Rubella is a viral disease that belongs to the so-called “childhood infections”, which for some reason threatens severe complications for an adult with a developed immune system. Therefore, a test for rubella antibodies is included in the standard examination of all pregnant women.
Rubella, “caught” during pregnancy, is fraught with complications for the fetus in 80% of cases if the virus enters the mother’s body in the first week of pregnancy, if at 2-4 weeks, then the fetus is affected with a 60% probability, if infection occurs later , then intrauterine infection occurs in 30% if the infection occurred at 5-8 weeks, and in 10% if at 9-12 weeks. That is, a woman, being 5 months pregnant, in one case out of ten runs the risk of giving birth to a sick child.
Rubella affects the fetus not very selectively, but the following anomalies predominate: congenital cataracts, congenital deafness and congenital heart disease. Doctors dubbed this trinity the Greta triad.
In addition, infection with rubella during pregnancy threatens spontaneous miscarriage or fading of fetal development - this occurs in 10-40% of all cases of maternal infection during pregnancy. In addition to this famous triad, rubella suffered during pregnancy can lead to brain damage: hydrocephalus and microcephaly.
Rubella can also provoke difficult labor: weakness of labor, bleeding, sepsis.
But even if you have successfully given birth to a relatively healthy child, you cannot relax, because the probability of death in infancy in a child whose mother suffered from rubella while pregnant is 20%!
<
So how can you find out if you are at risk of contracting rubella during pregnancy?
The test for antibodies to rubella is included in the test for antibodies to TORCH complex infections. The answer you can get is similar to the answers to studies of antibodies to other TORCH complex infections.
Accordingly, if as a result of this analysis you receive “IgG +”, then this means that you have stable immunity, and during pregnancy there is no point in being afraid of infection with the cranuch virus. However, if you are found to have “IgM+”, then you will be offered to retake the test in 2 weeks.
But it is much worse if no antibodies to rubella are detected at all. If this happens, you will be asked to have a rubella antibody test every two weeks throughout your pregnancy.
An indicator of the presence of immunity to the rubella virus.
IgG antibodies to the rubella virus begin to be produced 3-4 weeks after infection and are detected after the end of the acute illness for life, providing protection against re-infection. Detection of anti-Rubella-IgG in a concentration of less than 10 U/ml indicates their insufficient level to protect against clinical manifestations of the disease with or without exposure to the rubella virus.
An anti-Rubella-IgG level of more than 10 U/ml is recommended as an indicator of the presence of immunity to this virus. Determination of anti-Rubella-IgG titers over time (in paired studies with an interval of 2-3 weeks) is used, if necessary, to confirm a recent infection with the rubella virus (in addition to the determination of anti-Rubella-IgM). A significant increase in IgG titers indicates the severity of the process. Positive anti-Rubella IgG results when testing umbilical cord blood or newborn blood should be interpreted with caution, since specific IgG can be transmitted to the fetus from the mother through the placenta.
Features of infection. Rubella is an acute viral infectious disease that can occur in typical, erased and asymptomatic forms. The rubella virus is unstable in the external environment, so infection requires fairly long and close contact with the patient. Transmission of infection occurs by airborne droplets and transplacentally (from mother to fetus). Mostly children aged 1 to 7 years are affected. When a pregnant woman becomes infected, severe malformations or spontaneous abortion occur. When transmitted by airborne droplets, the virus infects the epithelial tissue of the upper respiratory tract, enters the bloodstream, then into the lymph nodes, where it replicates. The incubation period lasts 15 - 21 days.
In children, the disease is relatively mild. It begins with an enlargement of the lymph nodes in the neck and back of the head; after 1 to 5 days, a small-spotted rash up to 5 mm in size (not rising above the surface of the skin) appears on the face. During the day, the rash spreads from top to bottom to the extensor surfaces of the limbs, back, and buttocks. A slight fever and catarrh of the upper respiratory tract are present. After 1 - 3 days, the elements of the rash disappear without a trace.
In adults, rubella is more severe and complications develop more often. The most common is polyarthritis, lasting 1 to 2 weeks. Encephalitis occurs less frequently (1:5000), but the mortality rate in this case is 20 - 40%. Encephalitis may precede the rash by 1 - 12 days, but more often develops on the 3rd - 4th day of the appearance of the rash.
During transplacental transmission, the virus affects the endothelium of the capillaries of the placenta, causing fetal hypoxia, and then the embryonic tissues, where it suppresses the mitotic activity of individual cell populations. If primary rubella infection occurs during the first 12 weeks of pregnancy, the virus crosses the placenta and causes generalized and persistent infection of the fetus, which almost always causes multisystem disease and congenital malformations. When infected in later stages of pregnancy (13 - 16 weeks and later), the incidence of defects in intrauterinely infected infants decreases, but a certain danger remains until the third trimester.
| Time of infection | Developmental defects |
| 3 – 11 week | central nervous system |
| 4 – 7 week | Organ of vision, heart |
| 7 - 12 weeks | Hearing organ |
Laboratory diagnosis of rubella is of particular importance in the following categories of subjects:
| Category | Causes |
| Women preparing for pregnancy | 1. Latent course in childhood (no diagnosis - there is immunity); 2. Errors in the differential diagnosis of rubella (there is a diagnosis - there is no immunity; 3. Resolving the issue of vaccination. |
| Pregnant women | Congenital rubella, developmental defects, fetal malnutrition. |
| Adults | Severe course, complications. |
IMPORTANT! Rubella is part of the group of TORCH infections (the name is formed by the initial letters in the Latin names - Toxoplasma, Rubella, Cytomegalovirus, Herpes), which are considered potentially dangerous for the development of a child. Ideally, a woman should consult a doctor and undergo a laboratory examination for TORCH infection 2-3 months before the planned pregnancy, since in this case it will be possible to take appropriate therapeutic or preventive measures, and, if necessary, compare the results of studies before pregnancy in the future with the results of examinations during pregnancy.
Precautions during pregnancy
If you consciously approach pregnancy planning, then you will do the test before it occurs, in case antibodies of the required quality and quantity are not detected in order to have time to get vaccinated. Doctors recommend administering the vaccine no later than 2-3 months before the planned conception, so that stable immunity can develop.
If pregnancy has already occurred, and you have not been found to have immunity to rubella, then the doctor will recommend that you limit your contacts to your family circle and avoid contact with children - after all, they are known to get rubella more often than other people.
And if you already have a child, then closely monitor his environment at school or kindergarten (if quarantine is announced for this disease, you need to pick up the child from kindergarten or school and take sick leave - this way you will minimize the risk of infection).
If you do not have IgG antibodies to rubella, then even an ordinary cotton-gauze bandage, which you will wear in crowded places (public transport, mandatory events, etc.), will help you minimize the risk of infection, since the virus rubella is transmitted by airborne droplets.
Rubella during pregnancy
Rubella during pregnancy, as well as outside it, begins with an incubation period that lasts 11-24 days. Then a characteristic sign appears - enlargement and soreness of the occipital, cervical and parotid lymph nodes. About a third of women suffer from joint pain caused by the penetration of the pathogen into the synovial fluid. After a few days from the onset of these symptoms, rubella during pregnancy manifests itself as a small papular rash of pink color. Elements can merge with each other. Initially they are localized on the skin of the face, then spread to the body and limbs. The rashes disappear in the same sequence.
Rubella during pregnancy is often accompanied by signs of conjunctivitis: pain in the eyes, photophobia, lacrimation. Due to severe intoxication of the body, an increase in body temperature to 38-39˚C, weakness, fatigue, and headache are observed. Less often, patients are bothered by cough, sore throat, rhinorrhea, nasal congestion, redness of the mucous membrane of the pharynx. Rubella during pregnancy increases the risk of spontaneous abortion by approximately four times. Penetrating through the placental barrier, the virus reaches the fetus and provokes severe disorders of intrauterine development, which can be detected by ultrasound scanning. Additionally, the condition of the child and the concentration of the virus in the amniotic fluid in case of suspected rubella during pregnancy can be judged from the data of amniocentesis.
Rubella during pregnancy is accompanied by multiple embryopathies. On the fetal side, first of all, Gregg's characteristic triad is observed. It includes such defects as deafness, blindness, and heart disease. The development of cataracts is possible. Also, rubella during pregnancy causes disturbances in the mental and physical development of the fetus, congenital dystrophy, cerebral palsy, and idiopathic thrombocytopenic purpura. If a woman is affected in the late stages of pregnancy, the baby may experience such manifestations as vasculitis, a tendency to pneumonia with constant relapses, and chronic exanthema. In about a third of cases, rubella during pregnancy is fatal for the child.
Even if rubella during pregnancy does not provoke severe congenital defects in the fetus, which is typical for infections in the 2-3 trimester, it can have long-term consequences. In particular, the disease can give long-term manifestations during the child’s puberty and cause panencephalitis, insufficient production of growth hormone. Often, rubella suffered by the mother during pregnancy causes the development of an insulin-dependent form of diabetes mellitus in a child in adolescence. Hearing impairment and thyroiditis of autoimmune origin are also possible.
Contraindications
Vaccination is stressful for the body. During the period after vaccination, the state of health changes; some people experience negative reactions and complications. To minimize the likelihood of side effects, you need to know when and who should not undergo prophylaxis.
Absolute contraindications to rubella vaccination:
- hyperthermia;
- diagnosed early pregnancy;
- immunodeficiency state;
- intolerance to the components of the product used;
- development of severe reactions to the previous dose of rubella vaccination;
- exacerbation of a chronic disease;
- allergies to medications, food, hygiene products, etc.;
- the presence of an infectious or viral pathology.
It is recommended to get vaccinated a couple of weeks after you feel normal.
Caution should be exercised when immunizing persons:
- with a tendency to allergies, hyperthermia, convulsive seizures;
- whose relatives had anaphylaxis from rubella vaccination.
To identify contraindications to vaccination, the woman is examined and examined.
Rubella vaccine before pregnancy
The easiest way to find out if you are immune to rubella is to get tested for antibodies to this virus. Even if you think or are sure that you did not have rubella in childhood, you may have developed antibodies to it, which will mean that you have lasting immunity to the disease. Rubella is often asymptomatic or simply misdiagnosed (that is, during the course of rubella, the doctor makes an incorrect diagnosis), which is why many do not even suspect that they have had this infection.
It is also possible that after vaccination and exposure to rubella in childhood, immunity against the disease is not developed. Moreover, today doctors do not hide the fact that the virus is constantly mutating, and the vaccination made 20 years ago is no longer a lifelong protection against it.
So, if you are planning a pregnancy, then the rubella vaccination should be done several months before conception. Doctors recommend abstaining from pregnancy for at least 2-3 months after the vaccine is administered (or better yet, wait six months). There is no categorical ban on pregnancy before this period, but it is still stipulated that the risk of a negative impact of the administered vaccine on the development of the fetus cannot be excluded. In addition, the effect of the rubella vaccine is somewhat delayed in time, that is, immunity is not developed immediately.
Doctors say that timely vaccination will protect not only the woman and will not only minimize the threat of miscarriage due to infection, but will also provide the unborn child with immunity to rubella, which he will receive from his mother.
More on the topic
Vaccinations when planning pregnancy
Rubella and pregnancy
How dangerous is cytomegalovirus during pregnancy and when is treatment necessary?
What types of infections occur during pregnancy and how to identify them?
What vaccinations can pregnant women get?
Virus dangerous to the fetus (rubella and its prevention)
Rubella is an acute viral disease characterized by a small-spotted rash, generalized lymphadenopathy, moderate fever and fetal damage in pregnant women.
The source of infection is a person with rubella. Of great epidemiological importance are patients without a rash, as well as children with congenital rubella, in whose body the rubella virus can persist for many months (up to 1.5 years or more). The disease occurs in the form of epidemic outbreaks that recur after 7-12 years. During inter-epidemic times, sporadic cases are observed. The maximum number of diseases is recorded in April – June. During outbreaks, not only children but also adults get sick. The rubella virus is released into the external environment a week before the rash appears and for a week after the rash. Infection occurs by airborne droplets.
Rubella is especially dangerous for pregnant women due to intrauterine infection of the fetus. The frequency of fetal lesions depends on the timing of pregnancy. Rubella disease at 3-4 weeks of pregnancy causes congenital deformities in 60% of cases, at 9-12 weeks - in 15% and at 13-16 weeks - in 7%.
When pregnant women become ill with rubella, the virus, circulating in the blood, enters the placenta, multiplies there and infects the fetus. The infection causes chromosomal changes, which leads to delays in physical and mental development. Congenital rubella leads to a significant delay in the child's development (height and body weight). In most patients, the liver and spleen are enlarged, and congenital heart defects are detected. Approximately half of the patients develop eye damage (microphthalmos, cataracts, glaucoma), and deafness often develops. Sometimes congenital deafness is the only developmental defect due to rubella. The bones of the limbs and skull may be affected, anemia or thrombocytopenia with hemorrhagic diathesis and other developmental defects may develop.
With congenital rubella, the pathogen remains in the child’s body for a long time (up to 18 months). During this entire time, the child can be a source of infection for other children.
In order to prevent rubella disease, the National Vaccination Calendar provides for vaccination of children 12 months of age. and revaccinations at the age of 6 years.
Order of the Ministry of Health and Social Development of the Russian Federation dated January 31, 2011 No. 51 n “On approval of the national calendar of preventive vaccinations and the calendar of professional vaccinations for epidemic indications” also introduced immunization of all children from 1 to 18 years of age who were not sick, not vaccinated or vaccinated once against rubella , as well as girls from 18 to 25 years old who have not been vaccinated and have not had rubella.
Before vaccinating women, special attention should be paid to the date of the last menstrual period (exclude pregnancy) and counseling on contraception to avoid vaccination of women during pregnancy and planning pregnancy after it.
Doctor-epidemiologist of the State Budgetary Healthcare Institution of the Republic of Kazakhstan "KRPC" V.V. Danshchikova
