Walpole I R, Hodgen N, Bower C
Department of Paediatrics, University of Western Australia, Princess Margaret Hospital for Children, Perth.
Med J Aust. 1991 Jun 3;154(11):720-4. doi: 10.5694/j.1326-5377.1991.tb121307.x.
To determine the birth prevalence of congenital toxoplasmosis in Western Australia.
A prospective serological study of randomly selected pregnant women and their newborn infants. Paired sera collected from the mothers at their first antenatal visit and cord blood specimens taken from their infants were tested for toxoplasmosis by the direct agglutination test and Toxoplasma IgM-capture enzyme-linked immunosorbent assay.
A major Perth metropolitan obstetric teaching hospital where approximately one-quarter of infants born in Western Australia during January 1986 to December 1989 inclusive were delivered.
Sera were obtained from 10,207 pregnant women presenting for routine clinical evaluation at their first antenatal visit. Cord blood specimens were taken from 18,908 infants; 7523 of these could be paired to maternal specimens.
Maternal infection was indicated in cases where Toxoplasma specific IgM antibody was present or where an initial maternal specimen gave negative results for Toxoplasma antibody but the paired cord blood specimen gave positive results. Toxoplasma specific IgM antibody in a cord blood specimen indicated fetal infection.
Of the 10,207 women 3544 (35%) were Toxoplasma immune at their first antenatal visit; in 11 Toxoplasma specific IgM antibody was detected. There was no serological or clinical evidence of congenital toxoplasmosis in any of the offspring of these 11 mothers. The rate of maternal infection in susceptible pregnancies was 1.6 per 1000; the maternal-fetal transmission rate was estimated to be no greater than 24%. Three of the 18,908 cord blood specimens tested gave positive results for Toxoplasma specific IgM antibody giving a birth prevalence of congenital infection of 0.23 per 1000 births to non-immune mothers. There were no clinical features of congenital infection in these three infants but they will require long-term follow-up. Thirteen of the 14 mothers infected during pregnancy were interviewed retrospectively and in only three was a known risk factor for infection present.
a toxoplasmosis screening programme for pregnant mothers is not justifiable in Western Australia. A public education programme is also likely to have limitations.
确定西澳大利亚先天性弓形虫病的出生患病率。
对随机选取的孕妇及其新生儿进行前瞻性血清学研究。在孕妇首次产前检查时采集配对血清，从其婴儿处采集脐带血标本，通过直接凝集试验和弓形虫IgM捕获酶联免疫吸附试验检测弓形虫病。
珀斯一家主要的大都市产科教学医院，1986年1月至1989年12月（含）期间在西澳大利亚出生的婴儿中约有四分之一在此分娩。
从10207名首次产前检查前来进行常规临床评估的孕妇中获取血清。从18908名婴儿处采集脐带血标本；其中7523份可与母亲的标本配对。
若存在弓形虫特异性IgM抗体，或母亲最初的标本弓形虫抗体检测结果为阴性但配对的脐带血标本检测结果为阳性，则表明母亲感染。脐带血标本中弓形虫特异性IgM抗体表明胎儿感染。
在10207名女性中，3544名（35%）在首次产前检查时对弓形虫免疫；11名检测出弓形虫特异性IgM抗体。这11名母亲的任何后代均无先天性弓形虫病的血清学或临床证据。易感妊娠中母亲感染率为每1000例中有1.6例；母婴传播率估计不超过24%。在18908份检测的脐带血标本中，3份弓形虫特异性IgM抗体检测结果为阳性，非免疫母亲所生婴儿的先天性感染出生患病率为每1000例中有0.23例。这三名婴儿无先天性感染的临床特征，但需要长期随访。对14名孕期感染的母亲中的13名进行了回顾性访谈，其中只有三名存在已知的感染风险因素。
在西澳大利亚，对孕妇进行弓形虫病筛查项目不合理。公共教育项目可能也有局限性。
