Shedding of Ebola Virus in an Asymptomatic Pregnant Woman

Shedding of Ebola Virus in an Asymptomatic Pregnant WomanTo the Editor: In West Africa, the worst outbreak of Ebola virus disease (EVD) in history is continuing, with more than 11,100 deaths caused by the Zaire species (Zaire ebolavirus [EBOV]). 1 Symptoms include fever, headache, body pain, nausea with vomiting, diarrhea, hemorrhage, and symptoms of septic shock and multiorgan failure.It is thought that transmission occurs only through contact with body fluids from symptomatic patients. 2A 31-year-old woman in the late stage of a fifth pregnancy who had no history of coexisting illnesses or use of long-term medications presented to the hospital with suspected premature rupture of membranes.She was referred to the ELWA3 Ebola treatment unit (ETU) in Monrovia, Liberia, as was common practice in Monrovia for patients who potentially presented a hospital-exposure risk, such as during delivery.On admittance to the ETU, she had mild lower abdominal pain and sparse contractions and reported fetal movements (Fig. 1).She was afebrile and reported having had no contact with patients with EVD and did not meet the Ebola virus case definition.She underwent routine EBOV testing for anticipated transfer to the delivery clinic.On quantitative reverse-transcriptase-polymerase-chain-reaction (qRT-PCR) assay to detect L-gene sequences, her blood tested positive for EBOV, with a high viral load. 3Given the apparent asymptomatic presentation and since her acute symptoms were consistent with pregnancy-related issues, she was retested for EBOV on day 2, and the results were again positive.Additional EBOV testing was subsequently performed on blood and fluids to assess EBOV shedding to evaluate the potential risks associated with patient contact (Fig. 1), although no virus isolation was performed.All samples except those obtained from skin tested positive before the development of symptoms that were clearly associated with EVD.During the evening of day 3, she became mildly febrile and was considered to be symptomatic for EVD.During the following days, additional EVD-associated signs (vomiting, diarrhea,