When it comes to infectious diseases and the need for vaccinations, rubella issues often arise. Many have heard and know about this disease, and some have no idea what it is. And when they hear about it, they often ask the following questions: “What is this disease? Why and who has it? What are its main symptoms? Are they the same in children and adults? How can this pathology be differentiated from others? What is her therapy? How can it be complicated if you do not treat yourself and do not treat the child? How can you prevent its appearance? "
What do we know about the causative agent of rubella?
This pathology is an acute viral infection, which can be either acquired or congenital. The transmission mechanisms and their consequences can also be different.
The causative agent of this disease belongs to the Togoviridae family. It is the only member of the Rubivirus genus to contain RNA. It mainly affects the skin and lymph nodes. The virus is highly contagious. And after contact with him, people who do not have specific immunity fall ill in 90%.
Children under six months of age whose mothers have anti-rubella immunity are immune to this disease. But if mothers have no immunity, then babies can immediately become infected with this type of viral infection. The maximum number of cases of infection with this pathology falls on the age of one to seven years.
Literally, the name of the disease is translated from Latin as "little red".
Every three to five years, there are periodic rises in the incidence. They reach their maximum during the change of seasons (from autumn to spring).
Discovery history
Despite the fact that rubella affects mainly children, it can also occur in the adult population.
For the first time this pathology as an independent disease was identified and described in 1834 by the German researcher Wagner. He spoke of her as "German measles", since until that moment she was considered a kind of this disease. Rubella, as an independent nosological unit, was approved in 1881 at the International Congress in England.
The virus of this disease itself was isolated in 1961 by three scientists independently: T. H. Weller, P. D. Parkman, F. A. Neva.
Characteristics of the pathogen
The shape of the viral particles is spherical, and their diameter is 65 - 70 nm. From above, they are covered with a protein membrane with villi on it (this factor contributes to the attachment of the virus to cells). This virus is not resistant to external factors: room temperature contributes to its death within a few hours, at 56 - 57 ° C the pathogen is inactivated within an hour, at 100 ° C - within a few minutes. However, the virus is resistant to freezing and antibiotics. Dies in alkaline and acidic environments, ultraviolet rays, ether, chloroform, formalin.
How can you get rubella?
When infected with this virus in the first three months of pregnancy, almost always (in 100%) a miscarriage occurs or severe congenital pathologies are formed in a child.
A sick person is the only source of infection.
Infection with this virus occurs mainly in two ways: transplacental, airborne, however, a third method is additionally distinguished - household (contact).
Source of infection
After a person has been ill with this virus, he develops a persistent lifelong immunity.
Children who have congenital rubella can shed the virus with sputum, feces, urine for one and a half to two years, in this regard, a child born with this disease is a dangerous source of infection. These children are more infectious and tend to shed more viruses than those with the acquired form of the disease. The danger lies in the fact that congenital rubella in children is not always diagnosed, and such babies remain a hidden source of infection.
From an epidemiological point of view, the most dangerous are patients who have a subclinical form of this disease, since it occurs much more often than explicit forms.
Transmission routes
The main routes of transmission of this infection are considered to be the following.
- Airborne. It is the most common. The virus is transmitted during conversations, kisses.
- Transplacental (vertical). The virus is transmitted through the placenta from mother to child.
- Contact or household (when sharing hygiene items, dishes, toys, etc.).
The routes of rubella transmission are different, but it is important to know that this pathology is not transmitted through third parties!
The entrance gate for the acquired form of this pathology is the mucous membrane of the oropharynx, in some cases the skin. Then the virus enters the regional lymph nodes and contributes to their inflammation (lymphadenitis), mainly affecting the occipital and cervical lymph nodes.
The next step in finding it is getting it into the bloodstream and the development of viremia, followed by damage to the organs and systems of the baby. In the event that an inflammatory reaction develops on the skin with the participation of the immune response, enanthema occurs; if endothelial cells and hematopoietic organs are affected - thrombocytopenia; if this process affects the nervous system, meningitis and encephalitis develop.
The causative agent of this infection can be found in the nasopharyngeal mucus and blood seven to nine days before the rash appears, and after its appearance - urine, feces. Finding the virus in the blood contributes to the appearance of neutralizing antibodies (IgM, IgG) in it. In turn, IgG remains in the body for life, and it is he who testifies to the transferred pathology.
With the congenital form of this pathology, the entrance gate for infection is the placenta. The causative agent of the disease through the bloodstream of a pregnant woman affects the epithelial cells of the chorionic villi and the endothelium of the blood vessels of this organ. In addition, fetal B-lymphocytes are affected, and a defect in interferonogenesis occurs; the proliferation of its cells slows down and is suppressed. Because of these changes, the mitotic activity of cells in certain areas is slowed down and the correct growth of the organ is disrupted, the development of chronic infection and the formation of congenital deformities in those organs and systems that are at the stage of laying.
What deformities a newborn child has and what degree of severity they have is directly dependent on the period of gestation during which a pregnant woman was infected with rubella. If infection with it occurs in one or two months, then this contributes to the development of congenital heart defects, cataracts, deafness; in three to four months - brain damage. Whether a pregnant woman becomes ill with this disease or not upon contact with the virus depends on whether or not she is immune to this virus.
After the baby is born, the virus continues to circulate in the body. A baby with a congenital form of this disease develops congenital deafness, retinopathy, thyroiditis, diabetes, encephalitis.
In the modern world, this pathology occurs in 15% of pregnant women. In half of them, it has a subclinical course, and the process proceeds as a chronic infection. If a pregnant woman becomes infected with this virus after twenty weeks of gestation, then malformations occur much less often, but at the same time a chronic disease develops with damage to the nervous system and sensory organs.
What is the incubation period?
This period is also called latent. It denotes the period of time from the moment the microbial agent enters the body until the symptoms of the disease appear.
This period for the causative agent of this disease is from 14 to 21 days, on average - 18-23 days.
Rubella in a child, symptoms
In 2002, almost 60% of the countries of the world introduced vaccination against this virus and the number of people with this infection has sharply decreased.
Symptoms of the disease in the acquired form depends on the period of the disease and can be varied.
AT incubation period no symptoms.
It is very important that the symptomatology of this "childhood infection" is very similar to common cold symptoms, so it is not always possible to diagnose it in a timely manner (and even more so to parents without examining a doctor and taking anamnesis)!
Prodromal period is absent or lasts from several hours to several days. At this time, the occipital, posterior cervical, and behind the ear lymph nodes increase. They become hard and painful on palpation. In addition, the body temperature in the prodrome can rise to 37.5 - 38 ° C; there is a mild catarrh on the mucous membranes, roseola enanthema on the hard palate. The prodrome in most cases occurs in older children and is more severe than in small ones. Nonspecific symptoms can also take the form of mild chills, drowsiness, sore throat, coughing, minor rhinitis, etc.
Lymphadenopathy - This is an early and pathognomonic symptom of this pathology. It mainly affects the occipital and posterior cervical lymph nodes (in most cases, one to two days before the development of other symptoms). These groups of lymph nodes have an elastic consistency, they are not welded to other tissues, slightly painful on palpation. These changes persist for one to two weeks after the rash appears.
Rare complications of this disease are encephalitis, thrombocytopenia, arthritis.
The appearance of catarrhal phenomena and conjunctivitis does not always occur, more often they are weakly expressed. Their duration is on average two to three days.
The congenital form of this pathology is characterized by a triad of symptoms (the so-called Gregg triad):
- cataract... The onset of this symptom is the result of the direct cytopathogenic action of the infectious agent. Its persistence in the lens of the eye can last for several years. This pathology is both unilateral and bilateral and is prone to a combination with microphthalmia;
Eye manifestations of pathology can appear several years after the birth of a child.
- deafness. The mild degree of these changes is more often determined after several years. Quite often, this symptom is combined with vestibular dysfunction;
- heart disease. In 78% of cases, a duct that is not overgrown with botalis is determined.
In addition to this triad, there are many other congenital manifestations. These include: microcephaly, microphthalmia, dilated fontanelles, glaucoma, cleft palate, interstitial pneumonia, hepatitis, myocarditis, meningoencephalitis, damage to the vestibular apparatus, malformations of the genitourinary system, dermatitis, thrombocytopenia, hemolytic anemia, hypogelinema.
Changes in the nervous system are manifested in the form of: altered consciousness, drowsiness, irritability, seizures, decreased muscle tone, paralysis. In the future, manifested in the form of movement disorders, seizures, hyperkinesis. In addition, the baby may begin to lag behind in mental development.
Congenital rubella in children often also manifests itself: low body weight, short stature, significant lag in physical development. Approximately 16% of babies with this pathology die in the first four years due to heart defects, sepsis, and damage to internal organs.
The appearance of thrombocytopenia is most pronounced in the first week after the baby is born; hemorrhagic manifestations can persist on the skin for two to three months.
Typical manifestations of the congenital form include: hepatitis, hepatosplenomegaly, hemolytic anemia with reticulocytosis and deformed erythrocytes, serous meningitis, interstitial pneumonia, damage to the tubular bones. Most neonatal changes disappear within six months.
A patient with rubella is contagious until the fifth day after the onset of the rash, and with a congenital form - up to one and a half years.
The following defects are much less common: of the genitourinary system (cryptorchidism, hypospadias, hydrocele, bicornuate uterus, dicotyledonous kidneys), gastrointestinal tract (pyloric stenosis, atresia of the bile ducts), as well as skin changes in the form of dermatitis, age spots.
According to scientific evidence, it is known that children who were born to mothers who had this infectious disease during pregnancy most often have reduced mental capacity in the first seven years of life.
The main diagnostic characteristics of this pathology:
- it is known from the epidemic that there was contact between the child and a patient with this infectious disease;
- most often occurs in the winter-spring period;
- characterized by a maculopapular pink rash, which is mainly localized on the extensor surfaces of the limbs, back, buttocks;
- lymphadenopathy. It is referred to as an early sign of illness. The occipital and posterior cervical lymph nodes enlarge, become painful to the touch.
Characteristics of rubella rash. A photo
Its appearance is combined with catarrhal symptoms. The first elements appear on the face, and after a few hours on the whole body. On examination and even in the photo, it can be replaced that it is roseolous and fine-spotty-papular. Elements of the rash appear on an unchanged background of the skin, do not merge with each other, they are mainly located on the extensor surfaces of the limbs, on the back, buttocks, and the outer surface of the thighs. The presence of exanthema on the skin lasts two to three days, and then it disappears without a trace without pigmentation and peeling.
Rubella diagnosis
Only a doctor can correctly diagnose on the basis of complaints, anamnesis, examination, diagnostic research methods, so you should not deal with this issue yourself.
This diagnosis is made on the basis of:
- general blood test. It shows leukopenia, lymphocytosis, normal ESR, 10 - 30% of plasma cells;
- serological method. Antibodies to this virus are determined in blood serum due to serological reactions (RN, RTGA, RSK, RMF). The study of paired sera is performed on the first-third and eighth-twelfth days from the onset of the disease. If the antibody titer quadruples, then this fact indicates the presence of this infection in the body;
- virological method. The causative agent of the disease can be isolated from the nose, blood, cerebrospinal fluid, urine. Practically not used in practice.
If specific IgM antibodies are detected in the blood in ELISA, then this is direct evidence that the child has recently suffered this infection, or he has a congenital form of it.
Features of rubella in children of different ages
This disease in children in the first year of life occurs very rarely. However, when it occurs at this age, it has a lightning-fast course and is characterized by a serious condition of the child. Due to the immaturity of the blood-brain barrier, there is a high likelihood of encephalitis and meningitis.
Therefore, emergency hospitalization of children in the first year of life with infection with this virus is mandatory.
In adolescence and adulthood, the course of the disease is severe.It has more pronounced signs of intoxication (headache, febrile temperature, chills, myalgia), catarrhal manifestations (in the form of dry cough, sore throat, pronounced conjunctivitis with lacrimation, photophobia, runny nose). The rash at this age is more profuse, maculopapular, and tends to merge.
Women and adolescent girls with this pathology may complain of the appearance of symptoms characteristic of synovitis, arthritis (they disappear in seven to eight days). And boys at school age may complain of testalgia (pain in the scrotum).
Do I need hospitalization or where to treat rubella?
Therapy for the uncomplicated acquired form of this disease can be done at home. In this case, bed rest during the acute period, general hygiene measures, symptomatic therapy should be observed.
If the child has a congenital form of this pathology, then the treatment is carried out depending on the nature of the clinical symptoms either in a specialized hospital or in an isolated ward.
Not everyone needs hospitalization for rubella. It all depends on the severity of the course, the age of the patient, the presence of chronic foci of the infectious process.
Why is a childhood infection dangerous? Complications
Most often, rubella in children proceeds without complications, but there are times when they can occur. And they can appear in the form:
- thrombocytopenic purpura (approximately 1: 3000)... Platelets become less than 180 thousand U / μL). In this regard, bleeding increases in a sick child;
- lesions of the central nervous system. In 1: 6000 cases, encephalitis occurs;
- reactive arthritis. The largest number of cases of this complication occurs during adolescence in girls.
The greatest number of complications and deformities occurs due to congenital rubella. According to the WHO, it is she who causes complications annually in about 300,000 children, and therefore is included in the vaccination calendar in many countries of the world.
During pregnancy and after childbirth, the most insidious complications of this infectious disease are:
- miscarriages;
- malformations (in the form of deafness, blindness, heart and brain defects and other deformities).
When infected with this virus after the fourth month of pregnancy, the likelihood of complications decreases, and after the sixth month it is practically equal to zero.
The risk of side effects and complications after a prophylactic vaccination is one hundred times less than when infected with this virus.
Rubella in adults
The incidence of this childhood infection in adults is about 22%. In adulthood, infection with it can occur regardless of the fact that rubella was transferred in childhood. But the largest number of cases occurs in the unvaccinated population.
Infection of adults with this virus occurs almost always from their children. The clinical picture at this age is most pronounced. In rare cases, it is asymptomatic. Fever, sore throat, weakness, dizziness appear before the rash appears.
Rubella in adults during the incubation period has no clinical manifestations (it lasts more than ten days). In the prodromal period, the appearance of: muscle pain, loss of appetite, weakness, severe headache, fever, runny nose, cough, sore throat, increased tearing, redness of the eyes, enlarged lymph nodes is possible.
The main symptom of this viral infection is the presence of a specific rash characteristic of this pathogen.
Late manifestations of rubella are soreness in the joints, a rash on the body, an enlarged liver and spleen, and enlarged lymph nodes (they can be so even for more than a month after recovery).
Specific prevention. Vaccination
She happens specific and non-specific.
Active immunization is carried out with the help of a live attenuated rubella vaccine or a combination vaccine (mumps-measles-rubella) at the age of twelve to fifteen months. Six-seven-year-old children are subject to revaccination. Girls at the age of fifteen are re-vaccinated.
Passive immunization with normal human immunoglobulin is ineffective.
Conducting nonspecific prophylaxis is based on early detection of patients, their isolation and a clear record of those in contact without separation. If a woman contracted this infectious disease in the first three months of pregnancy, it is recommended to interrupt it (if there are no antibodies to this virus in the blood).
Complications of this disease in the form of meningitis, encephalitis, meningoencephalitis occur with a frequency of 1.5 per 10,000 population; and thrombocytopenic purpura - 1: 3000.
There are complex vaccines to combat this virus, as well as measles and mumps (these include: Priorix, Trimovax, Trivaccine) and monovaccines (Ervevax, Rudivax, etc.).
Children who are born to mothers who have had rubella while carrying a child, or have been in contact with such patients, must be under dispensary supervision for at least seven years. Moreover, they should be regularly examined by a pediatrician, ophthalmologist, otorhinolaryngologist, and neurologist.
Conclusion
Rubella can have both the most "harmless" symptoms and cause serious health problems for the child. Therefore, it is important to take into account who and when, and at what age this pathology arose, as well as how it manifested itself.
If the disease arose during the laying of the organs and tissues of the crumbs, then it is recommended to terminate the pregnancy. In the event that a child was born from a mother with this disease, then it is important to properly examine, observe and treat such a child. If the clinical picture of the disease is not very pronounced, an outpatient regimen, hygiene measures and symptomatic therapy are enough.
Do not self-diagnose and treat this viral infection, as if the therapy is not correct, a variety of complications can arise that can cost the baby's life. Take care of your children! Be healthy!
Bibliography
- Pediatrics: a textbook for students. higher honey. uch. institutions of IV level of accreditation / ed. V. Tyazhkoy, S. Kramarev / Ed. 2nd - Vinnitsa, 2010.
- Handbook of infectious diseases / ed. prof. I. Bogadelnikova, Simferopol - Kiev, 2005.
- Handbook of sane parents, E.O. Komarovsky, Kharkov, 2012.
