ROSOLIA: causes, symptoms and vaccine in children, adults and pregnant women

There rubella it's an illness infectious, contagious, caused by the Rubivirus. The infection it is transmitted through saliva and other secretions of the respiratory system, the incubation lasts about 2-3 weeks, it is contagious in the week preceding the appearance of the rash and for the following 6-14 days. THE symptoms they are mainly cutaneous - exanthema -, fever, malaise and lymphadenomegaly. If taken in pregnancy it can have serious consequences for the fetus. Prevention occurs with the vaccine, while there is no care really effective antiviral: therapy is symptomatic.

Rubella

There rubella it's a infectious disease caused by a virus member of the genus Rubivirus, of the Togaviridae family. The infection can affect people of all ages and its severity varies according to age, with milder lesions children and more severe and with complications in adolescents and adults.

It is part of the exanthematous diseases, together with measles, scarlet fever, chicken pox, fourth disease - also called scarlet fever -, fifth disease e sixth disease.

Contagion and incubation of rubella

How does the infection? The virus does transmits through tract secretions respiratory of infected subjects, penetrates and invades the respiratory epithelium and from there spreads through the blood - primary viraemia - towards the system lymphatic. After 6-20 days of infection, a second spread in the blood follows - secondary viraemia - which immediately precedes the onset of the skin rash.

How long does it last incubation of this infectious pathology? L'incubation rubella lasts about 2-3 weeks. An infected person is contagious from 3-8 days after contracting the infection to 6-14 days after the onset of the rash. The period of maximum contagiousness ranges from 5 days before to 6 days after the onset of skin manifestations. It can therefore be said that the duration symptomatic of rubella is one to two weeks.

Rubella Symptoms

What are the main ones symptoms of rubella? Regarding the symptoms, in children it generally has a benign course and is sometimes indistinguishable from other viral febrile diseases. The prodromes occur 14-21 days after infection, the main manifestations are:

  • temperature
  • sore throat
  • conjunctivitis with or without eye pain
  • headache
  • loss of appetite
  • lymphadenomegaly, or enlargement of the suboccipital, retroauricular and anterior cervical lymph nodes
  • Rash starting on the face and neck with irregular pink patches that join and spread to the rest of the body.
  • Skin itching
  • There may also be pink lesions in the mouth (Forchheimer's spots) or petechiae.
Rubella red dots rubella

In the photo the classic image depicting the back of a child suffering from rubella.

As it extends to the trunk and limbs, the rash disappears from the face and neck, has an average duration of about 3 days and is not followed by peeling, while itching can last for a few days after the disappearance of the red spots on the skin.

Rubella Diagnosis

On laboratory tests, one can be observed reduction gods White blood cells and of platelets. Clinical diagnosis can be difficult because other exanthematous diseases can resemble rubella, therefore the diagnosis requires serological tests with the finding of positivity of the IgM antibodies to the rubella virus.

Cases of false positivity of IgM antibodies against rubella have been reported in subjects with other viral infections (parvovirus B19, cytomegalovirus or CMV, Epstein-Barr virus or EBV) and in patients with positivity of rheumatoid factor. Cultures of the virus are very expensive, often unavailable, and take a long time to deliver.

Rubella can be easily confused with other infectious diseases that present similar clinical pictures, the pathologies that enter the differential diagnosis are infections from:

  • measles,
  • adenovirus,
  • parvovirus B19,
  • Epstein-Barr virus,
  • enterovirus,
  • Mycoplasma pneumoniae.

Complications of rubella

Complications are infrequent and are represented by:

  • thrombocytopenia (1/3000 cases) more frequent in children and occurring 2 weeks after the rash,
  • arthritis which mainly affects women, occurs 1 week after the rash and mainly affects the small joints of the hands,
  • complications of the central nervous system such as encephalitis and progressive panencephalitis.
  1. Encephalitis occurs in 1/5000 cases of rubella, occurs one week after the rash and manifests itself with headache, convulsions, confusion, ataxia, coma; mortality is 20% and neurological sequelae are frequent.
  2. There panencephalitis progressive is an extremely rare neurodegenerative complication, it can arise even years after infection and leads to death within 2-5 years of onset.
  • Guillain-Barrè syndrome,
  • peripheral neuritis
  • myocarditis.

Rubella therapy

How to care rubella? The treatment of rubella is symptomatic and of support, they do not exist medications antivirals. Paracetamol (acetaminophen, known by the trade name of Tachipirina) is often used to control fever.

Rubella in pregnancy

One of the most serious forms of rubella is infection of the fetus during the pregnancy by the trans-placental route. The severity of the infection is greater the earlier the mother contracts the infection during gestation.

Rubella in pregnancy

In the photo, the image depicts a future mother who has contracted rubella

In particular, the effects of the virus on the fetus are more severe if the infection occurs between the first and the 11th gestational week, in this case the probability of congenital defects it is in fact of the 90%. Manifestations of infection on the newborn are referred to as congenital rubella syndrome and I'm:

  • unilateral or bilateral hearing loss (sensorineural damage): this damage may not be recognizable until the second year of life
  • ocular abnormalities such as cataracts, infantile glaucoma, pigmentary retinopathy
  • congenital heart defects such as patency of the arterial duct or pulmonary artery stenosis
  • intrauterine growth retardation,
  • prematurity
  • abortion
  • central nervous system abnormalities, including mental retardation and behavioral disorders
  • liver enlargement - hepatomegaly
  • enlargement of the spleen - splenomegaly
  • jaundice
  • hepatitis
  • skin manifestations
  • bone abnormalities
  • endocrine abnormalities, such as thyroid disease or diabetes mellitus
  • haematological disorders such as anemia or thrombocytopenia

There is one therapy for this fearful complication in pregnancy? There is none care for congenital rubella syndrome, the treatment of affected subjects requires the involvement of several medical figures who must follow the patient over time because some manifestations may not be present at birth or may worsen over time.

It is important hearing screening and it visual screening for early interventions. Newborns with congenital rubella eliminate the virus through respiratory secretions for a long time, even up to a year, therefore precautions and repeated checks must be implemented through cultures of nasopharyngeal secretions and urine until their negativization.

Women in pregnancy with a history of suspected contact with a case of rubella should search for IgG antibodies for rubella, the demonstration of positivisation of the antibodies in 2 samples taken 3 and 6 weeks after exposure confirms the infection, ie the seroconversion.

Rubella prevention: the vaccine

There prevention of infection occurs through the vaccination. In Italy the vaccination schedule provides for the administration of the vaccine in the form of two doses of tetravalent vaccine (MPRV against measles, mumps, rubella, chicken pox).

When is the vaccine given?

  1. the first dose is given between 12 and 15 months of age
  2. the second dose at 5-6 years of age.

However, vaccination is also recommended for children and adults who have not been previously vaccinated.

Side effects of the rubella vaccine

After the vaccine they can be had mild reactions localized as swelling, pain, redness at the injection site and also fever, mild rash, swelling of the face or behind the neck (6-14 days after infection). Demonstrations seizures secondary to fever, joint pain, thrombocytopenia are rare; severe reactions it can be allergic manifestations.

Contraindications to the rubella vaccine

Contraindications to the vaccine for rubella are: subjects with a severe allergic reaction to the first dose of the vaccine, allergic to neomycin or other components, patients with rare hereditary problems of fructose intolerance, pregnant women (the vaccine must be postponed until after delivery).

The vaccinating doctor should be notified if the person has an immune system disease or uses drugs that cause immunosuppression, has a tumor, has a low platelet count, has recently received a blood transfusion, immunoglobulin, or a vaccine (in these cases the vaccine is not performed and / or is postponed).

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