Jacob Gerstenberg

Infection with respiratory syncytial virus (RSV) represents a substantial burden of disease, especially in children. While one vaccine (RSVpreF) has been recommended for administration in pregnant women, another one (RSVPreF3‐Mat) has been discontinued in a Phase 3 study due to an increased incidence of preterm births in the study group. When comparing the studies related to these two vaccine candidates, the differences in preterm birth rates appear inconsistent. For a more differentiated evaluation of birth outcomes associated with maternal RSV vaccination, we recommend introducing the previously described concept of “small and vulnerable newborns.”

Infection with respiratory syncytial virus (RSV) represents a substantial burden of disease, especially in children. While one vaccine (RSVpreF) has been recommended for administration in pregnant women, another one (RSVPreF3-Mat) has been discontinued in a Phase 3 study due to an increased incidence of preterm births in the study group. When comparing the studies related to these two vaccine candidates, the differences in preterm birth rates appear inconsistent. For a more differentiated evaluation of birth outcomes associated with maternal RSV vaccination, we recommend introducing the previously described concept of "small and vulnerable newborns."

Virologic failure of long-acting rilpivirine/cabotegravir is rare but may result in severely limited treatment options. Known risk factors cannot predict all cases. Therapeutic drug monitoring (TDM) may help identify patients at risk, but reliable thresholds are missing. We report retrospective TDM in a cohort of 5 patients, including 1 virological failure.

Background: Schistosome egg deposition in pregnant women may affect the placenta of infected mothers and cause placental schistosomiasis (PS). Histopathological examination of placental tissue is an inadequate detection method due to low sensitivity. So far, there has not been any systematic review on PS. Methods: We conducted a systematic literature search on PubMed, EMBASE, and Medline and included all publications that reported microscopically confirmed cases of PS, as well as the relevant secondary literature found in the citations of the primarily included publications. Results: Out of 113 abstracts screened we found a total of 8 publications describing PS with a total of 92 cases describing egg deposition of dead and/or viable eggs and worms of S. haematobium and S. mansoni in placental tissue. One cross-sectional study investigating the prevalence of PS and its association with adverse birth outcomes, found 22% of placentas to be infested using a maceration technique but only <1% using histologic examination. Additionally, no direct link to deleterious pregnancy outcomes could be shown. Conclusions: PS is a highly unattended and underdiagnosed condition in endemic populations, due to a lack of awareness as well as low sensitivity of histopathological examinations. However, PS may play an important role in mediating or reinforcing adverse birth outcomes (ABO) such as fetal growth restriction (FGR) in maternal schistosomiasis, possibly by placental inflammation.

Background: Schistosome egg deposition in pregnant women may affect the placenta of infected mothers and cause Placental Schistosomiasis (PS). Histopathological examination of placental tissue is an inadequate detection method due to low sensitivity. So far, there has not been any sys-tematic review on PS. Methods: We conducted a systematic literature search on PubMed and in-cluded relevant secondary literature found in the citations of the primarily included publications. Results: We found a total of 8 publications describing PS with a total of 92 cases, describing egg deposition of dead and/or viable eggs and worms of S. haematobium and S. mansoni in placental tissue. One cross-sectional study investigating the prevalence of PS and its association to adverse birth outcomes, found 22% of placentas to be infested using a maceration technique but only < 1% using histologic examination. Additionally, no direct link to deleterious pregnancy outcomes could be shown. Conclusions: PS is a highly unattended and underdiagnosed condition in en-demic populations, due to a lack of awareness as well as low sensitivity of histopathological examinations. However, PS may play an important role in mediating or reinforcing adverse birth outcomes (ABO) such as fetal growth restriction (FGR) in maternal schistosomiasis, possibly by placental inflammation.

Background The detection of schistosome-derived antigens in urine is a highly effective diagnostic approach for controlling schistosomiasis. It offers greater sensitivity compared to parasitological methods and involves a more convenient, user-friendly lab-based method. This diagnostic approach is particularly advantageous for pregnant women and young children, as early detection of active infections can lead to prompt treatment with Praziquantel (PZQ). The freeBILy clinical trial in Gabon (NCT03779347) evaluated the accuracy of the circulating anodic antigen (CAA) test for detecting Schistosoma haematobium (Sh) infections in pregnant women as well as an endpoint measure for PZQ efficacy. Methods The accuracy of the upconverting particle lateral flow (UCP-LF) CAA urine test was comprehensively evaluated using a cross-sectional design and comparing it against urine filtration (UF) and PCR. Subsequently, Sh-positive pregnant women were enrolled in sub-study and received a single dose of PZQ either immediately (intervention) or after delivery (control) to assess the safety of PZQ use during pregnancy and to monitor the kinetics of CAA levels following PZQ administration. Finally, in an observational, longitudinal study mothers and their newborns were followed to determine the incidence of schistosomiasis in infants with accurate diagnostics. Results A total of 733 pregnant women were enrolled in this study with mean age 25.3 years. The prevalence of schistosomiasis measured by the respective tests was 18% (UF), 19% (UCP-LF CAA), and 12% (PCR). Compared to the composite reference standard, the sensitivity of UCP-LF CAA was 71.8%, with 64% and 68% for UF and PCR, resp. Conclusion Preliminary data show a high prevalence of schistosomiasis among pregnant women. Furthermore, the UCP-LF-CAA test was more sensitive than conventional microscopy, which contributed to the improved health of pregnant women as they were treated during pregnancy. PZQ treatment had no deleterious effects on mother nor child, and administrating it to pregnant women can be considered to be safe.