Caseris M, Burdet C, Lepeule R, Houhou N, Yeni P, Yazdanpanah Y, Joly V
Service de maladies infectieuses et tropicales, hôpital Bichat-Claude-Bernard, 36, rue Huchard, 75018 Paris, France.
Service de maladies infectieuses et tropicales, hôpital Bichat-Claude-Bernard, 36, rue Huchard, 75018 Paris, France.
Rev Med Interne. 2015 May;36(5):339-45. doi: 10.1016/j.revmed.2014.10.362. Epub 2015 Jan 8.
Measles is a highly contagious infectious disease, which needs more than 95% worldwide vaccination coverage of 2 doses to be eradicated. Despite an important involvement of the WHO for massive immunization, goals have not bean reached, and outbreaks can occur at any time in many countries, including Western Europe. In France, 22,000 cases were identified between 2009 and 2011, mainly in infants and young adults, which are not or not enough vaccinated (one dose). In 2012, even though the number of cases has drastically decreased, the outbreak is still going on, especially in South of France. That is why every clinician needs to be concerned about the clinical manifestations of the disease, and its complications. Besides a febrile rash, measles is often responsible of pneumonia and biologic hepatitis in adults. Hepatitis does not seem frequent in children. Clinicians need to be aware of specific complications, like encephalitis in case of cellular immunodepression, high risk of pneumonia in pregnant women. In patients previously vaccinated, incidence of complications is the same but patients are not contagious. Even if measles diagnosis is clinical, blood confirmation by serology is recommended in France when possible. Outcome is mainly favourable, but measles is not well-tolerated with high levels of hospitalisation even without any complication. Vaccination is the only way to protect against it.
麻疹是一种高度传染性的传染病,要想根除该病,全球两剂疫苗接种覆盖率需超过95%。尽管世界卫生组织大力参与大规模免疫接种工作,但目标尚未实现,包括西欧在内的许多国家仍可能随时爆发疫情。在法国,2009年至2011年间确诊了22000例病例,主要集中在婴儿和年轻人中,这些人未接种疫苗或接种不足(仅一剂)。2012年,尽管病例数大幅下降,但疫情仍在持续,尤其是在法国南部。这就是为什么每位临床医生都需要关注该病的临床表现及其并发症。除了发热性皮疹外,麻疹在成人中常引发肺炎和肝损伤。肝损伤在儿童中似乎并不常见。临床医生需要了解特定的并发症,如细胞免疫抑制时发生的脑炎、孕妇患肺炎的高风险。在先前接种过疫苗的患者中,并发症发生率相同,但患者不具有传染性。即使麻疹的诊断基于临床症状,但在法国,如有可能,建议通过血清学进行血液确诊。麻疹的预后总体良好,但即使没有任何并发症,麻疹的耐受性也较差,住院率较高。接种疫苗是预防麻疹的唯一方法。