Rubella in children is a viral etiology that is among the most common childhood infections in the world.
According to medical statistics, in developing countries more than 100,000 cases of congenital rubella in children are diagnosed each year. The incidence is manifested mainly by individual outbreaks in organized groups (kindergartens and educational institutions, sanatoriums, hospitals). Epidemic outbreaks of rubella in children are recorded at 10–20-year intervals. In temperate latitudes, the incidence of rubella has seasonal fluctuations, with the peak incidence occurring in the spring-summer period.
Most often, the disease is diagnosed in children aged 1–7 years. Up to 6 months, children are usually protected by antibodies obtained from the mother, for this reason rubella is extremely rare in this age group. Equally susceptible to children are male and female.
Contact with rubella patients, especially pregnant women or women planning pregnancy, should be avoided.
In the case of intrauterine infection, the rubella virus can cause damage to the endothelium of the cerebral vessels, the pia mater, ischemic changes in neurons in the fetus, which is subsequently manifested by congenital anomalies of development, impaired vision and hearing.
Causes and risk factors
Rubella in children is a contagious disease that produces a lasting immunity. The causative agent is an RNA-containing Rubella virus belonging to the genus Rubivirus, the family Togaviridae, does not have antigenic variants and is characterized by moderate hemagglutinin activity. It propagates in cell cultures, is rapidly inactivated under the influence of high (more than 55 ˚С) or low (-10 С and below) temperature, under the influence of ultraviolet radiation, as well as with conventional disinfectants, at room temperature can maintain viability for several hours.
The source of infection is a sick person and virus carriers. Infection of others is possible both in the incubation period and in the stage of the height of clinical manifestations (2-3 weeks after the appearance of skin rashes).
The transmission of the rubella virus is carried out mainly by airborne droplets, it is also possible that it can be contaminated by household contact (through the hands and contaminated household items). When pregnant women become infected with rubella, transplacental transmission of the infection to the fetus can occur. Children infected at the prenatal stage of development are a potentially stable reservoir for the spread of infection and release the virus for another 19 months after birth with saliva, nasopharyngeal secretions, urine, less often with feces.
Among the complications that occur on the background of rubella in children, joint damage is most common.
The rubella virus is introduced into the human body through the mucous membrane of the upper respiratory tract, which gets along with the inhaled air. Also, the virus is able to enter the body through damaged skin. The infection spreads haematogenously (primary viremia), enters the regional lymph nodes, replicates in the system of mononuclear phagocytes, which is accompanied by the development of secondary viremia on the 7-9th day from the moment of infection. When this occurs, a wide dissemination of the virus in the tissues of the body, including in the placenta. In this phase, the virus can be isolated from tissues and organs, biological body fluids (urine, cerebrospinal, synovial fluid, breast milk, saliva). Viremia peaks before the onset of cutaneous manifestations and decreases shortly thereafter.
Forms of the disease
Rubella in children is congenital and acquired, complicated and uncomplicated.
Acquired rubella in children may have a typical, atypical and subclinical (inapparent) form.
Depending on the characteristics of the clinical picture, congenital rubella proceeds:
- with damage to the nervous system,
- with congenital heart defects,
- with eye damage,
- hearing impaired
- mixed forms
- residual (residual) phenomena.
Rubella symptoms in children
Acquired rubella in children in most cases has a mild or moderate course. The incubation period is 14-21 days after contact with the virus carrier.
The first signs of rubella in a child are usually skin rashes (rash) and an increase in regional lymph nodes, mostly posterior cervical, up to 1-2 cm in diameter. Pathognomonic sign of rubella - bilateral enlargement of the occipital lymph nodes.
Rubella patients should be isolated for a week from the onset of the rash.
In adolescent children, the onset of a rash is usually preceded by general weakness and fatigue, a moderate increase in body temperature, headaches, and conjunctivitis without purulent discharge. There may also be tearing, photophobia, hyperemia of the throat and the posterior pharyngeal wall, runny nose, dry cough, loss of appetite (may be accompanied by nausea), muscle pain. Some patients show petechial rash on the soft palate (Forchheimer symptom).
Rashes have the appearance of pink-red spots from 1 to 5 mm in diameter. In adolescents, the rash is more abundant than in younger children, accompanied by itchy skin, sometimes elements of the rash merge with each other.
The rash first appears on the face and neck, during the day spreads to the trunk and extremities, on the palms and soles it is absent. In some patients, rash occurs simultaneously on the face, torso, limbs. Already on the second day the rash begins to subside and disappears completely on the third or fourth day. In adolescents it may last longer.
Some children (more often adolescent girls) have arthralgia and arthritis of the interphalangeal and carpal-phalangeal joints, less often elbow and knee joints are involved in the pathological process. Changes in the joints most often occur at the end of the exanthema period and disappear over several weeks (less often - several months).
Sometimes there is an atypical course of rubella in children, with no skin manifestations. In this case, the signs of the disease are subfebrile body temperature and occipital lymphadenopathy.
Approximately 50% of children with a congenital form of the disease, infection of which occurred in the first two months of the prenatal period, form congenital malformations.
Complicated rubella in children is usually caused by the addition of a secondary infection, bacterial or viral.
In congenital rubella, children usually have unilateral or bilateral neurosensory hearing loss. In about 40% of patients, it is the only sign of the disease. Eye pathologies (infantile glaucoma, cataract, pigmentary retinopathy) are diagnosed in 43% of children with congenital rubella, while in 80% of the lesion is bilateral. In addition, congenital rubella can have the following manifestations:
- intrauterine growth retardation,
- disorders of the central nervous system,
- behavioral disorders
- endocrine disorders (diabetes, thyroid abnormalities),
- thrombocytopenic purpura,
- skin manifestations (spots resembling blueberries, which are areas of dermatoglyphic anomalies).
The diagnosis is established on the basis of typical clinical manifestations available, data obtained from the collection of complaints and anamnesis, as well as laboratory diagnostics.
A general blood test is administered, the results of which reveal a decrease in the number of leukocytes, relative lymphocytosis, the appearance of plasma cells (10–30%), the number of monocytes increases, and the erythrocyte sedimentation rate increases.
If necessary, conduct immunoassay, complement fixation reaction, hemagglutination inhibition reaction and radioimmunoassay.
In case of a high risk of developing complications, instrumental examination is undertaken: radiological diagnosis of the lungs, electroencephalography, echoencephalography, rheoencephalography. Consultation of the otorhinolaryngologist, the oculist can be required.
Differential diagnosis is carried out with measles, enterovirus exanthema, drug rash.
Uncomplicated forms of the disease have a favorable prognosis for life, in some cases in these patients there is a delay in development and neurological disorders.
To detect infection and determine the likelihood of fetal damage to pregnant women who have been in contact with rubella patients, they use the RBTL method (lymphocyte blast-transformation reaction). The study is recommended no later than the 12th day after contact with the patient. Confirmation of infection of a pregnant woman up to the 14th-16th week is indications for abortion.
Treatment of rubella in children
Treatment of rubella in children is symptomatic, is carried out at home. Shows bed rest. Hospitalization is carried out in the case of a severe disease course and the development of complications. Rubella patients should be isolated for a week from the onset of the rash.
If the skin manifestations of rubella in children are accompanied by itching, prescribe antihistamines. With increasing body temperature - antipyretic. If necessary, use antitussive drugs, vasoconstrictor nasal drops. In the presence of disorders of the joints, nonsteroidal anti-inflammatory drugs are shown in a short course. The main treatment can be supplemented with phytotherapy (tea from black currant berries, cranberries, rose hips, nettle leaves).
In congenital rubella with signs of an active infectious process, recombinant interferon preparations are indicated. In the case of meningoencephalitis in a patient with this form of the disease, corticosteroids are used. If possible, the correction of congenital malformations.
In the presence of neurological disorders prescribe anticonvulsant drugs, dehydration therapy.
Epidemic outbreaks of rubella in children are recorded at 10–20-year intervals.
For rubella patients, a balanced diet is shown. It is recommended to include dishes from fruits and vegetables in the diet, and to exclude food that provides the mucous membranes of the gastrointestinal tract, as well as having a high degree of allergenicity (chocolate, bright red fruits and vegetables, etc.).
Possible complications and consequences
Complicated rubella in children is usually caused by the addition of a secondary infection, bacterial or viral.
Among the complications that occur on the background of rubella in children, joint damage is most common (manifested by hyperemia of the skin, pain and swelling in the area of the joint). Less common are thrombocytopenic purpura, myocarditis, encephalitis, meningitis, meningoencephalitis, subacute progressive panencephalitis, optic neuritis, aplasia of the bone marrow, acute polyradiculoneuritis. Damage to the central nervous system in rubella in children does not lead to demyelination. On the background of encephalitis, myelitis disorders with trophic or pelvic disorders can be observed.
Rubella in newborns may be complicated by giant cell hepatitis, hemolytic anemia, increased fontanelle, damage to the tubular bones, interstitial pneumonia. The congenital form of the disease is characterized by arterial duct cleft (with or without pulmonary stenosis), aortic valve damage, aortic stenosis, interventricular and interatrial septal defects, transposition of the great arteries, deafness of varying severity, microcephaly, hydrocephalic, vestibular disorders.
With the acquired form of rubella, the prognosis is favorable. It worsens with the development of complications from the central nervous system.
Up to 6 months, children are usually protected by antibodies obtained from the mother, for this reason rubella is extremely rare in this age group.
In the case of a congenital form of the disease, the prognosis depends on the duration of the pregnancy on which the fetus has been infected, and the existing violations. Uncomplicated forms of the disease have a favorable prognosis for life, in some cases in these patients there is a delay in development and neurological disorders. With a complicated course of congenital rubella, the prognosis is usually poor.
Specific prevention of rubella consists of vaccination; a live rubella vaccine is used for rubella vaccination in children (KPC is usually used for measles, rubella, parotitis).
Contact with rubella patients, especially pregnant women or women planning pregnancy, should be avoided. Special quarantine measures for patients with rubella and contact persons are not made. In rooms where there are rubella patients, it is necessary to carry out regular wet cleaning and disinfection, to ensure adequate ventilation. In case of a high risk of developing the disease, the use of immunoglobulins is recommended during the first week after contact with a rubella patient.
Features of infection
Its pathogen is a highly resistant microorganism with a double membrane. This feature helps the virus to survive in the external environment, even under adverse conditions for a long time. Being introduced into the mucous membrane of the respiratory tract, the causative agent of the disease protects itself from the influence of lymphocytes by the villous layer. Therefore, without vaccination in the children's body there simply is no means of immune protection against the rubella virus.
Disease infection is dangerous. The disease is contagious, it is quickly transmitted by airborne droplets. The degree of his contact without vaccination of the body is more than 90%.
It is worth considering that the spread of this infection most quickly occurs in confined spaces, with a large number of people gathering. We are talking about preschool institutions, schools, camps, boarding schools. There are cases of nosocomial infection in hospitals.
The virus is released by talking, breathing, coughing and sneezing. Once in the external environment, it retains its aggressive properties for 6-8 hours. Its instantaneous deactivation occurs during quartz treatment and exposure to direct sunlight.
Consequences of rubella in children
If the rubella does not occur in a child in a severe form, then the disease is usually cured without problems, it does not cause any consequences. But not always the case. Sometimes ailment can cause complications in girls or boys. And the most serious of these pediatricians is called encephalitis (inflammation of the lining of the brain). As a complication of an infectious disease, it is not common in preschool-age patients. But teenagers, according to statistics, are more susceptible to it. Most often, encephalitis occurs quickly. Its symptoms appear even before the stage of the onset of a viral rash on the skin. In rare cases, rash occurs before the onset of autoimmune encephalitis. It is characterized by a sharp deterioration in general well-being, confusion. In young patients, meningeal signs may appear. When the case is severe, it is possible and convulsions with respiratory arrest, depression of cardiac activity.Of course, the treatment of encephalitis should be carried out in a pediatric hospital. After all, the timely provision of medical assistance helps to prevent death.
Another dangerous complication of rubella in children is damage to the central nervous system. It manifests itself in the form of paresis and paralysis. The risk of such consequences is 25% of all diagnosed cases of morbidity. At the same time, infant mortality due to such a complication is observed in 30% of cases.
If a child is born with congenital rubella, the consequences can also be serious. And they will make themselves known several years after the infection process. The intrauterine defeat of the future baby with this virus is fraught with a violation of brain activity, mental development, speech defects. Possible manifestations of mental disability. In children who were affected by the virus in the womb of the mother, over time (at preschool and school age) a decrease in intelligence, impaired coordination of movements can develop. All this is due to uncoordinated work areas of the brain. It is worth noting that in most cases the long-term effects of congenital rubella cannot be treated.
What can be complications after rubella in boys?
All of the above applies to both sexes. In addition, it is worth knowing that sometimes infertility in men is associated with infectious and inflammatory diseases. Among them and rubella. It should be noted that such a complication occurs only in cases of infection of a teenager during puberty, as well as lesions of the testicles (orchitis). This happens extremely rarely. If a rubella was transferred by a boy to the age of five, then the risk of infertility in the future is almost nil.
The inability to conceive a child due to rubella suffered in childhood is extremely rare. More often, measles leads to this consequence, which is confused with rubella.
What are the complications of rubella in girls?
Thrombocytopenic purpura may be a specific complication of this infectious disease. It is more common in girls a few days after the appearance of a rash on the skin. This condition is characterized by hematuria (blood admixture in the urine), hemorrhagic rash (minor hemorrhages on the skin), bleeding from the gums.
What is rubella?
Rubella refers to the epidemic quickly current diseases, is transmitted from a sick person to a healthy airborne route, through household items, from mother to fetus. In the international community of medical professionals received the Latin name Rubeola or Rubella. Also used the synonym "German measles". It is usually a non-dangerous disease that manifests itself on the skin and causes short-term discomfort. Scientists fear only cases of defeat of pregnant women, because it leads to serious fetal abnormalities. That is why WHO is working hard to eliminate this disease.
The etiology (pathogen) and epidemiology (pathways) are well studied. The infection is caused by an RNA-containing virus - rubella virus. It is unstable in the environment, it lives for several hours at room temperature, but it tolerates low temperatures very well. Dies easily when disinfecting surfaces in a dry and warm environment. The vectors are infected people and children with congenital rubella. Children tolerate the disease much more easily than adults.
Sometimes a synonym “third disease” is applied to this ailment, he got this name due to his symptoms. For a long time, this infection was considered just a type of measles and was not isolated as independent. Even in ancient times, scientists noted that children have a diverse rash that quickly passes. In the list of children's ailments that provoked a rash on the skin, rubella ranked third. Until now, some doctors can use this name to define a rash.
The susceptibility to rubella is universal, it is highest between the ages of 3 and 4 years. Mothers with many children and their children, employees of medical institutions, employees of preschool institutions, schools, people who have not been ill with rubella and who have not been vaccinated against this disease, as well as people who have low levels of protective antibodies to the virus are at increased risk of rubella. Children are more susceptible to the virus, so most patients are toddlers or teenagers. Nevertheless, rubella virus also affects adults. Symptomatology in older patients is severe, which is manifested by severe weakness, high temperature, common lymphadenopathy, swelling of the joints.
A particular risk group is infection of pregnant women. Back in 1941, an ophthalmologist from Australia, Norman Gregg, noted the relationship between cataract in infants and mother's illness during gestation. In subsequent years, it was determined that the infection during pregnancy leads to congenital rubella syndrome with severe chronic pathology and fetal deformities.
Types of disease
The virus is most often transmitted by airborne droplets, from infected to susceptible. For the vaccinated person is not a threat. In the overwhelming majority of cases, after an illness, the body develops a strong immunity, which persists for a lifetime. As already noted, the infection can be transmitted from mother to child in the womb by hematogenous route, through placental blood. Thus, there are two types of this disease - congenital and acquired.
This is the most common type of disease, it means the transfer of viruses from a sick person to a healthy person. It can occur in three forms:
Typical means the usual set of symptoms that can manifest easily, moderately and severely. In this case, the older the patient, the more likely it is a severe form. Atypical passes without red lesions on the body, but is accompanied by inflammation of the lymph nodes, sometimes fever, conjunctivitis. Innaparatny view and does belong to the subclinical, that is, proceeds without symptoms. In this form, a sick person may be unaware of the problem, but infect others.
According to the international classification of diseases ICD-10, rubella has the code B06. At the same time, the clinic is isolated without complications (В06.9), with neurological complications (В06.0) and other complications (В06.8).
It is a viral infection that is transmitted exclusively from the infected mother through the placental blood flow to the fetus. She also called chronic rubella. A woman can get sick before pregnancy or during pregnancy. The most dangerous is the infection of the mother in the first trimester. As a rule, it threatens the death of the embryo; in later periods the development of pathologies in the fetus is observed. As a result of transplacental infection, a child is born with congenital rubella syndrome - CRS.
The World Health Organization considers ICS to be the most serious consequences of a viral infection. A child with this syndrome is born with congenital anomalies. The most common variant of complications is called deafness, which is not always possible to cure. A child born with ICS is a carrier of the virus for at least a year after birth (in some cases more). At the same time, it can infect all susceptible people, which include adults and children who have not undergone routine rubella vaccination.
Causes of rubella
Until 1914, the nature of German measles was poorly understood. By that time, it was already classified as a separate disease, but the causes and consequences remained unknown. In the same year, American doctor Alfred Fabian Hess conducted a series of observations and studies on monkeys. It was he who first suggested that rubella is transmitted virally. Later, two scientists from Japan conducted a study with the participation of children, infecting the healthy with the help of a biomaterial taken from a patient. This confirmed the viral cause of the disease.
Among the indirect factors that influence infection and epidemics are three cases:
- lack of vaccination
- no early infection
- contact with patients.
Rubella is a preventable problem. The main cause of the disease is considered a virus, and the main way to avoid meeting with the disease is a vaccine. In some countries, scientists have been able to completely avoid the spread of this disease, mainly due to the creation of anti-measles and rubella initiative groups.
Nevertheless, there are regions in which outbreaks of the “third disease” are still occurring on a huge scale.
Ways of infection
In addition to countries where Rubella virus was completely eliminated, the rest of the world still suffers from rubella. Due to the fact that the disease is viral in nature and may be asymptomatic for the first time after infection, outbreaks of epidemics are still observed in some regions. Scientific observations show that the duration of such quarantines and their periodicity depends on the climate; in the temperate zone, epidemics occur by spring, flow quickly and return every five to nine years. With the development of a culture of vaccination, this happens less and less.
The overwhelming proportion of infected falls on the acquired form. At the same time, viruses are secreted from the nasopharynx with physiological materials, therefore the main route of infection is airborne. You can get sick from contact with an infected person, and it doesn’t matter if he has symptoms. Ailment is equally transmitted in typical, atypical and inaparant form.
Thus, there are two ways of spreading the virus:
- transplacental (vertical),
At the same time, the airborne path provides for direct infection, when the pathogens do not linger in the environment. This happens most often through direct contact with the infected, during coughing or sneezing. The transplacental mechanism spreads from the mother to the fetus through placenta blood.
Outbreaks of the disease are usually found in closed teams. These include kindergartens, schools, military units, working groups and others. With constant and close contact, everyone who is not immune to rubella virus is infected. The only carrier of this rubella virus is humans, animals or insects cannot tolerate it. In April 2012, the Measles Control Initiative — now known as the Measles and Rubella Initiative — announced a new Global Strategic Plan for Measles and Rubella Control, covering the period 2012–2020. By the end of rubella, complete the elimination of measles and rubella in at least 5 WHO regions.
Symptoms and signs of rubella
After infection, the illness can occur with or without clinical symptoms - latently, erased. Also, with typical rubella, the severity of these symptoms is different: from mild manifestations and malaise to a serious condition. The severity of symptoms of the disease is influenced by several factors, chief among which is the patient's age. Until the end of the causes of the individual course of the disease today are not studied, it is assumed that not the last role is played by immunity, the presence of other diseases or pathologies. The number and strength of symptoms increases and decreases as the patient recovers.
The time after which the first signs of the disease appear from the moment of rubella virus infection is 11-21 days, sometimes extending to 23 days. It is almost impossible to recognize the disease at this stage, since in most cases there are no signs at all or very poorly expressed. During this period, rubella virus penetrates the mucous membrane of the upper respiratory tract into the blood, and then spreads throughout the body.
During the incubation period, the most cases of transmission occur as the patient is unaware of the problem and continues to contact others. The virus begins to stand out from the nasopharynx 7 to 10 days before the onset of the rash period. With the advent of virus neutralizing antibodies (1 - 2 nd day of rash), its release stops. But it is possible to detect the virus in the nasopharyngeal mucus for another week. The infectious period for rubella is determined from the 10th day before the start and up to the 7th day after the first rash.
Clinical manifestations in children
In the children's body, all stages of the disease are faster and less pronounced. After the incubation period, the first visible and tangible signs come. As a rule, lymph nodes first react, because after penetration into the body, the virus settles in the regional lymph nodes of the upper respiratory tract, where it multiplies and accumulates, and then spreads by blood flow to other groups of lymph nodes and settles in the skin. The regional lymph nodes swell and hurt, usually affecting the nodes in the back of the head, behind the ears, mandibular, supra- and subclavian. This occurs about 2-5 days before the first rash. The child can easily find them, in the inflamed places there will be small dense lumps.
Clinical signs in children include:
- lymph node inflammation,
- slight temperature rise
- runny nose, tearing, coughing (not always),
- small reddish rash.
After the appearance of lymphadenitis on the body appears rash - pinkish-red rash. As a rule, the individual elements of the rash are not combined in large areas, and are located separately from each other. The size of each spot varies from 3 mm to 6 mm. A distinctive feature of rubella rashes is that they do not protrude above the surface of the skin, should not be like acne. First of all, the face, neck and shoulders are affected. Then gradually descends to the back, chest, legs.
Sometimes a rash appears in the mouth, it can be seen on the soft palate: small bright red spots that appear before the skin symptoms. Sometimes in the field of elements of rash a slight itch is noted, but, as a rule, there are no subjective sensations in the area of rash. Rashes keep more often 2-3 days. Unlike adults, babies' body temperature rises slightly to 37.50. The first signs are lack of appetite, lethargy, bad mood of the child.
Also, small children from the second half of the year of life are susceptible to rubella, since by this time the innate immunity transmitted to the child with the mother’s antibodies is lost. Therefore, children from six months are also exposed to infection. In such a situation, precursors are digestive disorders, rejection of food and water, and frequent crying. Unfortunately, even an experienced pediatrician can not always accurately determine German measles at the first symptoms.
Clinical manifestations in adults
In the case of the incidence of the adult population, we are talking about acquired rubella. If a person did not get sick in childhood, but was vaccinated, immunity to the pathogen persists for 15–20 years. Scientists say that adults in rare cases can get sick even again after an illness, the causes of this phenomenon are still being investigated. However, there is a secondary infection in isolated cases.
As with children, the incubation period takes from 14 to 18 days. However, in adults, clinical manifestations occur a little earlier. For example, in babies, often the first signals are immediately a rash, without first worsening their well-being. In men and women, the ailment first makes itself felt with fever, headaches, aching joints, etc.
Symptoms in adults include:
- False cold symptoms.Most patients often confuse symptoms with the flu or cold. So, in the throat begins to tickle, comes a cough, runny nose.
- Temperature. Unlike young patients, adults have to endure a higher temperature - 39.0, sometimes higher. Such a phenomenon, combined with cold symptoms, only confirms the suspicions of patients, which is why self-treatment with the wrong drugs only worsens the condition.
- Lack of appetite. Viruses when released into the bloodstream and lymph nodes produce waste products, poisoning the body. Intoxication in combination with high temperature leads to loss of appetite and increased thirst.
- Migraine. Intoxication also contributes to prolonged headaches, which are not eliminated with the help of tablets.
- Loss and pain in the joints. In most cases, when an adult is ill, muscle and joint pain occurs. It feels like it is the one that accompanies the flu.
- Inflammation of the lymph nodes. As in children, lymphadenopathy is found in the parotid, mandibular, occipital, supra- and subclavian areas.
- Teariness. The eyes often water without cause, especially in bright light.
- Exanthema. The appearance of red or pink spots on the skin remains the main feature. Unlike a childhood disease, in adults, the elements of the rash are prone to fusion, sometimes protruding slightly above the surface of the skin, itching. First sprinkles the areas on the head: on the face, nose wings, behind the ears, on the hairy part.
In men, such a clinic is sometimes aggravated by pain in the groin: the external genitals swell, ache, and cause discomfort. In women, these complications are not observed. Each individual symptom lasts individually, in one patient the temperature may be low, but prolonged, and in another - a strong fever can pass in one or two days. Inflammation of the lymph nodes persists for several weeks, but more often passes after the onset of a rash.
Rashes in adults are longer in time than in children. In young patients, the rash usually goes away in two days, after which recovery gradually begins. In men and women, this symptom can last up to 7 days. When the described clinical signs appear, it is necessary to seek help from a doctor, it is not recommended to be treated independently.
Rubella and rubella are one and the same
The child’s diagnosis of measles rubella often puzzles parents. Is it measles or rubella? Or something third? To never be confused in this, you should understand the history of this issue. In general, there are many childhood diseases that are accompanied by an exanthema. The symptoms of these ailments are very similar, so even today their diagnosis is very difficult.
In the XIX century, there were two types of rubella - scarlet-like and measles. However, over time, rubella was allocated to an independent disease that is not associated with measles and scarlet fever.
How the disease proceeds
After contact with an infected person, the rubella virus by airborne droplets, when sneezing or coughing an infected person, gets on the mucous membrane of the upper respiratory tract. After that, the rubelle virus multiplies and accumulates in the regional lymph nodes. From here, it gradually penetrates the bloodstream and spreads through the body, affecting other lymph nodes and settles in the skin, while provoking an immune response. This takes up the entire incubation period. In the first week, the patient is not aware of the problem. Approximately seven days after infection, viremia occurs.
Starting from the second week of the disease, the patient feels the signs of intoxication, from viral exposure. This is displayed in:
- lack of appetite
- temperature increase
- aching joints.
The symptoms gradually increase, depending on the age of the patient, it reaches its peak on the third or fourth day after the first signs. After entering the blood, the infectious agent enters all tissues and organs, including the skin. As a result, specific antibodies, IgG and IgM, begin to be produced in the body. From this moment comes the peak of the symptoms of the disease - rashes appear.
Pink or red spots first cover the areas on the head and then descend to the rest of the body. A distinctive feature of the eruptions in rubella is that the soles and palms remain clean, without exanthema. The older the patient, the longer the rash will persist. With the disappearance of the rash begins recovery. This usually occurs on the 17th day after infection. The IgG antibodies developed at the same time remain for life, in isolated cases the patient may become infected again.
Rubella during pregnancy
A relatively harmless disease for most children can be a real disaster for a pregnant woman. It can become infected just like everyone else, if it does not have innate or acquired immunity. Antibodies obtained by vaccination have a "shelf life", after 15-20 years, a person can again become susceptible to rubella virus. Therefore, women in reproductive age and during pregnancy planning are recommended to be tested for the presence of IgG antibodies.
Consequences of infection for the fetus
A particularly high risk is that of the mother during the first 12 weeks of gestation. Observations show that infection in the first 8 weeks leads most often to abnormalities of the heart and vision. Deafness and brain damage occur when infected for up to 18 weeks. In general, intrauterine infection can affect absolutely any organ that develops at the time of the disease. If such a diagnosis is detected, the pregnancy is terminated until the 20th week, in severe cases and in later periods. In some cases, serious damage to the embryo and fetus leads to his death, followed by spontaneous abortion or stillbirth.
What is the danger in late terms?
Infection after the 20th week causes severe consequences much less frequently. The main danger here is a violation in the work of the central nervous system of the fetus, which can be the cause of mental retardation. Most of these disorders are not diagnosed at birth or childbirth, but are noticed later. However, the longer the gestation period, the less the likelihood of serious consequences for the child. Infection of the mother from the 28th week or more is not considered a reason for termination of pregnancy, since it affects the fetus only slightly or does not affect it at all.
Congenital rubella syndrome
CRS are the consequences of infecting the mother in the first trimester of gestation. Fetal damage to the fetus leads to the development of the pathology of any organ. In some cases, it becomes the cause of stillbirth, spontaneous miscarriage. Most often, if the pregnancy is not terminated, the baby is born with a CRS, which includes a number of pathologies. The most common occurrence is the so-called Gregg triad, which includes:
- Congenital heart defect.
In this case, the baby with SVK is the carrier of the active virus for another year after delivery. A child may have several pathologies at once or only one of the options for severe consequences. In addition to the Gregg triad, abnormalities in the development of the skeleton, disorders of the central and peripheral nervous system, and pathology of the internal organs and the brain are among the possible complications.
With congenital rubella, late complications can develop - panencephalitis, diabetes, thyroiditis. All this forces us to recommend an artificial interruption of pregnancy when infected in the first trimester of pregnancy.
Consequences and complications of rubella
As you can see, the most serious consequences pursue pregnant women. Women in the situation often have to make a difficult choice between the termination of pregnancy and the probability of having a baby with disabilities. The situation is no less dangerous for the fetus itself: children born with CRS are most affected by the action of the virus.
For those children who have suffered the acquired form, complications are practically not observed. The negative outcome of the disease can be only if the baby has other chronic diseases or pathologies of internal organs. But even in such a situation, little patients tolerate it very easily without any complications.
For adolescents and adults there is a danger of side effects in the form of encephalitis and disruption of the central nervous system. This happens if infectious agents enter the brain. This is recorded in approximately one case out of 7,000, but the severity of these consequences greatly disturbs scientists. Thus, encephalitis may be accompanied by inhibition of the cardiovascular system and cause respiratory failure. Violations in the work of the central nervous system sometimes lead to incomplete or complete paralysis, which is also fraught with death.
Reactive arthritis is diagnosed as a mild complication, most often it occurs in women. Manifested in aching pain and swelling in the joints, persists for 5-10 days. It can turn into a chronic form, but this is extremely rare. Also, the effect of toxins sometimes affects the composition of the patient's blood, there is a low clotting associated with thrombocytopenia, a decrease in the number of platelets in the blood. This leads to bleeding gums, the appearance of small blue spots on the body. In women, low clotting leads to prolonged and abundant menstruation. Atypical and subclinical rubella are often without visible symptoms and complications.
Infertility is a complication that worries parents and those who get sick at an older age. This picture is relevant only when a boy or a girl fell ill during puberty, that is, in adolescence. However, this complication is not considered mandatory, most boys and girls get sick without subsequent infertility. There have been no cases of infertility caused by the rubella virus among adults.
Basically, the prognosis is favorable. Considering that the overwhelming majority are children, the infection is easily tolerated, after which lifelong immunity is produced. For adults and adolescents, the prognosis will depend on the form and type of disease. Sometimes it passes without symptoms and consequences, some patients experience complications that pass with time.
Severe consequences, such as encephalitis, are fatal in half of the cases. Congenital rubella syndrome is accompanied by defects that are not restored. Deafness, loss of vision, pathologies of internal organs and systems can be partially or completely eliminated, but not always. Damage to the brain, central nervous system, skeleton is not amenable to recovery.
Preparation for testing
Some factors can affect the result of the diagnosis, so doctors recommend preparing for the delivery of the biomaterial:
- 12 hours before the examination to exclude alcohol, fatty foods, fried, spicy, it is advisable not to smoke.
- On the eve of the study do not take medicine. If it is impossible to refuse them, in the laboratory it is necessary to inform about all the preparations that were taken 2 days before.
- If blood is taken from a vein, it is advisable to restrict physical activity for half an hour and rest.
- There is nothing before testing.
For examination of children under 5 years old, it is recommended to give the child 150-200 ml of warm boiled water half an hour before the biomaterial is collected. Laboratory diagnosis of PCR has no special training requirements.
Value of results
Since rubella is very similar to some other diseases, it is often based on test data for its detection. If necessary, laboratory diagnostics use the concept of antibody avidity.
Avidity is an indicator of the association of a virus with antibodies of the IgG class. Immunoglobulins G bind to the causative agent of the disease and neutralize it, in fact, are treated. In the early stages of infection, avidity is low and then increases. This means: the greater the avidity rate, the better for the patient.
|IgG availability||IgM presence||Avidity%||Value|
|–||–||0%||No antibodies are found in the body, this may mean that the patient is either not infected with the virus or in the early stages. In childhood, not sick. No immunity. Vaccination required|
|–||+||0%||Presumably the initial stage of the disease, to clarify the need for a second blood sampling and analysis to check the growth of antibodies. No immunity required vaccination|
|+||+||70%||There is immunity to the virus. The infection has been postponed or vaccination was given. No re-vaccination required|
Indicators of avidity can be transitional (51-69%), in this case, repeated analyzes are done. Each laboratory may have its own norm, boundary indicators must be indicated on the form. Such an analysis must pass when planning pregnancy. If a woman is diagnosed in the first trimester, the tests are repeated in the second. If the disease is confirmed during gestation, PCR is performed. The data of this reaction can be either positive, which means - rubella is, or negative - there is no disease.
According to the first signs, the “third disease” has a lot of twins, which is why it is difficult to diagnose it without laboratory tests. There are several diseases, each of which looks the same.
- Influenza, ARD, ARVI - in an atypical course or before the appearance of a rash, a person feels the symptoms characteristic of these diseases, namely, sore throat, fever, pain in muscles and joints, runny nose.
- Adenoviral and enterovirus infections - manifested by inflammation of the lymph nodes, may be accompanied by the symptoms described above.
- Infectious mononucleosis - also combines the symptoms of a cold with an increase and pain in the lymph nodes.
- Measles, scarlet fever, chickenpox - appear the same as rubella in the form of rash and malaise. However, there is a difference between the lesions themselves and the set of symptoms.
- Allergy - the characteristic features of a rash on the skin, inflammation of the mucous membranes.
In most cases, the pediatrician can identify and differentiate these diseases by external indicators. Despite the similarity, they have their differences. For example, in scarlet fever, measles, chickenpox and rubella, the nature of the rash is different. With rubella, they appear first on the head, do not protrude above the surface of the skin, do not itch. Chickenpox is more often in the form of bubbles, scarlet fever begins with the defeat of the mucous membranes in the mouth, in the groin, accompanied by more severe intoxication.
There is also a similar childhood ailment - roseola, which was called false rubella, caused by the hernaceous herpesvirus inhibitor. It manifests itself in prolonged high temperature, after which a skin reaction appears in the form of a reddish rash - a sign of an immune response. The reliable difference of these diseases will be the data of laboratory diagnostics.
Because adults suffer this disease more difficult, they pay more attention. Here you also need to observe quarantine, provide the patient with complete peace of mind, eliminate possible hypothermia and organize abundant drinking. Symptomatic treatment is added to this. In some cases, patients are hospitalized for professional help. Self-medication for adolescents and adults is especially dangerous.
Symptomatic treatment of rubella
With the help of medicines, patients alleviate the severe course of the disease or eliminate unpleasant symptoms. In symptomatic treatment use:
- glucocorticoid drugs - with anti-inflammatory purpose for serious complications and as a therapy for thrombocytopenia.
Treatment of rashes is not required, as they pass independently and do not cause special complications. In rare clinical pictures, exanthema is accompanied by itching, then the dermatologist or the attending physician can advise ointments or solutions with a cooling and anesthetic effect.
Most patients are vaccinated in infancy. The first vaccination is given to children of one year old, then revaccination is carried out at 6 years. Today, medicine uses several types of vaccines that cause immunity to rubella virus. These may be monovaccines against rubella virus, or combined against several diseases at once.
Introduce it intramuscularly in the shoulder or subcutaneously. After vaccination, in rare cases, there may be side effects in the form of a short-term increase in body temperature, lymphadenopathy, an exanthema may appear 3-10 days after vaccination. Immunization is carried out using live attenuated rubella viruses.
Which doctors should be consulted
If you suspect infection, the first thing you don’t need to do is go to the clinic or hospital. In case the suspicions are justified and you or your child have an infection, you should call the doctor at the house. To do this, you need the phone of the medical institution, you can contact the private clinic, your pediatrician, if the baby is sick. To diagnose and treat rubella can a therapist, an infectious diseases specialist or a pediatrician.
Due to the fact that rubella is extremely dangerous for the fetus and sometimes leads to serious consequences in adults, the states carry out anti-epidemic measures. These include isolation of patients and vaccination. The first is not very effective, because the virus does not make itself felt at first and is distributed in groups even before the patient’s isolation. Therefore, vaccination of children and adults remains the main specific prevention both in individual cases and across the country. In Russia, 90% of adults are vaccinated (the Protocol of medical care for 2016).
Additional anti-epidemic measures include informing the public about the importance of vaccination, symptoms of the disease and methods of combating it. This includes the work of the media, warnings and recommendations of doctors, special materials in medical institutions (posters, flyers, booklets).
Can I bathe a child with rubella
Yes, water procedures are not excluded, but after the acute period of the disease. If a child has a normal state of health, but there is a rash - there is no reason to refuse hygiene procedures. In most cases, baths even contribute to recovery, they help to maintain cleanliness, reduce itching, if any. It is also recommended to add chamomile, coltsfoot, rosehip to the water.
Rubella igg positive. What does it mean
If the results of studies of IgG + or just "positive", this means that the body has developed a strong immunity to rubella. Such an indicator occurs in the case of post-vaccination or acquired rubella immunity. When IgG + is detected together with JgM +, the data indicate an acute course, that is, the body is still struggling with the disease, and the fact that vaccination is not indicated. A negative result for the detection of JgG, says that there is no antibody and you need to be vaccinated.
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Specialty: therapist, nephrologist.
Total experience: 18 years .
Place of work: Novorossiysk, medical center "Nefros".
Education: 1994-2000 Stavropol State Medical Academy.
- 2014 - "Therapy" full-time refresher courses on the basis of the Kuban State Medical University.
- 2014 - “Nephrology” full-time refresher courses based on the Stavropol State Medical University.
The most serious effects of rubella in children
If the disease proceeds without any manifestations, then it does not cause any consequences in the child who had had measles and rubella. Encephalitis is considered the most serious complication of rubella. Such a consequence of the disease occurs only among adolescents and in adult patients. Inflammation of the membranes of the brain develops in one case out of 10 thousand. Most often, the complication occurs very quickly and manifests itself before the rash appears. Very rarely, a rash over the entire body of the patient appears before the onset of autoimmune encephalitis.
Encephalitis is accompanied by a sharp deterioration in general condition and confusion. Very soon, patients develop meningeal symptoms, in the most severe cases, a convulsive syndrome occurs, which can cause respiratory arrest and depression of the cardiovascular system. Lack of medical care can cost the child life.
Another serious complication of rubella can be a lesion of the central nervous system, which can be expressed in the form of paresis and paralysis. The probability of developing such diseases is approximately 25% of all diagnosed cases of the disease, with infant mortality in such a rubella course reaching 30% or more.
Congenital rubella in children can also cause serious consequences, which manifest themselves several years after the infectious process. Intrauterine defeat of the fetus with a virus sometimes turns into a violation of brain activity, a violation of mental development, mental disability, a violation of speech and the ability to write. In addition, children over time may develop a persistent decrease in intelligence, which proceeds with an impaired coordination of movement, which is associated with the uncoordinated work of certain parts of the brain. Such long-term effects of rubella are not treatable.
Vaccination against rubella
The only reliable way to prevent outbreaks of rubella is vaccination against this infectious disease. The first time it is placed in the 12 months of the child's life, re-vaccination is carried out at 6 and 12 years. In adolescence, the drug is administered mainly to girls, for young men of puberty, rubella is no longer a danger.
Modern medicine proposes the use of a combination vaccine containing, in addition to rubella titers, attenuated pathogens of smallpox, measles and mumps. Sustained immunity, according to studies, provided that all requirements of the vaccination calendar are met, are produced in 95% of cases.
Before planning to conceive a child, a woman is recommended to have a blood test for rubella. In the absence of antibodies, the doctor may recommend re-vaccination. It is important to remember that during the onset of pregnancy, vaccination is not carried out in order to prevent serious complications in the fetus. From the moment of introduction of the drug to a woman and to conceive a child, at least 90 days must pass, on these days also breastfeeding is not allowed.
Expert Editor: Pavel Alexandrovich Mochalov | D.M.N. general practitioner
Education: Moscow Medical Institute. I. M. Sechenov, specialty - “Medicine” in 1991, in 1993 “Occupational diseases”, in 1996 “Therapy”.
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Characteristics of the pathogen and methods of its transmission
Rubella is a highly contagious infectious disease, susceptibility to this infection in people without specific immunity is 90%.
The causative agent is the Rubella virus RNA virus - the only member of the Rubivirus genus of the Togaviridae family. In the external environment, it is unstable, remains viable only for 5–8 hours. It quickly dies under the action of UV rays (quartz treatment), changes in pH, sunlight, high temperatures, various disinfectants (formalin, chlorine-containing compounds), organic solvents, detergents . However, it survives at low temperatures and is able to remain active for several years even in the frozen state.
The incidence of rubella is most often recorded during periods of seasons: in spring, winter and autumn. Transmission of the virus is from an infected person:
- airborne (sneezing, coughing, talking, kissing),
- by contact (through toys, dishes, towels and other household items),
- transplacentally from the pregnant woman to the fetus.
In the first two cases, rubella is acquired. The entrance gates of the infection are the mucous membranes of the respiratory tract and oral cavity, then the virus penetrates the bloodstream through the capillary walls and spreads through the blood through all organs and tissues of the body. The incubation period is 2-3 weeks. With intrauterine infection through the placenta, rubella is congenital.
Carrier Rubella virus is dangerous to others from the second half of the incubation period: one week before the rash and one week after. Most easily and quickly it will spread in confined spaces, in crowded places (kindergartens and schools, hospital wards).
After the acquired acquired rubella form, a child develops a strong immunity, so re-infection happens extremely rarely. It is fundamentally possible with failures in the immune system and with severe immunodeficiency.
It is believed that after 20 or more years after the illness, the immunity formed to it may be weakened, therefore, during this period, reinfection is not excluded. In case of secondary infection, the infection usually proceeds without symptoms or with an implicitly expressed clinical picture (cough, runny nose), without a rash on the body.
In the congenital form of the disease, the immunity against the rubella virus is less resistant because it is formed in conditions of the still immature immune system of the fetus. These babies are carriers of the infection for 2 years from the moment of birth and release the virus into the environment.
The first obvious symptoms of rubella in children appear by the end of the incubation period. He himself is usually asymptomatic, some children may complain of indisposition, weakness, be capricious, sleepy, sluggish. A sign of the presence of a virus in the body at this stage is a slight hardening and enlargement of the lymph nodes, first in the inguinal, axillary and submandibular regions, and then only at the back of the head and behind the ears. Occipital lymph nodes are least resistant to Rubella virus and it is in them that its accumulation and reproduction occur.
The prodromal period is distinguished in the disease. It happens not at all and can last from several hours or up to a couple of days and is accompanied by the following symptoms:
- pain in muscles and joints,
- loss of appetite,
- sore throat,
- nasal congestion.
The main signs of the disease
After 1–1.5 days, there is a sharp pain in the back of the neck, the lymph nodes in this area become immobile and dense, up to 1 cm in diameter. Can be observed:
- paroxysmal dry cough,
- nasal congestion caused by mucosal edema,
- body temperature rises to 38 ° C and lasts 2 days.
Period of rash
After 2 days, a small red rash appears on the face, neck and scalp. It is a round or oval pink-red spots with a diameter of 2 - 5 mm, not merging with each other. The appearance of lesions due to the toxic effect of the virus on the capillaries under the skin.
Within a few hours, the rash spreads throughout the body (to the shoulders, arms, back, abdomen, groin and legs), except for the palms and feet. After 3 days, it turns into nodules, begins to fade and disappear, leaving no scars or pigment spots on the skin. Lastly, the rash runs on the buttocks, the inner surface of the thigh and the arms, where the highest density of its elements is noted.
The period of rash lasts an average of 3 to 7 days. Then the child's condition improves markedly, appetite returns, cough and sore throat disappears, nasal breathing is alleviated. The size and density of lymph nodes returns to normal after 14-18 days after the disappearance of the rash.
How to distinguish from other diseases
Diagnosis can be difficult with an atypical form or when rubella in children is mild, with mild symptoms.
If you suspect rubella, it is important to differentiate it from other infectious diseases, accompanied by similar symptoms, or allergic skin reactions. Often, by external signs, it can be confused with measles, scarlet fever, adenoviral or enterovirus infection, infectious erythema, mononucleosis.
Unlike measles, rubella is not accompanied by severe intoxication and high temperature, the elements of the rash do not connect with each other, appear almost simultaneously, there are no pathological changes in the oral mucosa.
Rubella differs from scarlet fever in the absence of blanching of the nasolabial triangle, larger elements of the rash, localized mainly on the back and extensor surface of the extremities, and not on the stomach, chest and folds of the arms and legs.
Unlike mononucleosis, with rubella, peripheral lymph nodes are enlarged slightly, there is no purulent tonsillitis, there is no enlargement of the liver and spleen.
Compared with adults, rubella in children is mild and very rarely is accompanied by complications. The disease is generally characterized by a favorable course and, as a rule, does not require hospitalization. The exceptions are children with the congenital form of rubella, infants, children with severe comorbidities, as well as children who develop convulsive syndrome and other complications against the background of the disease.
There is no specific treatment for rubella. During illness it is recommended:
- bed rest during the acute period (from 3 to 7 days),
- wet cleaning and frequent airing of the room where the sick child is,
- drink plenty of water
- eating food (preferably dietary and rich in vitamins) often in small portions.
The following drugs can be prescribed for treating rubella in children: symptomatic remedies:
- vitamins (group B, ascorbic acid, ascorutin),
- antihistamines with a large number of rashes (suprastin, Erius, fenistil, zyrtek, zodak and others),
- antipyretic on the basis of ibuprofen or paracetamol at temperatures above 38 ° C,
- lozenges or sprays for severe sore throat (septefril, lysobact),
- vasoconstrictor drops from severe nasal congestion.
Antibacterial drugs are used to treat a secondary bacterial infection, if it occurs.
Features rubella in children under one year
In children under one year, rubella is extremely rare. This is explained by the fact that by the time of conception, most women either had already had rubella in childhood, or had been vaccinated against it. In this case, during prenatal development and subsequent breastfeeding, the baby receives antibodies from the mother's body to a variety of infections, including rubella, and up to about a year his body is protected by the mother’s immunity.
If a woman before conception did not suffer from rubella and did not receive a vaccination in childhood, then the chances of her unborn child to become ill with rubella in utero or before the age of one year (before the planned vaccination) are high.
Rubella in infants is dangerous to health.It may be accompanied by convulsive syndrome, DIC (disseminated intravascular coagulation), the development of meningitis and encephalitis. A feature of the disease at this age is the rapid development. Characteristic rashes can be present on the skin for no more than 2 hours, and then immediately disappear, leaving no trace. In children under one year old who have recovered rubella, a strong immunity to the disease is being formed, which allows them not to carry out a routine vaccination.
Consequences in pregnant women
The most severe and dangerous is intrauterine rubella infection. And the earlier it happened, the less favorable the prognosis. When a pregnant woman is infected before the 12-week period, the probability of fetal death and miscarriage or the occurrence of gross deviations in its development is high. These include lesions of the central nervous system (microcephaly, hydrocephalus, chronic meningoencephalitis), defects in bone formation and the triad of malformations:
- eye damage (cataract, retinopathy, glaucoma, chorioretinitis, microphthalmos) up to complete blindness,
- damage to the auditory analyzer up to complete hearing loss,
- development of combined abnormalities in the cardiovascular system (open arterial duct, defects of the heart walls, stenosis of the pulmonary arteries, incorrect localization of large vessels).
The teratogenic effect of Rubella virus is manifested in the fact that it inhibits cell division and thereby stops the development of certain organs and systems. Rubella causes fetal ischemia due to vascular lesions of the placenta, suppresses the immune system, and has a cytopathic effect on fetal cells.
If the fetus becomes infected after the 14th week of pregnancy, the risk of malformations is significantly reduced, single defects, meningoencephalitis, mental retardation, mental disorders are possible. Symptoms of congenital rubella in children can be low birth weight and a hindered reaction to age-appropriate external stimuli.
Rubella in children causes complications if the child has a weakened immune system. Most often they occur as a result of secondary bacterial infection. The most common complications include:
Rheumatoid arthritis, myocarditis, pyelonephritis, otitis media, thrombocytopenic purpura are less common.