Zgórniak-Nowosielska I, Zawilińska B, Szostek S
Department of Virology, Jagiellonian School of medicine, Cracow, Poland.
Eur J Epidemiol. 1996 Jun;12(3):303-8. doi: 10.1007/BF00145421.
The study covered 310 pregnant women from southern Poland who were exposed to rubella during the 1985-86 epidemic, none of whom had been vaccinated against rubella. Rubella specific antibodies were detected by hemagglutination-inhibition (HI) tests, and IgM antibodies by enzyme immunoassay (ELISA) (Organon Teknika). Clinical symptoms according to anamnesis were recorded. The consequences of serologically confirmed maternal rubella on the course of pregnancy and on fetal outcome were evaluated. IgM antibodies could be examined in only 10 newborns at delivery or in the first days of life. After seven years, follow-up studies of children born to infected mothers were done. The mental development of 14 of these children was evaluated with Terman-Merrill test. Among 310 women examined during pregnancy, rubella infection was confirmed serologically in 46 cases (14.8%). All but 3 of those had clinical symptoms. The course of pregnancy was observed in 36 of the infected mothers. Only 5 women (22.7%) who had the infection in the first trimester of pregnancy delivered a healthy child. The rate of complications in pregnancy among women infected in the second trimester was lower, and 8 (66.7%) bore healthy children. All the children born to mothers infected in the third trimester were healthy. Eight of the 10 newborns examined at delivery were IgM positive. Of 29 children congenital rubella syndrome (CRS) was confirmed in 5 cases, CRS compatible or CRS possible in 7 and 3 had congenital infection only confirmed serologically (IgM-positive) without defects or symptoms. Seventeen (58.6%) children were found healthy including the 3 who had congenital infection only. The mental development of 14 children at age 7 was assessed; 10 cases (72%) fell within rank II 130-85, and 4 (28%) were of borderline intelligence. The study indicates that congenital rubella is still a serious problem in Poland. Immunization was introduced only in 1988-89, for 13-year-old girls. Women of child-bearing age should be screened for rubella antibodies and those susceptible to rubella infection should be vaccinated.
该研究涵盖了310名来自波兰南部的孕妇，她们在1985 - 1986年风疹疫情期间接触过风疹病毒，且均未接种过风疹疫苗。通过血凝抑制（HI）试验检测风疹特异性抗体，采用酶免疫测定法（ELISA）（欧加农公司产品）检测IgM抗体。根据既往病史记录临床症状。评估血清学确诊的母亲风疹对妊娠过程及胎儿结局的影响。仅对10名新生儿在分娩时或出生后的头几天进行了IgM抗体检测。7年后，对感染母亲所生儿童进行了随访研究。其中14名儿童的智力发育通过特曼 - 梅里尔测试进行评估。在孕期接受检查的310名女性中，46例（14.8%）血清学确诊感染风疹。其中除3例之外均有临床症状。对36名感染风疹的母亲的妊娠过程进行了观察。仅5名（22.7%）在妊娠早期感染的女性分娩出健康婴儿。妊娠中期感染风疹的女性中，妊娠并发症发生率较低，8名（66.7%）产下健康婴儿。妊娠晚期感染风疹的母亲所生的所有婴儿均健康。分娩时接受检查的10名新生儿中有8名IgM呈阳性。在29名儿童中，5例确诊为先天性风疹综合征（CRS），7例可能或疑似CRS，3例仅血清学确诊为先天性感染（IgM阳性），但无缺陷或症状。17名（58.6%）儿童被认定健康，包括3例仅为先天性感染的儿童。对14名7岁儿童的智力发育进行了评估；10例（72%）处于II级130 - 85，4例（28%）智力处于临界水平。该研究表明，先天性风疹在波兰仍是一个严重问题。1988 - 1989年才开始对13岁女孩进行免疫接种。应对育龄妇女进行风疹抗体筛查，对易感染风疹的妇女应进行疫苗接种。
