Live neonates born to mothers with Ebola virus disease: a review of the literature.

Ebola virus disease (EVD) is associated with a high mortality, especially among neonates. There is a paucity of literature on live neonates born to pregnant women with EVD, and therefore, our understanding of their clinical illness and outcomes is extremely limited. A literature search was conducted to identify descriptions of live neonates born to pregnant women with EVD. To date, five known reports have provided limited information about 15 live neonates born to pregnant women with EVD. All 15 neonates died, and of those with information, death was within 19 days of birth. Of the 12 neonates with information on signs and symptoms, 8 (67%) were reported to have fever; no other signs or symptoms were reported. There are no published data describing the clinical course or treatments provided for these neonates. Potential modes of Ebola virus transmission from mother to neonate are through in utero transmission, during delivery, direct contact or through breast milk. There is an urgent need for more information about neonates with EVD, including clinical course (for example, onset and presentation of illness, symptomatology and course of illness) and treatments provided as well as information on Ebola viral load in breast milk from Ebola-positive and convalescing mothers.

A large-scale, rapid public health response to rabies in an organ recipient and the previously undiagnosed organ donor.

This article describes and contrasts the public health response to two human rabies cases: one organ recipient diagnosed within days of symptom onset and the transplant donor who was diagnosed 18 months post-symptom onset. In response to an organ-transplant-related rabies case diagnosed in 2013, organ donor and recipient investigations were conducted by multiple public health agencies. Persons with potential exposure to infectious patient materials were assessed for rabies virus exposure. An exposure investigation was conducted to determine the source of the organ donor's infection. Over 100 persons from more than 20 agencies spent over 2700 h conducting contact investigations in healthcare, military and community settings. The 564 persons assessed include 417 healthcare workers [5.8% recommended for post-exposure prophylaxis (PEP)], 96 community contacts (15.6% recommended for PEP), 30 autopsy personnel (50% recommended for PEP), and 21 other persons (4.8% recommended for PEP). Donor contacts represented 188 assessed with 20.2% recommended for PEP, compared with 5.6% of 306 recipient contacts recommended for PEP. Human rabies cases result in substantial use of public health and medical resources, especially when diagnosis is delayed. Although rare, clinicians should consider rabies in cases of encephalitis of unexplained aetiology, particularly for cases that may result in organ donation.

Inhibitory effects of pertussis toxin on the cAMP generating system in human mononuclear leucocytes.

In a previous investigation of children infected with pertussis during the first week of paroxysmal stage, we found a 50-75% reduction of the isoprenaline (IPN)-induced cAMP response in peripheral MN leucocytes. In order to characterize these findings further, intact human MN leucocytes from healthy adults were treated with PT in vitro. Basal, as well as prostaglandin E1-stimulated cAMP levels were decreased by PT in a dose-dependent fashion over a range of 0.01 to 1000 ng ml-1 to about 65% of control levels. Stimulation of PT-pretreated cells (100 ng ml-1, 90 min, 37 degrees C) showed significantly reduced IPN and PGE1-induced cAMP accumulation, indicated by a depression and shift of the dose-response curves to the right. In contrast, cAMP generation was unchanged by forskolin, a diterpene that is believed to directly stimulate adenylyl cyclase. The anti-allergic drug ketotifen had no direct effects on basal, IPN or PGE1-induced cAMP responses; however the inhibitory actions of PT pretreatment on cAMP levels were diminished (basal and isoprenaline-stimulated) or reversed (PGE1-stimulated). To further locate the site of impaired cAMP responses, beta-adrenoceptor binding, as well as displacement characteristics of the receptor, were estimated by 125I-cyanopindolol binding to a plasma membrane fraction pretreated with or without PT. No differences in beta-adrenoceptor number or in the affinities of the binding sites could be detected. These data are in close agreement with the findings on MN leucocytes from pertussis-infected children and support the notion of PT-induced impaired signal transduction in the cAMP generating system in human MN leucocytes.