Rubella in children

Rubella is an acute viral disease, manifested by a small spotted-papular rash, generalized lymphadenopathy, mild fever. Possible fetal damage 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. Morbidity has periodic upswings every 3-5 years and seasonal fluctuations. The highest incidence is observed in the cold season. In children's preschool groups and even among adults (barracks for recruits), epidemic outbreaks of rubella are possible.

Susceptibility is high, but less than measles. Rubella is affected by people of any age, but more often children aged 1 to 7 years. Children under 6 months are seldom ill due to the presence of transplacental immunity, but if the mother does not have rubella, the child can get sick at any age.

The source of the infection is a patient who is dangerous not only in the period of pronounced clinical manifestations of rubella, but also in the incubation period and in the period of convalescence. In epidemiological terms, healthy virus carriers are also dangerous. Isolation of the virus from the nasopharynx begins 7-10 days before the onset of the rash and lasts 2-3 weeks after the onset of the rash. In children with congenital rubella, the virus can be secreted within 1.5-2 years after birth. Infection occurs by airborne droplets. After the transferred disease, persistent immunity remains.

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What causes rubella?

The rubella virus belongs to the genus Rubivirus of the Togaviridae family . Viral particles with a diameter of 60-70 nm contain RNA. There is one antigenic type of the virus.

Pathogenesis of rubella

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

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, as the other symptoms of rubella are usually mild.

The general condition of the child is not significantly affected. Body temperature rarely rises to 38 ° C, it usually remains subfebrile (37.3-37.5 ° C), often does not increase throughout the illness. They note lethargy, malaise, older children and adults sometimes complain of such symptoms of rubella as: headache, muscle and joint pain. The rash appears first on the face, then spreads throughout the body for several hours, mainly localized on the extensor surfaces of the limbs around the joints, on the back and on the buttocks. The rash is spotty, sometimes papular, pink in color, appears on unchanged skin. A reddish rash is much smaller than a measles rash, without the tendency to merge separate elements. Only in some patients larger rash elements are noted, but in these cases the exanthema differs from the measles in that the individual elements of the rash are approximately the same and have a round or oval shape. A rash with rubella is usually unaffected. The rash lasts 2-3 days, disappears, does not leave pigmentation, peeling also does not happen.

Catarrhal phenomena in the upper respiratory tract in the form of a small runny nose and cough, as well as conjunctivitis appear simultaneously with the rash. In the throat there may be a slight hyperemia and looseness of the tonsils, enanthem on the mucous membranes of the soft palate and cheeks. It is small, with a pinhead or slightly larger pale pink specks. Enanthem on the mucous membrane of the mouth appears the same as the catarrhal phenomena, before the rash. There is no symptom of Filatov-Koplik.

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

Rubella is more severe in adults. They have a high body temperature, severe headaches, muscle pains, an increase in the lymph nodes more than in children.

Diagnosis of rubella

The diagnosis of rubella is based on a characteristic rash that appears almost simultaneously on the entire surface of the skin, mild catarrhal phenomena and an increase in peripheral lymph nodes. Changes in blood (leukopenia, lymphocytosis and the appearance of plasma cells) largely confirm the diagnosis of rubella. Of great importance are epidemiological data. IgM and IgG antibodies to rubella virus in the blood or the growth of antibody titer in RPHA are crucial

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

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Treating rubella

Patients with rubella recommend bed rest during the rash. Rubella is not treated with medications.

Prevention of rubella

Ill with rubella isolate at home for 5 days from the time of rash. Disinfection is not carried out. Children who were in contact with a sick rubella are not separated. In pregnant women who did not have rubella and had contact with the patient in the first months of pregnancy, the issue of abortion should be addressed.

Vaccination against rubella

Vaccination against rubella is regulated by the national calendar of preventive vaccinations. Rubella in children is prevented with the help of both monovaccine (rudivax) and combined preparations - inoculation against measles, mumps and rubella (Prioriks, MMR II). The first dose is administered at the age of 12-15 months, the second (revaccinating) at 6 years. In addition, it is recommended to vaccinate women of fertile age who are not sick with rubella.