日本未熟児新生児学会雑誌　第18巻　第1号　67～71頁（2006年）

日本未熟児新生児学会雑誌　18(1)：67-71；2006　

受付日：平成16．11．11

受理日：平成17．06．01

周産期麻疹の臨床的検討

Perinatal Measles

＊1沖縄県立中部病院　総合周産期母子医療センター新生児科，＊2同　小児科，＊3沖縄県立那覇病院

＊1 Department of Neonatal Medicine, Okinawa prefectural Chubu hospital，＊2 Department of Pediatrics, Okinawa prefectural Chubu hospital，＊3 Department of Pediatrics, Okinawa prefectural Naha hospital

小濱守安＊1・源川隆一＊1・真喜屋智子＊1・吉村仁志＊2・中矢代真美＊2・安次嶺馨＊3

Moriyasu KOHAMA＊1，Ryuichi GENKAWA＊1，Tomoko MAKIYA＊1， Hiroshi YOSHIMURA＊2，Mami NAKAYASHIRO＊2，Kaoru ASHIMINE＊3

Key Words：Neonatal measles，Vaccine，Maternal infection，Pregnancy

　1998年および2001年の633例の麻疹流行時に新生児麻疹4例，新生児麻疹疑い1例，妊産婦麻疹11例を経験した。新生児麻疹の発疹は軽微であり，発熱期間も短期間であった。麻疹罹患妊婦8例中2例が自然流産，3例が切迫流早産となった。6例は満期で分娩した。1例は母体麻疹発症が分娩の契機となった。ワクチン世代が親となる時代となってきたが，ワクチンにより抗体獲得した母親からは，経胎盤性の麻疹抗体の移行が少なく消失も早い。現在のワクチン接種状況では今後，妊婦・新生児麻疹例が増加する可能性がある。妊婦や新生児麻疹の予防には，短期的には妊娠適齢期の両親の麻疹抗体検査，妊娠前ワクチン接種を考慮する必要がある。最も重要なことは集団としての流行阻止であり，感染の危険性の高い1歳頃のワクチン接種率を95％以上に高め，さらに追加投与により集団の抗体保有率を高める必要がある。

　During 1998 to 2001, 450 cases of measles were admitted in Okinawa Chubu Hospital. Five cases of neonatal measles, 11 cases of pregnant women with measles were recorded. All of neonatal measles revealed mild symptom and rash resolved without pigmentation. Fever were also low grade or afebrile and the duration of fever were shorter than that of elder infants. In measles with pregnant women, there were 2 spontaneous abortions, and 3 threatened abortions, 6 cases were delivered spontaneously without sequale.
　One case was delivered by spontaneously during maternal measles. There were no preterm delivery. Early loss of maternally derived passive measles antibody may occur in infants of mothers who received measles vaccine because measles vaccine induces lower antibody titers than does natural infection.
　The most important thing is the prevention of measles in the community, maintaining high levels of measles immunity. The parents who have vaccine induced immunity will need second booster, and infants are recommended to achieve high vaccination rate at any year and receive second booster dose later.