Pennsylvania issues alert on congenital measles—something US hasn't seen for decades

Pennsylvania’s health department issued a health alert Monday as cases of measles in pregnancy and, in turn, cases of congenital measles have continued to increase. Before the current outbreak—which continues to rage across the state—congenital measles cases hadn’t been seen in decades, the department noted in its advisory.

宾夕法尼亚州卫生部周一发布了一项健康警报，原因是孕期麻疹病例以及随之而来的先天性麻疹病例持续增加。该部门在公告中指出，在当前这场席卷全州的疫情爆发之前，先天性麻疹病例已数十年未见。

The alert included detailed clinical guidance for managing measles exposures and cases during pregnancy as well as cases in newborns. Many doctors have never seen such cases in their careers given the decades of successful use of the measles, mumps, and rubella (MMR) vaccine.

该警报包含了针对孕期麻疹暴露和病例，以及新生儿病例管理的详细临床指导。鉴于麻疹、腮腺炎和风疹（MMR）疫苗已成功使用了数十年，许多医生在职业生涯中从未见过此类病例。

But now, with vaccination rates slipping nationwide, the highly infectious virus is better able to get footholds in communities and spread rapidly through under-vaccinated pockets, as is happening in Pennsylvania. As of October 19, Pennsylvania had reported 1,286 measles cases this year across 42 counties.

但现在，随着全国疫苗接种率的下滑，这种高传染性病毒更容易在社区中立足，并迅速在疫苗接种不足的群体中传播，宾夕法尼亚州目前的情况正是如此。截至10月19日，宾夕法尼亚州今年已在42个县报告了1,286例麻疹病例。

Of those, 247 have been hospitalized, and six people have reportedly died (though the latest reported death is still pending an investigation by the state health department before it is added to the state tally). The Pennsylvania health department did not immediately respond to a request for information from Ars Technica.

其中，247人住院治疗，据报道有6人死亡（尽管最新报告的一例死亡尚待州卫生部调查确认，之后才会计入州统计数据）。宾夕法尼亚州卫生部未立即回应Ars Technica的信息查询请求。

But reporting from The 19th earlier this month put the number of measles cases during pregnancy at 53. At least one case of congenital measles led to a death; the first death reported in the current outbreak was in a newborn baby boy, who died immediately after birth while his mother was severely ill with measles.

但《The 19th》本月初的报道显示，孕期麻疹病例数为53例。至少有一例先天性麻疹导致了死亡；当前疫情中报告的首例死亡是一名新生男婴，他在出生后立即死亡，当时其母亲正患有严重的麻疹。

Risky infection: Pregnant people who have not been vaccinated against measles nor previously had the infection are susceptible. A case of measles during pregnancy increases the risk of hospitalization, pneumonia, the need for oxygen support or mechanical ventilation, and death. It also increases the risk of miscarriage, stillbirth, low birth weight, and preterm labor.

高风险感染：未接种麻疹疫苗且此前未感染过麻疹的孕妇易受感染。孕期感染麻疹会增加住院、肺炎、需要氧气支持或机械通气以及死亡的风险。它还会增加流产、死产、低出生体重和早产的风险。

The MMR vaccine is not recommended during pregnancy because it is a live attenuated vaccine and poses a theoretical risk of causing an infection in a fetus. If a pregnant person is exposed to the virus, they’re recommended to receive intravenous immunoglobulin to help protect against infection—but only if it is given within six days of exposure.

孕期不建议接种MMR疫苗，因为它是一种减毒活疫苗，存在导致胎儿感染的理论风险。如果孕妇接触了该病毒，建议接受静脉注射免疫球蛋白以帮助预防感染——但前提是必须在接触后的六天内进行注射。

If there’s a measles infection during pregnancy, the measles virus can pass to a fetus in utero or can transmit during or just after birth, leading to a congenital case. These cases can vary widely in symptoms and severity. Some babies will remain asymptomatic while others develop severe, multisystem disease and death.

如果孕期发生麻疹感染，麻疹病毒可能会在子宫内传给胎儿，或在分娩期间及分娩后立即传播，从而导致先天性病例。这些病例的症状和严重程度差异很大。一些婴儿可能保持无症状，而另一些则会发展为严重的全身性疾病并导致死亡。

Some common symptoms of congenital measles include fever and jaundice. They can also develop the telltale measles rash, but it is sometimes delayed or atypical given a newborn’s underdeveloped immune system. Other symptoms can include low platelet counts, pneumonia, and neurologic complications.

先天性麻疹的一些常见症状包括发烧和黄疸。患儿也可能出现典型的麻疹皮疹，但由于新生儿免疫系统发育不全，皮疹有时会出现延迟或表现不典型。其他症状可能包括血小板计数低、肺炎和神经系统并发症。

Even if a newborn survives the acute infection, they are at risk of long-term complications. These include immune amnesia, a type of immunosuppression in which the measles virus destroys immune cells and adaptive responses. They are also at risk of subacute sclerosing panencephalitis (SSPE), a progressive, fatal neurological disorder that can strike years after an infection.

即使新生儿在急性感染中幸存下来，他们仍面临长期并发症的风险。这些并发症包括“免疫失忆”，这是一种麻疹病毒破坏免疫细胞和适应性反应的免疫抑制现象。他们还面临亚急性硬化性全脑炎（SSPE）的风险，这是一种进行性、致命的神经系统疾病，可能在感染多年后发作。

The alert warns that babies with congenital measles need long-term clinical follow-up and monitoring for these neurologic and immunologic complications, and parents need counseling on how to spot early signs of SSPE, which include seizures, regression in milestones, and academic difficulties in older children.

该警报警告称，先天性麻疹患儿需要长期的临床随访，以监测这些神经和免疫并发症。家长需要接受咨询，了解如何识别SSPE的早期迹象，包括癫痫发作、发育里程碑倒退，以及大龄儿童在学业上的困难。