Neonatal Survival Following Spontaneous Maternal Recovery From Ebola Virus Disease in a Resource-Limited Setting in Western Democratic Republic of the Congo.

Background: Pregnancy induces physiological decline in maternal immunity. Ebola virus disease (EVD) in pregnancy is associated with obstetrical complications, and vaccination in early pregnancy is recommended, but may not be without risk. Case Presentation: We described neonatal survival after spontaneous maternal EVD recovery. This neonate was born to a 25-year-old mother admitted to an Ebola Treatment Unit (ETU) in July, 2020, after 11 days of symptoms. She was vaccinated with rVSV-ZEBOV three days before symptom onset and her real-time polymerase chain of reaction (RT-PCR) results confirmed EVD and malarial infection two days after, but she refused hospitalization. She was treated at home with PO ASAQ, amoxicillin, paracetamol, albendazole, omeprazole, and papaverine. Eleven days later, due to clinical deterioration and onset of vaginal hemorrhage, she finally accepted to be transferred in ETU. She was Parity 2, fetal age at admission was 5 weeks and 3 days. Upon admission, her EVD PCR measured NP 26.3 and GP 32.9. She did not receive monoclonal therapy against Ebola infection due to stock shortage. She received intravenous, artesunate, ceftriaxone, and papaverine. She experienced spontaneous resolution of EVD 18 days after symptom onset and was discharged. At 40 weeks gestation, seven and a half months after EVD recovery, she delivered a healthy female infant, APGAR 10/10/10, weighing 3450 g. Maternal blood, adnexal, and newborn blood samples were RT-PCR negative, and the mother and the baby were discharged after 14 days. At our last follow-up, in June 2023 (2 years, 3 months after delivery), the mother and the baby were in good health. Conclusion: Neonatal survival following spontaneous maternal recovery from EVD in the first trimester of gestation is rare but possible, even in the context of limited clinical resources for treatment.