Susceptibility to infectious rash illness in pregnant women from diverse geographical regions

Varicella-zoster (VZV), rubella (RV) and parvovirus B19 (B19V) infections are important causes of rash illness in pregnancy, due to their potential adverse impact on both mother and fetus. We determined susceptibility to these infections in pregnant women attending our hospital in 2002. Age and nationality were recorded. Sera were tested for VZV, RV, and B19V antibody by enzyme immunoassay. Of 7,980 women screened for VZV IgG, 11.3% were seronegative and therefore susceptible to infection. Across different worldwide regions, 6.9% of Irish and other Western European women were susceptible to VZV, compared to 19.7% of other women tested (p < 0.001), most of whom were from Central and Eastern Europe, sub-Saharan Africa and Asia. Of 7,872 women screened for RV IgG, 2.3% were seronegative. Few Irish (0.6%) or other Western European women (0.7%) were rubella non-immune, but 5.5% of women from other regions tested were susceptible to rubella (p < 0.001). A random subset of 1,048 women were tested for B19V IgG. About 38% were susceptible, varying from 22% to 63% across the different regions studied. There are important differences in immunity to these infections and so of potential risk of an adverse outcome in indigenous and immigrant pregnant women in Ireland.     

Guidelines on the management of,and exposure to,rash illness in pregnancy (including consideration of relevant antibody screening programmes in pregnancy)

These guidelines, produced by the Public Health Laboratory Service (PHLS) aim to help decision making in the investigation and management of pregnant women who have 'a rash compatible with a systemic viral illness', or who have contact with a person with such an illness. They address particularly rubella, parvovirus B19, and varicella-zoster virus infection, but consider other infective causes of rash illness in the United Kingdom. The guidelines give the magnitude and degrees of risk to the fetus in terms of outcomes for the gestation at which maternal infection occurs. Recent changes in epidemiology and management lead to the following specific advice, which both updates and re-affirms established guidelines. All pregnant women with a non-vesicular rash illness should be investigated simultaneously for rubella and parvovirus B19 infection. All pregnant women who have had significant contact with a person suffering from a non-vesicular illness should be investigated for asymptomatic parvovirus B19 infection, and for asymptomatic rubella infection unless there is satisfactory evidence of past rubella infection (vaccine or natural infection). A significant contact is defined as being in the same room for over 15 minutes, or face-to-face contact. Specific investigation to detect asymptomatic rubella reinfection is not advised. It is essential to confirm by adequate laboratory investigation all cases of possible rubella and parvovirus B19 infection in pregnancy. Management of proven rubella in pregnancy should be based on established risks of adverse outcome. Women with proven parvovirus B19 infection in the first 20 weeks of pregnancy should be followed by regular, ultrasound scanning, and referred to Regional Units of Fetal Medicine if hydrops fetalis is detected. Parvovirus B19 antibody screening in pregnancy is not advised, and consensus has been reached on the procedures to be followed for rubella antibody screening, including the concentration of antibody that reflects past infection. Oral antiviral treatment (aciclovir) is advised with informed consent for pregnant women who present within 24 hours of onset of varicella. Referral to hospital and intravenous antiviral treatment is indicated for pregnant women with complications and/or risk factors, or whose illness continues for six days or more. Pregnant women exposed to varicella or herpes zoster can be reassured as to their protection if they themselves have a history of varicella or herpes zoster. If this history is uncertain or not known, susceptibility should be tested, and varicellazoster immunoglobulin (VZIG) offered to those found susceptible if within 10 days of first exposure. Infants whose mothers develop varicella 7 days before to 7 days after delivery should be given VZIG, and aciclovir if onset was 4 days before to 2 days after delivery.     

Human parvovirus B19 infection in healthcare workers

This paper reports the occurrence of human parvovirus B19 infectionin seven healthcare workers in an acute hospital. The clinicalpresentation mimicked that of rubella and the diagnosis wasmade by the detection of human parvovirus B19 lgM antibody inblood samples taken from the affected members of staff. Thepaper discusses the importance of accurate diagnosis of B19infection because this virus has been implicated in causingor exacerbating a variety of medical conditions. B19 infectionmay be serious for people with chronic haemolytic anaemias,those who are immunocompromised or those who are pregnant. B19infection in pregnancy may be a cause of hydrops fetalis, particularlyif the infection occurs during the second trimester. This isin contrast to the risk of intra-uterine rubella infection whichis maximal in the first few weeks of pregnancy and which affectsfetal development. The paper highlights the need for guidelinesfor occupational health practitioners on the management of parvovirusB19 infection and the need to make healthcare workers awareof the importance of this infection.     

Parvovirus B19 infection in pregnancy: a cause of non-immune hydrops fetalis

Four pregnancies, in two women aged 39 and two women aged 34 years respectively, were complicated by foetal parvovirus B19 infection. First-trimester intrauterine death resulting from multiple congenital anomalies was diagnosed in one patient with proven foetal parvovirus B19 infection. In three patients foetal hydrops was found in the second trimester with variable clinical course. In one of them, foetal hydrops resulted in second-trimester foetal death; in another, foetal hydrops resolved following intrauterine blood transfusion and in a third foetal hydrops resolved spontaneously. Foetal parvovirus B19 infection was diagnosed by polymerase chain reaction (PCR) using foetal cells obtained by amnioscentesis. It is concluded that maternal parvovirus B19 infection is mostly asymptomatic. However, the clinical impact of maternal infection on the foetus is diverse, i.e. infection may result in foetal death or--transient--foetal morbidity, in particular foetal anaemia. In mothers with proven foetal parvovirus B19 infection close monitoring of the foetus by ultrasound is warranted. Occasionally intrauterine transfusion is required. From the literature to date, the estimated incidence of maternal parvovirus B19 infection in pregnancy is 3-7%. The vertical transmission rate approximates 30%. When pregnancy is complicated by foetal hydrops foetal parvovirus B19 infection should be kept in mind.     

人微小病毒B19母婴感染的血清学调查

目的调查该地区B19病毒母婴感染情况。方法用ELISA和套式PCR分别检测母婴血清B19病毒IgG、IgM抗体和DNA。结果92例孕妇血清B19病毒IgG抗体阳性率3704%,720例孕妇血清B19病毒IgM抗体阳性率902%,而95例婴儿脐血IgM抗体阴性;720例孕妇血清和95例婴儿脐血B19病毒DNA亦均为阴性。结论部分孕妇存在B19病毒感染既往史,少数孕妇有近期或急性B19病毒感染,但母婴垂直传播B19病毒风险很低。     

风疹病毒研究进展（综述）

风疹病毒是披膜病毒科风疹病毒属的惟一成员，是第一个被证明具有致畸性的病毒。如果在妊娠的前3个月感染了风疹病毒，具有很高的先天性风疹综合症（CRS）的风险，特别是那些没有免疫保护的妇女。应用先进的产前诊断技术鉴别鉴别诊断胎儿有无损伤是非常必要的，因为当在妊娠前3个月被诊断为原发性风疹病毒感染，孕妇要考虑是否妊娠终止。在这篇文章里我们主要综述了风疹病毒（RV）的流行病学、基因结果、临床特征和RV的实验室诊断。     

Parvovirus B19 infection in five European countries: seroepidemiology, force of infection and maternal risk of infection

We conducted a seroprevalence survey in Belgium, Finland, England & Wales, Italy and Poland on 13 449 serum samples broadly representative in terms of geography and age. Samples were tested for the presence of immunoglobulin G antibody using an enzyme immunoassay. The age-specific risk of infection was estimated using parametric and non-parametric statistical modelling. The age-specific risk in all five countries was highest in children aged 7-9 years and lower in adults. The average proportion of women of child-bearing age susceptible to parvovirus B19 infection and the risk of a pregnant women acquiring B19 infection during pregnancy was estimated to be 26% and 0.61% in Belgium, 38% and 0.69% in England & Wales, 43.5% and 1.24% in Finland, 39.9% and 0.92% in Italy and 36.8% and 1.58% in Poland, respectively. Our study indicates substantial epidemiological differences in Europe regarding parvovirus B19 infection.     

深圳市宝安区育龄妇女风疹病毒免疫力状况调查

目的:通过对育龄妇女风疹抗体水平的调查,了解育龄妇女对风疹病毒免疫力状况,为科学接种疫苗提供理论根据。方法:采用定量间接ELISA方法对深圳市宝安区20～40岁1291例育龄妇女进行风疹病毒免疫力检测。结果:深圳市宝安区育龄妇女风疹病毒无保护力人群占到15.88％,明显高于80年代的调查结果;另外,20～29岁年龄组、30～40岁年龄组风疹病毒无保护力人群分别为19.4％,13.5％,两组比较统计学有显著差异(P<0.05)。结论:约有1/5生育活跃期育龄妇女对风疹病毒无保护力,孕前应加强风疹疫苗注射,以减少先天性风疹综合征的发生。     

Parvovirus B19 outbreak on an adult ward.

In November and December 1992, an outbreak of parvovirus B19 infection occurred among patients and staff on an adult mixed surgical ward at a large hospital in London. Three patients and 15 staff members were serologically confirmed as acute cases. The attack rate among susceptible members of staff was 47%. In those infected, arthralgia (80%) and rash (67%) were the most common symptoms. Of six susceptible in-patients on the ward, three became infected. One of the in-patients who had carcinoma of the mouth was viraemic for more than 10 days with marrow suppression resulting in the postponement of chemotherapy until intravenous immunoglobulin was given and he was no longer viraemic. Control measures taken included closure of the ward to new admissions, transfer of only immune staff to the ward, and restriction of the ward nursing staff to working only on that ward. Although no specific exposure was conclusively identified as a risk factor, there was a suggestion of an increased risk of acquiring parvovirus B19 infection among those staff who did not adopt strict hand washing procedures after each physical contact with a patient (RR = 2.33; P = 0.07). Knowledge of parvovirus B19 among interviewed health care workers was poor: only 42% reported knowing about parvovirus B19 and only 38% could name a patient category at risk of a severe outcome following infection. This is the first report of a nosocomial outbreak affecting an adult ward and of possible transmission of parvovirus B19 infection from staff to in-patients. Hospital control of infection teams should include parvovirus B19 in their outbreak containment plans.     

Rubella infection during pregnancy in the 1985–86 epidemic: Follow-up after seven years

The study covered 310 pregnant women from southern Poland who were exposed to rubella during the 1985–86 epidemic, none of whom had been vaccinated against rubella. Rubella specific antibodies were detected by hemagglutination –inhibition (HI) tests, and IgM antibodies by enzyme immunoassay (ELISA) (Organon Teknika). Clinical symptoms according to anamnesis were recorded. The consequences of serologically confirmed maternal rubella on the course of pregnancy and on fetal outcome were evaluated. IgM antibodies could be examined in only 10 newborns at delivery or in the first days of life. After seven years, follow-up studies of children born to infected mothers were done. The mental development of 14 of these children was evaluated with Terman-Merrill test. Among 310 women examined during pregnancy, rubella infection was confirmed serologically in 46 cases (14.8%). All but 3 of those had clinical symptoms. The course of pregnancy was observed in 36 of the infected mothers. Only 5 women (22.7%) who had the infection in the first trimester of pregnancy delivered a healthy child. The rate of complications in pregnancy among women infected in the second trimester was lower, and 8 (66.7%) bore healthy children. All the children born to mothers infected in the third trimester were healthy. Eight of the 10 newborns examined at delivery were IgM positive. Of 29 children congenital rubella syndrome (CRS) was confirmed in 5 cases, CRS compatible or CRS possible in 7 and 3 had congenital infection only confirmed serologically (IgM-positive) without defects or symptoms. Seventheen (58.6%) children were found healthy including the 3 who had congenital infection only. The mental development of 14 children at age 7 was assessed; 10 cases (72%) fell within rank II 130-85, and 4 (28%) were of borderline intelligence. The study indicates that congenital rubella is still a serious problem in Poland. Immunization was introduced only in 1988–89, for 13-year-old girls. Women of child- bearing age should be screened for rubella antibodies and those susceptible to rubella infection should be vaccinated.     

Seroprevalence of rubella among Jordanian women of childbearing age

This study was conducted to assess immunity (seroprevalence) to rubella among Jordanian women of childbearing age. A multistage cluster sampling was used to recruit 1125 women of childbearing age (15-49 year) from the 12 Governorates of Jordan. Anti-rubella antibody titers were measured using enzyme-linked immunoassays. The overall immunity rate to rubella among women in childbearing age was 90.9% (CI: 88.8-92.9). However, the immunity rate was significantly lower in younger women aged 15-19 years (83%) compared to the whole cohort (P相似文献   

HIV感染者微小病毒B19抗体的调查

目的研究HIV感染人群微小病毒B19抗体的流行情况。方法采用ELISA方法检测126例HIV感染者和95例健康人血清中微小病毒B19-IgG、IgM抗体的阳性率,分析影响阳性率的因素。结果HIV感染人群的B19-IgG、IgM阳性率分别为61.1%和7.1%,健康人群的B19-IgG、IgM阳性率分别为17.9%和1.1%。两者均有明显的差异(P<0.05)。结论HIV感染人群微小病毒B19远期和近期感染率明显高于健康人群。     

Prevalence of rubella-specific IgG antibody in non-immunized pregnant women in Maiduguri,north eastern Nigeria

The prevalence of IgG antibody specific to the rubella virus was assessed in 207 consenting pregnant women. The women were in the age range of 14 to 40 years (mean 25.8 years) and parity range of 0 to 8 (mean para 4), in their first and second trimesters of pregnancy. All attended the antenatal clinic of a tertiary health facility (University of Maiduguri Teaching Hospital) in northeastern Nigeria. Of the 207 serum samples tested, 112 (54.1%) were positive for rubella IgG antibody. In this area therefore, the proportion of susceptible pregnant women to rubella virus is up to 46%. The results from this study also indicated that with increased maternal age the percentage of immune women increased significantly (P = 0.04382) from 23.8% in the 14 to 19 years age group to 74.4% in the age group of 30 to 40 years. There was again a gradual increase in rubella seroprevalence from 43% amongst primigravidae to 59% and 78% in multiparous and grandmultiparous women respectively. The pregnancy outcome was normal in 27% of the women studied, with miscarriage occurring in 24.6% and 24.2% each had a premature delivery and stillbirth. There were 30 (58.8%) miscarriages, 27 (54%) premature deliveries and 30 (60%) stillbirths, with no clinically detectable malformations in 25 (44.6%) of all the deliveries from the immune women. There is therefore, an increase in the number of rubella immune women with each of the pregnancy outcomes compared to the non-iminune ones. Hence, the need to protect children of these susceptible women from contracting congenital rubella and its sequelae by including routine rubella vaccination of all women of childbearing age in the current programme on immunization.     

Seroprevalence of parvovirus B19 infection in daycare educators

This study was undertaken to provide first-time estimates for the seroprevalence of parvovirus B19 infection among daycare educators in Montréal, Canada, and to identify factors associated with seropositivity. A cross-sectional design was used. Directors and educators from 81 daycare centres (DCCs) were surveyed about DCC and personal characteristics respectively, and serum samples from 477 female educators were tested for parvovirus B19 IgG antibodies. The seroprevalence of parvovirus B19 was 70%. Parvovirus B19 seropositivity was significantly associated with age and with working experience in DCCs, but the latter association was restricted to educators aged less than 40 years. In conclusion, working as a daycare educator appears to be associated with increased risk of acquiring parvovirus B19 infection, but this finding will require further investigation. Because of the large proportion of educators susceptible to acquiring parvovirus B19 infection, our findings also highlight the need for preventive measures.     

2017年成都地区孕妇孕早中期红肉摄入及其对妊娠期糖尿病影响的前瞻性研究

目的 了解成都地区孕妇孕早、中期红肉摄入现状,探讨孕早、中期红肉摄入量对妊娠期糖尿病(gestational diabetes mellitus,GDM)的影响.方法 采用前瞻性研究,于2017年2-7月通过立意抽样方法选取成都市某三甲妇幼医疗机构产前门诊孕8～14周单胎健康孕妇为研究对象,于纳入时通过问卷调查收集孕妇...     

A comparison of oral fluid collection devices for use in the surveillance of virus diseases in children

Three oral fluid collection devices (OraSure, Omni-SAL and Oracol) were compared in terms of the quality of oral fluid collected by each device for antibody testing and their acceptability to participants. Participants (143 children aged 3.5-5 y from North Hertfordshire, UK, who had recently received DTaP and MMR vaccination) were randomised to use one of the three types of collection device. Oral fluid was collected by a parent who completed a short questionaire recording information on ease of use and willingness to use the device again. A matching serum sample was collected by a nurse. Oral fluid samples were screened for total IgG and IgM by ELISA and for rubella specific IgG and parvovirus specific IgG by radioimmunoassay. Serum samples were screened for rubella specific IgG and parvovirus B19 specific IgG by ELISA. 87.4% (125) of participants provided a matching oral fluid and serum sample. Of these, 100% (125) and 10.4% (13) had serum IgG specific for rubella and parvovirus B19, respectively. The Oracol device provided oral fluid samples with the highest geometric mean titres of total IgG and IgM and with rubella specific IgG results which correlated most closely with those of matching sera. A higher proportion of parents found the Oracol and OraSure devices easier to use than the Omni-SAL (P<0.001) and the proportion who would not take another test was higher for the Omni-SAL than for the Oracol or Orasure. Oral fluid samples collected by each of the devices gave qualitative results acceptable for surveillance and epidemiological studies of rubella and parvovirus B19. The highest quality oral fluid sample for antibody testing in terms of total IgG and IgM concentration and rubella specific IgG concentration was collected by the Oracol. The acceptability to participants of both the Oracol and OraSure was high. As the cheapest device available, the Oracol is the preferred oral fluid collection device for studies involving children in the UK.     

Rubella susceptibility in pregnant women and results of a postpartum immunization strategy in Catalonia,Spain

BackgroundElimination of congenital rubella syndrome depends not only on effective childhood immunization but also on the identification and immunization of rubella susceptible women. We assessed rubella susceptibility among pregnant women and evaluated the adherence and response to postpartum immunization with measles, mumps and rubella (MMR) vaccine.MethodsCross-sectional study of women who gave birth at the Hospital Clinic de Barcelona (Spain) between January 2008 and December 2013. Antenatal serological screening for rubella was performed in all women during pregnancy. In rubella-susceptible women, two doses of MMR vaccine were recommended following birth. We evaluated rubella serological response to MMR vaccination in mothers who complied with the recommendations.ResultsA total of 22,681 pregnant women were included in the study. The mean age was 32.3 years (SD 5.6), and 73.6% were primipara. The proportion of immigrants ranged from 43.4% in 2010 to 38.5% in 2012. The proportion of women susceptible to rubella was 5.9% (1328). Susceptibility to rubella declined with increasing maternal age. Immigrant pregnant women were more susceptible to rubella (7.6%) than women born in Spain (4.6%). Multivariate analyses showed that younger age (≤19 years) aOR 1.7 (95% CI 1.1–2.5), primiparas aOR 1.3 (95% CI 1.1–1.5) and immigrant women aOR 1.6 (95% CI 1.4–1.8) were more likely to be susceptible. The second dose of MMR vaccine was received by 57.2% (718/1256) of rubella-susceptible women, with the highest proportion being immigrant women compared with women born in Spain. After vaccination, all women showed rubella immunity.ConclusionsThe higher rubella susceptibility found in the three youngest age groups and in immigrant women highlights the relevance of antenatal screening, in order to ensure identification and postpartum immunization. The postpartum immunization strategy is an opportunity to protect women of childbearing age and consequently prevent occurrence of CRS, and to increase vaccination coverage against rubella and other vaccine-preventable diseases.     

甘肃省孕前期及孕早期妇女风疹感染血清学调查

目的 了解甘肃省妇女妊娠前期及妊娠早期风疹感染现况，为“甘肃省出生缺陷干预工程”项目的实施提供基线资料．方法 根据甘肃地理特点及经济状况，按分层整群抽样方法，抽取了4个县中妊娠前期妇女518例及妊娠3个月内孕妇373例。每人采静脉血5ml，统一由甘肃计生委科研所进行IgM和IgG抗体检测。结果 妊娠前期妇女风疹IgM和IgG抗体阳性率分别为5.02%和83.78％，妊娠3个月内孕妇风疹IgM和IgG抗体阳性率分别为2．41％和86．33％。妊娠前期IgM和IgG抗体双项阳性率为2．14％；妊娠早期IgM和IgG双项阳性率为5．02％．妊娠前期妇女风疹感染率为88．80％，妊娠3个月内孕妇风疹感染率为88．74％。结论 甘肃省妇女妊娠前期及妊娠早期的风疹感染较为普遍。     

Pilot study on the use of sublingual misoprostol for medical abortion.

A new route of sublingual administration of misoprostol was used by 25 women with first trimester, non-viable intrauterine gestation and by 18 women requesting mid-trimester termination of pregnancy. Twenty-three women (92%, 95% CI 75, 98) with first trimester, non-viable gestation had complete abortion after sublingual misoprostol. All women (100%, 95% CI 82, 100) requesting second trimester abortion aborted, and the median induction-to-abortion interval was 11.6 h. Our preliminary results on sublingual misoprostol show that it is a promising method for medical abortion. Prospective randomized studies are required to compare its efficacy and side effects with vaginal misoprostol and to work out the dosage and dosing interval.