追加：第 27 节第 17 条，怀孕了不用把猫送走，猫砂换别人每天铲，肉要做熟、碰土戴手套

2026-10-09。读者 issue #100「对养宠物的建议」。用户定：不新开节，只把有官方或原始文献、能落到动作的几条分散补进已有节，费用和保险不写。本条是其中孕期那一处。

四问：① 养猫家庭里怀孕很常见，会碰上；② 「怀孕要把猫送走」是读者真信的说法，对照组孕妇里也是猫被提得最多（见下文 Cook 2000 表 4）；③ 动作是新的，全书 grep「弓形虫」「猫砂」「养猫」此前在正文条目里零命中（第 34 节第 12 条备注只把猫砂当混药的材料提到）；④ 有官方原文和原始研究。

1. 美国疾控中心 Risk Factors 页

  • URL：https://www.cdc.gov/toxoplasmosis/risk-factors/index.html（curl 直连和带代理都 403，无头 Chrome 带代理取到，页面标 Updated: February 14, 2025）
  • 原文：「If you get infected with Toxoplasma for the first time while you are pregnant or just before your pregnancy, you can pass the infection to your baby.」「Most infected infants do not have symptoms at birth, but can develop serious symptoms later in life, such as blindness or mental disability」「Occasionally, infected newborns can have serious eye or brain damage at birth」
  • 原文（给孕妇的做法）：「If possible, have someone else change cat litter. If no one else can, wear disposable gloves and wash your hands with soap and water afterwards.」「Keep cats indoors to prevent them from hunting other animals. This will reduce your cat's chances of becoming infected with Toxoplasma .」「Feed cats commercially prepared dry or canned food; do not feed cats raw or undercooked meats」「Do not adopt or handle stray cats, especially kittens. Do not get a new cat while you are pregnant or immunocompromised.」

2. 美国疾控中心 Preventing Toxoplasmosis 页

  • URL：https://www.cdc.gov/toxoplasmosis/prevention/index.html（同上，无头 Chrome）
  • 原文：「Change the cat litter box daily. The Toxoplasma parasite does not become infectious until 1 – 5 days after a cat shed it in its feces. By cleaning the litter box every day, you remove the feces before they become infectious.」「Rinse fruit and vegetables under running water.」「Wear gloves when gardening or when touching any soil or sand that may be contaminated with cat feces」「Do not drink unpasteurized goat's milk.」
  • 同站 Causes 页（https://www.cdc.gov/toxoplasmosis/causes/index.html，没进来源栏）：「Kittens and cats can shed millions of parasites in their feces for as long as 3 weeks after infection. Mature cats previously infected with toxoplasmosis are less likely to shed Toxoplasma .」「Drinking water contaminated with Toxoplasma gondii」——备注「以前感染过的成年猫再排出的可能更小」「生水」据此。
  • 原题里的 CDC 孕妇专页 /toxoplasmosis/pregnancy/ 已下线（跳转 archive.cdc.gov），没引。

3. NHS Toxoplasmosis

  • URL：https://www.nhs.uk/conditions/toxoplasmosis/（curl 带代理 200，Page last reviewed: 25 August 2023）
  • 原文：「If you get toxoplasmosis while you're pregnant it can cause miscarriage.」「avoid cat poo in cat litter and soil if you can, wearing gloves if you need to empty cat litter trays and washing your hands afterwards」「do not eat raw or undercooked meat, or cured meats like salami or parma ham」「do not have unpasteurised goats' milk or any products made from it」「You cannot catch toxoplasmosis from stroking a cat, having a cat as a pet or from coming into contact with someone who's got it.」

4. 中国疾控中心 2025 科普（国内官方指引，有写到猫砂）

  • URL：https://www.chinacdc.cn/jkkp/crb/qtcr/202501/t20250103_303681.html（curl 直连 200；站内搜索要无头 Chrome。供稿：中国疾控中心传染病处，2025-01-03）
  • 原文：「准爸爸尽量承担清理猫砂盆任务，若准妈妈清理，务必戴手套，清理完毕后及时将手套和猫砂一起密封丢弃，并仔细洗手。保持猫砂盆的清洁，每天至少清理一次」「孕期科学养宠可留宠物在身边，但要加强管理和预防。若担忧或无法做好预防，可考虑寄养。」「孕早期感染，流产、死胎风险高」「家里没有宠物就不会感染弓形虫吗？ 不是，食用未煮熟食物、接触污染物品等也可能感染」「孕 前和 孕早期检测弓形虫抗体， 检测 阴性者孕中晚期复查」
  • 没照收的：同文「家中养猫的准妈妈备孕前应带猫检测弓形虫」「减少准妈妈与猫的亲密接触，不要让猫舔舐脸、手」——前者国外官方没有对应建议，后者和 NHS「摸猫不会染上」口径不一致，条目只收两边一致的部分。查抗体只写「问产检医生」：是否常规筛查各国做法不同，没去查证据。
  • 卫健委站内搜索（zs.kaipuyun.cn）「弓形虫」只出 WS/T 486—2015《弓形虫病的诊断》等诊断标准，「猫砂」零命中；gov.cn 政策库「弓形虫」零命中。

5. Cook 2000 BMJ 欧洲六中心病例对照

  • 题录：Europe PMC，PMID 10894691，DOI 10.1136/bmj.321.7254.142，321(7254):142-147；全文 PMC27431（Europe PMC fullTextXML 返回 500，改从 pmc.ncbi.nlm.nih.gov 带代理取 HTML）。
  • 原文：「A total of 252 infected women (cases) and 858 control women were enrolled」
  • 表 1：「Any cat in home 42 206 124 697 1.0 (0.7 to 1.5) 0.99」「Cleaning litter tray 26 214 65 748 1.3 (0.8 to 2.1) 0.37」
  • 表 2（多因素）：「Raw/undercooked lamb * 3.13 (1.4 to 7.2) 0.007」「Contact with soil * 1.81 (1.2 to 2.7) 0.005」。同表「Raw/undercooked beef * 1.73 (1.1 to 7.2) 0.01」的区间原文如此、看着像排印错误，没用。
  • 摘要：「Contact with cats was not a risk factor. Between 30% and 63% of infections in different centres were attributed to consumption of undercooked or cured meat products and 6% to 17% to soil contact.」
  • 讨论：「Contact with cats, kittens, cats' faeces, or cats who hunt for food was not a risk factor for infection.」「Contact with cats is not a risk factor for infection as excretion of oocysts is limited to only a few weeks」
  • 局限（备注据此）：「This route of transmission, however, was not considered in detail at interview」（指没洗净的生菜和生蔬菜）「In all centres a large proportion of infection (14% to 49%) remained unexplained」「All women and their interviewers were aware of the woman's infection status.」——事后回忆、双方都知道是否感染，所以定 B。
  • 表 4：对照组孕妇被问「怎么防弓形虫」时，提到猫的占 49%，提到碰土的只有 6%。读者真信「要防猫」由此佐证，没写进条目。

6. Dunn 1999 Lancet 母婴传播风险

  • 题录：Europe PMC，PMID 10359407，DOI 10.1016/s0140-6736(98)08220-8，353(9167):1829-1833。
  • 摘要原文：「We analysed obstetric and paediatric data on 603 confirmed maternal toxoplasmosis infections. At least 564 women received antiparasitic drugs according to a standard protocol.」「The overall maternal-fetal transmission rate was 29% (95% CI 25-33), which masked a sharp increase in risk with duration of gestation from 6% at 13 weeks to 72% at 36 weeks. However, fetuses infected in early pregnancy were much more likely to show clinical signs of infection.」「women who seroconverted at 24-30 weeks of gestation carried the highest risk (10%) of having a congenitally infected child with early clinical signs」

定级

  • 证据等级 B：猫和肉的风险数字只有一项病例对照研究，事后回忆、可能有偏差；做法来自 CDC、NHS、中国疾控中心，没有试验算过照做能少多少感染。没标争议：几家官方机构方向一致，Cook 的「清猫砂盆 OR 1.3 不显著」和「仍建议别人铲、戴手套」不矛盾，后者是低成本的预防。
  • 收益量级「中」凭判断：死亡率口径没有相对降幅可套。后果是流产、死胎、孩子失明和智力残疾，严重且不可逆；但孕期新感染本身少见，又没有人群层面的效应量，所以不定「大」。成本几乎为零、后果严重，所以不定「小」。
  • 成本标签：钱=0（交给家人铲不花钱，手套几块钱），时间=少，毅力=些（肉要全熟、碰土戴手套是改习惯）。

没收的

  • 「备孕前带猫查弓形虫」「孕期减少和猫亲密接触」：只有中国疾控中心一家说，见上。
  • 弓形虫抗体筛查要不要做：只指路到产检医生，没写结论。
  • 费用、宠物保险：用户已定不写。