Rubella

The rubella virus has two unique features:

high permeability through the placenta,
pronounced teratogenic effect.

Forms of rubella infection

The development of intrauterine infection with the manifestation of the teratogenic effect of the virus is possible with the following forms rubella infection:

natural infection caused by a (wild) virus
- primary rubella infection (in seronegative women);
- reinfection - reinfection after a natural infection;
- with the development of rubella infection in vaccinated;
vaccinal process caused by an attenuated strain of the virus during accidental vaccination of a pregnant woman with a live rubella vaccine.

Primary rubella infection

Rubella virus infection in pregnant women by airborne droplets. The risk of infection in pregnant women is the same as in non-pregnant women. Pregnant women get sick no more than non-pregnant women. Rate of seronegative susceptible women childbearing age varies in different regions countries quite widely (from a few percent to 30%).

The relevance of rubella infection for perinatal pathology in modern Russia due to the following factors:

reduction of places in preschool institutions;
a decrease in the proportion of girls with rubella;
an increase in the number of seronegative susceptible women of childbearing age;
insufficient coverage of girls with rubella vaccination;
an increase in the number of pregnant women who carry rubella infection (asymptomatic or manifest);
an increased risk of developing congenital rubella syndrome (CRS).

Rubella is an anthroponotic infection: infection occurs only from an infected person.

Sources of infection:

children:
- with acquired (manifest, erased, asymptomatic) infection within 4 weeks (one week before the appearance of the rash and up to 3 weeks after the disappearance of the rash);
- with congenital rubella overt infection for up to 12–18 months;
- with congenital subclinical infection for up to 12 months.
adults with acquired overt or subclinical infection for up to 4 weeks.

Infection mechanisms:
Pregnant - by airborne droplets (the virus is detected in patients with rubella and in persons who carry asymptomatic rubella infection in the nasopharyngeal mucus for 7 days before the development of rashes and up to 3 weeks after the disappearance of the rash);
fetus - transplacental way during the period of viremia in a pregnant woman (within 7 days before the appearance of the rash and during the period of rashes).

Incubation period acquired postnatal infection: 14–21 days.

Clinic of infection in children

Complications

A roseolous rash is recorded on the extensor surfaces of the limbs, back, buttocks (absent on the palms, soles), The duration of the rash period is up to 3 days.
Register fever (39 ° C), lymphadenopathy (often posterior cervical lymph nodes), enanthema (rashes on the mucous membrane of the soft palate), mild catarrhal phenomena, arthropathy, changes in the blood (leukopenia, lymphocytosis, plasmacytosis, thrombocytopenia). The duration of the illness is 3-5 days.
The asymptomatic course of the disease is recorded in 50-66% of cases.

Complications severe course infections: thrombocytopenic purpura, meningoencephalitis, neuritis, catarrhal purulent bronchitis, focal pneumonia, hepatitis. AT rare cases register a death.

Clinic of infection in adults

The proportion of adults with rubella is about 10% of the total number of patients. The risk of infection in seronegative pregnant women is 15–18%. In adults (including pregnant women), the infection may be accompanied by arthropathy of the ankle and knee joints.
Other symptoms: malaise, chills, weakness, myalgia, conjunctivitis, runny nose, soreness of the lymph nodes, fever, rash, paresthesia, pain in the testicles in men.

In most cases (60–70%), rubella infection is asymptomatic.

Laboratory diagnosis of rubella

Material for research: blood, nasopharyngeal mucus, lavage, urine, liquor, discharge from the conjunctiva.

Methods of laboratory diagnostics.

virological method: virus isolation in sensitive cell structures;
molecular biological method: determination of virus RNA in PCR;
serological methods: detection of M-antibodies in primary infection within 1–2 months (absent during reinfection);
detection of low-avid G-antibodies up to day 25 during primary infection (absent during reinfection);
detection of seroconversion (seropositivity) or a significant increase in G-antibodies (4-fold or more) in the study of paired sera obtained at intervals of 3-4 weeks (with negative 2nd serum, 3rd serum is obtained 2 weeks after the 2nd serum).

Clinic of congenital rubella

Up to 1,000 children with congenital rubella syndrome are registered annually in Russia. The incidence of congenital rubella syndrome has more than doubled over the past 20 years. Specific gravity CRS accounts for about 10% of the total number of children with congenital anomalies. In the first trimester of pregnancy, the frequency of intrauterine infection reaches 90%, CRS - 60%.

The clinical picture of CRS is characterized by Gregg's triad:

defeat visual analyzer(cataract, corneal clouding, congenital glaucoma, chorioretinitis, microphthalmia, myopia, retinopathy, underdevelopment of the eyelids, stenosis of the lacrimal canal);
pathology auditory analyzer(deafness, defect of the organ of Corti, stenosis of the Eustachian passage);
formation disorders of cardio-vascular system(non-closure of the batal duct, defect of the interatrial and interventricular septa, stenosis of the pulmonary artery, endocarditis, stenosis, coarctation of the aorta).

Intrauterine rubella infection is accompanied by viremia, proceeds as a generalized systemic process with multiple organ lesions. Damage to the central nervous system is also recorded (hydrocephalus, microcephaly, increased intracranial pressure, dysfunction of the limbs - hypo- and hyperkinesis, lag in mental development), organs abdominal cavity(hepatitis, hepatosplenomegaly), lesions of the genitourinary, digestive, bone and other systems. Combined anomalies are recorded in 66% of cases. In severe cases of intrauterine infection, incompatible with the life of the fetus, spontaneous abortions (10–40%) and stillbirths (20%) are recorded. The lethal outcome of newborns reaches 10-25%.

Laboratory diagnosis of congenital rubella Material for research: cord blood, blood of a newborn child, pharyngeal mucus, conjunctival discharge, urine, cerebrospinal fluid. Methods of laboratory diagnostics: determination of M-antibodies, low-avid G-antibodies in cord blood, blood of a newborn, virus RNA in PCR, isolation of the virus from clinical samples of a newborn within 6-12 months.

Antenatal diagnosis of rubella infection

Conduct research amniotic fluid obtained during amniocentesis for the presence of virus RNA, cord blood (obtained during cordocentesis) for M-antibodies to the virus, virus RNA.

CDC Criteria for Diagnosis of Congenital Rubella Syndrome

Main symptoms: cataract, glaucoma, retinopathy, heart disease, deafness.

Additional symptoms: purpura, splenomegaly, jaundice, meningocephalitis, microcephaly, mental retardation, limb damage.

Availability of SVK: the main additional symptoms, M-antibodies, or two main symptoms (or one main and one additional) in the absence of laboratory data.

Intrauterine infection without CRS: main and additional symptoms are absent. Positive result isolation of the virus (determination of the RNA of the virus) in clinical samples, M-antibodies in the child's blood.

There is no intrauterine infection: decrease in G-antibody titers by 50% every month and their disappearance at the age of a child older than 12 months.

Treatment

There are no treatments for pregnant women with rubella infection that prevent intrauterine infection of the fetus. The introduction of immunoglobulin containing antibodies to the virus stops clinical symptoms in pregnant women, but does not prevent intrauterine infection of the fetus. However, if a woman with rubella infection in the first trimester refuses to terminate her pregnancy, immunoglobulin administration may be recommended.

Prevention

The only way to prevent the development of rubella in women of childbearing age (and therefore the prevention of CRS) is to vaccinate them before conception. The vaccination process after the introduction of a live rubella vaccine lasts several weeks, after which the vaccine strain is eliminated from the body of vaccinated women. In connection with the specified feature of the pathogenesis of the vaccinal process and the possible teratogenicity of the vaccine virus, it is imperative to exclude conception within 3 months after vaccination.

Several vaccines are licensed in Russia: 2 single vaccines and a trivaccine (against rubella, measles, mumps).

Indications for vaccination: seronegativity of a woman, seropositive women with an antiviral antibody titer of less than 15 IU / ml.
Contraindications: pregnancy, acute respiratory infections, malignant tumors, secondary immunodeficiencies, the use of immunosuppressants.

reinfection

Immunity after a natural infection in some cases is not lifelong (with immunodeficiencies, autoimmune diseases). Recurrent cases of rubella infection are possible in those who have previously had an infection (reinfection). The frequency of reinfection ranges from 3 to 10%. A feature of repeated cases of rubella infection is more easy current, frequent development of asymptomatic forms. This is due to the presence of antiviral antibodies in the blood, as well as the booster effect during repeated stimulation of the immune system with a viral antigen.

Epidemiological data (contact with a patient with rubella) and laboratory testing (increased titers of G-antibodies in the absence of markers of primary infection: M-antibodies, low-avid G-antibodies) are of diagnostic value.

Rubella in vaccinated

Post-vaccination immunity does not provide lifelong protection to all vaccinated individuals. In part of those vaccinated with a decrease in the titer of antiviral antibodies below 15 IU / ml, re-infection is possible. The incidence of rubella infection in women previously vaccinated against rubella is 14–18%.

Vaccination process in pregnant women

An analysis of more than 1200 cases of accidental vaccine administration to pregnant women showed that the frequency of intrauterine infection of the fetus is about 9%. Congenital rubella syndrome was not registered in any case. However, due to the possible teratogenic effect of the live rubella vaccine strain, pregnancy is a contraindication for vaccination. At the same time, accidental vaccination of pregnant women is not an indication for termination of pregnancy.

Measures to prevent congenital rubella syndrome

Termination of pregnancy with laboratory confirmation of the diagnosis of both overt and asymptomatic rubella infection in pregnant women in the first trimester.

Testing women preparing for motherhood for the presence of antibodies in the blood to the rubella virus and determining their concentration. Vaccination of seronegative as well as seropositive women with a concentration of anti-rubella antibodies below the protective level (less than 15 IU / ml) and mandatory exclusion of conception within 3 months after the introduction of the vaccine.

In case of accidental administration of the vaccine to pregnant women, termination of pregnancy is not recommended.

The treatment of rubella in children, which occurs in an uncomplicated form, does not require special efforts. The disease begins with an increase in temperature from 37 ° C to 38 ° C, an increase in the lymph nodes located in the back of the neck and behind the ears, the appearance of a rash in the form of red spots, gradually taking on the form of nodules.

Rubella is contracted by contact with a carrier of the virus or a sick person. The virus is not very stable in the external environment, so contact (airborne or household) should be close. It is noticed that rubella practically does not get sick in the summer. This is due to the fact that the virus dies under the influence of ultraviolet radiation and is afraid high temperature. The peak of diseases falls on the off-season.

An infected person begins to shed the virus during external environment a week before symptoms of the disease appear, and is dangerous for 7-10 days after rubella appears. Most of the rubella virus is shed in saliva, urine, and feces. Once in the body, the virus spreads through the bloodstream. The incubation period lasts from two to three weeks.

signs

Rubella symptoms: fever, rash, headache, lethargy, pain in muscles and joints, enlarged lymph nodes, symptoms of SARS (red throat, runny nose, dry cough). Rashes on the body appear rapidly. The first red spots can be observed on the face, neck and scalp. Further, the rash spreads throughout the body, located mainly on external surfaces limbs, back and buttocks. The child feels itchy. By the time the body is completely covered with a characteristic rash, it may already disappear on the face and neck (photo).

The temperature in sick children lasts 1-2 days. The lymph nodes remain elevated until the rash disappears. Red nodules disappear as quickly as they appeared. Within 2-4 days, the rash disappears without leaving scars or age spots. The skin after rubella is a little dry, sometimes there is a slight peeling, but it does not look damaged.

Diagnostics

Rubella is sometimes difficult to identify. Its symptoms often resemble those of measles and scarlet fever. The doctor will help to recognize the disease. The implicit nature of the rash means the appointment of additional tests by a pediatrician. Urinalysis in case of rubella disease will show high level the content of leukocytes, and in the blood test an increased ESR level, above average will be indicators of leukocytes and monocytes. modern medicine can also offer an enzyme immunoassay, which will determine at what stage the disease proceeds and find out if there are antibodies to the virus in the blood.

Treatment is symptomatic

As a rule, rubella in children is mild. After signs of the disease have been discovered, parents should provide the child with bed rest, limit the load on vision (reduce reading time, watch TV, play on the computer). Treat the child should be in case of inconvenience to the child. Elevated temperature(38 ° C), which is extremely rare, you need to give an antipyretic. Sore throat sprays help local action, nasal congestion is overcome by frequent rinsing saline solution and instillation of drops on plant-based. Itching will be removed by antiallergic drugs.

Not allowed to use medicinal herbs with anti-inflammatory, analgesic ( Birch buds), antipyretic (clover, raspberry, burdock), tonic effect ( coltsfoot, a decoction of wild rose, calendula, cornflower inflorescences) by actions. Phytotherapy in this case has no negative consequences, carried out under the supervision of a doctor.

congenital disease

Sometimes rubella is congenital. A child suffering from it, in the vast majority of cases, has complications. He can get sick prenatal period, and the earlier the infection occurs, the more severe the consequences will be.

The health of a pregnant woman is extremely important, watch it. In the first trimester future mom, which does not have antibodies to the rubella virus, can get sick in 80% of cases of meeting it. Minimal Risk- 50% - achieved by the end of the second trimester. In the last three months of pregnancy, rubella infection is almost inevitable.

In some cases, the virus infects the fetus, the embryo becomes unviable, and a miscarriage occurs. If spontaneous abortion does not occur, the virus will certainly cause numerous malformations of the fetus. Rubella affects cells in such a way that they stop dividing, and the development of some organs and systems stops. Most often, in newborns infected transplacentally or with the flow of mother's blood, deafness of varying severity, visual impairment, malformations of the cardiovascular system, and bone tissues are observed. Recognizing the disease in infants is easy. He has a low weight, an inhibited reaction to age-appropriate stimuli, and there are obvious pathologies.

Rubella in newborns is characterized by the fact that such children pose a danger in terms of infecting others. If there is at least one baby infected in utero in the neonatal unit, it causes an outbreak of the disease in all infants and unvaccinated staff. A patient with congenital rubella is contagious for two years. The consequences of the disease are as follows - throughout life, such a child will suffer from various diseases due to his illness. And year by year they will develop.

What are the dangers of complications?

Symptoms in children differ from the course of the disease in adults with relative ease. In Russia, rubella is considered a harmless childhood disease. Indeed, children aged 2-9 get sick more easily than others. age categories. Already after adolescence rubella can be much more severe, but causes complications in healthy people infrequently. However, the consequences can be very serious.

The most common complication is rubella encephalitis (inflammation meninges). In this case, the probability lethal outcome quite real. After recovery from encephalitis, the child is registered with a neurologist and an infectious disease specialist, who monitor his health for two years, and if necessary, more.

Thrombocytopenic purpura is another complication of rubella. It is quite rare and is characterized by frequent nasal, renal and gastrointestinal bleeding due to a reduced number of platelets in the blood. There may also be local hemorrhages on the skin.

With a difficult course of the disease, as well as in the treatment of its complications, the child must certainly be hospitalized.

If with acquired rubella complications are relatively rare, then with congenital disease they are the constant companion of the child. That is why the prevention of rubella is very important.

How to avoid illness

The simplest and effective method don't get sick - get vaccinated. Vaccination is carried out in several stages, starting from 1-1.5 years. The live attenuated vaccine is given in combination with measles and mumps medicines. After immunization, a small percentage of those vaccinated experience mild symptoms rubella, but they disappear without therapeutic effects.

Vaccination is reliable way do not become infected even if the child or adult had prolonged contact with a rubella patient.

After last stage vaccination produces strong immunity to the disease.

Rubella prevention is a necessary point in pregnancy planning. The expectant mother should be vaccinated if she does not have antibodies to the virus, not earlier than three months before the intended conception. If the woman is already pregnant, the vaccine should be postponed.

In Russia, immunization against rubella is mandatory. She gave positive results and deserved positive reviews. If, for some reason, information about past illness is absent, then the expectant mother and her immediate environment must be tested for the presence of antibodies to the rubella virus in the blood.

Rubella symptoms should immediately mobilize parents to localize the spread of the virus. If there is a patient with her in the house, prevention is as follows:

Isolation of the patient in a separate room
Compliance with the rules of personal hygiene.
Use of individual utensils and essentials by the patient.
Boiling the clothes of a rubella-infected person.
Disinfection of the room with hydrogen peroxide.
Regular ventilation and wet cleaning of the premises.

If in the house, in addition to the patient with rubella, there is also a future mother, then, if possible, she should be relocated for the duration of the contagious period of the disease to another place. When a woman who has been ill in childhood or has been vaccinated is pregnant, but must care for the sick, the likelihood of initiating a fetus is minimal.

Children of the first year of life are hard to tolerate rubella. For infants breastfeeding is a good preventive measure.

Now it has become fashionable to talk about the dangers of vaccinations. This is false truth. The consequences of not vaccinating can be dire. They are at stake normal pregnancy and family happiness, life and health of the child.

Unidox Solutab tablets from which they are used. Unidox Solutab - from what, with ureaplasma, side effects

Page 10 of 17

Chapter III
CONGENITAL RUBELLA
Problem intrauterine pathology is now especially topical against the backdrop of great success in reducing child morbidity and mortality. The number of embryopathies not only does not decrease, but steadily increases year by year. In the United States, about 500 thousand pregnancies are registered annually, complicated by fetal death, 62 thousand newborns die from congenital anomalies development, and many surviving children have birth defects interfering normal life in society (Blattner .e.a., 1973).
Congenital malformations may be due to hereditary causes, as well as external influences on the developing fetus. Among the latter, an important role is apparently played by viral infections. Currently, there is information about the participation in intrauterine pathology of many types of viruses: cytomegaloviruses, herpes, influenza, smallpox, measles, mumps, hepatitis, picornaviruses (O. P. Oganesyan et al., 1969; Blattner E. A., 1973). However, the first place in this regard undoubtedly belongs to the rubella virus.
How much serious problem congenital rubella, showed the epidemic that took place in the United States in 1964-1965. During this epidemic, more than 50,000 pregnant women fell ill with rubella, and as a result, about 20,000 children were born with congenital malformations. The American researcher Horstmann (1970) wrote about this epidemic: “Many of these children died, and many remained feeble-minded; the costs of their treatment and maintenance are estimated at many billions of dollars, but how to evaluate the grief and suffering of their parents and families.
According to estimates by epidemiologists in the United States, 25-50 thousand pregnant women fall ill with rubella in each unsuccessful year, and several thousand in each inter-epidemic year. On average, over a decade, about 100 thousand pregnancies are complicated by rubella. Every year, 600,000 pregnant women who do not have antibodies to this infection are at risk of infection (Meyer, Parkman, 1971). The emergence of epidemics in a number of countries has attracted the close attention of physicians and researchers to congenital rubella. In the last 30 years, there has been a large number of works relating to the danger to pregnancy and the fetus, clinical manifestations and pathogenesis of congenital rubella infection. We have tried to summarize the results of these works in this chapter.

CLINICAL CHARACTERISTICS OF "CONGENITAL RUBELLA SYNDROME"

The history of the study of congenital rubella begins with a brilliant clinical observation Australian ophthalmologist Norberta Gregg. Already in the first published work (1942), Gregg gives an extensive description of typical rubella developmental anomalies, such as cataracts, microphthalmos, retinopathy, nystagmus, corneal opacity, heart defects, low weight at birth and poor nutrition, dermatitis and high mortality at birth. Somewhat later, he was noted and deafness. The author points out that the most dangerous period rubella disease is the first trimester of pregnancy and especially the first two months. Thus, Gregg was the first to describe the triad of developmental anomalies most commonly observed in rubella: cataracts, heart defects and deafness, which later became known as " classic syndrome rubella." In addition to the "classic" there is an "extended" rubella syndrome, which, in addition to the three indicated defects, includes many other developmental anomalies characteristic of this infection (Fig. 6). "Rubella Syndrome" has been the subject of much research. Particularly valuable in this regard were the studies undertaken in the United States during the epidemic of 1964-1965. In these studies, children born to mothers who had had rubella in different dates pregnancies were observed for several years, which made it possible to characterize in more detail the course and consequences of congenital rubella infection (Cooper e. a., 1969; Sever e. a., 1969; Siegel e. a., 1971).

Figure 6. "Extended" rubella syndrome.

Of particular interest in this regard are the studies of Cooper et al. (1969), who over a period of 5 years carefully monitored the development of 376 children born to mothers who had rubella during the epidemic.
Of the neonatal manifestations of rubella, thrombocytopenic purpura is the most characteristic. Purpura is found immediately after birth and is most pronounced during the first week of life. The rash usually disappears at the end of the second week, but sometimes it can last for 2-3 months. To typical manifestations rubella in the neonatal period also includes hepatosplenomegaly; hepatitis accompanied by jaundice high content bilirubin in the blood; hemolytic anemia with characteristic reticulocytosis and deformed erythrocytes; non-closure of the anterior fontanelle, which is often accompanied by pleocytosis in the cerebrospinal fluid; interstitial pneumonia; defeat tubular bones. The last pathology, very characteristic of rubella, is detected X-ray examination and is expressed in the alternation of areas of rarefaction and compaction of the bone. Unlike similar lesions in syphilis bone changes rubella usually disappear within 1-2 months. Most of the other neonatal manifestations also disappear within the first 5 months of life.
Among the heart defects observed in rubella, the most common is cleft ductus arteriosus, with or without stenosis. pulmonary artery or its branches. In a study by Cooper et al. (1969), non-closure of the ductus botulus accounted for 78% of all defects found; stenosis of the right pulmonary artery - 70%, and the left -56%. Rubella also has lesions aortic valve, aortic stenosis, aortic coarctation, ventricular and atrial septum, transposition large vessels. Blue-type malformations are rare in rubella. Therefore, it is believed that if a child does not die in the first years of life from a pronounced heart disease, then in the future, rubella defects do not pose an immediate danger to his life. Most heart defects go unnoticed at birth and are detected in the later years of a child's life. However, some children have very serious defects leading to death during the first 6 months of life.
The most typical lesion of the organs of vision in rubella is cataract (Fig. 7). Cataracts can be unilateral or bilateral and are often accompanied by microphthalmia. Cataract is the result of a direct cytopathic action of the rubella virus, which can persist in the lens for several years (Cooper EA, 1969). It may be absent at birth and develop during the neonatal period. This anomaly often eludes the superficial medical examination of the newborn, and is usually noticed by the mother herself. Glaucoma is much less common than cataracts (approximately 1:10) and may progress during the neonatal period (Fig. 8). There is almost never a combination of glaucoma and cataracts. Often there is retinopathy, which is characterized by scattered areas of dark pigmentation and depigmentation throughout the retina, which are important diagnostic features congenital rubella. Sometimes there is also a transient clouding of the cornea. Anomalies of the organs of vision are often accompanied by severe myopia, requiring early correction.
The most common defect in congenital rubella is deafness. It can be light and strong, one-sided and two-sided and does not have any specific characteristic. Mild cases of deafness often escape attention in the first years of life and appear only later. This defect is often accompanied by vestibular dysfunction, the severity of which usually correlates with the degree of deafness.
Another defect, also often unnoticed in the first years of life, is the defeat nervous system. These lesions appear to be due to both chronic meningoencephalitis and vascular disorders, hypoxia and asphyxia, developing during the period of generalized intrauterine infection(Desmond e. a., 1969). Frequent anomaly development is microcephaly. Chronic meningoencephalitis is found in children at autopsy, as well as in living children, isolating the virus from the cerebrospinal fluid. Damage to the nervous system in congenital rubella in the first months of postnatal life manifests itself in drowsiness or, conversely, in increased excitability, in disorders muscle tone. Later observed varying degrees movement disorders, hyperkinesis, convulsions, paralysis. Decreased intelligence joins neurological symptoms - from a slight lag in mental development to the point of idiocy.
Children with congenital rubella are often underweight and short stature at birth and thereafter, especially in the presence of chronic infection, significantly lag behind in physical development.
In addition to the most typical developmental anomalies listed above, which are included in the "extended rubella syndrome", there are more rare lesions, such as malformations of the skeleton and skull (non-overgrown fontanelles, cleft palate, atresia of the auditory canals, spina bifida, sternum bifidum, etc. ); malformations urinary organs(cryptorchidism, hypospadias, hydrocele, bilobar kidneys, bicornuate uterus); vices digestive organs(pyloric stenosis, obliteration of the bile ducts). There are also various skin lesions: dermatoglyphia, dermatitis, age spots, excessive sweating, etc. In this case, a virus can often be isolated from the skin.
birth defects with rubella rarely occur in isolation; usually this is a combination of various developmental anomalies, which is very characteristic of this disease.
Cooper and others (1969) among 376 children with rubella syndrome in 252 children noted deafness; mental disability - in 170 (mild in 80, moderate in 40 and strong in 50); paralytic phenomena of varying degrees - in 46; heart defects - in 182; vices organs of vision 120 (bilateral cataract in 58, unilateral in 50, glaucoma in 12); neonatal thrombocytopenic purpura - in 85 children. Thus, in terms of frequency, the defects are arranged in the following sequence: deafness, damage to the nervous system and mental disorders, defects of the heart and organs of vision. 77 children had one defect each (68 - hearing defect, 7 - heart defects, 1 - cataract and 1 - mental disability). The nature of the deformity depends on the time of exposure to the rubella virus on the fetus, but this issue is discussed in more detail when describing the pathogenesis of congenital rubella infection.

List of abbreviations [show] .

	Newcastle disease virus
	virus chicken pox- Varicella-Zoster virus
	vesicular stomatitis virus
	hepatitis G virus
	hepatitis C virus
	virus herpes simplex
	human papillomavirus
VTLST	human T-cell leukemia virus
	Epstein-Barr virus
HFRS	hemorrhagic fever with renal syndrome
	disseminated intravascular coagulation
	deoxyribonucleoprotein
	cerebral palsy
	lymphocytic choriomeningitis
	congenital rubella syndrome
	sudden death syndrome
	cytomegalovirus
	Center for Disease Control and Prevention - Center for Disease Control and Prevention

Bibliography [show] .

Barinsky I.F., Shubuladze A.K., Kasparov A.A., Grebenyuk V.I. Herpes (etiology, diagnosis, treatment). - M., 1986, 206 p.
Barinsky I.F., Shubladze A.K., Kasparov A.K., Grebenyuk V.N. Herpes: etiology, diagnosis, treatment. - M.: Medicine, 1986. 272 p.
Batkaev E.A., Kitsak V.Ya. Korsunskaya I.M., Lipova E.V. Viral diseases skin and mucous membranes. Tutorial. - M., RMAPO, 2001.
Bocharov A.F., Kitsak V.Ya., Bocharov E.F., Trukhachev A.A. Herpes simplex virus. - Novosibirsk. 1982. 322 p.
Karazhas N.V. Cytomegalovirus infection - typical representative opportunistic infections / Russian medical news. - 1997. - N 2. - S. 35–38.
Kitsak V.Ya. Herpetic and cytomegalovirus infection: role in the pathology of the fetus and newborns, development, mixed infections and issues laboratory diagnostics/ Advances in theoretical and clinical medicine. 1995, p. 58–61.
Kitsak V.Ya. The role of viral infections in the pathology of pregnant women, fetuses and newborns and implementation mechanisms / Postgraduate Bulletin medical education. 1997, N 1, p. 44–47.
Kitsak V.Ya Ways to improve the effectiveness of anti-relapse therapy in patients herpetic infection/ Advances in theoretical and clinical medicine. 1999, no. 3, p. 240–243.
Kitsak V.Ya. "Parent" viruses: role in perinatal pathology/ Advances in theoretical and clinical medicine. 2001, no. 4, p. 354–356.
Korovina N.A., Zaplatnikov A.L., Cheburkin A.V., Zakharova I.N. Cytomegalovirus infection in children early age(clinic, diagnostics, modern possibilities Therapy): A Guide for Physicians. - M.: Posad, 1999. - S. 56.
Rubella. congenital rubella syndrome. (Information collection). - Moscow, St. Petersburg, 1997. 64 p.
Samokhin P.A. Cytomegalovirus infection in children (clinical and morphological aspects). - M.: Medicine, 1987. - 160 p.
Sidorova I.S., Chernienko I.N. Intrauterine infections: chlamydia, mycoplasmosis, herpes, cytomegaly / Russian Bulletin of Perinatology and Pediatrics. - 1998. - N 3. - S. 7–13.
Tabolin V.A., Volodin N.N., Geraskina V.P. etc. Diagnosis, clinic and treatment cytomegalovirus infection in children / Russian Bulletin of Perinatology and Pediatrics. - 1994. - T. 39. N 3, - S. 16–18.
Khakhalin L.N. VVZ- and CMV-infections in pregnant women and newborns / Unknown infection: herpes. - Smolensk: Pharmagraphics, 1997. - S. 93–99.
Chaplygina N.M., Kitsak V.Ya. Ros. / Vestn. Perinatology and Pediatrics. - 1996, - S. 31–34.
Shcherbo S.N. The role of the polymerase method chain reaction in the diagnosis of intrauterine infections / Perinatology today. - 1997. - N 3. - S. 9 -12.
Britt W.J. Human cytomegalovirus infection during pregnancy. herpes; 1996; 3(2): 37–43.
Britt W.J. Cytomegalovirus. New-York: Raven Press, 1996: 2493–2523.
Jones C.A., Isaacs D. Predicting the outcome of symptomatic congenital cytomegalovirus infection. J Pediatric Child Health; 1995; 31:70–71.

Kitsak Vasily Yakovlevich,
doctor medical sciences, prof.,
head Department of Medical Virology, RMAPE, Ministry of Health of the Russian Federation

Author of over 150 scientific works, including 7 monographs and manuals on topical issues of medical virology. In 1984 he defended his doctoral dissertation on the topic "Herpes simplex virus and carcinogenesis". Research interests: urogenital viral infections (herpes, cytomegaly, papillomavirus infection), the role of viral infections in the pathology of pregnant women, fetuses and newborns, prevention of intrauterine infections, viral hepatitis, chronic fatigue syndrome, etc.