Be careful - rubella is dangerous during pregnancy!

Quick transition Treatment of rubella

Rubella is an infection that mainly affects the skin and lymph nodes.

The disease is caused by the rubella virus (for a long time it was believed that rubella was a mild variant of measles, but later science learned to distinguish between these diseases), transmitted by airborne droplets, through particles of saliva of a sick person sneezing. In addition, the rubella virus can be transmitted transplacentally, that is, from a pregnant woman to the fetus.

Rubella is usually quite mild and rarely causes complications, although rubella encephalitis and even fatal cases occur. The main medical danger of rubella is infection of pregnant women, since the rubella virus can cause congenital rubella syndrome in the fetus.

Before the rubella vaccine became available in 1969, epidemics of the disease occurred every 6–9 years, usually among children aged 5–9 years, along with many cases of congenital rubella (that is, deafness, heart defects, and other physical defects in newborn children whose mothers had rubella during pregnancy). Thanks to mass immunization, cases of rubella and congenital rubella syndrome have become incomparably smaller.

Most cases of rubella now occur not in children, but in young, unvaccinated adults.

Symptoms

The illness usually begins with one to two days of mild fever (up to 38°C) and swollen, tender lymph nodes, usually in the back of the neck or behind the ears. A pale pink, blotchy rash then appears on the face and spreads downward. As it spreads to the lower parts of the body, the face is usually already cleared.

A rubella rash is often the first sign of illness that a parent notices. It may look like many other viral rashes, appearing as pink or light red spots that may coalesce to form patches of even color. The rash may be itchy and lasts up to 3 days. When the rash disappears, fine-plate peeling may remain in its place.

Other symptoms of rubella (more common in teenagers and adults) may include headache, loss of appetite, mild conjunctivitis (inflammation of the lining of the eyelids and eyeballs), nasal congestion or discharge, and swollen lymph nodes in other parts of the body.

If a pregnant woman contracts rubella, she may develop congenital rubella syndrome, which can have devastating consequences for the developing fetus. Children infected with rubella before birth are at risk of impaired growth, intellectual defects, heart and eye defects, deafness, and problems with the liver, spleen, and bone marrow.

The rubella rash usually lasts 3 days. Lymph nodes may remain swollen for a week or more, and joint pain may last over 2 weeks. Children with rubella usually recover within 1 week, but adults may take longer.

Treatment of rubella

There are no specific medications to treat the rubella virus. Treatment is generally given to relieve symptoms associated with the infection:

• If a rash appears, fever, or malaise, bed rest and drinking plenty of fluids are recommended.
• If you have a runny nose or conjunctivitis, your doctor may recommend taking antihistamines.
• To reduce elevated temperature, antipyretics (paracetamol) are prescribed.

Rubella is not treated with antibiotics.
Therapy is symptomatic; for example, the child may be prescribed antipyretics. Photo: natapetrovich / Depositphotos Also, if indicated, it is possible to prescribe anticonvulsant, anti-edematous, anti-inflammatory drugs⁵.\

Important!

When treating rubella, antibiotics are used only if there are complications in the form of an associated bacterial infection. Antibacterial therapy is not effective against the virus, and its use can be dangerous. Any medications used to treat rubella should be prescribed by a doctor.

If specific complications occur, the attending physician or pediatrician will refer you to a specialized specialist (for example, an infectious disease specialist or neurologist).

Nutrition for rubella

If rubella is moderate or severe, your doctor may recommend a special diet. Usually this is treatment table No. 13 according to Pevzner, used for acute infectious diseases. It has several features:

• diet - 5-6 times a day;
• exclude any fresh bread, butter dough;
• soups should be low-fat, meat or fish, seasoned with cereals or vegetables;
• lean meat and fish, boiled or steamed;
• exclude pasta, legumes, barley, millet, pearl barley, and corn from the diet;
• rolled oats, ground buckwheat or semolina semi-viscous porridge are allowed;
• dairy products are allowed with the exception of cream, full-fat sour cream and whole milk;
• All vegetables and fruits are allowed, except those rich in fiber and having rough skin, as well as cabbage, mushrooms, onions and garlic, radishes, turnips, rutabaga, cucumbers;
• The only sweets you can eat are marmalade;
• Fats allowed include butter and refined vegetable oil;
• Drinks allowed are weak tea and coffee, fruit drinks, diluted juices, and decoctions.

Rubella is a highly contagious disease, so it is important to stop the spread of the virus. If the patient is being treated at home, he must be isolated and contact with non-sick, unvaccinated people should be excluded. If this is not possible, hospitalization in an isolated department (box) of an infectious diseases hospital is recommended.

When rubella requires urgent or emergency hospitalization:

• Children under 5 years of age with a severe course of the disease (refuse to eat or drink, have nausea after every meal or drink, the disease is accompanied by convulsions, loss of consciousness).
• In case of moderate or severe rubella: high temperature, which cannot be reduced with antipyretics, severe intoxication (weakness, nausea, vomiting, dehydration, headaches, muscle and joint pain).
• Concomitant chronic diseases, the course of which may be complicated by the rubella virus.
• The development of complications such as: encephalitis, meningoencephalitis, pneumonia, thrombocytopenic purpura, etc.

Treatment of congenital rubella syndrome

Children with congenital rubella syndrome require constant medical supervision. Treatment of such children is symptomatic and is intended to mitigate the effects of infection⁵.

When organizing medical care for newborns with CRS, it is taken into account that the child secretes virions for a long time and remains infectious. Samples are taken periodically to assess the presence and shedding of the virus. Until these tests come back negative, precautions are taken to prevent the spread of infection.

Contagiousness

The rubella virus is spread from person to person through tiny droplets of fluid from the nose and throat when sneezing and coughing. People with rubella are most contagious 1 week or more before the rash appears and up to 1 week after it appears. Someone who is infected but has no symptoms can also spread the virus.

Infants with congenital rubella syndrome can shed the virus in their urine and nasal mucus for a year or more, which means they can infect unvaccinated people.

Definition of disease

Rubella is a viral infection caused by the Rubella virus. It is extremely contagious, occurs in an acute form, causes fever and the appearance of a red rash on the skin. Children get it more often, but they tolerate the disease more easily compared to adults. The older the infected person, the more severe the symptoms of rubella will be¹.

Rubella and measles: what is the difference

Rubella is often confused with measles. Both diseases are considered “childhood” diseases, have a similar course, and even vaccination against them is carried out simultaneously. The difference is in the causative agent (they are caused by different viruses), as well as in the course of the disease and the level of contagiousness and risk of complications. Compared to measles, rubella is a less dangerous disease, in which the rash is not as severe, passes faster, and the temperature most often rises slightly. Measles is a disease with a severe course, a high risk of complications, and one of the leading causes of child mortality.

Prevention

Rubella can be prevented with a vaccine. This vaccination is included in the calendars of all countries and is critical to curb the spread of the disease and prevent birth defects in the fetus caused by congenital rubella syndrome.

The first dose of the vaccine is usually given to children at 12 months of age as part of routine immunization against measles, mumps and rubella. The second dose is usually given at age 6 years. It is acceptable to give a second dose of the vaccine 6 months after the first, or even 1 month later if we know the child is at increased risk of contracting the disease.

Rubella vaccine should not be given to pregnant women or women who plan to become pregnant within 1 month of vaccination. If you are thinking about pregnancy, make sure you are immune to rubella by getting a blood test or looking for documentation of any vaccines you have received (you must have two doses of the vaccine). If there is no immunity, you should get vaccinated at least 1 month before pregnancy.

Be careful - rubella is dangerous during pregnancy!

Rubella is considered to be a mild disease.

However, this definition is valid for the course of this infection only in children, since rubella in pregnant women is fraught with serious consequences for the unborn child.
The danger of the rubella virus is that it is almost always transmitted from the mother to the fetus, freely passes through the placental barrier - since it is a virus - (a particle smaller than a blood cell) and damages it. Depending on the stage of pregnancy at which infection occurs, the fetus has a different probability of developing malformations.

Yes, the disease in children is very mild, the body itself copes with the pathogen (rubella virus), most often you can get by with a limited regimen, plenty of fluids and vitamins. This is true. But! During pregnancy, the fetus develops congenital rubella syndrome (cataracts, damage to the inner ear, heart defects, microcephaly).

In many countries, acute rubella is a medical indication for termination of pregnancy because the syndrome occurs in the fetus in almost all cases when the mother becomes ill with rubella in the first months of pregnancy. If a girl was not vaccinated in childhood, if she did not have rubella, there remains a danger of contracting rubella as an adult. 15-30% of women of childbearing age do not have such protection.

So, what is rubella?

• Why is it dangerous?
• Who needs to be examined and when?
• How to determine whether there is a danger to the baby and what to do?

Rubella is an infectious disease of a viral nature, which is highly contagious, manifested by a rash on the skin that tends to spread quickly, enlarged lymph nodes (occipital group) and a slight increase in temperature. There are periodic increases in incidence with an interval of 5-7 years, in addition, there is an autumn-spring seasonality. The rubella virus is transmitted by airborne droplets. In addition, there is transmission of the virus from mother to fetus through the placenta during pregnancy (transplacental transmission).

• The source of the virus is often children, especially those who attend kindergarten, sports section or school. Therefore, a woman who does not have immunity to rubella and is pregnant with her second child has a greater chance of becoming infected with the rubella virus. The insidiousness of rubella is that the incubation period, that is, the period between infection and the appearance of the first symptoms of the disease, lasts approximately 2-3 weeks.
• Moreover, during the last week of the incubation period, the patient already releases the virus and poses a danger of infection to others, despite the fact that he himself feels great and may not know about his disease.
• Rubella is considered contagious 7 days before the rash appears and another 7-10 days after it disappears.
• In addition, very often (50-90% of cases) rubella is asymptomatic, but the person also releases the virus and can infect others. In general, the disease is mild and complications are rare.
• The most serious complication is rubella encephalitis, which, fortunately, is quite rare (1:5000-1:6000).

In adolescents and adults, rubella is much more severe than in children. However, most patients do not require special treatment. Medicines are used to treat symptoms and complications that alleviate the general condition. After an illness, lifelong immunity develops, but its intensity may decrease with age and under the influence of various circumstances. Thus, a history of rubella in childhood cannot serve as a 100% guarantee against recurrent disease.

What is the danger to the fetus?

Rubella is considered to be a mild disease. However, this definition is valid for the course of this infection only in children, since rubella in pregnant women is fraught with serious consequences for the unborn child.

The danger of the rubella virus is that it is almost always transmitted from the mother to the fetus and damages it.

Depending on the stage of pregnancy at which infection occurs, the fetus has a varying probability (in the first trimester the probability reaches 90%, in the second - up to 75%, in the third - 50%) multiple malformations are formed. The most typical are damage to the organ of vision (cataracts, glaucoma, corneal opacities), the organ of hearing (deafness), and the heart (congenital defects).

Congenital rubella syndrome also includes defects in the formation of the bones of the skull, brain (small brain size, mental retardation), internal organs (jaundice, enlarged liver, myocarditis, etc.) and bones (areas of rarefied bone tissue of long tubular bones). In 15% of cases, rubella in pregnant women leads to miscarriage or stillbirth.

If rubella is detected, an artificial termination of pregnancy is always carried out.

What methods are used to diagnose rubella?

The most widely used methods in diagnosing rubella are serological methods, in particular the enzyme-linked immunosorbent assay (ELISA) .

• The immunological marker of primary infection is IgM to the rubella virus. IgM begins to be produced in the first days of the disease, reaches its maximum level at 2-3 weeks and disappears after 1-2 months. But the period of circulation of IgM antibodies can vary significantly depending on the infectious pathogen and the individual characteristics of the body’s immune response.
• When infected with rubella, trace amounts of IgM antibodies to the rubella virus are detected in some cases for 1-2 years or more. Thus, their presence in the blood of a pregnant woman does not always confirm primary infection during pregnancy. In addition, the specificity of even the best commercial test systems for detecting IgM antibodies is not absolute. In some situations, as a consequence of the very high sensitivity of the tests, nonspecific false-positive results are possible. IgG is detected 2-3 days later than IgM, increases to a maximum by a month from the onset of the disease and persists throughout life. In an infected fetus, anti-rubella IgM begins to be produced from 16-24 weeks and can persist for a long time (up to a year or longer). Until 6 months of age, maternal IgG circulates in the newborn, and then specific IgG begins to be produced in a child with congenital rubella during the first year of life.
• Since the risk of pathology of fetal development during acute primary infection with the rubella virus during pregnancy is significant, in order to confirm or exclude the fact of recent infection with the rubella virus in a pregnant woman, PCR testing of biological fluids for the presence of rubella virus RNA and a blood test using ELISA for the avidity of IgG to the rubella virus are used.

For the purpose of early diagnosis of rubella in a pregnant woman or intrauterine infection, the following can be used to detect rubella virus RNA by PCR:

1. blood from the mother's vein,
2. umbilical cord blood obtained by cordocentesis,
3. amniotic fluid,
4. chorionic villi obtained from infected pregnant women by transabdominal amniocentesis.

• Detection of high-avidity IgG antibodies in the blood (IgG avidity ≥70%) allows one to exclude recent primary infection.

Low-avidity IgG antibodies (IgG avidity ≤ 50%), on average, are detected within 3-5 months from the onset of infection (this may depend to some extent on the method of determination), but are sometimes developed over a longer period. In itself, the detection of low-avidity IgG antibodies is not an unconditional confirmation of the fact of fresh infection, but serves as additional confirmatory evidence among other serological tests.

Who needs to be examined?

Laboratory diagnosis of rubella is especially important in the following categories of subjects:

• Women who are planning a pregnancy or pregnant women in order to identify risk groups. If a woman has not previously had rubella, is not sure that she has had it, or does not know for sure about it, it is necessary to study the level of specific IgG using the ELISA method. If the result is positive, there is no risk of fetal infection. In case of a negative result, vaccination is recommended. In this case, the planned pregnancy must be postponed for three months!!!
• Pregnant women with suspected rubella virus infection and adults with severe cases or complications of rubella. It is necessary to determine specific IgM and IgG and interpret test results from an infectious disease specialist to select further tactics.

In general, the diagnostic algorithm looks like this:

1. IgM - not detected, IgG - not detected, or their concentration is not sufficient to protect against infection. It is recommended: exclude contact with patients with rubella, repeat the examination after 2 weeks, during which medical observation of the pregnant woman is carried out. If the result is negative again, conduct a third serological examination, continuing medical observation. If the test is negative in the third study, stop observation and warn the pregnant woman that she is susceptible to rubella infection.
2. IgM – not detected, IgG – detected, their concentration corresponds to the protective level. During the initial examination of a pregnant woman in the early stages of pregnancy, further observation for rubella infection is not indicated.
3. Specific IgM antibodies to the rubella pathogen were detected. In this case, IgG antibodies are either detected or not detected. There is a risk of congenital pathology of the fetus.

A repeat serological test is indicated after 2 weeks, with further consultation with an infectious disease specialist. To exclude cross-reaction and the influence of rheumatoid factor, confirm/exclude the diagnosis, it is recommended to do an IgG avidity test, conduct a quantitative analysis for IgM and PCR testing of the mother's blood for the presence of rubella virus RNA.

Newborns with signs of congenital rubella.

If intrauterine infection with the rubella virus is suspected in a newborn, it is necessary to examine the level of IgM in the newborn's blood serum. A positive test result indicates an acute infection. The diagnosis can be confirmed if a positive IgM titer is also detected in the mother's blood. In cases where infection occurred in the first or second trimester of pregnancy, IgM may not be detected. Then the presence of infection can be judged by the dynamics of IgG. In the presence of infection, the level of IgG increases in the first months of a newborn's life.

In the absence of infection, IgG in the blood of the newborn is either not detected (the mother is seronegative) or decreases (elimination of maternal antibodies).

The presence of specific IgG in a child older than 6 months indicates intrauterine infection.

What should a pregnant woman do if she finds herself in a rubella outbreak?

If a pregnant woman who has not had rubella, has not been vaccinated and has not had immunity to the rubella virus determined, finds herself in a focus of rubella infection (contact with a person who has rubella), she must immediately contact an infectious disease specialist!

As mentioned above, the danger of infection of pregnant women through contact with a person with rubella exists only for those women who are susceptible to the rubella virus due to the lack of protective immunity. The presence of specific antibodies (IgG to the rubella virus) indicates the patient's immunity.

It is very important to begin testing as early as possible after exposure. If antibodies to the rubella virus are found in protective concentrations in a woman in the first 6 days after contact, then these antibodies are a consequence of long-term rubella. In this case, the woman is not susceptible to the rubella virus, and contact does not pose a danger to her. The absence of antibodies or a weakly positive result in the early stages of the examination indicates that the woman is not protected against rubella, and there is a risk of infection.

But you shouldn’t despair in advance, since it is known that susceptible women who have been in contact with people with rubella may not get sick.

To exclude infection, it is necessary to conduct a repeated serological examination over time 2-4 weeks after contact.

Serological monitoring of contacted women must be carried out until the end of the 2nd trimester of pregnancy.

If a woman comes late after contact (a week or more after contact with a sick person), it is necessary to detect IgG, IgM and IgG avidity to the rubella virus using ELISA, and examine the blood for rubella virus RNA using PCR.

In addition to a visit to an infectious disease specialist, a woman must contact a gynecologist, who will prescribe the necessary tests to determine the condition of the fetus (detailed ultrasound, screening studies of the 2nd and 3rd trimesters). If these tests indicate any problems in the child’s development, an amniocentesis procedure may be prescribed.

Further, based on the results of all examinations and tests, the issue of the presence of congenital defects and termination of pregnancy is decided. In many countries, rubella detected in the first trimester of pregnancy is an indication for termination of pregnancy. If pregnancy is complicated by rubella at 14-16 weeks, the issue of recommendations for maintaining pregnancy is decided at a consultation of doctors. If it is impossible to abort a pregnant woman, immunoglobulin is administered intramuscularly in a dose of 20–30 ml intramuscularly. In the future, preventive measures are taken to protect the fetus, treatment of placental insufficiency, prevention and treatment of miscarriage.

Prevention of rubella in pregnant women.

To prevent congenital rubella syndrome, WHO (World Health Organization) recommends combining three principle approaches to the elimination of rubella and congenital rubella syndrome:

1. vaccination of children,
2. vaccination of teenage girls
3. vaccination of women of childbearing age planning to have children.

According to statistics, 11-30% of women of childbearing age are not protected from rubella .

If a girl or young woman has not had rubella and is not vaccinated, then before planning a pregnancy, she herself needs to think about the appropriate vaccination.

1. You need to donate blood for rubella antibodies.
2. If there are no antibodies, it is necessary to get vaccinated against rubella 3 months before the expected pregnancy. Vaccination protects almost 100%; immunity after a single vaccination lasts for an average of 15-20 years, then immunization can be repeated.

It must be remembered that after the administration of the rubella vaccine, it is not recommended to become pregnant for 3 months.

But !!! If pregnancy occurred earlier than this period or a woman already expecting a child was vaccinated, this is not an indication for termination of pregnancy.

In conclusion, I would like to remind you that there are no hopeless situations! They appear only if you allow them to enter your life. Having a healthy baby is not only necessary, but also possible!

If you are planning a pregnancy, diagnose your immunity to the rubella virus, and then get pregnant,

wear it calmly, give birth easily and raise a healthy baby! Good luck to you!

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Folk remedies

Popular methods of traditional treatment are:

1. Lubrication of the rash. Rashes on the body cause itching in the baby. This reaction can be eliminated by lubricating problem areas with a (strong) soda solution. It is recommended to hold it on the surface of the skin for about 10 minutes. A weak solution of manganese will have a beneficial effect. The moistened napkin should be applied to the itchy area for about 10 minutes.
2. Stimulation of immunity. Vitamin teas made from black currant, rose hips, and lingonberries can increase vitality and protective functions.
3. Enrichment of children's body with vitamins. An infusion of rose hips, strawberries, and black currants is beneficial for the baby. Parsley, green onions, and dill should be included in the diet.
4. Elimination of swelling of the lymph nodes. A cooling compress can help treat this condition. Use homemade cottage cheese. It has excellent anti-inflammatory properties. Place a 1 cm layer of cottage cheese on gauze. Secure this compress on the baby’s neck. Leave it on all night.
5. Fighting fever. You can use an old remedy. If the temperature is high, place a damp, cool cloth on the baby's shins.

Features of rubella in children under one year of age

Rubella is extremely rare in children under one year of age. This is explained by the fact that most women, by the time they conceived, had either already had rubella in childhood or had been vaccinated against it. In this case, during intrauterine development and subsequent breastfeeding, the baby receives antibodies from the mother’s body to a variety of infections, including rubella, and for about a year his body is protected by the mother’s immunity.

If a woman did not have rubella before conception and was not vaccinated in childhood, then the chances of her unborn child getting rubella in utero or before the age of one year (before the scheduled vaccination) are high.

Rubella in infants is dangerous to health. It may be accompanied by convulsive syndrome, DIC syndrome (disseminated intravascular coagulation), the development of meningitis and encephalitis. A feature of the course of the disease at this age is its rapid development. Characteristic rashes can be present on the skin for no more than 2 hours, and then immediately disappear without leaving a trace. Children under one year of age who have had rubella develop a strong immunity to this disease, which means they no longer need to undergo routine vaccination.

Diagnosis of the disease

If the above symptoms appear in a child, you should call a pediatrician at home. The doctor will listen to complaints and check the condition of the lymph nodes, skin and respiratory tract. If rubella is suspected, the patient will be referred to an infectious disease specialist.

To confirm the diagnosis, a complete blood count and laboratory serological testing for antibodies will be ordered. The latter make it possible to detect the disease even in asymptomatic cases.

First signs

In children in the initial stages of the disease, the first symptoms resemble a cold.

During the incubation period, rubella manifests itself as follows:

• weakness;
• The temperature with rubella increases (slightly);
• conjunctivitis;
• runny nose;
• pain in the throat;
• lymph nodes enlarge;
• the final symptom is the appearance of a rash.

Symptoms at the height of the disease are somewhat different. The virus has a toxic effect, which causes:

1. Polyadenitis. The baby's lymph nodes become painful and enlarged: occipital, parotid, cervical.
2. Fine-grained rash - round spots, localized on the skin surface, do not rise. Their size is approximately the same - 2-5 mm. They first appear on the neck and face, and after a few hours they cover the entire body. The rashes are abundant on the buttocks, back, and bends of the limbs.
3. Catarrhal phenomena. Children exhibit cold symptoms.
4. Mild intoxication. At elevated temperatures (not higher than 38 degrees), the baby feels unwell, headaches, and weakness.

Routes of infection

A child can only become infected with rubella measles from an infected person.

The disease spreads through airborne droplets. The virus from the mucous membrane of the respiratory organs of an infected person enters the air. During inhalation, it is introduced into the body of a healthy child.

Your baby can get rubella if he has been in contact with:

• patients with an atypical form of the disease (with an uncharacteristic course of rubella, the rash and many other signs may be completely absent);
• infected people who exhibit all the characteristic symptoms;
• infants who are diagnosed with a congenital form of the disease (in such children, the virus can multiply in the body for 1.5 years).

The virus can be transmitted from an infected mother through the placenta to the fetus. The child develops congenital rubella. The pathogen has an extremely negative effect on the development of the fetus and can cause many developmental defects.

Medical observations show that the frequency of development of abnormalities in congenital rubella depends entirely on the period of pregnancy:

• 3-4 weeks – the probability of developing defects in a newborn is 60%;
• 9-12 weeks – deviations occur in 15% of infants;
• 13-16 weeks – malformations are diagnosed in 7% of newborns.

Complications

Usually the disease in children is mild. Consequences from a previous illness are possible if the child’s immunity was weakened, or at the time of the illness another one was added to it. The disease is more difficult for unvaccinated children to tolerate.

Possible complications:

• angina;
• pneumonia;
• meningoencephalitis;
• otitis;
• arthritis;
• thrombocytopenic purpura (a decrease in the number of platelets in the blood is characterized by frequent bleeding, local hemorrhages on the skin);
• rubella encephalitis (inflammation of the membranes of the brain). The child recovers and is registered with a neurologist and infectious disease specialist for another 2 years (or maybe more). There is a possibility of death.

Congenital pathology has the following consequences:

• deafness;
• diabetes;
• encephalitis;
• bone damage;
• thrombocytopenic purpura;
• pneumonia;
• developmental delays;
• hepatolienal syndrome (enlarged liver and spleen);
• malformations of the eyes, heart defects.

What rubella looks like, photo

Not all parents know how rubella manifests itself in children and often confuse this disease with a typical cold or acute respiratory infection. But it is necessary to carefully diagnose each such case and take measures to prevent complications of infection, which can affect brain structures, nerve fibers, spinal cord and connective tissue. The walls of small blood vessels are especially often affected.

Photo of rubella in a child: