Mortamet G, Dina J, Freymuth F, Guillois B, Vabret A
Laboratoire de virologie, Centre national de référence de la rougeole et des paramyxovirus respiratoires, CHU de Caen, avenue Clemenceau, 14000 Caen, France.
Arch Pediatr. 2012 Nov;19(11):1269-72. doi: 10.1016/j.arcped.2012.08.006. Epub 2012 Oct 22.
Measles is one of the most contagious diseases implicated in an outbreak in Western Europe for a few years. In France, the outbreak began in 2008, especially in the southern regions. Most of the cases are mild but deleterious effects can occur in infants, during the pregnancy, or in immunosuppressive patients. Pneumonia and encephalitis are the major complications in these patients. Measles illness during pregnancy results in a higher risk of premature labor, spontaneous abortion, and low-birthweight infants. Death from measles was reported in approximately 0.3% of cases. The National Reference Center for measles and paramyxoviridae is implicated in biological confirmation of cases and epidemiologic surveillance. Virologic diagnosis consists in a direct detection of viral RNA (real time PCR), or indirect detection of the immune response (IgM and IgG) in saliva samples. The measles genotype is determined by sequencing a 450 nucleotids fragment of the N gene, as the World Health Organization (WHO) recommendation. This molecular analysis helps determine the geographic origin of the virus and the viral strains circulating in the country. In 2011, 3105 specimens were received. PCR was positive for 1990 patients (64%), with a large majority of children younger than 2 years of age and young adults. The most important cause of measles resurgence is low vaccination coverage. The role of pediatricians is important in order to achieve the goal of 95% of vaccination coverage established by the WHO.
麻疹是近年来在西欧爆发疫情的最具传染性的疾病之一。在法国,疫情于2008年开始,尤其在南部地区。大多数病例症状较轻,但婴儿、孕妇或免疫抑制患者可能会出现有害影响。肺炎和脑炎是这些患者的主要并发症。孕期感染麻疹会导致早产、自然流产和低体重儿的风险增加。据报道,麻疹病例的死亡率约为0.3%。国家麻疹和副粘病毒参考中心参与病例的生物学确认和流行病学监测。病毒学诊断包括直接检测病毒RNA(实时PCR),或间接检测唾液样本中的免疫反应(IgM和IgG)。按照世界卫生组织(WHO)的建议,通过对N基因的450个核苷酸片段进行测序来确定麻疹基因型。这种分子分析有助于确定病毒的地理来源以及在该国传播的病毒株。2011年,共收到3105份样本。1990名患者(64%)的PCR检测呈阳性,其中绝大多数是2岁以下的儿童和年轻人。麻疹疫情再次出现的最重要原因是疫苗接种覆盖率低。为实现WHO制定的95%的疫苗接种覆盖率目标,儿科医生的作用至关重要。