The effect of Ribavirin for Crimean-Congo hemorrhagic fever in pregnancy and its outcome; a warning for physicians and health care providers

Crimean-Congo hemorrhagic fever (CCHF) is an acute tick-borne infection which is associated with significant mortality (up to 50%) and serious risk in pregnancy. Ribavirin is an antiviral and of course a teratogenic drug that has significant effects in the treatment of CCHF. The present study was performed with aim to examine the level of awareness of people with CCHF about the teratogenicity of the drug in the embryonic period and the outcome of pregnancy during six months after taking ribavirin.

In this retrospective study, the files of all the hospitalized patients with a definite diagnosis of Crimean Congo fever in two hospitals of Mashhad were assessed over 10 years. Telephone calls were made to the patients and their families and the required information was collected. Data were analyzed using SPSS software (version 22) and Chi-square and Exact Fisher tests. P< 0.05 was considered statistically significant.

In this study, 177 CCHF patients were assessed, and their information regarding education or lack of education about pregnancy at discharge was available for 84 patients, only 9 people (5.1% of all patients) were trained about contraception after treatment with Ribavirin. In the follow-up of the patients, 3 pregnancies resulted in abortion and 7 unhealthy children were reported due to lack of attention to the principles of pregnancy prevention at the time of taking ribavirin and 6 months later.

Considering the effects of teratogenicity of ribavirin, it seems necessary to provide adequate training to patients about the risks of pregnancy during the 9-month after receiving ribavirin.