MSF case studies show first two babies reported to be born Ebola-negative to mothers with the virus

Democratic Republic of Congo 2019 © Pablo Garrigos/MSF

NEW YORK/PARIS, DECEMBER 7, 2020—Doctors Without Borders/Médecins Sans Frontiéres’ (MSF) case studies published in The Lancet this month examine the first two Ebola-negative babies ever known to be born to Ebola-positive mothers. Both the mothers and babies received trial Ebola treatments while in an MSF-supported Ebola Treatment Center (ETC) in the Democratic Republic of Congo (DRC). Historically, nearly all babies born to Ebola-positive mothers have been miscarried or stillborn, or died shortly after birth. While the survival of these two newborns could signal that babies at risk of Ebola may benefit from these medicines immediately after they’re born, more research is needed before any conclusions can be made, said the international medical humanitarian organization.

“MSF has been working with affected countries to fight Ebola outbreaks for decades,” said Dr. Saschveen Singh, tropical infectious diseases advisor for MSF and one of the authors of the report. “These cases provide hope that Ebola may no longer be a death sentence for babies born to mothers with the virus. We can’t say for certain that these antibody therapies are the answer to preventing the spread of Ebola from mothers to their babies, but we can say these observations from our work in DRC are very encouraging and that more research should urgently be done for vulnerable groups like pregnant women and their babies.”

The paper published documents two babies who were born in an MSF-supported ETC in Beni, DRC in 2019 during the 2018–20 Kivu Ebola epidemic. Each set of mothers and infants were given monoclonal antibody treatment (mAB114 or REGN-EB3) as part of the PALM randomized controlled trial, which was led by the Institut National de Recherche Biomédicale, DRC Ministry of Health, and the National Institutes of Health. In addition to these medicines, strict infection prevention and control measures were in place at the ETC, which helped reduce the possibility of the babies being exposed after birth. Neither newborn developed Ebola while in the hospital and were able to be discharged home approximately 21 days after they were born.

Historically, babies born to mothers with Ebola are infected with Ebola themselves and very rarely have survived. Only 15 babies were reported to be born alive to Ebola-positive mothers before 2015, but all were infected and subsequently died within 28 days. Before these two babies observed in MSF’s case studies, only two others had been reported to survive past 28 days, but both were Ebola-positive at birth—one in Guinea in 2015 who received new treatments that were being studied at the time and one in DRC in 2019 who was born to a mother who was uninfected at the time of delivery after recovering from Ebola three weeks earlier.

“When Ebola hits a community, it hits hard,” Dr. Singh said. “The neonatal mortality rate during the West African Ebola epidemic was practically 100 percent for infants born to mothers with Ebola. Only one infected newborn who was given new Ebola treatments that were being studied was known to survive the West Africa outbreak. That means almost every single mother who contracted Ebola lost her baby. Most of those mothers tragically also lost their lives.”

Ebola is a viral hemorrhagic fever that has killed anywhere from 25 percent to 90 percent of infected people in past outbreaks, causing terror among affected communities. Until very recently, no effective treatments existed against Ebola. However, new tools have become available in the last several years to help fight the virus, including two effective vaccines and two antibody treatments that have been shown to reduce risk of death if given to people with Ebola early in the course of their infection. In the past, vulnerable groups like pregnant women and babies born to Ebola-positive mothers had been left out of most research and clinical trials, so health workers didn’t know exactly how to treat them to give them the best chance of survival. During the 2018–2020 Kivu Ebola epidemic in DRC, pregnant women and babies were offered new treatments and showed some promising outcomes, though further research is needed to determine the best possible care for these groups.

MSF has a long history of responding to Ebola outbreaks, including the largest one ever documented—in West Africa from 2014 to 2016—and several in DRC throughout the last few decades. Most recently, MSF responded to the outbreak in Équateur province that was declared in June and declared over in November.

“The best care someone with Ebola could hope for used to be supportive care, pain relief, and psychological support,” Dr. Singh said. “Our teams went from feeling like they were, at times, almost empty-handed during previous Ebola outbreaks—including the one in West Africa from 2014 to 2016—to finally having vaccines to prevent people from getting sick and some promising new treatments to offer to those who fall ill. However, we now need to learn more about how we can save the lives of every pregnant woman and baby exposed to Ebola. This means the global health community needs to continue this research and conversation before the next Ebola outbreak takes more lives.”