The 1984/85 rubella epidemic in Austria

As a consequence of the rubella epidemic in Austria in 1979, prophylaxis against this disease was intensified. In spite of this measure, however, there was an increase in cases of rubella in 1984/85. The peak incidence in both years occurred in May. In 1984, most cases were found in Vienna, Lower and Upper Austria, and Salzburg, whereas in 1985, Styria and Vienna were most affected. The clinical diagnosis of rubella was confirmed serologically in 685 patients. Of these, 151 were pregnant women and 104 were women of childbearing age who gave no information as to pregnancy. Due to the virtually complete recognition of cases, which usually led to therapeutic abortion, only 7 cases of intrauterine rubella infection were recorded. In spite of the vaccination of all prepuberal schoolgirls, of women at occupational risk, and of seronegative women after delivery, 10% of women of childbearing age still have no reliable immunity (HI titre 1:32) to rubella. This situation can be improved only by testing women at around 20 years of age for immunity (irrespective of their vaccination status) and vaccinating them if necessary.     

High rubella seronegativity in daycare educators

BACKGROUND: Congenital rubella syndrome, which is associated with severe malformations, can result from infants exposed in utero to maternal rubella infection. Health care workers and school-based educators are targeted for immunization, but evidence is scarce on rubella seronegativity in daycare centre educators who appear to be a high-risk occupational group. The purpose of the study was to generate new evidence on the magnitude of rubella seronegativity and associated risk factors in daycare centre educators. METHODS: Sera and questionnaires were collected between October and December 2001 from 481 female educators working in 81 daycare centres in Montréal, Québec. Rubella IgG serology was performed using ELISA. RESULTS: An overall seronegativity of 10.2% was found. The positive predictive value of previous rubella vaccination with seropositivity was high (92.1%). Ninety-one percent of the women were of childbearing age (= 49 years). Only 1.3% (n = 6) were currently pregnant, none of whom were seronegative. Significant predictors of seronegativity for educator- and daycare-level variables included lack of previous rubella vaccination (OR = 3.60; 95% CI: 1.43, 9.01), not having own children (OR = 3.76; 95% CI: 1.67, 8.55), age per 5-year increment (OR = 0.81; 95% CI: 0.66, 0.99), and increased number of colds in educators in the daycare centre in the last two weeks (OR = 1.15; 95% CI: 1.01, 1.31). INTERPRETATION: The high proportion of seronegativity, in addition to the potential increased transmission in daycare centres emphasize the need for a review of the rubella vaccination recommendations and health promotion interventions targeted to this occupational group.     

Pregnancy and adult congenital heart disease

Increasing numbers of women with complex congenital heart disease are reaching childbearing age. Pregnancy is a major issue in the management of adult congenital heart disease. Cardiac disease is one of the most common causes of maternal morbidity and mortality. Complications, such as growth retardation, preterm and premature birth and even fetal and neonatal mortality, are more frequent among children of women with congenital heart disease. The risk of complications is determined by the severity of the cardiac lesion, the presence of cyanosis, the maternal functional class and the use of anticoagulation. However, the pathophysiology of these complications is not completely understood and may be related to a diminished increase in cardiac output and/or endothelial dysfunction. The management of pregnant cardiac patients is based on limited clinical information. This article reviews prepregnancy counseling and management during pregnancy in patients with congenital heart disease.     

Pregnancy and adult congenital heart disease

Increasing numbers of women with complex congenital heart disease are reaching childbearing age. Pregnancy is a major issue in the management of adult congenital heart disease. Cardiac disease is one of the most common causes of maternal morbidity and mortality. Complications, such as growth retardation, preterm and premature birth and even fetal and neonatal mortality, are more frequent among children of women with congenital heart disease. The risk of complications is determined by the severity of the cardiac lesion, the presence of cyanosis, the maternal functional class and the use of anticoagulation. However, the pathophysiology of these complications is not completely understood and may be related to a diminished increase in cardiac output and/or endothelial dysfunction. The management of pregnant cardiac patients is based on limited clinical information. This article reviews pre-pregnancy counseling and management during pregnancy in patients with congenital heart disease.     

妇女风疹病毒,弓形虫、巨细胞病毒感染调查分析

目的本文主要探讨风疹病毒,弓形虫、巨细胞病毒的IgG、IgM在产科和妇科人群中的分布。为预防TORCH感染和做好优生优育工作提供依据。方法采用化学发光法检测产科和妇科人群的风疹病毒,弓形虫、巨细胞病毒的IgGI、gM,并对两组人群进行比较。结果本次调查结果上海市TORCH感染中,育龄孕妇风疹病毒IgG阳性率为82.65%,弓形虫IgG阳性率为0.092%,巨细胞病毒IgG阳性率为94.75%;风疹病毒IgM阳性率为9.25%,弓形虫IgM阳性率为3.55%,巨细胞病毒IgM阳性率为2.49%。结论上海市育龄妇女巨细胞病毒、风疹病毒感染率较高,提示应及早进行育龄妇女TORCH筛查,以做好优生优育工作,提高出生人口素质。     

Predictive value of serological tests in rubella virus infection during pregnancy

In an attempt to define diagnostic criteria that may help to distinguish the congenital rubella syndrome (CRS) from subclinical intrauterine rubella virus (RV) infection, maternal and fetal serum samples were analyzed using (1) enzyme immunoassay employing RV synthetic peptides as antigen, (2) IgG avidity assay, and (3) immunoblot under nonreducing conditions, in addition to hemagglutination inhibition and commercial enzyme immunoassays. Infants born with CRS and their mothers were shown to reveal low or undetectable levels of E2-specific antibodies and deficient IgG recognizing the major neutralizing antibody-inducing epitope on the E1 protein (SP15). Antibody responses were normal in mothers with presumed RV reinfection as well as in asymptomatic infants born after maternal primary rubella. The results indicate that the maturation of specific humoral immune responses is obviously less efficient when intrauterine RV infection results in CRS. The detection of high avidity IgG, conformational E2-specific as well as SP15-reactive antibodies may serve as a potential predictor for a benign outcome of intrauterine RV infections.     

Hypoplasia of the abdominal aorta associated with rubella syndrome.

Our patient, a 23-year-old white woman with congenital rubella syndrome, presented with claudication and upper extremity hypertension. To our knowledge this is the first patient with congenital rubella syndrome to present with an abdominal coarctation. Since 75% of the patients with abdominal coarctation are young women, this may be only a chance association.     

Hygiene interventions for prevention of cytomegalovirus infection among childbearing women: systematic review

Title.  Hygiene interventions for prevention of cytomegalovirus infection among childbearing women: systematic review.
Aim.  This paper is a report of a systematic review to examine the effectiveness of preventive interventions to reduce congenital cytomegalovirus transmission and infection among women of childbearing age.
Background.  Congenital cytomegalovirus has been identified as the leading infectious cause of damage to the growing fetus in developed countries, including Down syndrome, fetal alcohol syndrome and spina bifida. Despite the prevalence and consequences of this infection, it has a low profile and pregnant mothers are often unaware of the risks and protective behaviours related to its transmission. Women with children in daycare and nurses working with children are particularly at risk of acquiring the virus.
Data sources.  A computerized literature search for articles up to 1 December 2007 was performed using MEDLINE (from 1950); EMBASE (from 1980) and CINAHL (from 1982).
Review methods.  Both authors independently reviewed studies that met inclusion criteria and assigned a quality rating determined by the number of validity criteria met. Differences were discussed until consensus was reached.
Findings.  Differences in hygiene behaviour changes were most statistically significant for pregnant, seronegative women. Although the methodological quality of the three included studies was not strong, seroconversion rates consistently decreased as cytomegalovirus education and support increased.
Conclusion.  Nurses can act as preventive agents for cytomegalovirus infection through education about hygiene precautions during antenatal care and through preventive measures in the workplace. The review findings suggest educational interventions in hygiene practices have the potential to be a feasible, large-scale, primary prevention strategy.     

Congenital toxoplasmosis

Approximately 85 percent of women of childbearing age in the United States are susceptible to acute infection with the protozoan parasite Toxoplasma gondii. Transmission of T. gondii to the fetus can result in serious health problems, including mental retardation, seizures, blindness, and death. Some health problems may not become apparent until the second or third decade of life. An estimated 400 to 4,000 cases of congenital toxoplasmosis occur in the United States each year. Serologic tests are used to diagnose acute T. gondii infection in pregnant women. Because false-positive tests occur frequently, serologic diagnosis must be confirmed at a Toxoplasma reference laboratory before treatment with potentially toxic drugs is considered. In many instances, congenital toxoplasmosis can be prevented by educating pregnant women and other women of childbearing age about not ingesting raw or undercooked meat, using measures to avoid cross-contamination of other foods with raw or undercooked meat, and protecting themselves against exposure to cat litter or contaminated soil.     

Managing varicella zoster infection in pregnancy

Varicella zoster virus (VZV) infection can be serious for pregnant women and their babies, although it is rare. The implications of primary VZV infection vary with the gestational age at infection. For the mother, the risk of severe illness is greatest after mid-pregnancy, when she is relatively immunocompromised. For the fetus, the risk of congenital infection is greatest when maternal infection occurs in the first or second trimester. Maternal infection is preventable by preconception vaccination.     

不同风疹疫苗接种策略对广东省风疹流行的影响

目的 了解不同风疹疫苗接种策略对广东省风疹流行的影响。 方法 采用描述流行病学方法对广东省1997-2010年风疹流行情况进行分析。 结果 广东省自20世纪90年代开始推广风疹疫苗接种,通过2000年15岁以下儿童的风疹疫苗普种、2001年风疹疫苗接种纳入计划免疫管理和2008年9月实施扩大免疫规划,风疹年平均报告发病率由1997-2000年的3.20/10万降至2001-2008年的0.78/10万和2009-2010年的1.11/10万;0~19岁青少年儿童发病比例减少,20~39岁年龄组人群发病比例增加,其中育龄妇女病例比例增加明显,分别为20.48%、33.82%和49.38%。2010年20~39岁本地户籍育龄妇女风疹IgG抗体阳性率为81.30%。 结论 通过实施不同风疹疫苗接种策略,广东省风疹发病率下降,儿童青少年发病比例减少,发病年龄后移,育龄妇女感染风疹的风险加大,发生先天性风疹综合征的危险增加。     

早产儿先天性巨细胞病毒感染特点及危险因素分析

目的调查早产儿先天性巨细胞病毒(CMV)感染状况,分析其特点及危险因素。方法选择住院的早产儿,分别采用荧光定量PCR(FQ-PCR)法和ELISA法检测脐血血清CMV IgM与DNA。同时记录新生儿和母亲的人口学信息,采用二元多因素logistic回归分析早产儿先天性CMV感染相关影响因素。结果共纳入1315例早产儿,血清CMV IgM和(或)CMV DNA阳性者占1.98%(26/1315),CMV IgM阳性者占1.44%(19/1315),血清CMV DNA阳性者占1.14%(15/1315),CMV IgM与CMV DNA均为阳性者占0.61%(8/1315)。早产儿先天性CMV感染症状较为轻微。母亲年龄<25岁、初次妊娠、孕期胎膜早破是早产儿先天性CMV感染的危险因素(P均<0.05)。结论早产儿先天性CMV感染发生率较高,以无症状感染为主。提高年轻育龄妇女对CMV的知晓率、加强早产儿先天性CMV感染的管理是很有必要的。     

铜陵地区2845例孕妇TORCH感染状况分析

目的了解铜陵地区孕妇TORCH感染状况,分析其与妊娠年龄的关系。方法对2010年1月至2012年11月进行孕检的2 845例孕妇抽取血样,用酶联免疫吸附法对TORCH-IgM抗体进行检测。结果孕妇TORCH-IgM总阳性率2.601%,弓形虫(TOX),风疹病毒(RV),巨细胞病毒(CMV)和单纯疱疹病毒(HSVⅡ)IgM抗体阳性率分别为0.141%,0.211%,1.617%,0.738%;其中高龄(35～50岁)孕妇组TORCH-IgM总阳性率和CMV-IgM阳性率(6.178%,5.405%)均明显高于适龄(20～34岁)组(2.243%,1.237%)(P<0.01)。结论铜陵地区孕妇TORCH-IgM阳性率较低,高龄是孕妇发生CMV感染的一个高危因素,应加强孕妇的产前筛查,提高人口质量。     

Varicella-zoster virus infections in pregnancy

Chickenpox is an uncommon disease in women during pregnancy. If, however, maternal varicella infects the fetus, intrauterine death or severe diseases (congenital or fetal varicella syndrome) may ensue depending on the time of maternal infection. On the basis of our own clinical observations and virological testing we report on 31 women with varicella during pregnancy and their infants. Five neonates born to mothers with varicella between the 8th and 21st week showed clinical signs of the congenital varicella syndrome. Varicella-zoster virus DNA could be detected in different tissues, including lung, liver, skin and adrenal glands. As a consequence of maternal chickenpox within 12 days before delivery, 6 newborn babies developed neonatal varicella. Measures for diagnosis, treatment and prophylaxis are discussed.     

Rubella virus genome diagnosis during pregnancy and mechanism of congenital rubella

Fetal infection with rubella virus was diagnosed based on the detection of viral genome in the fetus-derived tissues. While viral genomes were detected in 41 of those 112 cases (36.7%) where rubella virus infection of the mother was apparent, only 7 of 141 cases (5. 0%) showed evidence of fetal infection when maternal rubella infection was inapparent. All 184 babies born of genome-negative mothers have no congenital disorder, while 2 out of 7 genome-positive babies have a congenital disorder (28.6%). Rubella virus was not transmitted across the placenta when infection occurred prior to gestation. Transmission rate increased to a maximum level during the first trimester and declined to 0% until 20 weeks of gestation. Interval of viral transmission from the onset of rash in the mother was about 10 days to the placental villi and 20-30 days to the fetus. A phylogenetic tree of 61 virus isolates suggested no difference of virulence/teratogenicity among the virus isolates.     

3320例孕中期妇女唐氏综合征产前筛查结果分析

目的探讨孕中期妇女(14~20周)血清标志物甲胎蛋白(AFP)、游离绒毛膜促性腺激素(f-βhCG)及游离雌三醇(uE3)在胎儿唐氏综合征(DS)、18三体综合征和神经管畸形(NTD)筛查中的应用。方法采用化学发光技术检测孕妇血清中AFP、f-βhCG及uE3的浓度,结合孕妇年龄、孕周,利用上海腾臣唐氏软件计算胎儿患DS、18三体综合征和NTD的风险概率。结果对3 320例孕妇筛查结果进行分析,DS高危孕妇155例,阳性率4.67%;18三体综合征高危孕妇27例,阳性率0.81%;NTD高危孕妇57例,阳性率1.72%。经羊水穿刺确诊DS25例,经B超确诊NTD 9例。结论产前筛查对于严重先天性缺陷儿的宫内诊断具有重要的临床价值,对孕妇血清中AFP、f-βhCG及uE3标志物检测可有效地筛查出DS高危孕妇,能显著降低需要进行创伤性产前诊断的孕妇比例,降低唐氏儿出生率。     

Dermatologic manifestations of infectious diseases in pregnancy

Several pathogens that have been identified as teratogenic or fetotoxic have associated dermatologic changes when active infection is present. Viral and bacterial teratogenic pathogens include herpes simplex virus 1, herpes simplex virus 2, varicella-zoster virus, cytomegalovirus, human papilloma virus, human parvovirus B19, rubella, viral hepatitis, syphilis, and gonorrhea. This article focuses on the characteristic dermatologic manifestation of these diseases in pregnancy; diagnostic strategies; interpretation of maternal and fetal laboratory test results; treatment of the pregnant woman, fetus, and newborn; and congenital outcomes of treated and untreated infection. Emphasis is placed on vaccination and prevention of transmission of infection to pregnant women.     

育龄妇女细菌性阴道病的发病情况及高危因素分析

目的 了解本地区育龄妇女细菌性阴道病（BV）的发病情况及相关高危因素.方法 对2011年1月-2013年1月本地区1967例育龄妇女体检结果进行统计分析,并对研究对象行问卷调查,探讨BV感染的高危因素.结果 1967例体检育龄妇女BV检出率12.35％（243/1967）;243例细菌性阴道病患者阴道分泌物清洁度检查Ⅰ-Ⅱ级24例,占9.9％,Ⅲ级以上为21 9例,占90.1％,胺实验阳性201例,占82.7％;人流史、口交为细菌性阴道病高危因素,使用避孕套为细菌性阴道病保护性因素.结论 对细菌性阴道病流行病学特征及高危因素的研究有助于临床更好的预防及治疗,维护女性的生殖健康.     

温州地区育龄期妇女及孕妇弓形虫感染情况调查

目的了解温州地区育龄期妇女及孕妇弓形虫感染情况,为预防弓形虫先天性感染提供参考资料。方法收集577份婚前体检的育龄期妇女及229份孕妇体检静脉血标本,分离血清,采用间接酶联免疫吸附试验(ELISA)检测弓形虫特异性抗体IgG和IgM,以OD490≥cut off值定为阳性。结果 577份育龄期妇女血清中弓形虫特异性抗体IgG阳性标本452例,阳性率为78.34%;弓形虫特异性抗体IgM阳性标本3例,阳性率为0.52%。229份孕妇血清中弓形虫特异性抗体IgG阳性标本171例,阳性率为74.67%;弓形虫特异性抗体IgM阳性标本16例,阳性率为6.99%。结论温州地区妇女人群(育龄期妇女和孕妇)弓形虫隐性感染较为普遍,而孕妇IgM抗体阳性的新近感染率明显高于育龄期妇女。     

学龄前孤独症谱系障碍儿童相关危险因素的调查分析

目的:探讨学龄前儿童孤独症谱系障碍(ASD)患病的危险因素。方法:选取2019年4月至12月就诊的100例ASD患儿为ASD组,健康儿童100例为对照组。通过自编调查问卷的方式收集2组的ASD相关因素,进行组间比较;再选取有差异的指标进行Logistic回归分析,寻找ASD的危险因素。结果:ASD组的养育环境、母亲焦虑或抑郁、孕期经常使用电脑、母亲生育年龄、全面发育落后及婴幼儿睡眠障碍与对照组的差异有统计学意义(P0.05)。Logistic回归分析结果发现养育环境、母亲焦虑或抑郁、孕期经常使用电脑、母亲生育年龄较大、全面发育落后及婴幼儿睡眠障碍均为ASD的危险因素。结论:家庭养育环境、孕妇精神状态、孕期经常使用电脑、母亲生育年龄较大、儿童全面发育落后及睡眠障碍可能为ASD发病危险因素,需重视以上危险因素,实现早期筛查、诊断与干预。