Infectious Diseases Institute, Rambam Health Care Campus, 3109601, Haifa, Israel.
Division of Epidemiology, Ministry of Health, 9101002, Jerusalem, Israel.
Eur J Clin Microbiol Infect Dis. 2018 May;37(5):883-888. doi: 10.1007/s10096-017-3181-7. Epub 2018 Jan 17.
To investigate the association between the incidence of human brucellosis (HB) and adverse pregnancy outcomes (APOs), a population-based, cross-sectional aggregate data study was conducted in Israel between 2010 and 2014. HB-endemic localities were matched by ethnicity, population size and socioeconomic status to localities with a low incidence of HB. We compared APO rates in high-incidence vs low-incidence localities. The primary outcome was intrauterine fetal demise (IUFD). Secondary outcomes were premature birth (less than 37 weeks), early or threatened labour and poor fetal growth. APOs are expressed as events per 1,000 live or dead births. Eleven high-incidence localities, all Arab villages or cities, were matched to 11 low-incidence localities. Localities were well-matched with regard to the matching criteria, fertility indices, health insurance access and education, but were imbalanced geographically. All defined APOs occurred significantly more frequently in the high-incidence localities. The associations translated to an absolute increase of 3.6 cases of IUFD (95% CI 1.6-5.3), 11.7 preterm births (4.8-18.3), 6.6 cases of early or threatened labour (2.2-10.9) and 7 cases of poor fetal growth (3-10.8), per 10,000 live or dead births. Owing to a geographic imbalance between high- and low-incidence localities, we conducted an analysis restricted to Southern localities of Arab Bedouins showing a significant association between yearly HB incidence and IUFD incidence, odds ratio 1.05 (1.03-1.06). HB incidence is epidemiologically linked to serious pregnancy complications. Early detection of infection through active surveillance during pregnancy followed by appropriate treatment should be evaluated as additional public heath strategy in endemic settings.
为了研究人类布鲁氏菌病（HB）的发病率与不良妊娠结局（APO）之间的关系，本研究于 2010 年至 2014 年在以色列进行了一项基于人群的、横断面的聚合数据研究。将 HB 流行地区按照种族、人口规模和社会经济地位与 HB 发病率低的地区相匹配。我们比较了高发病率地区和低发病率地区的 APO 发生率。主要结局是宫内胎儿死亡（IUFD）。次要结局是早产（不足 37 周）、早期或威胁性分娩和胎儿生长不良。APO 以每 1000 例活产或死产的事件表示。11 个高发病率地区，均为阿拉伯村庄或城市，与 11 个低发病率地区相匹配。这些地区在匹配标准、生育率指数、医疗保险获得情况和教育方面匹配良好，但在地理位置上不平衡。所有定义的 APO 在高发病率地区发生的频率明显更高。这些关联转化为 IUFD 绝对增加 3.6 例（95%CI 1.6-5.3）、早产 11.7 例（4.8-18.3）、早期或威胁性分娩 6.6 例（2.2-10.9）和胎儿生长不良 7 例（3-10.8），每 10000 例活产或死产增加 7 例。由于高发病率和低发病率地区之间存在地理不平衡，我们对阿拉伯贝都因南方地区进行了分析，发现每年 HB 发病率与 IUFD 发病率之间存在显著关联，比值比为 1.05（1.03-1.06）。HB 发病率与严重妊娠并发症有流行病学联系。应通过在妊娠期间进行主动监测来早期发现感染，并随后进行适当治疗，这应作为流行地区的额外公共卫生策略进行评估。
