• Regime – mouth and eyes washing

• Etiotropic therapy (ribavirin) – unclear efficacy, recommended for encephalitis cases

• Vitamin a

• Antibiotics (children under 3 years of age, immunodeficient or development of complications)

• Detoxication

• Symptomatic

Hospitalization of all children under 2 years of age

Prophylaxis (MEASLES) :

Active : Alive attenuated vaccine (MMR)

Passive : Anti-measles Ig

Contagious period (MEASLES) :

• till 4^th days

Isolation (measles) :

• Till the 4^th day after appearance of the exanthema (uncomplicated cases)

• Till the 10^th day after appearance of the exanthema (complicated cases)

Rubella

Definiton (RUBELLA):

Viral infection – acquired (airborne, mild clinical presentation and benign outcome) or inborn (transplacental transmission, severe defects of the fetus)

Etiology (RUBELLA):

• RNA-containing

• Togaviridae, genus Rubivirus

Epidemiology (RUBELLA):

• Incubational period – 9-21 days

• Most cases in children of 2 to 9 years

• The source of infection is a patient from 1-2 weeks of incubational period and till 3 weeks of the disease

• Inborn rubella – can be contagious up till 1-2 years

Pathogenesis (Inborn rubella):

1. Direct cytopathic action on the fetus (lens and cochlear cells)

2. Mitosis activity delay

Critical periods:

• brain – 3-11 weeks of gestation,

• eyes and heart – 4-7 weeks,

• ears – 7-12 weeks

Clinics (Inborn rubella):

Typical Triad:

1. Deafness

2. Blindness

3. Heart defects

Clinics periods (RUBELLA):

1. Incubational period - 9-21 day

2. Prodromal period – can be several hours; mild intoxication and catarrhal period, lymph nodes enlargement

3. Rash period - 3-4 days

4. Convalescence period

Clinics (RUBELLA):

1. Intoxication syndrome : mild; fever under 37,5 – 1-2 days

2. Exanthema syndrome

3. Lymphadenitis – posterior cervical and occipital lymph nodes

Clinics – rash characteristics (RUBELLA):

1. Character of the elements – pale macular

2. Prevalent localization – face, back, buttocks, extension surfaces of the extremities

3. Background skin color – normal

4. Time of appearance – 1^st day of the disease

5. Connection to fever – mild if any fever

6. Itching – no

7. Fusion of rash elements – no

8. Step-wise appearance – no

9. Presence of enanthema –palate enanthema (concurrent with rash, Forscheirmer spots)

10. Disappearance of the rash – no residuals

Classification (RUBELLA):

1. Typical (mild, moderate, severe) and atypical (low-grate, asymptomatic)

2. With / without complications

3. Acquired or inborn

Complications (RUBELLA):

• Arthritis and arthralgias – 1-2 week of the disease, more often in females

• Encephalitis (1:6 000) –- on the 5-8^th day

• Thrombocytopenic purpura – 1-2^nd week

• Encephalitis : fever to 40, symptoms of encephalitis

• Mortality rate is 15-20%

• Recovery takes 2-3 months, can be residual symptoms

Laboratory diagnosis (RUBELLA):

• CBC: Plasmocytes (Turke cells)– to 10-20%

Required confirmation

• Virusology – PCR and IFA, nasal secretion, CSF

• Serological – increase of IgM titer

Ig M – positive 12 weeks after disease;

Ig G - anamnestic

Treatment (RUBELLA):

• Uncomplicated forms - no treatment

• At arthralgias – NSAIDs

• Encephalitis and meningitis – appropriate treatment

Prophylaxis (RUBELLA):

Active : Alive attenuated vaccine (MMR) – at 1 and 12-14 (girls) years.

Passive : In pregnant women, but low efficacy .

Contagious period (RUBELLA):

Since last 1-2 weeks of incubation period – till 2-4 weeks after appearance of the disease .