The effect of Ribavirin for Crimean-Congo hemorrhagic fever in pregnancy and its outcome; a warning for physicians and health care providers

Document Type : Original Article

Authors

1 General physician student, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Associate Professor, Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Resident, Department of Psychiatry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction: Crimean-Congo hemorrhagic fever (CCHF) is an acute tick-borne infection which is associated with significant mortality (up to 50%) and serious risk in pregnancy. Ribavirin is an antiviral and of course a teratogenic drug that has significant effects in the treatment of CCHF. The present study was performed with aim to examine the level of awareness of people with CCHF about the teratogenicity of the drug in the embryonic period and the outcome of pregnancy during six months after taking ribavirin.
Methods: In this retrospective study, the files of all the hospitalized patients with a definite diagnosis of Crimean Congo fever in two hospitals of Mashhad were assessed over 10 years. Telephone calls were made to the patients and their families and the required information was collected. Data were analyzed using SPSS software (version 22) and Chi-square and Exact Fisher tests. P< 0.05 was considered statistically significant.
Results: In this study, 177 CCHF patients were assessed, and their information regarding education or lack of education about pregnancy at discharge was available for 84 patients, only 9 people (5.1% of all patients) were trained about contraception after treatment with Ribavirin. In the follow-up of the patients, 3 pregnancies resulted in abortion and 7 unhealthy children were reported due to lack of attention to the principles of pregnancy prevention at the time of taking ribavirin and 6 months later.
Conclusion: Considering the effects of teratogenicity of ribavirin, it seems necessary to provide adequate training to patients about the risks of pregnancy during the 9-month after receiving ribavirin.

Keywords


  1. Leblebicioglu H, Bodur H, Dokuzoguz B, Elaldi N, Guner R, Koksal I, et al. Case management and supportive treatment for patients with Crimean-Congo hemorrhagic fever. Vector-Borne and Zoonotic Diseases 2012; 12(9):805-11.
  2. Jamieson DJ, Theiler RN, Rasmussen SA. Emerging infections and pregnancy. Emerging infectious diseases 2006; 12(11):1638.
  3. Price ME, Fisher-Hoch SP, Craven RB, McCormick JB. A prospective study of maternal and fetal outcome in acute Lassa fever infection during pregnancy. British Medical Journal 1988; 297(6648):584-7.
  4. Black BO, Caluwaerts S, Achar J. Ebola viral disease and pregnancy. Obstetric Medicine 2015; 8(3):108-13.
  5. Ergonul O, Celikbas A, Yildirim U, Zenciroglu A, Erdogan D, Ziraman I, et al. Pregnancy and Crimean‐Congo haemorrhagic fever. Clinical microbiology and infection 2010; 16(6):647-50.
  6. Gozel MG, Elaldi N, Engin A, Akkar OB, Bolat F, Celik C. Favorable outcomes for both mother and baby are possible in pregnant women with Crimean-Congo hemorrhagic fever disease: a case series and literature review. Gynecologic and Obstetric Investigation 2014; 77(4):266-71.
  7. Sharifi Mood B, Mardani M, Metanat M. Clinical Manifestations, Laboratory Findings and Clinical Outcome in 6 Pregnant Women with Crimean-Congo Hemorrhagic Fever. Iranian Journal of Clinical Infectious Diseases 2007; 2(4):193-6.
  8. Pshenichnaya NY, Nenadskaya SA. Probable Crimean-Congo hemorrhagic fever virus transmission occurred after aerosol-generating medical procedures in Russia: nosocomial cluster. International Journal of Infectious Diseases 2015; 33:120-2.
  9. Sinclair SM, Jones JK, Miller RK, Greene MF, Kwo PY, Maddrey WC. The Ribavirin Pregnancy Registry: an interim analysis of potential teratogenicity at the mid-point of enrollment. Drug safety 2017; 40(12):1205-18.
  10. Roberts SS. Assessing ribavirin exposure during pregnancy: the Ribavirin Pregnancy Registry. Gastroenterology Nursing 2008; 31(6):413-7.