Regional Virus Laboratory, Royal Victoria Hospital, Belfast, UK.
Royal Jubilee Maternity Hospital, Royal Victoria Hospital, Belfast, UK.
J Med Microbiol. 2013 Jan;62(Pt 1):86-92. doi: 10.1099/jmm.0.046714-0. Epub 2012 Sep 13.
In Europe, fetal loss due to Parvovirus B19 (B19V) is under-reported and a poorly addressed occupational risk to pregnant women. This is exemplified internationally, where it was unmentioned in the last two European Centre for Disease Prevention and Control (ECDC) annual surveillance reports or its 2009 special report on infections in pregnancy. To assess this potential for underestimating B19V fetal loss in pregnancy, we undertook a systematic review of practice in Northern Ireland in the management and reporting of B19V infections over a 12-month period of heightened transmission, one of six observed in a span of 9 years. Pregnant and non-pregnant women presented with symptomatic infection in 24 and 93 % of confirmed B19V infections, respectively, with no difference in viral loads. There was underinvestigation of viral causes of fetal loss, with only 143/2739 (5 %) tested for B19V, and a failure to follow up most non-immune women tested following rash contact. Occupational exposure was recorded in 31/60 (51.6 %) of pregnancies audited following rash exposure, the majority teachers or day care workers. Against a background seroprevalence of 66.5 % immunity in women of child-bearing years, two patterns of infection were identified. Firstly, pregnant women investigated for a rash or exposure to slapped cheek syndrome, where an infection incidence of 18 % was observed, resulted in 42 confirmed infections, all proceeding to healthy term deliveries. Secondly, pregnant women with unsuspected infection had six cases of confirmed B19V fetal loss, including four of 22 (18 %) diagnosed at autopsy, of which three were non-hydropic. While many studies have reported B19V fetal loss in pregnancy, there are no robust public health surveillance figures to draw on. That all six confirmed fetal losses came from the small number of miscarriages/stillbirths investigated, 143 out of 2739, suggests inadequate follow-up of those pregnancies where B19V-related fetal loss may be most common, and supports the need for enhanced surveillance pilots to address this significant gap in public health knowledge.
在欧洲，由于细小病毒 B19（B19V）导致的胎儿丢失报告不足，且这对孕妇来说是一个职业风险，尚未得到妥善处理。国际上也存在这种情况，在过去两份欧洲疾病预防控制中心（ECDC）年度监测报告或其 2009 年关于妊娠感染的特别报告中都没有提到这一点。为了评估这种低估妊娠细小病毒 B19 胎儿丢失的可能性，我们对北爱尔兰在病毒传播加剧的 12 个月期间管理和报告 B19V 感染的做法进行了系统审查，这是 9 年期间观察到的 6 个周期之一。有症状感染的孕妇和非孕妇分别占确诊 B19V 感染的 24%和 93%，病毒载量没有差异。对胎儿丢失的病毒原因调查不足，只有 143/2739（5%）例进行了 B19V 检测，并且大多数非免疫女性在皮疹接触后没有进行随访。在 60 例（51.6%）经皮疹暴露后进行了监测的妊娠中记录了职业暴露，其中大多数是教师或日托工作者。在育龄妇女的血清流行率为 66.5%的背景下，确定了两种感染模式。首先，对皮疹或 slapped cheek 综合征暴露的孕妇进行了调查，观察到感染发生率为 18%，导致 42 例确诊感染，所有孕妇均顺利足月分娩。其次，对无症状感染的孕妇进行了 6 例确诊的细小病毒 B19 胎儿丢失，其中 4 例（18%）在尸检中诊断，其中 3 例为非水肿性。虽然许多研究报告了妊娠期间细小病毒 B19 导致的胎儿丢失，但没有可靠的公共卫生监测数据可供参考。所有 6 例确诊的胎儿丢失都来自于调查的少数流产/死胎中，即 2739 例中有 143 例，这表明对那些可能最常见细小病毒 B19 相关胎儿丢失的妊娠的随访不足，并支持需要加强监测试点计划，以解决这一重大公共卫生知识差距。
