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新冠疫苗接种率过低,美国孕妇成“高危人群”

新冠疫苗接种率过低,美国孕妇成“高危人群”

Shira Stein, 彭博社 2021年08月30日
截至8月14日,美国有76.2%的孕妇未接种新冠疫苗。

德尔塔变种病毒在美国掀起新一波疫情。在此期间,许多健康的年轻孕妇因为感染新冠病毒,最终不得不住院接受呼吸机治疗,有的甚至导致早产或者死亡。

美国各地的医生均报告了这种趋势,主要集中在南方各州,但加利福尼亚州和华盛顿等地也有类似的情况。在之前的几波疫情当中并未出现过这种情况。截至8月14日,美国有76.2%的孕妇未接种疫苗。

《美国医学会杂志—网络公开版》(JAMA Network Open)本月发表的一篇论文称,与未感染新冠病毒的孕妇相比,感染新冠病毒的孕妇死亡概率要高出15倍,需要接受插管治疗的概率高出14倍,早产的概率高出22倍。华盛顿大学(University of Washington)的妇产科教授琳达•埃克特说:“我从未见过这类风险。”

孕妇不愿意接种疫苗的情况非常普遍,因为辉瑞(Pfizer Inc.)-BioNTech、Moderna Inc.和强生(Johnson & Johnson)的新冠疫苗在临床试验时均排除了孕妇。针对孕妇接种疫苗的研究在2月启动,目前有证据表明孕妇接种疫苗不会导致流产风险增加。美国卫生官员本月呼吁孕妇接种疫苗。

埃克特称:“现在我们已经掌握了大量更有说服力的数据,可以证明孕妇接种新冠疫苗的安全性,以及不接种疫苗可能面临的危险性。”

得克萨斯大学(University of Texas)奥斯丁•戴尔医学院(Austin Dell Medical School)女性健康教授、该校女性健康学会(Women’s Health Institute)妇幼内科专家艾莉森•卡希尔表示,孕妇较低的新冠疫苗接种比例和德尔塔变种病毒“导致出现重症和需住院治疗的孕妇数量大幅增加,有些患者甚至需要在重症监护室内接受治疗。因新冠病毒出现的极端重症的患者,让我们的医疗服务变得异常忙碌。”

对新冠疫苗的担忧

已经怀孕六个月的加布里埃尔•纳迪-麦吉住在纽约市。她在怀孕三个月之后接种了第一剂疫苗。此前她曾经担心疫苗会对胎儿造成伤害。但她表示,自己同时又担心免疫系统受损的其他妈妈们感染病毒,“我不想在没有接种疫苗的情况下去医院。我真的非常害怕。”

南佛罗里达大学(University of South Florida)妇产科医学院(College of Medicine Obstetrics and Gynecology)的院长朱迪特•路易斯表示,绝大多数因为新冠肺炎住院治疗的孕妇都没有接种疫苗。

路易斯说:“确实有一两例接种新冠疫苗后的突破性感染病例最终需要接受住院治疗,但她们不必使用呼吸机。”

佛罗里达州妇产科医生施薇塔•帕特尔指出,人们在怀孕期间通常会出现免疫系统变化,这增加了她们出现重症新冠肺炎的风险,可能发生呼吸道问题。

在《美国医学会杂志》(JAMA)发表的论文中,加州大学欧文分校(University of California, Irvine)、医生和一名统计学家分析了美国超过650家学术医院的临床数据库,对比了自2020年3月1日至2021年2月28日期间分娩的新冠肺炎患者和非新冠肺炎患者。

在感染新冠病毒和未感染新冠病毒的两组产妇中,前者有5.2%被送入了重症监护室,后者只有0.9%;前者有1.5%接受了插管治疗,后者只有0.1%。此外,感染新冠病毒的孕妇未满37周分娩的比例为16.4%,而未感染病毒的孕妇只有11.5%。

卡希尔说:“有时候患者的病情非常严重,我们不得不让孕妇提前分娩,而过早出生的新生儿将承担早产的所有风险,可能患终生疾病甚至夭折。”

免疫系统

加州大学洛杉矶分校罗纳德里根医疗中心(Ronald Reagan UCLA Medical Center)重症监护室副主任尼达•卡迪尔表示,该医院在新冠疫情期间收治了许多被送入重症监护室的孕妇。该医院是洛杉矶少数几家为患者提供体外膜肺氧合(ECMO)治疗的医疗设施。体外膜肺氧合可以绕过心肺,支持身体康复。

随着新冠肺炎病例增多,卡迪尔所在的重症监护室收治了更多患有新冠肺炎的孕妇。

南佛罗里达大学医学院的路易斯表示,早产和接受体外膜肺氧合治疗的患者要经历“漫长的康复期”。

对患有重症新冠肺炎的孕妇的治疗更有挑战性。帮助呼吸困难患者的一种重要方法是将患者腹部朝下置于俯卧位。卡迪尔表示:“尽管能够采用这种方式,但由于显而易见的原因,这对孕晚期的患者更有难度。”

卡迪尔称,医生还需要为怀孕的患者保证体内的含氧量,因为“我们尽量考虑到胎儿的氧气输送。胎儿对于氧合变化非常敏感。”

早产

卡迪尔治疗的一名年轻女性的妊娠并不复杂,在怀孕之前是一名运动员。但这名女性被迫早产,“多次出现病危”,住院几个月后才得以出院回家。

位于南卡罗来纳州芒特普莱森特的东库博医疗中心(East Cooper Medical Center)妇产科主任兼妇幼内科主任克里斯托弗•罗宾逊说:“我们无法预测哪些人会出现严重的新冠肺炎呼吸衰竭。唯一可以用来判断哪些患者较为安全的指标似乎只有疫苗接种记录。”

来自纽约州杜鲁门斯堡的莫莉•瓦德克•克劳斯在怀孕期间曾经考虑接种新冠疫苗,但当时还没有疫苗安全性数据。她说:“我曾经纠结过是否要接种疫苗。”

她的产科医生称这取决于她自己。在新冠疫苗安全性数据发布之后,瓦德克•克劳斯再次与产科医生进行了讨论,然后决定接种疫苗。四周后,她生下了一名健康的女婴。

瓦德克•克劳斯说:“我宁愿承担疫苗接种带来的流产风险,也不愿意死于新冠病毒,让两个孩子失去妈妈。”(财富中文网)

翻译:刘进龙

审校:汪皓

德尔塔变种病毒在美国掀起新一波疫情。在此期间,许多健康的年轻孕妇因为感染新冠病毒,最终不得不住院接受呼吸机治疗,有的甚至导致早产或者死亡。

美国各地的医生均报告了这种趋势,主要集中在南方各州,但加利福尼亚州和华盛顿等地也有类似的情况。在之前的几波疫情当中并未出现过这种情况。截至8月14日,美国有76.2%的孕妇未接种疫苗。

《美国医学会杂志—网络公开版》(JAMA Network Open)本月发表的一篇论文称,与未感染新冠病毒的孕妇相比,感染新冠病毒的孕妇死亡概率要高出15倍,需要接受插管治疗的概率高出14倍,早产的概率高出22倍。华盛顿大学(University of Washington)的妇产科教授琳达•埃克特说:“我从未见过这类风险。”

孕妇不愿意接种疫苗的情况非常普遍,因为辉瑞(Pfizer Inc.)-BioNTech、Moderna Inc.和强生(Johnson & Johnson)的新冠疫苗在临床试验时均排除了孕妇。针对孕妇接种疫苗的研究在2月启动,目前有证据表明孕妇接种疫苗不会导致流产风险增加。美国卫生官员本月呼吁孕妇接种疫苗。

埃克特称:“现在我们已经掌握了大量更有说服力的数据,可以证明孕妇接种新冠疫苗的安全性,以及不接种疫苗可能面临的危险性。”

得克萨斯大学(University of Texas)奥斯丁•戴尔医学院(Austin Dell Medical School)女性健康教授、该校女性健康学会(Women’s Health Institute)妇幼内科专家艾莉森•卡希尔表示,孕妇较低的新冠疫苗接种比例和德尔塔变种病毒“导致出现重症和需住院治疗的孕妇数量大幅增加,有些患者甚至需要在重症监护室内接受治疗。因新冠病毒出现的极端重症的患者,让我们的医疗服务变得异常忙碌。”

对新冠疫苗的担忧

已经怀孕六个月的加布里埃尔•纳迪-麦吉住在纽约市。她在怀孕三个月之后接种了第一剂疫苗。此前她曾经担心疫苗会对胎儿造成伤害。但她表示,自己同时又担心免疫系统受损的其他妈妈们感染病毒,“我不想在没有接种疫苗的情况下去医院。我真的非常害怕。”

南佛罗里达大学(University of South Florida)妇产科医学院(College of Medicine Obstetrics and Gynecology)的院长朱迪特•路易斯表示,绝大多数因为新冠肺炎住院治疗的孕妇都没有接种疫苗。

路易斯说:“确实有一两例接种新冠疫苗后的突破性感染病例最终需要接受住院治疗,但她们不必使用呼吸机。”

佛罗里达州妇产科医生施薇塔•帕特尔指出,人们在怀孕期间通常会出现免疫系统变化,这增加了她们出现重症新冠肺炎的风险,可能发生呼吸道问题。

在《美国医学会杂志》(JAMA)发表的论文中,加州大学欧文分校(University of California, Irvine)、医生和一名统计学家分析了美国超过650家学术医院的临床数据库,对比了自2020年3月1日至2021年2月28日期间分娩的新冠肺炎患者和非新冠肺炎患者。

在感染新冠病毒和未感染新冠病毒的两组产妇中,前者有5.2%被送入了重症监护室,后者只有0.9%;前者有1.5%接受了插管治疗,后者只有0.1%。此外,感染新冠病毒的孕妇未满37周分娩的比例为16.4%,而未感染病毒的孕妇只有11.5%。

卡希尔说:“有时候患者的病情非常严重,我们不得不让孕妇提前分娩,而过早出生的新生儿将承担早产的所有风险,可能患终生疾病甚至夭折。”

免疫系统

加州大学洛杉矶分校罗纳德里根医疗中心(Ronald Reagan UCLA Medical Center)重症监护室副主任尼达•卡迪尔表示,该医院在新冠疫情期间收治了许多被送入重症监护室的孕妇。该医院是洛杉矶少数几家为患者提供体外膜肺氧合(ECMO)治疗的医疗设施。体外膜肺氧合可以绕过心肺,支持身体康复。

随着新冠肺炎病例增多,卡迪尔所在的重症监护室收治了更多患有新冠肺炎的孕妇。

南佛罗里达大学医学院的路易斯表示,早产和接受体外膜肺氧合治疗的患者要经历“漫长的康复期”。

对患有重症新冠肺炎的孕妇的治疗更有挑战性。帮助呼吸困难患者的一种重要方法是将患者腹部朝下置于俯卧位。卡迪尔表示:“尽管能够采用这种方式,但由于显而易见的原因,这对孕晚期的患者更有难度。”

卡迪尔称,医生还需要为怀孕的患者保证体内的含氧量,因为“我们尽量考虑到胎儿的氧气输送。胎儿对于氧合变化非常敏感。”

早产

卡迪尔治疗的一名年轻女性的妊娠并不复杂,在怀孕之前是一名运动员。但这名女性被迫早产,“多次出现病危”,住院几个月后才得以出院回家。

位于南卡罗来纳州芒特普莱森特的东库博医疗中心(East Cooper Medical Center)妇产科主任兼妇幼内科主任克里斯托弗•罗宾逊说:“我们无法预测哪些人会出现严重的新冠肺炎呼吸衰竭。唯一可以用来判断哪些患者较为安全的指标似乎只有疫苗接种记录。”

来自纽约州杜鲁门斯堡的莫莉•瓦德克•克劳斯在怀孕期间曾经考虑接种新冠疫苗,但当时还没有疫苗安全性数据。她说:“我曾经纠结过是否要接种疫苗。”

她的产科医生称这取决于她自己。在新冠疫苗安全性数据发布之后,瓦德克•克劳斯再次与产科医生进行了讨论,然后决定接种疫苗。四周后,她生下了一名健康的女婴。

瓦德克•克劳斯说:“我宁愿承担疫苗接种带来的流产风险,也不愿意死于新冠病毒,让两个孩子失去妈妈。”(财富中文网)

翻译:刘进龙

审校:汪皓

More young and healthy pregnant people are ending up hospitalized on ventilators, delivering babies prematurely and sometimes dying from COVID-19 during the Delta-fueled spike in cases.

Doctors across the country are reporting this trend, not seen in previous surges, largely in the South but also in states like California and Washington. As of Aug. 14, 76.2% of pregnant people were unvaccinated.

Pregnant women with COVID-19 are 15 times more likely to die, 14 times more likely to need to be intubated, and 22 times more likely to have pre-term birth than those who are uninfected, according to a study published this month in JAMA Network Open. “I have not seen risks like this,” said Linda Eckert, professor of obstetrics and gynecology at the University of Washington.

Reluctance to get the shots has been widespread among the pregnant population because they were excluded from clinical trials for the Pfizer Inc.-BioNTech SE, Moderna Inc., and Johnson & Johnson vaccines. Studies on pregnant women began in February, and evidence has shown no increased risk of miscarriage from the shots. U.S. health officials this month stepped up calls for pregnant people to get vaccinated.

“Now we have a lot more compelling data about the safety of the vaccine in pregnancy and we have amazingly compelling data about how dangerous it is to get COVID when you’re pregnant,” Eckert said.

The low numbers of pregnant people who are vaccinated and the Delta variant have “created this perfect storm of pregnant people getting extremely sick and being hospitalized, and even requiring care in the intensive care unit,” said Alison Cahill, a professor of women’s health at the University of Texas at Austin Dell Medical School and maternal-fetal medicine specialist at the school’s Women’s Health Institute. “We have very, very busy services with patients extremely sick from COVID.”

Vaccine worries

Gabriella Nardi-McGee, who is six months pregnant and lives in New York City, got her first vaccine dose after the end of the first trimester of her pregnancy after initially worrying about harming her unborn child. However, she also was concerned about exposing her immuno-compromised mother to the virus and “did not want to be in a hospital and not be vaccinated,” she said. “That really scared me.”

Judette Louis, chair of the University of South Florida College of Medicine Obstetrics and Gynecology, said the vast majority of pregnant people getting hospitalized with COVID are unvaccinated.

“We did have a couple of vaccine breakthroughs that did end up needing to be hospitalized, but they did not end up on the ventilator,” Louis said.

People often undergo immune changes during pregnancy that can increase vulnerability to a severe type of COVID, potentially with respiratory issues, said Shweta Patel, an obstetrician and gynecologist in Florida.

In the study published in JAMA, University of California, Irvine, doctors and a statistician analyzed a clinical database of more than 650 academic hospitals in the U.S. to compare patients who gave birth with or without COVID-19 between March 1, 2020 and Feb. 28, 2021.

Of those cases, 5.2% of those giving birth with COVID were admitted to the ICU, compared with 0.9% of women without the virus; 1.5% of those with COVID were intubated, compared with 0.1% of women without the virus. Additionally, 16.4% of women with COVID delivered at less than 37 weeks, compared with 11.5% of those without the virus.

“Sometimes the illness can be significant enough such that we have to deliver folks early and when that happens, then that newborn baby who’s delivered extremely prematurely takes on all of the risks of a very preterm delivery that can be lifelong morbidities and even death,” Cahill said.

Immune systems

Ronald Reagan UCLA Medical Center in Los Angeles has seen a lot of pregnant people admitted to the ICU throughout the pandemic, said Nida Qadir, associate director of the hospital’s medical ICU. It is one of the few facilities in the Los Angeles area that can put patients on extracorporeal membrane oxygenation (ECMO), a machine that bypasses the heart and lungs to allow the body to heal.

Now that there are more cases overall, there are even more pregnant COVID patients in her ICU.

People who have to deliver early and end up on ECMO have a “long course to recovery,” said South Florida College’s Louis.

Taking care of severely ill COVID-19 patients can be more challenging if they’re pregnant. One important way to help patients in respiratory distress involves putting someone on their belly, known as proning. “While we’re able to do it, it for obvious reasons becomes more difficult if somebody is further along in their pregnancy,” Qadir said.

Doctors also need to keep oxygen levels higher for pregnant patients because “we are trying to keep in mind oxygen delivery to the fetus, which is very sensitive to changes in oxygenation,” Qadir said.

Premature birth

Qadir took care of one young woman who had an uncomplicated pregnancy and was athletic prior to getting COVID. The woman had to deliver her baby prematurely, “nearly died so many times,” and was in the hospital for months before she was able to go home.

“We cannot predict who is going to have that severe COVID pneumonia respiratory failure outcome,” said Christopher Robinson, chair of obstetrics and gynecology and director of maternal fetal medicine at East Cooper Medical Center in Mount Pleasant, South Carolina. “The only thing that appears to be suggestive of who is safe and who is not is vaccination history.”

When Molly Wadzeck Kraus from Trumansburg, New York was considering getting vaccinated while pregnant, safety data still wasn’t available. “I struggled with the decision of whether or not to do it,” she said.

Her obstetrician said it was up to her. When data came out, Wadzeck Kraus discussed it again with her obstetrician and decided to get the vaccine. Four weeks ago, she gave birth to a healthy baby girl.

“Even if there was a risk of miscarriage, I would’ve much rather risked that than risk me getting COVID and dying and leaving my two children I already have without a mom,” Wadzeck Kraus said.

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