Rubella (German measles) is an acute respiratory infectious disease caused by the rubella virus, characterized by a short prodromal period and mild systemic symptoms, commonly seen in children aged 2 to 5 years.

bubble_chart Clinical Manifestations

The incubation period is 10 to 21 days.

1. Prodromal stage: Fever lasts for half a day to one day, accompanied by grade I upper respiratory symptoms.
2. Stage of full eruption: The rash starts from the head and face, then spreads to the neck, trunk, and limbs, covering the entire body within 24 hours. The rash appears as light red or red maculopapules, with normal skin visible between the lesions, resembling measles but without mucous membrane spots. During the stage of full eruption, the fever does not rise further. The rash subsides within 2 to 3 days. It is often accompanied by enlargement of the posterior auricular, cervical, occipital, and other superficial lymph nodes, as well as splenomegaly.
3. Stage of convalescence: After the rash subsides, there is no desquamation or pigmentation, which can also distinguish it from mild measles. Lymphadenopathy and splenomegaly gradually resolve. In rare cases, complications such as encephalitis, arthritis, or thrombocytopenic purpura may occur.
4. Congenital rubella syndrome: If a pregnant woman is infected with rubella within * months of pregnancy, the rubella virus can cross the placenta and cause intrauterine infection in the fetus, leading to dead fetus, premature labor, or various malformations. The most common include internal visual obstruction, cardiovascular malformations, deafness and dumbness, microcephaly, and hepatosplenomegaly, collectively known as congenital rubella syndrome. If rubella infection occurs within 4 to 8 weeks of pregnancy, the malformation rate in infants can be as high as 50–100%; in the second month, it is 30%; in the third month, 20%; and in the fourth month, 5%.
5. Progressive rubella panencephalitis: A rare slow viral infection of the central nervous system, occurring in children with a history of congenital rubella, typically manifesting several years after birth. Symptoms include progressive ataxia, rigidity, and dementia. The course is slow, and the prognosis is poor.

bubble_chart Auxiliary Examination

The following tests may aid in diagnosis when necessary:

1. Blood test: Total white blood cell count decreases, with lymphocyte proportion initially reduced in the first 1-2 days and subsequently increased.
2. Virus isolation: Collect nasopharyngeal secretions from the child to isolate the virus. For congenital rubella cases, urine, blood, cerebrospinal fluid, or bone marrow can be used to isolate rubella virus. Viral detection in the placenta can be performed using monoclonal antibodies and in situ hybridization.
3. Serological tests: Hemagglutination inhibition test, neutralization test, complement fixation test, or immunofluorescence test can be used. A fourfold or greater increase in antibody titer between paired sera is considered positive. Specific IgM and IgG antibodies can be detected in the serum. Elevated specific IgM antibodies at birth aid in the diagnosis of congenital rubella.

bubble_chart Treatment Measures

1. Strengthen nursing care, bed rest during fever, and provide easily digestible meals.
2. Symptomatic treatment may include clearing heat and removing toxin Chinese medicinal oral liquids, vitamin C, etc.

bubble_chart Prevention

1. Isolated children should be kept in isolation until 5 days after the eruption.
2. Active immunization should be carried out using monovalent rubella attenuated live vaccine, or combined "rubella-measles" or "rubella-mumps" vaccines, or the "measles-rubella-mumps" trivalent vaccine. Antibodies can be produced in 95% of susceptible children, peaking at 6-8 weeks, with effective antibody titers lasting for more than 7 years. Women of childbearing age can receive the aforementioned vaccines. Since the vaccine itself may also cause fetal malformations, it should not be administered during pregnancy and should be given at least half a year before conception. If rubella infection occurs in early pregnancy and rubella virus IgM antibodies are detected in the blood, the pregnancy should be terminated.
3. For weak children and pregnant women in early pregnancy, administering 20-30ml of specific high-titer immune globulin within 5 days of exposure to rubella patients can have a preventive effect.

bubble_chart Differentiation

It should be differentiated from measles, scarlet fever, roseola infantum, etc.