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Investigating the pregnant woman exposed to a child with a rash

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e1790 (Published 26 March 2012) Cite this as: BMJ 2012;344:e1790

Rapid Response:

Re: Investigating the pregnant woman exposed to a child with a rash

According to author the rash could be due to any one of several infectious or non-infectious causes, but the initial approach needs to focus on those infections that pose risks to the mother and fetus or neonate, and for which intervention can improve the outcome.1 These infections are measles, rubella, parvovirus B19, and varicella zoster virus1. But author has forgotten that secondary syphyllis may also present in this way and can be harmful to the unborn child, however it is treatable and should be kept in mind.

Moreover, due to widespread immunization epidemiological changes have occurred in Measles. These epidemiological changes include a shift in the age distribution of measles towards older children and adults2,3,4.

Thus, we can infer that child with a rash could be a secondary syphillitic case and the pregnant woman should be investigated for this too. And measles may occurr in adults as well and the pregnant woman should be investigated when exposed to any person presenting with rash and just not the child only.

References:

1. Macmahon E.Investigating the pregnant woman exposed to a child with a rash. BMJ. 2012 Mar 26;344:e1790. doi: 10.1136/bmj.e1790.

2. Cutts FT, Steinglass R.Should measles be eradicated? BMJ. 1998 Mar 7;316(7133):765-7.

3. Cutts FT, Henderson RH, Clements CJ, Chen RT, Patriarca PA. Principles of measles control. Bull WHO. 1991;69:1–7.

4. Gay NJ, Hesketh LM, Morgan-Capner P, Miller E. Interpretation of sero-logical surveillance data for measles using mathematical models: implications for vaccine strategy. Epidemiol Infect. 1995;115:139–156.

Competing interests: No competing interests

13 April 2012
Neeru Gupta
Scientist E
KK Jani, Shalini Singh
Indian Council of Medical Research
Ansari Nagar, New Delhi-110029