Bar-Oz B, Ford-Jones L, Koren G
Division of Infections Dieases at the Hospital for Sick Children, Toronto.
Can Fam Physician. 1999 Aug;45:1865-9.
QUESTIONMy 22-year-old patient immigrated to Canada 6 years ago from a country where there are no routine immunizations. She is now at 10 weeks' gestation and was exposed to a child with rubella infection. Her immune status is unknown. Should I give her passive or active immunization? How should I follow her pregnancy? And what should I tell her about the risk for her fetus?ANSWERIf the exposure took place less than 1 week ago, blood should be sent for rubella antibody titre. If results are positive for IgG, she is immune and there is no risk for the fetus. If a patient's immune status is unknown and the time of exposure is uncertain, serum samples for rubella antibodies should be obtained 3 weeks apart. Detection of rubella-specific IgM in a sample will confirm recent infection. Your patient should be counseled about the potential risk for her fetus and referred to high-risk pregnancy clinic for follow up. If seroconversion does not take place, she requires immunization immediately postpartum before discharge from hospital.
问题
我有一位22岁的患者，6年前从一个没有常规免疫接种的国家移民到加拿大。她现在怀孕10周，接触了一名患风疹感染的儿童。她的免疫状况未知。我应该给她进行被动免疫还是主动免疫？我应该如何跟踪她的孕期情况？关于她胎儿的风险我应该告诉她什么？
答案
如果接触发生在不到1周前，应采集血液检测风疹抗体滴度。如果IgG结果为阳性，她具有免疫力，胎儿没有风险。如果患者的免疫状况未知且接触时间不确定，应相隔3周采集血清样本检测风疹抗体。样本中检测到风疹特异性IgM将证实近期感染。应向你的患者咨询其胎儿的潜在风险，并转诊至高危妊娠门诊进行随访。如果未发生血清转化，她需要在产后立即住院期间进行免疫接种。
