Rubella
is an acute viral, predominantly childhood disease. Typical presentation: a pink-red rash that appears first on the face and then spreads throughout the body within a few hours.
Children are highly susceptible to rubella. Typically, children under 6 months of age have innate immunity received from their mother, but if the child does not have specific antibodies, he can get sick even in the first months of life.
Children aged 2 to 9 years are most often affected by rubella.
Immunity after rubella is stable and lifelong.
Causes of rubella
Rubella is transmitted by airborne droplets. Although the virus is considered unstable, contact transmission of the disease (for example, through children's toys) is also possible.
The incubation period of rubella is from 11 to 24 days (in most cases - from 16 to 20 days). The patient is contagious a week before the rash appears. After the rash, the risk of infection remains for another 5-7 days.
Another option for transmission of infection is during pregnancy, from mother to fetus. With such congenital rubella, the virus is released for a long time - for 1.5-2 years after birth (with sputum, urine, feces).
What kind of disease is this?
Rubella has been known for a long time; it was described back in the sixteenth century and had the character of epidemics. Today, thanks to vaccination efforts in children and adults, rubella is not very common, but it remains a very important and dangerous disease due to the fact that it causes congenital defects in the fetus if a pregnant woman gets sick. Rubella is a viral infection that only affects people; it is not transmitted from animals. It is transmitted from sick to healthy people by coughing, sneezing, talking; children can also have a contact route of infection through shared toys. The virus is not transmitted through third parties; if guests come to you whose family has a rubella patient, and they themselves are not sick, there is no need to fear infection. Viruses do not survive on clothing, skin or hair. Newborns with congenital rubella (they can shed viruses for up to six months), or children with rubella, and less often adults, are contagious to others. A person becomes contagious a week before the typical rash and can infect many people until the characteristic rash and clinical symptoms appear. In addition, viruses are released for about a week, from the moment new rashes stop appearing. However, you should not be afraid of fleeting contact - in order to get sick you need to communicate closely or for a long time with the patient, if you followed him in the entrance, rode in the elevator or went into a store where there was a rubella patient before - the risk of becoming infected is minimal. If you have previously had rubella, then you are no longer afraid of it - after the illness, stable lifelong immunity develops. If you or your child are vaccinated, you need to remember that stable immunity lasts for 5-6 years, then revaccinations are necessary to create the required level of antibodies. The rubella virus does not withstand environmental conditions, so to keep the house safe, it is enough to carry out wet cleaning with conventional disinfectants. Viruses tolerate cold well, so the peak incidence occurs in the cold season.
The danger of rubella
The main danger of the disease lies in its effect on the fetus in the early stages of pregnancy. Up to 11 weeks, the probability of infection of the fetus upon contact with a source of infection is 90%. The consequences can be serious: various pathologies and fetal death. Therefore, rubella is included in the list of ToRCH infections (a group of infections that pose a particular danger to the fetus and the health of the unborn child).
Rubella symptoms
The main symptoms of rubella are:
Rash
Rubella manifests itself primarily as a rash. The rubella rash looks like small pink-red spots of a round or oval shape.
In children, the rash lasts 2-4, occasionally 5-7 days, then disappears - without pigmentation or peeling.
More about the symptom
Enlarged lymph nodes
There is an increase in lymph nodes, especially those located on the back of the head and back of the neck.
Catarrhal phenomena
Sometimes children with rubella experience catarrhal symptoms: slight runny nose, sore throat, dry cough.
Symptoms of rubella in adults
In adults, rubella is much more severe: headache, general weakness, increased temperature (up to 38-39°C), and muscle pain. The disease can affect the joints (primarily the small joints of the hands).
How does rubella manifest in children?
The incubation period for rubella is quite long, it can last two to three weeks, then the so-called prodromal period begins, characterized by general symptoms - there may be weakness, malaise, loss of appetite, headaches, pain in muscles and joints. Babies may have slight redness of the eyes without purulent discharge and redness of the throat. Later, enlargement of the lymph nodes - occipital, posterior cervical and parotid - occurs; they are slightly painful. All these manifestations usually last up to three days, and then the height of the disease comes with typical rashes, fever and changes in the mucous membranes of the mouth. Typically, bright pink specks form in the mouth in the area of the soft palate, which merge and move to the arches, forming dark red spots. The rash has a characteristic sequence - it starts from the face, spreading to the chest and whole body. The rash is especially pronounced on the child’s buttocks and back, but there is no rash on the palms and soles, which also distinguishes it from other diseases. It is abundant, in the form of spots with elevations, without bubbles, it is especially abundant in the first day. The spots may merge into a single whole, especially in the face area, and from the second day they become like red dots on a pink base with slight itching. By the third day, the rash usually turns pale and gradually disappears, leaving no changes on the skin; only mild peeling may be noted. The temperature rarely rises above 37.5-38 C, and usually lasts for a couple of days. The reaction of the child’s blood also helps the doctor in making a diagnosis - the analysis will indicate neutrophilic (due to segmented and band cells) leukocytosis and specific plasma cells may appear. Sometimes, especially in girls and young women, swelling and tenderness of the joints may occur, which goes away on its own within a couple of weeks. Rubella is dangerous for children with pathologies of the nervous system, decreased immunity and disorders in the blood coagulation system - such children are more at risk of developing complications and severe course of the disease. Therefore, vaccination of such babies should be taken care of first.
Methods for diagnosing rubella
You should not rely on the fact that you or your child already have immunity, since symptoms consistent with the description of rubella have been observed. Other viral diseases may have similar symptoms. Absolute certainty can only be given by a blood test for specific antibodies.
Serological blood test
A serological test can detect the presence of antibodies to the rubella virus in the blood. A similar analysis can be done separately, or you can use the “Diagnostics of ToRCH infections” profile.
More information about the diagnostic method
Sign up for diagnostics To accurately diagnose the disease, make an appointment with specialists from the Family Doctor network.
How to make a diagnosis and how to identify rubella?
When classic rubella develops in a baby, it is not difficult to make a diagnosis - enlarged lymph nodes in combination with a typical rash make it possible to suspect the disease. In addition, rubella will be supported by the fact that there are other cases of the disease in the kindergarten that the child attended, or there are sick people in the environment. For an accurate diagnosis, a blood test for antibody levels will also be required. Let us pay close attention to this analysis, since it allows us to accurately determine the presence of rubella in a child and woman. Doctors recommend that all women planning a pregnancy be tested for rubella antibody levels. If it turns out that a woman is not immune, it is worth vaccinating her, and after 2-3 months you can safely become pregnant without fear of disease. How is rubella determined? It's simple - they study the so-called antibodies, special immunoglobulins of two groups - IgM and IgG. Group M immunoglobulins are a sign of acute infection - they appear in the body from the first days of the disease, their maximum amount is formed in the second or third week, and they disappear after one or two months. If a large amount of these immunoglobulins is found in the blood, it means there is an acute infection, even if there are no obvious signs or rash. If immunoglobulins M are not detected, there can be two situations: - there is no immunity to rubella, that is, the person has not had it, or rubella was in the past, more than 3 months ago. But how can one determine whether it was or not? This is exactly what IgG immunoglobulins are needed for, they are also called memory molecules. These immunoglobulins begin to be produced later than M, around the end of the first week of the disease, their maximum number reaches a peak by the month. In addition, these IgG immunoglobulins will remain in a certain amount throughout life, making it possible to provide lifelong immunity to rubella. Now let’s look at the analysis: if there is IgM and no IgG, it means the person has rubella or has recently been vaccinated. If both of these types of immunoglobulins are present, this indicates the second week of illness. In addition, if there is only IgG, this indicates that the child or woman has had rubella and it is no longer dangerous to them; the body has developed a stable immunity. If the analysis does not detect any antibodies, this indicates that rubella is dangerous for this patient, he has not been sick, is not vaccinated and may get sick.
Treatment methods for rubella
If symptoms appear that suggest rubella, the child should be shown to a pediatrician, and an adult should consult a therapist.
Symptomatic treatment
For rubella, bed rest is prescribed and symptomatic treatment is provided. The patient should receive enough vitamins (in the form of vitamin preparations or in natural form).
Vaccination
Vaccination is a simple and effective way to avoid the risk of getting sick as an adult. It is especially important to exclude the threat of rubella in the expectant mother. Prevention of this disease is so important that vaccination against rubella is included in the National and Regional calendars of preventive vaccinations.
The vaccine is administered subcutaneously or intramuscularly. Vaccination is carried out at the age of 12 months, repeated immunization (re-vaccination) - at 6 years. For girls who have not had rubella and have not previously been vaccinated, the vaccine is administered between the ages of 18 and 25 years. Specific immunity is provided in almost 100% of cases. It develops 15-20 days after vaccination and persists for more than 20 years.
More information about the treatment method
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Rubella vaccination: protecting the health of future generations
Rubella is considered a mild childhood infection. However, for expectant mothers it poses a serious danger, causing severe chronic damage to the fetus. Tatyana Ivleva, a doctor at the city vaccination office, talks about how insidious the rubella virus is and how to protect yourself from it.
Before mass vaccination against rubella, outbreaks of the disease occurred constantly and had a wave-like character, characteristic of an uncontrolled infection. After vaccination against rubella was included in the National Vaccination Calendar of the Russian Federation in 2001, rubella became a controlled infection. However, the risk of infection still exists.
If the infection is mild, why is it necessary to get vaccinated? Maybe it’s better to get over it?
The vaccination is done in order to avoid contact of a pregnant woman with a person who has rubella, since the rubella virus poses the greatest danger to the fetus. If a pregnant woman is infected before 12 weeks, very severe chronic damage to the fetus occurs.
It is also necessary to be vaccinated against rubella in order to prevent the disease, and therefore the possible development of complications. The goal of all vaccination programs in the world is to eliminate congenital rubella syndrome. Today, WHO sets the task for all countries to eliminate rubella infection in principle. Rubella is not as mild a disease as it might seem at first glance. Yes, many do not even notice that they have had this infection, since the rash that characterizes it passes quickly enough, the disease is tolerated with virtually no decrease in the child’s activity, without an increase in temperature. However, rubella also has complications, most often in the form of damage to the central nervous system - encephalitis (1 case in 5-6 thousand cases of rubella).
According to the literature, only 30% of people who have received this complication recover from the disease without residual effects. In second place among the complications of rubella are arthritis, and in adults, joint damage occurs much more often (up to 30%) than in children. Another “classic” complication is thrombocytopenic purpura, a disease in which the number of platelets decreases, resulting in hemorrhages on the skin or various organs.
What danger does rubella pose to pregnant women?
Due to the fact that in the first trimester of pregnancy all the main organs and systems of the fetus are formed, the rubella virus is the culprit of a large number of congenital malformations.
In some cases, this leads to termination of pregnancy when defects incompatible with life occur. But a much larger proportion of children are born with congenital defects, and the most common are developmental defects of the central nervous system and congenital heart defects. There may also be abnormalities of the gastrointestinal tract, urinary system, and skeleton. Some data from international studies show that with the introduction of rubella vaccination, the incidence of all birth defects has decreased.
The classic three signs of congenital rubella - congenital heart disease, cataracts and deafness - are long gone. Today, such signs are practically not observed, but others are observed, which suggests that the rubella virus can also cause other lesions.
Often children with congenital rubella syndrome die not so much from developmental defects as from the addition of bacterial and viral infections. They often experience complicated pneumonia, sepsis (blood poisoning), manifested by the appearance of purulent foci throughout the body. Such children also very often have prolonged jaundice.
What should you do if a pregnant woman who has not been ill before becomes infected with rubella?
In this situation, the woman is given immunoglobulin. But since today, fortunately, the incidence of rubella is rare, pregnant women are extremely rarely exposed to the infection.
What is the schedule for administering the rubella vaccine?
According to the National Vaccination Calendar, vaccination against rubella is carried out twice: at 1 year and 6 years. Two vaccinations are enough to maintain lifelong immunity. Vaccination at this age allows, on the one hand, to protect the child from infection, and on the other hand, to exclude contact of pregnant women with sick children. In addition, by the time girls grow up, they will already have fairly reliable protection, and repeated vaccinations before pregnancy will not be required.
Initially, mainly teenage girls were vaccinated against rubella in the world, but it turned out that such selective vaccination was ineffective. That is why they subsequently began to vaccinate both children and girls under 25 years of age. This combined vaccination of both children and adults gave good results. To date, the incidence of rubella has been reduced to isolated cases. What is the rubella vaccine?
Several vaccines against rubella are registered in Russia. These are monovaccines and combined trivaccines (measles, mumps and rubella vaccine), which are convenient to use because one injection contains protection against three diseases at once. All vaccines contain a live, attenuated virus. In this form, the virus is not capable of causing disease, but successfully “trains” the immune system.
What to do if a person does not know whether he has been vaccinated or has had rubella before?
In this case, a blood test is performed to determine the level of antibodies. If there are no antibodies to rubella in a person’s blood, vaccination is indicated for him. If for some reason it is not possible to donate blood, it is better to get vaccinated. Giving the vaccine to a person who has previously been vaccinated or has had rubella is absolutely safe. Determination of the level of antibodies to the rubella virus is included in the standard examination of women before pregnancy. If there are no antibodies, vaccination is indicated. After vaccination, you must refrain from becoming pregnant for 3 months. This is due to the fact that there is a theoretical risk of the virus being in a woman’s body.
However, the world has accumulated observational data on 100 women who were accidentally vaccinated during pregnancy. In 10% of these women, the fetus became infected with the vaccine strain, but not a single child developed malformations.
Contraindications to rubella vaccination
Contraindications include ages under 12 months, as the child may have maternal antibodies that will block the vaccine. Let me note that we are not talking about the danger to the child, but rather about the effectiveness of vaccination.
In addition, contraindications include pregnancy, immunodeficiency conditions (congenital immunodeficiency, congenital oncohematological diseases, AIDS, prescription of drugs that suppress the immune system for certain diseases), allergic reactions to vaccine components (aminoglycoside antibiotics) and exacerbation of a chronic disease. In other cases, the issue of vaccination is decided individually. What reactions can occur after rubella vaccination?
Reactions to the rubella vaccine are extremely rare. Since the vaccine contains a live, weakened virus, there may be manifestations typical of rubella: swollen lymph nodes, rashes, fever. They usually appear no earlier than the 4th day, most often 7–14 days after vaccination, and do not pose a health hazard.
