Measles rubella in children: symptoms, consequences and treatment. Why is rubella dangerous?

Rubella is a highly contagious acute infection caused by the rubella virus.

Most often, unvaccinated children aged 2-9 years suffer from rubella. Rubella is especially dangerous in the first 3 months of pregnancy, and severe complications often develop. birth defects child development is possible fetal death fetus In general, rubella is more severe in adults than in children.

The source of infection is a person with a clinically pronounced or erased form of rubella. Transmission routes are airborne (when talking to a patient, kissing) and vertical (from mother to fetus). It is also possible contact path infection through children's toys. The patient becomes infectious 1 week before the rash appears and continues to shed virus for 5-7 days after the rash appears. A child with congenital rubella secretes the pathogen more long time(up to 21-20 months).

What happens when you become infected with rubella?

The incubation period of the disease lasts from 11 to 24 days (usually 16-20).

The rubella virus enters the body through mucous membranes respiratory tract and is carried by the blood throughout the body, causing an increase in lymph nodes, especially those located on the back of the head and back of the neck. Sometimes there is a slight runny nose and dry cough, a sore throat, and watery eyes. Rubella is most severe in adults: characterized by increased body temperature (up to 38-39°C), headache, muscle pain, and decreased appetite.

On the first day of illness, 75-90% of patients develop a characteristic skin rash, and rashes are more often observed in children. The elements of the rash are round or oval pink-red small spots. More often, the rash first appears on the face and neck, behind the ears and on the scalp, and then within 24 hours it appears on the torso and limbs. The location of the rash is especially typical on the back, buttocks, outer surface arms and the front of the legs. There is no rash on the soles and palms. Sometimes, at the same time, small single rashes appear on the oral mucosa. The rash lasts for two to three days.

In children, rubella is usually mild.

Complications of rubella are extremely rare and occur in children with immunodeficiency. These include: pneumonia, otitis, arthritis, tonsillitis, thrombocytopenic purpura. Very rarely (mainly in adults) brain lesions occur - encephalitis and meningoencephalitis. Rubella in pregnant women does not pose a serious danger to the expectant mother, but significantly increases the risk of fetal malformations.

Diagnosis and treatment of rubella

The diagnosis of rubella is usually made if the child has had contact with a person with rubella, is not vaccinated, and there is a characteristic skin rash, swollen lymph nodes, other symptoms.

The diagnosis is confirmed by a blood test from a vein for antiviral antibodies, which is carried out on the 1-3rd day of illness and 7-10 days later. Rubella is indicated by an increase in antibodies by 4 times or more.

Treatment is usually carried out at home. During the period of rashes, the child needs bed rest. Special treatment are not prescribed, sometimes symptomatic drugs are used (medicines that eliminate the symptoms of the disease).

If complications occur, urgent hospitalization is necessary.

The prognosis of the disease is favorable in most cases. Re-infection with rubella is impossible.

Prevention of rubella in children

To prevent the spread of infection, patients with rubella are isolated for 5 days from the moment the rash appears. No restrictive measures are provided for persons who communicated with them; quarantine is not imposed on groups of children's institutions. It is important to prevent contact of a sick child with pregnant women.

Vaccination against rubella is included in the vaccination calendar. In Russia, the measles-rubella-mumps trivaccine is most often used. The vaccine is administered subcutaneously or intramuscularly at 12-15 months and again at 6 years. Specific immunity develops in 15-20 days in almost 100% of vaccinated people and lasts for more than 20 years.

Rubella is a disease transmitted by airborne droplets. If it goes into childhood, it has virtually no effect on the body. But rubella during pregnancy is early stages is very dangerous for the fetus: through the mother’s blood, the virus reaches the child and affects its development processes, leading to serious pathologies of tissues and skeleton. Mom may feel great, but this does not inspire hope. What is the cause of the disease? How to protect yourself from it?

Read in this article

Where does rubella come from?

The disease spreads by airborne droplets. The virus enters the mother's body mainly from children. That is why it is especially dangerous to carry a child in a family where there is another baby visiting the kindergarten or other places with big amount kids.

The mechanism of penetration into the body is as follows:

1. Penetration of the virus through the respiratory tract.
2. Reproduction of rubella in the lymph nodes.
3. Penetration into the blood a week after infection.
4. Increased vascular permeability, tissue swelling.
5. , cough, runny nose, rash, damage to skin blood vessels.
6. Formation of antibodies from the third day after the appearance of the rash.
7. Persistent and long-lasting immunity.

Why is the disease dangerous for the fetus?

Rubella and early pregnancy are a terrible combination. In 80% of cases, this leads to damage to the child, which can result in (in 30% of cases), (in 20% of cases), as well as the death of the newborn (20% of cases). In case of survival, cataracts, deafness and heart disease are diagnosed, often all three diseases at the same time, and they are called the Greta triad. Quite often, pneumonia is diagnosed in a newborn, problems in circulatory system, spleen, bone tissue, low body weight and short stature. Subsequently, in children with congenital rubella, mental retardation, paralysis, increased nervous excitability, convulsions, hyperkinesis, etc.

In 60% of cases, organ damage occurs from 2 to 4 weeks of pregnancy, in 30% from 5 to 8 weeks, in 10% of cases from 9 to 12 weeks. This is why it is especially dangerous to catch the disease in the first trimester. From the second, the probability of getting this serious consequences decreases, however, even at 5 months the disease will not go away without a trace for 1 in 10 children. The organ that is developing most actively at this stage will suffer the most. In 70% of cases, the disease affects the hearing organs.

It is worth noting that rubella during pregnancy is later may have a negative impact on labor activity in the form of bleeding, blood poisoning, weakness of labor.

If the virus infection occurs after the 20th week, then the risk of pathologies in the fetus is significantly reduced, but is not completely eliminated. Possible future disorders nervous system and damage to the hearing organs. After 28 weeks, doctors will not recommend terminating the pregnancy, but will make every effort to exclude placental insufficiency. Additionally, the mother will be prescribed antiviral therapy and a vitamin complex. The pregnant woman will be registered as a woman at risk.

Doctors also note the fact that until 2001 in Ukraine, for example, vaccination against of this disease. Therefore, about 30% of women childbearing age can potentially transfer it during pregnancy. Unfortunately, if the mother’s doctors have diagnosed symptoms of rubella during early pregnancy, she will have to make a choice - either, or hope that everything will work out.

Symptoms of rubella and its manifestations

Pregnancy and rubella, the symptoms of which may go unnoticed in some cases, are still incompatible. Unfortunately, the disease will not pass without a trace for the child. How exactly the virus manifests itself in the body will be influenced by the state of the mother’s immunity, as well as the type of virus.
The disease develops within 5 to 25 days from the moment of infection without symptoms, and only then does a rash appear. Much less frequently, but already from the first days, pregnant women may begin to complain of:

• frequent;
• deterioration;
• weakness, poor health;
• runny nose;
• redness of the throat.

A few days after the onset of the disease, the temperature may rise slightly, and already with the appearance of the rash it will rise to 39 C. Also, the sick person will have enlarged lymph nodes (behind the ears, on the neck and in the back of the head), and when pressing on them, the pregnant woman will feel pain.

How is the presence of the virus diagnosed?

It is worth noting that if the expectant mother had rubella in childhood, then the likelihood of becoming infected again is extremely low, since antibodies are produced in the body. The same applies to mothers who suffered from the virus before pregnancy. Everyone else will be recommended to take a test for TORCH infections, the results of which will reveal immunoglobulins (IgG and IgM).

At the same time, IgM is an index of the presence of the virus, which manifests itself from the onset of the disease and reaches maximum quantity by the third week. If antibodies were not detected, this may indicate that either the pregnant woman did not have rubella and does not have it now, or that she suffered from the disease a very long time ago. More detailed information in this case it will give the second one immunoglobulin IgG. It is a lifelong indicator of the presence of antibodies in the body. If it is not detected in the blood, then the woman has not yet encountered the disease. If a pregnant woman becomes infected with the virus, maximum rate will be in a month.

When, after analysis, the presence of IgM without IgG is established, then in this case I recognize the onset of the disease. If identified high performance both antibodies, then the virus is in full swing. It is easier to understand whether rubella is present during pregnancy from the table:

What to do if there are first signs of illness

If future mommy had contact with sick people or found out that the child was sick a week after the contact, she mandatory it is necessary to visit an infectious disease specialist and a gynecologist. The first one will send you for a blood test, and the second one will send you for an ultrasound, and will also advise you to undergo a “triple test” (from the second trimester). Based on the results obtained, a decision will be made to continue or terminate the pregnancy.

In the first trimester, everything usually ends in abortion. After 28 weeks, doctors will administer immunoglobulin (20-30 mg) to the mother, and will also carry out a set of procedures aimed at protecting the fetus, preventing placental insufficiency and maintaining pregnancy.

Prevention against rubella virus

Even if a woman has already suffered from the disease, it is still recommended to carry out prevention methods. After all, reduced immunity can provoke reinfection. To do this, doctors insist, even at the planning stage, on taking a test to detect antibodies to the virus and, if they are absent, on vaccination.

The vaccine that will be administered to the expectant mother, based on living bacteria. Its effectiveness is 100%, and protection lasts for 20 years from the date of administration. However, there are contraindications for routine vaccination:

• long-term treatment with hormonal drugs;
• immunodeficiency;
• recent radiation therapy;
• individual intolerance to neomycin;
• pregnancy.

It is worth noting that after the vaccine is administered, it is not recommended to plan a child for three months. Additionally, it is recommended to undergo tests to confirm the production of antibodies. However, if pregnancy has occurred, it will not be interrupted, since the risk of fetal damage is possible only in 2% of cases.

Useful video

Watch this video about the dangers of rubella during pregnancy:

Rubella (rubeola) is a viral infectious diseases moderate type.For rubella characterized by mild lesions of the child's body - slightly enlarged lymph nodes and the appearance of fine-spotted exanthema. But in older children, the disease can be severe, involving purpura (capillary fine-spotted hemorrhages in the mucous membrane or skin) and joints.
Etiology of rubella :
The rubella virus is frost-resistant, but quickly dies under the influence of disinfectants and when exposed to ultraviolet rays and Stores at room temperature for 2-3 hours.
Humans are the only source and distributor of the virus rubella.The source of this viral infection can be infant with congenital rubella, spreading pathogen during the first 5-6 months from birth.
Distributed by rubella by airborne droplets from infected person to healthy when talking, coughing or sneezing. A patient with rubella is a source of infection a week before the first symptoms appear and a week after the end of the period of rash.
The contagiousness (the ability of an infection to be transmitted from sick people to healthy people) of rubella is low and therefore infection requires closer contact than with chickenpox or measles. In poorly ventilated areas and in places with large crowds of people, the risk of infection rubella increases. In addition, there is a transplacental (from mother to fetus) route of infection with rubella, which can lead to the formation of pathologies in the development of the fetus. Women who have not had rubella by the time of childbearing age and do not have antibodies remain at high risk of infection during pregnancy.
With absence immunity against rubella, susceptibility to infection is very high and does not depend on age. Children under 1 year old get rubella in rare cases, since they retain passive immunity acquired from their mother. The peak of infection activity occurs between March and June among younger children. age group(from 3 to 6 years).

Symptoms of rubella in children :
Usually rubella in children occurs at low temperature with minor conjunctivitis and a runny nose. The incubation period for rubella is from two to three weeks. During these days, the child develops mild symptoms of intoxication of the body: headache, malaise, lethargy, loss of appetite, enlargement and redness of the pharynx, sometimes muscle pain and joints. The posterior cervical, parotid and occipital lymph nodes are often enlarged. Before the rash, an enanthema (rash on the mucous membranes) may appear on the child’s skin, which is small pink specks on the mucous membrane of the palate. A little later, these specks may merge and spread to the arches, acquiring dark red color.
The lymph nodes become enlarged at least two days before the rash appears on the child's skin and remain enlarged for 7-9 days. Rash with rubella, it manifests itself in a much more varied manner than with chickenpox or measles. The rash covers a significant part of the child’s body for several days and is a maculopapular formation of a pale pink color. First, the rash appears on the face (where some of the spots often merge). Then it quickly spreads over the entire surface of the child’s skin - especially many spots appear on inside arms, back and buttocks. After 2-3 days, the rashes turn pale and gradually disappear, leaving no traces of pigmentation. Photophobia (unlike measles) is absent.

Diagnosis of rubella :
With characteristic clinical picture(especially during the spreading season) and the identified source of rubella infection, diagnosing this disease does not present any special difficulties. In some cases, diagnosis can be difficult due to the similarity of the course with some childhood diseases (scarlet fever, measles, allergic skin rashes). Therefore, when symptoms of the disease, contact your pediatrician or invite a doctor to your home.
Rubella poses a great danger to women who have not been vaccinated and were not ill before pregnancy and who have communicated with carriers of this infection.
Therefore, to confirm rubella infection, it is highly advisable to undergo a laboratory examination.

Treatment of rubella :
In the absence of any complications, rubella treatment does not require any special means. Only isolation of the sick child from other children and bed rest are indicated. If complications arise with rubella, the following are used: sulfonamide drugs; analgesics; in some cases - antibiotics; gargling with antiseptic solutions; hyposensitizing and detoxification therapy; multivitamins.

Possible complications with rubella :
To the very dangerous complications rubella in a child refers to meningoencephalitis(rubella encephalitis). The development period is from two to six weeks after the skin rash. The course of rubella encephalitis is quite long and severe. Over 60% of children who have had this form of encephalitis acquire serious changes in their psyche and motor function.
Also, serious diseases caused by rubella include viral meningitis.

Prevention:
General prevention in hotspots rubella is ineffective, since the activity of the virus begins long before the appearance of visible symptoms of the disease in infected children. In places where the infection is spreading, frequent ventilation of the room and wet cleaning are carried out. Strengthening the immune system reduces the likelihood of complications in the child. Many countries provide general vaccination children preschool age (in some European countries, all children aged 1.5-2 years are vaccinated with the rubella vaccine. In others, only girls aged 9-13 years are vaccinated). After vaccination, approximately 98% of children develop antibodies, and stable immunity to the virus appears rubella. It is especially important that girls develop immunity to rubella before the onset of pregnancy - either as a result of an illness in childhood or through vaccination. During pregnancy, vaccination with the rubella virus is strictly contraindicated.
Vaccination Rubella is also contraindicated in: development oncological diseases; immunodeficiency state body; allergic reaction to aminoglycosides. You should also not be vaccinated during treatment using blood products (vaccination in this case is indicated 3 months after or 3 weeks before the course).

Indications for termination of pregnancy in women who have not been vaccinated or who have not had rubella in preschool age:
Pregnant women without immunity to rubella Those who have visited the outbreak area or communicated with a rubella-infected person must undergo mandatory laboratory research to identify possible infection. If rubella disease is confirmed in the 1st trimester and even before 4-5 months of fetal development, an artificial termination of pregnancy is indicated. positive analysis it is indicated to terminate pregnancy even in the absence of visible rubella symptoms, taking into account the possibility of a hidden course of the disease.
When infected with rubella late stages pregnancy, the woman falls into a high-risk group and is placed on special registration. Treatment of placental insufficiency, prevention of miscarriage, and measures to protect the fetus are carried out.

Folk remedies for treating rubella :
For treatment of rubella You can recommend herbal preparations containing immunostimulating substances and facilitating expectoration.
- Prepare a mixture: elecampane root, marshmallow root, licorice root in equal proportions. Brew 2 teaspoons of the mixture per glass of boiling water (boil for 10 minutes) and then filter. Take 1/4 cup every 3 hours.
- Very helpful vitamin teas: lingonberries and rose hips 1:1 (brew in boiling water and drink 3 times a day); or black currant berries and rose hips 1:1 (brew in boiling water and drink 3 times a day); or take 1 part lingonberry berries, 3 parts rose hips, 3 parts nettle leaves (brew in boiling water and drink 3 times a day).

One of the most common viral infections, occurring mainly in childhood, is rubella. This viral disease, which in most cases occurs in a mild form, is accompanied by a short-term increase in body temperature, small rash, enlargement of all lymph nodes. Rubella most often affects children of early and preschool age, the so-called risk group - from 1 year to 7 years. Older children get sick much less often. What are the first signs, what incubation period, as well as how to treat the disease - we will consider further.

What is rubella?

Rubella in children is a disease belonging to the group of infectious, viral in nature, the main symptoms of which are considered to be fever, a widespread pinpoint rash over the body and catarrhal phenomena on the respiratory organs.

The rubella virus tolerates freezing well, remains aggressive for several hours at room temperature, and quickly dies under the influence of ultraviolet radiation, heat and disinfectants.

Factors that destroy the rubella virus:

• drying;
• the effect of acids and alkalis (the virus is destroyed when the pH decreases below 6.8 and increases above 8.0);
• action of ultraviolet radiation;
• action of esters;
• effect of formalin;
• effect of disinfectants.

Transmission routes

A person can only become infected with rubella from another person. The infection is transmitted by airborne droplets (the virus enters the air from the mucous membrane respiratory organs sick person and then inhaled by a healthy person). Most of cases of infection occur during the incubation period, when the virus has already settled in the body, but has not yet manifested itself with external signs.

Routes of transmission of rubella:

• Airborne;
• Transplacental (especially in the first trimester of pregnancy);
• In young children, the virus can be transmitted from mouth to mouth through toys.

A carrier of Rubella virus poses a danger to others from the second half of the incubation period: a week before the rash and a week after.

The risk of morbidity is high for those who have never been sick and have not been vaccinated; children 2-9 years old fall into this category of people. Outbreaks of morbidity are characterized by seasonality - winter-spring. Epidemic outbreaks recur every 10 years. After an illness, stable lifelong immunity is formed, but according to some data, re-infection is still possible.

When released into the external environment, the microorganism retains its aggressive properties for 5 - 8 hours, depending on the dryness and air temperature.

Incubation period

The incubation period for rubella is from 10 to 25 days. It is believed that children in whom the disease occurs without any manifestations or with mild symptoms are stronger sources of infection than children with clear signs infections.

Your baby can get rubella if he has been in contact with:

• infected people who exhibit all the characteristic symptoms;
• sick atypical form diseases (with an uncharacteristic course of rubella, the rash and many other signs may be completely absent);
• infants who are diagnosed with a congenital form of the disease (in such children, the virus can multiply in the body for 1.5 years).

Typical symptoms of the disease are noticeable at the end of the incubation period.

How rubella begins: the first signs in a child

Signs of rubella in children are often similar and largely due to the nature of the rash. Red spots appear rapidly, quickly covering the entire surface of the body. The first are localized on the neck, face, head, and later spread to the back, buttocks, and the surface of the limbs.

How rubella begins:

• First, the following symptoms appear: nasal congestion, sore throat, weakness, drowsiness, fever.
• Next, enlarged lymph nodes and their swelling become noticeable. Pain is noted on palpation.
• Most characteristic symptom during diagnosis - red spots.

Flow infectious process rubella in children is divided into several periods:

• incubation (from the moment the infection enters the human body until the development initial symptoms diseases);
• period of precursors (prodromal);
• rash period;
• convalescence (recovery).

What rubella looks like: photos of children with a rash

Not all parents know how rubella manifests and looks like and often confuse this disease with a typical cold or acute respiratory infection. But it is necessary to carefully diagnose each such case and take measures to prevent complications of infection that may affect brain structures, nerve fiber, spinal cord and connective tissue. The walls of small blood vessels are especially often affected.

The rash associated with rubella in children is localized around the ears, on the cheeks, in the area of ​​the nasolabial triangle, and on the neck. After 1–2 days, the elements spread throughout the body from top to bottom, and after 3 days they turn pale and begin to disappear. The rash never affects the skin of the palms and soles, but is most disturbing on the inner surface thighs, outer forearms, buttocks.

Symptoms of rubella in children

From the moment of infection with rubella until the appearance of the first symptoms, there is an incubation period that lasts 11–24 days (in most patients - 16–20 days). At this time, the virus penetrates the cells of the mucous membrane of the respiratory organs, and from there into the bloodstream, spreads with the bloodstream throughout the body, multiplies and accumulates.

During the incubation period, rubella manifests itself as follows:

• the temperature rises (slightly);
• weakness;
• conjunctivitis;
• pain in the throat;
• runny nose;
• lymph nodes enlarge;
• the final symptom is the appearance of a rash.

After 1–1.5 days, sharp pain occurs in the occipital part of the neck, the lymph nodes in this area become motionless and dense, up to 1 cm in diameter. May be observed:

Children experience the following symptoms:

• body temperature rises to 38°C and lasts for 2 days;
• slight enlargement and mild tenderness of the cervical and submandibular lymph nodes;
• redness of the throat;
• slight runny nose;
• conjunctivitis.

Skin rashes due to rubella (exanthema) appear first on the face, neck and behind-the-ear area, after which they quickly spread down the body. This process goes quickly, so sometimes it seems that the rash appears all over the body at the same time.

The highest concentration of elements is observed on the back, buttocks and extensor surfaces of the limbs. The rash can be all over the body, but in other locations it is more sparse. The rash usually does not itch.

If children have reached older ages, parents may receive complaints about painful sensations in the area of ​​muscles, joints, rashes initially appear in the face, but then the rash starts on the body, spreading over the limbs, torso, and scalp.

The period of rash lasts on average from 3 to 7 days. Then the child’s condition noticeably improves, appetite returns, cough and sore throat disappear, and relief nasal breathing. The size and density of the lymph nodes return to normal 14–18 days after the rash disappears.

Complications

Complications of rubella, as a rule, are detected when it is severe and are most often represented by the following pathologies:

• Connection of secondary bacterial infection(pneumonia, otitis);
• Serous meningitis or encephalitis, characterized by a relatively favorable course (this complication can develop on days 4-7 of illness);
• Thrombocytopenic purpura;
• Intrauterine fetal death;
• Congenital malformations.

The reason for the complications is severe course rubella, lack of treatment, non-compliance with medical prescriptions, addition of a secondary infection of a bacterial nature against the background of reduced immunity.

Diagnostics

If you develop or only suspect rubella infection, you should immediately contact a doctor such as an infectious disease specialist.

Even knowing how rubella manifests itself in children, it is not always possible to unambiguously identify this infection. Considering that the most telling sign - the rash - appears towards the end of the disease, the diagnosis must be made on the basis of anamnesis, data on the epidemiological situation and laboratory tests.

Diagnostic testing includes the following laboratory tests:

• General blood analysis ( increased ESR, lymphocytosis, leukopenia, possible detection of plasma cells).
• Serological examination of nasal mucus (RSC, RIA, ELISA, RTGA).
• Determination of the concentration of antiviral immunoglobulins.

Diseases similar in symptoms to rubella:

• adenovirus infection - colds, in which the lymph nodes become enlarged;
• enterovirus infection: enteroviruses can affect the intestines (acute intestinal infection), respiratory system(pneumonia, colds), skin and lymph nodes;
• measles is a viral disease that also manifests itself as a rash on the skin;
• infectious - a viral disease in which signs of a cold appear and enlarge in the lymph nodes, liver, spleen;
• - fungal disease, in which spots appear on the skin;
• urticaria - allergic reaction, in which red spots appear on the skin;
• Erythema infectiosum is a red skin rash that can occur in some patients with any infectious disease.

Treatment of rubella

Special medicines, which could directly affect the virus, namely rubella, have not been developed. Usually the disease occurs in a mild form and the child’s body, in the absence of complications, copes well with the disease.

The only important aspect is compliance with bed rest, plenty of drinking regime, for the speedy removal of pathogen toxins from the body, as well as the prescription of drugs that help eliminate the symptoms that arise.

No specific treatment has been developed, so they use:

1. bed rest for 3-7 days;
2. nutritious nutrition, taking into account age characteristics;
3. Etiotropic therapy with the use of viracids (arbidol, isoprinosine), immunomodulators (interferon, viferon) and immunostimulants (cycloferon, anaferon).
4. detoxification therapy - drinking plenty of fluids;
5. Ascorutin 500 mg three times a day (replenishes vitamin deficiency).
6. Temperature headache, body aches are relieved by antispasmodics and children's anti-inflammatory drugs: Paracetamol, No-shpa, Nurofen.
7. symptomatic therapy (expectorants - a certain group is used for of a certain nature cough, i.e. you cannot use expectorants and antitussives at the same time), mucolytics, antipyretics, analgesics).

Medicines are prescribed to prevent complications and relieve symptoms

Treatment of rubella disease in a hospital is required if the child develops convulsive syndrome and there are signs of infection spreading across the blood-brain barrier. In this case, the disease poses a threat to the health and life of the child.

Principles of treatment of rubella in children under 1 year of age:

• treatment only in an infectious diseases department for the entire period of rashes and infectivity, for constant monitoring of the child by medical personnel;
• in some cases, detoxification therapy is recommended by prescribing droppers with various infusion solutions;
• antihistamines prescribed in all cases;
• symptomatic drugs (anti-fever, vomiting, other drugs when signs of complications develop);
• vitamins, especially C and A;
• correct diet.

Rubella in children under one year of age provides stable lifelong immunity, which allows you to refuse vaccination within the prescribed period.

For congenital rubella, a child is treated by several specialists, depending on the affected organs: dermatologist, neurologist, endocrinologist, ophthalmologist, ENT doctor and others.

Even if the child feels well, he should not visit kindergarten, school or others public places. It is best to stay at home for at least a week. At the same time, it is important to ensure that the child takes vitamins and products that strengthen the immune system. It is also advisable for the child to drink as much liquid as possible.

Prevention

The main prevention of rubella is timely vaccination. It is carried out according to the following scheme: at the age of 1–1.5 years, the child is vaccinated, and then at 5–7 years – revaccination. After revaccination, the virus develops strong immunity.

Basic methods of prevention:

1. A sick baby is isolated from other children until complete recovery. Usually, from the onset of the rash, the sick person is isolated for 10 days. Sometimes (if there are pregnant women in the family or team) the quarantine period is extended to 3 weeks.
2. Complete exclusion of contact between pregnant women and a sick person. If contact occurs, repeat serology is performed on days 10-20 (detection of asymptomatic course). The administration of immunoglobulin does not prevent the development of rubella during pregnancy.
3. All children are vaccinated against rubella according to the vaccination schedule. It is given as an intramuscular or subcutaneous injection. Vaccination after 15-20 days forms a strong immunity in the child, which remains active for more than 20 years.

Causes of the disease

Viruses rubella belong to a special family. Virions have a spherical shape (diameter 100-300 nm) and contain RNA. Viruses are susceptible to exposure chemical substances and temperatures, are inactivated by the action of ether, chloroform, formaldehyde.

Rubella diseases are mostly sporadic, but epidemic outbreaks also develop periodically. Inter-epidemic intervals for rubella reach 7-12 years, but more often 6-9 years.

The age-related incidence of rubella in the absence of vaccination is characterized by its intensive spread among children from three to 10-12 years old. The incidence of rubella without vaccination is on average 250-300 cases per 100 thousand population and every decade takes the form of very large epidemics, when 1-2% of the population falls ill. During rubella epidemics, there is a significant increase in the number of cases of congenital rubella.

Epidemic outbreaks of rubella are characterized by a long duration among both children and adults, since rubella infection requires longer and closer contacts with patients. A single contact with rubella patients is usually not sufficient to cause the disease, which distinguishes it from measles, chickenpox, and mumps. At the same time, the infectious period for rubella is quite long, and close and prolonged contact of susceptible persons with patients, especially in families, kindergartens, schools, hospitals, and barracks, leads to infection.

Rubella is characterized by a winter-spring peak incidence. In Moscow, January-May accounts for up to 70%, and 3 spring months - up to 50-60% of the total annual incidence. The incidence of rubella depends on the density and mobility of the population, so in cities the incidence of rubella is higher than in rural areas.

The source of infection is only a person (adult or child), not only with clinically expressed, but also erased forms of rubella; the patient during the incubation period and the recovery period is also dangerous. It is worth considering that in almost half of patients with rubella, it is asymptomatic, in the form mild cold. Due to the instability of viruses in conditions external environment, it is impossible to become infected through third parties or objects. The patient is contagious last week incubation period and in the first week of illness.

The main source of infection are children, including newborns with congenital rubella syndrome, in whom the pathogen is found in urine, tissues, and cerebrospinal fluid and is excreted from the body within 12-18-30 months. and more after birth. But more often, virus shedding stops after 6 months. In 75-80% of children with congenital rubella at the 1st month. During life, the virus is found in the throat, nose, and later in urine, feces, blood, bone marrow. Thus, these children develop a chronic persistent infection, and they can be a source of rubella, especially for service personnel.

15-50% of women remain at risk of contracting rubella during pregnancy. If up to 90% of children get sick with measles by the age of 8-10 and by the age of 15 there are practically no people left susceptible to this infection, then up to 20% of people remain susceptible to rubella even by the age of 20.

It is believed that if the population of non-immune women of childbearing age reaches the 20% barrier, then there will be a threat of a rubella outbreak. If persons immune to rubella do not have contact with rubella patients for a long time, their level of immunity may decrease so much that if they encounter the virus again, they may become reinfected.

Mechanism of development of rubella

The entry point for the virus in acquired rubella is usually the upper respiratory tract; through the child’s nose and mouth, the virus enters the lymph nodes, where the virus is believed to multiply, accumulate and subsequently enter the blood. Rubella viruses spread through the blood during the incubation period. Thanks to viremia, the infectious principle spreads hematogenously throughout the body. Possessing lymphotropic and dermotropic properties, the virus causes enlargement of lymph nodes already during the incubation period, and then skin damage occurs.

From the moment the rash appears, viremia usually ends, which is greatly facilitated by the appearance of virus-neutralizing antibodies in the blood, which are detected in the blood a couple of days after the rash: subsequently their titer increases. The virus can be isolated not only from the nasopharynx of the sick person, but also from the skin, feces and urine. As soon as immunity is formed, the child recovers, and the immunity itself is stable and lifelong.

Manifestations of rubella

The incubation period for rubella lasts from two to three weeks, although cases have been known to extend the period to 25 days or shorten to 10 days, usually in adults. The disease begins acutely, in children there are usually no warning signs - a rash appears immediately, but a day before the rash, headaches or mild moodiness can be noted; cold symptoms in the nose or throat are weak and not all children have them. In babies, three types of illness can be observed: with only a rash, with the presence of a rash and fever; with the presence of rash, fever and catarrhal symptoms.

One of typical manifestations Rubella is a rash, and it is characterized by a special distribution - on the face and behind the ears, then on the scalp, and then it descends to the whole body without any particular sequence. Due to the rapid appearance of the rash, the effect of its immediate appearance occurs; the rash increases to maximum severity 24 hours after the onset of the exanthema. The rash is round or oval in appearance, small, the size of the elements is up to 2-3 mm, and does not rise above the skin level, since with rubella the exudation is weakly expressed, although in some patients the rash may acquire a papular character.

Spreading in spurts, the rash appears throughout the body, but only various areas her character may be different. The rash appears more abundantly on the back, buttocks, and extensor surfaces of the arms, and less intensely on the face and neck. There is no rash on the palms and soles. In some patients, small elements of the rash predominate, in others - larger ones. In general, rubella exanthema does not tend to merge, but in some cases a confluent rash still forms, resulting in solid red fields of rash, which complicates the differentiation of rubella with measles and scarlet fever. In some cases, the rash may at times resemble measles, and then scarlet fever, which often leads to an erroneous diagnosis of these infections, with the face and torso usually resembling measles, and on the extremities - similar to scarlet fever. But with rubella, elements of the rash smaller in size than with measles, but bigger size than with scarlet fever.

In children, the rash lasts an average of three days and goes away without a trace, leaving no pigmentation or peeling behind. Some children with rubella have a bright and large rash, which in some cases takes on a maculopapular character with a tendency to merge. The rash may be absent in some patients, and then rubella, due to moderate damage to the respiratory tract and lymphadenopathy, is more often diagnosed as an acute respiratory disease.

A severe rash occurs more often in adults (76%) than in children (56%). However, it was not possible to establish a parallelism between the degree of general intoxication and the intensity of the rash with rubella in both adults and children.

Parallel skin rashes or a little earlier, enanthema may appear on the mucous membrane of the pharynx in the form of small pale pink spots. IN foreign countries Rubella enanthema is also called Forxheimer's spots. In children, enanthema is usually faint and insignificant. The oral mucosa in patients with rubella may be inflamed, hyperemic, and the presence of granularity is noted.

Characteristic and one of early signs rubella is an enlargement of groups of lymph nodes, especially the posterior cervical, parotid and occipital groups. They can appear two or two days before the rash and signs of a cold and begin to disappear a few days after the rash subsides. This symptom can be used to early detection children during an outbreak of rubella in children's or other organized groups.

The most typical enlargement of the lymph nodes located behind the sternocleidomastoid muscle, in the back of the head and around mastoid process. Enlarged lymph nodes are clearly visible along the sternocleidomastoid muscle, especially when turning the head in the opposite direction.

Defeats from the side internal organs usually does not occur, but sometimes, against the background of a febrile reaction, slight tachycardia and muffled heart sounds occur.

The blood side at the height of the disease is characterized by moderate leukopenia (3000-4000), lymphocytosis and an increase in the number (up to 10-20%) of plasma cells. Plasma cells are always present in the blood in the first days of the disease and then for several weeks and even months. The presence of these cells in combination with hyperplasia of lymphoid tissue is one of reliable signs rubella. With rubella, relative monocytosis (up to 15% or more) and increased ESR may be observed.

There are no significant changes in urine in patients with rubella, but in some cases transient phenomena of febrile albuminuria, leukocyturia, and microhematuria are observed.

Along with pronounced, typical forms of rubella, its erased forms are also widespread. In children, the ratio of clinically pronounced and erased forms, according to various authors, ranges from 1:1-1:2. However, erased forms of rubella in adults and children pose the same danger for pregnant women, in terms of infection, as rubella with pronounced symptoms.

Diagnosis

The clinical manifestations of rubella are quite characteristic, and the diagnosis of the disease is carried out on the basis of clinical data. Epidemiological data, as well as widely used blood tests for antibodies, provide great assistance in recognizing rubella. Recognition of rubella outside of an epidemic outbreak and in the absence of reliable contact with a patient in the anamnesis can be difficult due to its great similarity with other diseases.

A 4-fold increase in antibody titer, which is determined both in the IgG and IgM fractions, is considered evidence-based. The detection of IgM type antibodies to the rubella virus in the blood indicates rubella infection, while the detection of IgG type antibodies does not exclude the possibility of rubella infection. The presence of IgM antibodies in the blood serum of patients for several months is the main sign of past embryopathy associated with rubella, which gives grounds for diagnosing rubella retrospectively, within 1 year.

Treatment

No specific treatment for rubella has been developed. Conduct symptomatic therapy, if it becomes more complicated, antibiotics are prescribed. Patients with uncomplicated rubella can be treated at home, where they are on ward rest, but with a significant increase in temperature they are transferred to bed rest. Patients with rubella are prescribed a complex of vitamins, and for severe rashes, joint and muscle pain, antihistamines are additionally prescribed - diphenhydramine, pipolfsn, suprastin. For significant conjunctivitis, 15-20% is instilled into the eyes Albucid solution, with severe lymphadenitis, the area of ​​​​enlarged and painful lymph nodes is exposed to dry heat, UHF.

Pregnant women who have not had rubella should avoid contact with sick people for at least three weeks. If a pregnant woman becomes infected or becomes ill with rubella, some authors recommend possible development for congenital rubella in the fetus, administration of 10-30 ml of gamma globulin.

Information about the effectiveness of gamma globulin prophylaxis against rubella is quite contradictory. The use of gamma globulins during the period of already developed viremia does not provide a preventive effect.