Rubella
Description:
Rubella ("the German measles") - an antroponozny viral infection with a generalized lymphadenopathy and a melkopyatnisty dieback.
Tank and source of an infection - the person with clinically expressed or erased rubella form. The patient allocates a virus in external environment for 1 week before emergence of rash and within 5-7 days after emergence of rashes. Children with an inborn rubella have great epidemiological value. At the last the activator is revealed in slime of a nasopharynx and urine (is more rare in excrements) for several weeks, sometimes - up to 12-20 months.
The transfer mechanism - aerosol, a way of transfer - airborne. Infection requires longer and close communication with the patient, than at measles and chicken pox. There is a vertical way of transfer (transplacental transfer of a virus), especially in the first 3 months of pregnancy. Hands and objects of leaving have no epidemiological value. The exception is made by toys by means of which transfer of a virus by small children from a mouth in a mouth is possible.
Natural susceptibility to an infection high. Serological inspections testify to big percent (30% and more in certain regions of the country) seronegative women of childbearing age, especially at the age of 20-29 years. Results of serological inspection of pregnant women testify to a high susceptibility of women of childbearing age to a rubella virus, especially in an age group of 20-29 years (in different years from 8 to 30% seronegative are revealed).
Main epidemiological signs. The rubella is carried to number of infections which elimination is possible in the near future, according to the program of WHO. In a number of the countries (the USA, Sweden, etc.) it is revealed at extremely low level. Taking into account value for health care of a syndrome of an inborn rubella, the 48th session of Regional committee of WHO for Europe (1998) included a rubella in number of infections, fight against which will define the purposes of the "Health for All in the 21st Century" program. By 2010 the frequency of a syndrome of an inborn rubella has to be reduced to level less than 0,01 on 1000 newborns.
During the dovaktsinalny period the rubella with high incidence was registered everywhere. Due to the lack so far programs of broad immunization of the population in Ukraine note a tendency to incidence growth. According to WHO data, from all cases of a rubella registered in Europe, 83% are the share of the CIS countries. Periodic rises in incidence are characteristic of a rubella: moderated (each 3-5 years) and more intensive (each 10-12 years). In recent years the shift of incidence on more advanced age is noted: school students and women of childbearing age are ill preferential. Note a high ochagovost in organized preschool and school collectives, among pupils of average and higher educational institutions. Incidence significantly increases in the spring and in the summer.
The rubella is considered to be a slight disease. However such definition is fair for the course of this infection at children. The disease at adults characterizes heavier current (quite often proceeds with long fever, a joint syndrome, and also development of organ pathology). The special problem is created by an inborn rubella. At infection of pregnant women it can cause serious complications and the child's birth with various heavy malformations. According to various authors, the risk of development of inborn defects (organs of sight, hearing, cardiovascular system, etc.) makes from 12 to 70%, or 10% of total number of inborn anomalies. At infection in the first 3 months of pregnancy the infection of a fruit develops in 90% of cases. Besides, it is established that at an inborn rubella late complications can also develop (a panencephalitis, a diabetes mellitus, a thyroiditis). Adverse influence of a krasnushny infection on a fruit is shown by also spontaneous abortions (10-40%), a still birth (20%) and death in the neonatal period (10-25%). The special alarm is caused by the strong growth of incidence of women of childbearing age, increase in quantity of cases of the syndrome of an inborn rubella which is shown inborn uglinesses turns out to be consequence of what. The number of cases of a syndrome of an inborn rubella averages 0,13% of all diseases. According to WHO data, annually the rubella cripples only about 300 000 children. Expenses on treatment and keeping of the child with a syndrome of an inborn rubella make, by the most modest estimates, about 200 000 US dollars.
Rubella symptoms:
The incubation interval is identical at children and adults and 10-25 days proceed. The subsequent catarral period at children is, as a rule, not expressed; in these cases the diagnosis of a rubella quite often can be established only after emergence of a dieback. At adults during this period the indisposition, a headache, mialgiya, a loss of appetite are possible fervescence (in hard cases to high figures). The catarral phenomena can be expressed as insignificant cold and dry cough, feeling of irritation in a throat, a photophobia and dacryagogues. At survey find conjunctivitis and reddening of a mucous membrane of a pharynx in a part of patients. Increase and morbidity of lymph nodes, especially occipital and zadnesheyny, are equally characteristic both of children, and of adults, however meet this sign not at all patients. In the subsequent the lymphadenopathy remains long enough (to 2-3 weeks). Duration of the catarral period makes 1-3 days.
Then there comes the dieback period; manifestations of this main syndrome develop at 75-90% of patients in the first day of a disease, at the same time rashes observe at children more often. Elements of rash represent round or oval pink or red small spots with smooth edges. They are located on not changed skin and do not tower over its surface. At adults of a rash are inclined to merge, at children merge seldom. Sometimes emergence of rash is preceded by a skin itch. At first (but not always) elements of rash appear on a face and a neck, behind ears and on a pilar part of the head. Further within a day they extend on various body parts without a certain pattern. The rash arrangement on a back, buttocks and on extensor surfaces of upper and lower extremities is especially typical. On soles and palms the dieback is absent. In certain cases along with a dieback it is possible to note emergence of an enantema on mucous membranes of an oral cavity in the form of small single specks (Forkhgeymer's spot). At adult patients the dieback is more plentiful and more long, its elements can merge, forming erythematic fields. The drain nature of rash, and also its absence at a part of patients (in 20-30% of cases, according to literature) extremely complicate statement of the clinical diagnosis.
Body temperature in the period of a dieback can remain normal or slightly increases. Clearly the increased and moderately painful peripheral lymph nodes in all areas available to a palpation, but especially - occipital, parotid and zadnesheyny are defined. A part of patients complains of joint and muscular pains. At certain patients note the dispeptic phenomena, increase in a liver and spleen, women have symptoms of polyarthritis. Usually manifestations of a dieback last no more than 4 days. Rash can quickly die away, it disappears completely.
Generalizing distinctions in clinical displays of a disease at children and adults, it is possible to note once again that the course of a rubella at adults in general is similar to its manifestations at children. At the same time at adults the symptomatology of the catarral period is more expressed and long, the disease proceeds much heavier, rash is usually more plentiful, its elements can merge that complicates differential diagnosis. Manifestation of one of the leading syndromes of a disease - a lymphadenopathy - at adults happens slowly and step by step; at some patients this syndrome can be absent in general. Frequency of clinically expressed rubella and asymptomatic infection at children corresponds as 1:1, at adults - 1:2.
Rubella reasons:
The activator - a RNA-genomic virus of the family Rubivirus of the Togaviridae family. All known strains carry to one serotype. In external environment the virus is quickly inactivated under the influence of ultraviolet rays, disinfectants and heating. At the room temperature the virus remains within several hours, well transfers freezing. He shows teratogenic activity.
Treatment of the Rubella:
At uncomplicated forms appoint symptomatic therapy; it can be seen off in house conditions. It is not required to the majority of sick active therapeutic actions. In more hard cases apply pathogenetic and symptomatic means.
Actions in the epidemic center
The patients with a rubella are subject to isolation till 5th day from the moment of emergence of rash. Concerning the persons communicating with them no restrictive actions are provided, the quarantine for groups of child care facilities is not imposed. As the emergency prevention to the children and pregnant women communicating with the patient enter protivokrasnushny immunoglobulin. For the purpose of prevention of secondary cases in the center during 72 h from the moment of identification of the first patient vaccination (revaccination) the following categories of persons (aged from 12 months up to 35 years) from among communicating with the patient are subject:
* not having a rubella earlier and not imparted against it;
* not having a rubella earlier and once vaccinated against it (if from the moment of an inoculation there passed no more than 6 months);
* persons with the unknown infectious and inoculative anamnesis concerning a rubella.
The pregnant women who are in the I trimester of pregnancy are isolated from the patient for 10 days from the beginning of a disease (temporary moving on other apartment, transfer into other work from children's collective, etc.) and conduct their serological examination in dynamics: the first sample is taken in the first days of contact, but no later than the 10th day, the second - in 2 weeks after contact establishment. At a disease of women in the first 3 months of pregnancy recommend to interrupt it. Dispensary observation is carried out for children with an inborn form of an infection. Observation includes regular serological and virologic researches. Final disinfection in the center is not carried out.
