Rubella in children

Rubella is an acute viral disease, manifested by a small maculopapular rash, generalized lymphadenopathy, moderate fever. It may affect the fetus in pregnant women.

ICD-10 code

• B06.0 Rubella with neurological complications (rubella encephalitis, meningitis, meningoencephalitis).
• 806.8 Rubella with other complications (arthritis, pneumonia).
• 806.9 Rubella without complications.

Epidemiology of rubella

Rubella is a widespread infection. The incidence rate has periodic increases every 3-5 years and seasonal fluctuations. The maximum incidence is observed in the cold season. In preschool groups and even among adults (barracks for recruits) epidemic outbreaks of rubella are possible.

Susceptibility is high, but less than to measles. Rubella affects people of any age, but most often children aged 1 to 7 years. Children under 6 months rarely get sick due to the presence of transplacental immunity, but if the mother has not had rubella, the child can get sick at any age.

The source of infection is a patient who is dangerous not only during the period of pronounced clinical manifestations of rubella, but also during the incubation period and the recovery period. Healthy virus carriers are also dangerous from an epidemiological point of view. The virus is released from the nasopharynx 7-10 days before the onset of the rash and continues for 2-3 weeks after the onset of the rash. In children with congenital rubella, the virus can be released for 1.5-2 years after birth. Infection occurs through airborne droplets. After the disease, persistent immunity remains.

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What causes rubella?

Rubella virus belongs to the genus Rubivirus of the family Togaviridae. Viral particles are 60-70 nm in diameter and contain RNA. There is one antigen type of the virus.

Pathogenesis of rubella

The virus is transmitted by airborne droplets. Penetrating the body through the mucous membrane of the upper respiratory tract, the virus primarily multiplies in the lymph nodes, from where it enters the blood during the incubation period (1 week after infection). A rash appears after 2 weeks. 7-9 days before the rash appears, the virus can be detected in nasopharyngeal discharge and in the blood, and when the rash appears, in urine and feces. The virus disappears from the blood 1 week after the rash appears.

Symptoms of rubella

The incubation period of rubella is 15-24 days, most often the disease begins 16-18 days after contact. The first symptom of rubella is a rash, since other symptoms of rubella are usually mild.

The general condition of the child is slightly disturbed. The body temperature rarely rises to 38 °C, usually it remains subfebrile (37.3-37.5 °C), often does not rise during the entire illness. Lethargy, malaise are noted, older children and adults sometimes complain of such symptoms of rubella as: headache, muscle and joint pain. The rash first appears on the face, then within a few hours spreads throughout the body, mainly localized on the extensor surfaces of the limbs around the joints, on the back and buttocks. The rash is spotty, sometimes papular, pink in color, appears on unchanged skin. Rubella rash is much smaller than measles, without a tendency for individual elements to merge. Only some patients have larger elements of the rash, but even in these cases, exanthema differs from measles in that the size of the individual elements of the rash is approximately the same and they are round or oval. The rash with rubella is usually not abundant. The rash lasts for 2-3 days, disappears, does not leave pigmentation, and there is no peeling.

Catarrhal symptoms in the upper respiratory tract in the form of a slight runny nose and cough, as well as conjunctivitis, appear simultaneously with the rash. In the pharynx there may be slight hyperemia and looseness of the tonsils, enanthem on the mucous membranes of the soft palate and cheeks. These are small, pinhead-sized or slightly larger pale pink spots. Enanthem on the oral mucosa appears in the same way as catarrhal symptoms, before the rash. There is no Filatov-Koplik symptom.

Pathognomonic symptoms of rubella are enlargement of peripheral lymph nodes, especially occipital and posterior cervical. The lymph nodes are enlarged to the size of a large pea or bean, juicy, sometimes sensitive to palpation. Enlargement of the lymph nodes appears before the rash and lasts for some time after the rash disappears. In the peripheral blood, leukopenia, relative lymphocytosis and the appearance of plasma cells (up to 10-30%), sometimes the number of monocytes is increased. Often, rubella symptoms are absent, are erased or even asymptomatic.

Rubella is more severe in adults. They experience high body temperature, severe headaches, muscle pain, and a more pronounced enlargement of the lymph nodes than in children.

Diagnosis of rubella

Rubella diagnosis is based on the characteristic rash that appears almost simultaneously on the entire skin surface, mild catarrhal symptoms and enlargement of the peripheral lymph nodes. Blood changes (leukopenia, lymphocytosis and the appearance of plasma cells) largely confirm the diagnosis of rubella. Epidemiological data are of great importance. IgM and IgG antibodies to the rubella virus in the blood or an increase in the antibody titer in the RPGA are of decisive importance.

Differential diagnosis of rubella is primarily carried out with measles, enterovirus exanthema and drug rash.

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Treatment of rubella

Patients with rubella are advised to stay in bed during the rash period. Rubella is not treated with medications.

Prevention of rubella

Rubella patients are isolated at home for 5 days from the moment the rash appears. Disinfection is not carried out. Children who have been in contact with a rubella patient are not separated. Pregnant women who have not had rubella and who have had contact with a patient in the first months of pregnancy should consider terminating the pregnancy.

Vaccination against rubella

Vaccination against rubella is regulated by the national calendar of preventive vaccinations. Rubella in children is prevented with both monovalent vaccines (Rudivax) and combined preparations - vaccination against measles, mumps and rubella (Priorix, MMR II). The first dose is administered at the age of 12-15 months, the second (revaccination) - at 6 years. In addition, it is recommended to vaccinate women of childbearing age who have not had rubella.