.

Joachim Hombach, PhD, MPH, executive secretary of SAGE and senior advisor at the European Vaccine Initiative, said the risk-benefit analysis suggests that risk of contracting Ebola is very low for nonvaccinated people—including pregnant women—in settings where ring vaccination is under way.

In the months ahead, health officials hope to have more information from detailed follow-up on pregnant women who were vaccinated, officials said, adding that there's not enough evidence for SAGE for make a final conclusion. They added that local ethics committees may also be taking up the issue, based on the situation on the ground.

Advisors foresee role for second vaccine

During their meeting this week, SAGE members also heard status reports on several other Ebola vaccines that are in the development pipeline.

Cravioto said the only other vaccine that the group sees being used in the near future is the prime-boost regimen that combines a priming dose of the adenovirus-vectored Ad26.ZEBOV vaccine developed by Johnson & Johnson and a booster dose of MVA-BN-Filo from Bavarian Nordic. He said SAGE advisors heard a presentation on phase 2 findings for the vaccine.

Over the past few years, experts have said they see roles for different Ebola vaccine formulations. For example, VSV-EBOV has been useful in outbreak settings, because it induces rapid protection, but researchers are exploring vaccines that could provide long-lasting protection for preventive vaccination campaigns, including protecting health workers in outbreak zones.

The vaccines in the Johnson & Johnson regimen are genetically modified so they can't replicate, which might provide an option that health officials would be more comfortable recommending for pregnant women.

Cravioto said it's up the company to decide the next steps for the clinical trial, but the group suggested including pregnant women.

See also:

Oct 26 DRC update

Oct 26 WHO SAGE telebriefing audio file

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