RESUMEN
Neonates are highly susceptible to viral infections in the periphery, potentially due to deviant cytokine responses. Here, we investigated the role of interferon-gamma (IFNγ), a key anti-viral in the neonatal brain. We found that (i) IFNγ, which is critical for viral control and survival in adults, delays mortality in neonates, (ii) IFNγ limits infiltration of macrophages, neutrophils, and T cells in the neonatal brain, (iii) neonates and adults differentially express pathogen recognition receptors and Type I interferons in response to the infection, (iv) both neonates and adults express IFNγ and other Th1-related factors, but expression of many cytokines/chemokines and IFNγ-responsive genes is age-dependent, and (v) administration of IFNγ extends survival and reduces CD4 T cell infiltration in the neonatal brain. Our findings suggest age-dependent expression of cytokine/chemokine profiles in the brain and distinct dynamic interplays between lymphocyte populations and cytokines/chemokines in MV-infected neonates.
Asunto(s)
Encéfalo/inmunología , Encéfalo/virología , Interferón gamma/inmunología , Sarampión/inmunología , Neuronas/inmunología , Neuronas/virología , Animales , Animales Recién Nacidos , Humanos , Sarampión/congénito , Virus del Sarampión/inmunología , Ratones , Ratones Transgénicos , Células TH1/inmunologíaRESUMEN
Existen numerosas infecciones bacterianas, virales y parasitarias que pueden transmitirse desde la madre al feto o recién nacido (RN) y que significan un riesgo para él. El acrónimo TORCH se utiliza en forma universal para caracterizar a aquel feto o RN que presenta un cuadro clínico compatible con una infección congénita y que permite un enfrentamiento racional, tanto diagnóstico como terapéutico. El concepto tradicional de realizar un "test de TORCH" sin consideraciones específicas a cada paciente, hoy en día se considera no adecuado y ha sido reemplazado por exámenes específicos para patógenos específicos bajo circunstancias bien definidas. El presente documento revisa las características generales, epidemiológicas, patogénicas, diagnósticas y terapéuticas de los patógenos más frecuentemente involucrados en el estudio de pacientes con sospecha de TORCH.
There is a lot of bacterial, viral or parasite infections who are able to be transmitted vertically from the mother to the fetus or newborn which implicates an enormous risk for it. The TORCH acronym is used universally to refer to a fetus or newborn which presents clinical features compatible with a vertically acquired infection and allows a rational diagnostic and therapeutic approach. The traditional "TORCH test" is nowadays considered not appropriate and it has been replaced for specific test for specific pathogens under well defined circumstances. The present document reviews the general characteristics, epidemiology, pathogenesis, diagnostic and therapeutic options for the most frequently involved pathogens in the fetus or newborn with TORCH suspicion.
Asunto(s)
Humanos , Femenino , Embarazo , Recién Nacido , Toxoplasmosis/diagnóstico , Enfermedad de Chagas/epidemiología , Infecciones por Citomegalovirus/congénito , Chile , Toxoplasmosis/terapia , Toxoplasmosis/epidemiología , Tamizaje Neonatal/métodos , Guía de Práctica Clínica , Enfermedad de Chagas/terapia , Infecciones por Citomegalovirus/diagnóstico , Transmisión Vertical de Enfermedad Infecciosa , Herpes Simple/congénito , Herpes Simple/epidemiología , Sarampión/congénito , Sarampión/epidemiologíaRESUMEN
BACKGROUND: Previous studies of maternal, fetal, and neonatal complications of measles during pregnancy suggest the possibility of increased risk for morbidity and mortality. In 2009-2011, a nationwide laboratory-confirmed measles outbreak occurred in Namibia, with 38% of reported cases among adults. This outbreak provided an opportunity to describe clinical features of measles in pregnant women and assess the relative risk for adverse maternal, fetal, and neonatal outcomes. METHODS: A cohort of pregnant women with clinical measles was identified retrospectively from 6 district hospitals and clinics over a 12-month period. Each pregnant woman with measles was matched with 3 pregnant women without measles, randomly selected from antenatal clinic registers at the same hospital during the same time interval. We reviewed hospital and clinic records and conducted in-person interviews to collect demographic and clinical information on the pregnant women and their infants. RESULTS: Of 55 pregnant women with measles, 53 (96%) were hospitalized; measles-related complications included diarrhea (60%), pneumonia (40%), and encephalitis (5%). Among pregnant women with known human immunodeficiency virus (HIV) status, 15% of those without measles and 19% of those with measles were HIV positive. Of 42 measles-related pregnancies with known outcomes, 25 (60%) had ≥1 adverse maternal, fetal, or neonatal outcome and 5 women (12%) died. Compared with 172 pregnancies without measles, after adjusting for age, pregnancies with measles carried significantly increased risks for neonatal low birth weight (adjusted relative risk [aRR] = 3.5; 95% confidence interval [CI], 1.5-8.2), spontaneous abortion (aRR = 5.9; 95% CI, 1.8-19.7), intrauterine fetal death (aRR = 9.0; 95% CI, 1.2-65.5), and maternal death (aRR = 9.6; 95% CI, 1.3-70.0). CONCLUSIONS: Our findings suggest that measles virus infection during pregnancy confers a high risk of adverse maternal, fetal, and neonatal outcomes, including maternal death. Maximizing measles immunity among women of childbearing age would decrease the incidence of gestational measles and the attendant maternal, fetal, and neonatal morbidity and mortality.
Asunto(s)
Virus del Sarampión/aislamiento & purificación , Sarampión/congénito , Sarampión/patología , Complicaciones Infecciosas del Embarazo/patología , Complicaciones Infecciosas del Embarazo/virología , Adolescente , Adulto , Estudios de Casos y Controles , Estudios de Cohortes , Femenino , Humanos , Incidencia , Recién Nacido , Masculino , Sarampión/epidemiología , Sarampión/mortalidad , Namibia/epidemiología , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/mortalidad , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento , Adulto JovenRESUMEN
Infection of the central nervous system (CNS) in children is an important entity and early recognition is paramount to avoid long-term brain injury, especially in very young patients. The causal factors are different in children compared with adults and so are the clinical presentations. However, imaging features of CNS infection show similar features to those of adults. This article reviews some of the common types of pediatric infections, starting with the congenital (or in utero) infections followed by bacterial infections of the meninges and brain parenchyma.
Asunto(s)
Infecciones del Sistema Nervioso Central/diagnóstico , Aumento de la Imagen , Interpretación de Imagen Asistida por Computador , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Encéfalo/patología , Infecciones del Sistema Nervioso Central/complicaciones , Infecciones del Sistema Nervioso Central/congénito , Niño , Preescolar , Infecciones por Citomegalovirus/complicaciones , Infecciones por Citomegalovirus/congénito , Infecciones por Citomegalovirus/diagnóstico , Diagnóstico Diferencial , Encefalitis por Herpes Simple/complicaciones , Encefalitis por Herpes Simple/congénito , Encefalitis por Herpes Simple/diagnóstico , Encefalomielitis Aguda Diseminada/complicaciones , Encefalomielitis Aguda Diseminada/congénito , Encefalomielitis Aguda Diseminada/diagnóstico , Infecciones por VIH/complicaciones , Infecciones por VIH/congénito , Infecciones por VIH/diagnóstico , Herpes Genital/complicaciones , Herpes Genital/congénito , Herpes Genital/diagnóstico , Humanos , Lactante , Recién Nacido , Sarampión/complicaciones , Sarampión/congénito , Sarampión/diagnóstico , Meningitis Bacterianas/complicaciones , Meningitis Bacterianas/congénito , Meningitis Bacterianas/diagnóstico , Pronóstico , Médula Espinal/patología , Sífilis Congénita/complicaciones , Sífilis Congénita/diagnóstico , Toxoplasmosis Congénita/complicaciones , Toxoplasmosis Congénita/diagnósticoRESUMEN
Although measles is usually considered a benign viral disease of childhood, people may be affected whatever their age with severe pneumologic or neurologic consequences are more frequent before 5 years old and after 20 years old. The consequences of a congenital measles, defined as a newborn eruption within 10 days after birth, can be dramatic. The incidence of measles has significantly decreased since first vaccines were introduced in the late 1960s. In France, active immunization for measles is proposed since 1983. Since the beginning of 2008, France has been experiencing a measles outbreak with more than 17,000 notified cases. The current measles outbreak affects more particularly very young children and young adults and, among these, pregnant women. Measles during pregnancy may be severe mainly due to pneumonia. Measles is associated with a risk of miscarriage and prematurity, but congenital anomalies have not been described. If rash occurs near term, the consequences of congenital measles could be severe. Prevention of measles in pregnant women is based on improving immunization coverage, currently insufficient to eradicate virus circulation. The aim of this review is to state on the latest data concerning measles virus, give latest vaccine recommendations, and also to suggest management of measles contact or measles infection during pregnancy.
Asunto(s)
Sarampión , Complicaciones Infecciosas del Embarazo/virología , Aborto Espontáneo/virología , Femenino , Humanos , Recién Nacido , Sarampión/congénito , Sarampión/diagnóstico , Sarampión/prevención & control , Vacuna Antisarampión , Neumonía/virología , Embarazo , Complicaciones Infecciosas del Embarazo/diagnósticoRESUMEN
Congenital measles is a well recognised but uncommon transplacental infection in the post-vaccine era. A 4-day-old infant is described who presented with uncomplicated congenital measles during the 2010 South African measles outbreak. Clinicians working in regions affected by measles outbreaks should be mindful of waning vaccine-induced measles immunity where infections among pregnant women may result in a resurgence of congenital measles.
Asunto(s)
Sarampión/congénito , Sarampión/diagnóstico , Adulto , Brotes de Enfermedades , Femenino , Humanos , Recién Nacido , Masculino , Sarampión/epidemiología , Sudáfrica/epidemiologíaRESUMEN
The incidence of measles epidemics has decreased recently owing to the development and widespread use of measles vaccine in the United States of America and Europe. However, repeated measles epidemics have been reported in Japan. Here, the authors report a case of an extremely low body weight infant (ELBWI) whose mother had a measles virus infection. Real-time PCR was performed on the infant's blood and urine samples and skin, nasal secretion, and anal swabs, as well as on the mother's breast milk, blood samples and throat swabs. The infant was found to be positive for measles virus by PCR, but not immunoglobulin M positive. An earlier report showed that there were no such cases in which the patient was found to be positive for measles virus by real-time PCR but was not infected by the measles virus.
Asunto(s)
Anticuerpos Antivirales/sangre , Recien Nacido con Peso al Nacer Extremadamente Bajo , Transmisión Vertical de Enfermedad Infecciosa , Sarampión/congénito , Complicaciones Infecciosas del Embarazo/virología , Adulto , Femenino , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Lactante , Recién Nacido , Recien Nacido Prematuro , Sarampión/inmunología , Sarampión/transmisión , EmbarazoRESUMEN
A review of published literature was undertaken to investigate the maternal and fetal effects of measles infection in pregnancy and to inform the need for post-exposure prophylaxis. There is no evidence to support an association between measles in pregnancy and congenital defects. However, the need for effective post-exposure protection is supported by studies suggesting a high risk of severe maternal morbidity, fetal loss and prematurity. Measles in late pregnancy can also lead to perinatal infection in the infant, which may be associated with a high mortality and the risk of subacute sclerosing panencephalitis. UK guidance recommends using human normal immunoglobulin for susceptible pregnant women exposed to measles. Although there is no direct evidence that this will reduce the complications of measles in pregnancy, it may attenuate disease and therefore reduce the rate of complications. Measures to identify women likely to be susceptible include assessment of age, vaccination history, and/or antibody testing.
Asunto(s)
Sarampión/prevención & control , Profilaxis Posexposición , Complicaciones Infecciosas del Embarazo/prevención & control , Femenino , Humanos , Sarampión/complicaciones , Sarampión/congénito , EmbarazoRESUMEN
We report the case of a male infant born to a mother diagnosed as having measles before delivery. Although he was given standard immunoglobulin soon after delivery, he developed congenital measles. The diagnosis was confirmed by serology and PCR assay from the infant's pharyngeal secretions.
Asunto(s)
Transmisión Vertical de Enfermedad Infecciosa , Sarampión/congénito , Sarampión/transmisión , Femenino , Humanos , Recién Nacido , Masculino , Embarazo , Adulto JovenRESUMEN
PURPOSE: To analyze the results in a series of children submitted to unilateral cataract surgery. METHODS: A retrospective study was conducted through the analysis of 35 patient files from the Congenital Cataract Service of UNIFESP/EPM. RESULTS: The main cause of unilateral cataract was idiopathic, the second cause was ocular trauma and the third cause was congenital rubella. Initial visual acuity was very poor in 51.4% of the cases (did not fix or follow), and the best corrected final visual acuity was better than 20/200 in 42.8% of the eyes. DISCUSSION: Although controversial, the surgical treatment of unilateral cataract, in this study, showed improvement in many cases.
Asunto(s)
Extracción de Catarata , Catarata/congénito , Agudeza Visual/fisiología , Adolescente , Catarata/patología , Niño , Preescolar , Lesiones Oculares/complicaciones , Femenino , Humanos , Lactante , Masculino , Sarampión/complicaciones , Sarampión/congénito , Periodo Posoperatorio , Cuidados Preoperatorios , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJETIVO: Analisar os resultados visuais de uma série de crianças operadas de catarata unilateral. MÉTODOS: Um estudo retrospectivo foi realizado através da análise de 35 prontuários médicos do Serviço de Catarata Congênita da UNIFESP/EPM. RESULTADOS: Quanto à etiologia, a primeira causa de catarata foi idiopática, a segunda causa foi o trauma e a terceira foi a rubéola congênita. Em 51,4 por cento dos olhos tinham acuidade visual pré-operatória de ausência de fixação. E em 42,8 por cento dos casos operados a acuidade visual final foi igual ou melhor que 20/200. DISCUSSÃO: Embora a cirurgia em catarata unilateral seja motivo de controvérsias entre os oftalmologistas, obteve-se melhora de acuidade visual em número significativo de casos.
PURPOSE: To analyze the results in a series of children submitted to unilateral cataract surgery. METHODS: A retrospective study was conducted through the analysis of 35 patient files from the Congenital Cataract Service of UNIFESP/EPM. RESULTS: The main cause of unilateral cataract was idiopathic, the second cause was ocular trauma and the third cause was congenital rubella. Initial visual acuity was very poor in 51.4 percent of the cases (did not fix or follow), and the best corrected final visual acuity was better than 20/200 in 42.8 percent of the eyes. DISCUSSION: Although controversial, the surgical treatment of unilateral cataract, in this study, showed improvement in many cases.
Asunto(s)
Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Extracción de Catarata , Catarata/congénito , Agudeza Visual/fisiología , Catarata/patología , Lesiones Oculares/complicaciones , Sarampión/complicaciones , Sarampión/congénito , Periodo Posoperatorio , Cuidados Preoperatorios , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Measles, mumps and rubella are common childhood diseases. Therefore, frequent and intense contact with children of preschool age may be associated with a higher infection risk for childcare providers. This overview summarizes current knowledge on possible adverse effects of these infections on pregnant women, pregnancy outcome and the fetus. Acute rubella or mumps virus infections are apparently not more severe in pregnant than non-pregnant women. In contrast, measles virus infection in pregnancy is linked to a higher incidence of pneumonitis and hospitalization. Evidence of congenital defects due to fetal infection is only provided in case of rubella virus infection in early pregnancy. Following rubella virus infection in the first trimester an increased fetal loss rate was reported. In 1966, a prospective study showed also a significant association between maternal mumps in the first trimester and an increased risk of abortion. But other investigators could not confirm this association. Measles and rubella but not mumps virus infections are linked to an increased premature birth rate. Occurring in late pregnancy, all three infections can result in birth of an infected infant. But severe disease occurs rarely and is mostly reported for premature infants with early neonatal measles. Preventive measures, aimed to reduce the risk of infection or severe complications for pregnant childcare providers, should consider the individual history of the employee (e.g. previous immunizations or antibody test results), the current epidemiological situation and possible interventions like passive immunization in case of exposure to measles.
Asunto(s)
Intercambio Materno-Fetal , Sarampión/epidemiología , Paperas/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Resultado del Embarazo/epidemiología , Medición de Riesgo/métodos , Rubéola (Sarampión Alemán)/epidemiología , Femenino , Alemania/epidemiología , Humanos , Recién Nacido , Sarampión/congénito , Paperas/congénito , Embarazo , Prevalencia , Factores de Riesgo , Rubéola (Sarampión Alemán)/congénitoAsunto(s)
Sarampión/complicaciones , Sarampión/prevención & control , Complicaciones Infecciosas del Embarazo/prevención & control , Vacunación , Aborto Espontáneo/etiología , Susceptibilidad a Enfermedades , Femenino , Humanos , Recién Nacido , Tamizaje Masivo , Sarampión/congénito , Sarampión/epidemiología , Vacuna Antisarampión/administración & dosificación , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Resultado del Embarazo , Nacimiento Prematuro/etiología , Factores de RiesgoRESUMEN
A 13-month-old male presented with repetitive episodes of myoclonic jerks of the head and extremities for two months. His past medical history revealed that his non-immunized mother had measles at the time of delivery. Measles antibody titers in serum and cerebrospinal fluid (CSF) were 1/512 (hemagglutinin inhibition [HI]) and 1/128 HI, respectively. Immunofixation electrophoresis of CSF revealed an oligoclonal IgG band. The magnetic resonance imaging (MRI) of the brain on T2-weighted images showed lesions of high signal intensity in the subcortical white matter. Electroencephalography (EEG) revealed periodic high-amplitude slow waves. Diagnosis of subacute sclerosing panencephalitis (SSPE) was based upon clinical presentation, a characteristic EEG, and abnormal CSF studies. MRI findings supported the diagnosis. To the best of our knowledge, this is only the 3rd case to date, of SSPE-associated congenital measles in the literature.
Asunto(s)
Sarampión/complicaciones , Panencefalitis Esclerosante Subaguda/complicaciones , Anticuerpos Antivirales/sangre , Encéfalo/patología , Electroencefalografía , Fiebre/etiología , Humanos , Inmunoglobulina G/sangre , Lactante , Imagen por Resonancia Magnética , Masculino , Sarampión/congénito , Sarampión/virología , Morbillivirus/inmunología , Mioclonía/etiologíaRESUMEN
During a measles outbreak, 2 mothers with measles gave birth at University Hospital in São Paulo City, Brazil. Blood, saliva and urine were collected from the mothers and newborns. Measles virus genome and IgM antibodies against measles were detected. In 1 infant, measles virus genome persisted in peripheral blood mononuclear cells for 157 days after birth.
Asunto(s)
Brotes de Enfermedades , Virus del Sarampión/aislamiento & purificación , Sarampión/congénito , Sarampión/epidemiología , Adulto , Anticuerpos Antivirales/sangre , Brasil , Femenino , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa , Leucocitos Mononucleares/virología , Sarampión/virología , Virus del Sarampión/genética , Virus del Sarampión/inmunología , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/virología , Saliva/microbiología , Orina/virologíaRESUMEN
UNLABELLED: To determine how long the measles virus genome was detected in a patient with congenital measles, the peripheral blood mononuclear cells were tested for 203 d. The measles virus genome was detected up to 140 d. CONCLUSION: The period for which the measles virus genome was detected in this patient with congenital measles was much longer than in normal children with measles.
Asunto(s)
Genoma Viral , Virus del Sarampión/genética , Sarampión/congénito , Femenino , Humanos , Recién Nacido , Virus del Sarampión/aislamiento & purificación , Factores de TiempoRESUMEN
UNLABELLED: We report an 18-month-old girl with rapidly progressive subacute sclerosing panencephalitis, whose non immunised mother had measles at the time of delivery. The patient presented with repetitive episodes of myoclonic jerks of the head and arms, followed by a drop of head and trunk with frequent falls. EEG, CSF studies and MRI confirmed the diagnosis. Despite therapy with isoprinosine and valproate, seizure activity continued and she became vegetative within 2 months, with severe spasticity and swallowing difficulties, and died at the age of 28 months. Early age of onset and rapid progression were most likely related to haematogenous in utero acquisition of the measles virus prior to delivery, as well as immaturity of neuronal and immune systems. CONCLUSION: this case emphasises the importance of a high measles vaccine coverage in the population in order to prevent the risk of disease in general and, in particular, gestational measles.
Asunto(s)
Transmisión Vertical de Enfermedad Infecciosa , Sarampión/congénito , Panencefalitis Esclerosante Subaguda/diagnóstico , Panencefalitis Esclerosante Subaguda/virología , Edad de Inicio , Anticonvulsivantes/uso terapéutico , Antivirales/uso terapéutico , Progresión de la Enfermedad , Electroencefalografía , Resultado Fatal , Femenino , Humanos , Lactante , Inosina Pranobex/uso terapéutico , Imagen por Resonancia Magnética , Sarampión/transmisión , Mioclonía/virología , Factores de Riesgo , Panencefalitis Esclerosante Subaguda/tratamiento farmacológico , Ácido Valproico/uso terapéuticoRESUMEN
Objetivo. Describir la experiencia del manejo de embarazadas con rubéola, evaluando el resultado perinatal. Material y métodos. Del 1 de enero de 1990 al 31 de octubre de 1997 se incluyeron 67 embarazadas con diagnóstico de rubéola, corroborada con la determinación de anticuerpos séricos en 66 de estas mujeres: en cuatro se realizó un aborto electivo y una tuvo un embarazo molar. En 61 pacientes se pudo evaluar el efecto de la rubéola sobre el producto y la gestación. A los productos con determinación positiva de IgM contra rubéola se les realizó ecocardiograma, estudio oftalmológico y potenciales provocados auditivos del tallo cerebral (PPATC). Resultados. El promedio de edad de las embarazadas fue de 24.7 ñ 5.5 años; 28 pacientes cursaban su primer embarazo. Ninguna de las embarazadas presentó alguna complicación de episodios de rubéola. En 35 casos (52.2 por ciento) la infección viral se presentó durante el primer trimestre de gestación; en 23 (34.5 por ciento) sucedió durante el segundo trimestre, y en nueve (13.3 por ciento) ocurrió en el último trimestre. De los casos de infección materna durante el primer trimestre gestacional, 71 por ciento de los productos se infectaron y 51.6 por ciento desarrollaron un síndrome de rubéola congénita. Las manifestaciones de rubéola congénita más frecuente fueron prematurez, bajo peso al nacimiento y alteración de los PPATC. Conclusiones: En México la rubeóla continúa causando daño fetal, de tal manera que es necesario establecer medidas de prevención, como la vacunación universal, para evitar la infección por rubéola
Asunto(s)
Humanos , Femenino , Embarazo , Recién Nacido , Adolescente , Adulto , Complicaciones Infecciosas del Embarazo/epidemiología , Resultado del Embarazo , Sarampión/diagnóstico , Sarampión/epidemiología , Incidencia , Edad Gestacional , México/epidemiología , Sarampión/congénitoRESUMEN
OBJECTIVE: To determine whether exposure to a measles epidemic in utero or in infancy is a risk factor for the development of Crohn's disease, and to determine whether such an association can be found in individuals with subacute sclerosing panencephalitis (SSPE), a condition in which early infection with measles is known to be of aetiological importance. METHODS: A postal questionnaire was sent to 16,875 members of two national inflammatory bowel disease patient support groups. A control group was composed of friends or neighbours. Birth data were compared with the dates of measles epidemics and six possible periods of susceptibility were examined. Birth data from a national register of patients with SSPE were analysed similarly. Previously identified risk factors were also examined. RESULTS: The answers from 2522 members and 2379 controls were analysed. We found no evidence of an association between the development of Crohn's disease and exposure to a measles epidemic. The birth dates of both groups were distributed normally throughout the year. No other early risk factor for the development of inflammatory bowel disease was detected. Exposure to a measles epidemic before the age of 1 year did not emerge as a risk factor for SSPE. CONCLUSION: These data contradict reports from a recent study in central Sweden, but relatively early exposure to measles in childhood may still be a risk factor for the development of Crohn's disease.