風疹發(fā)病機理和病程(英文及中文對照)課件

風疹Rubella—commonlyknownasGermanmeaslesor3-daymeasles—isaninfectionthatprimarilyaffectstheskinandlymphnodes.Itiscausedbytherubellavirus(not

thesamevirusthatcausesmeasles),whichisusuallytransmittedbydropletsfromthenoseorthroatthatothersbreathein.Itcanalsopassthroughapregnantwoman'sbloodstreamtoinfectherunbornchild.It'sagenerallymilddiseaseinchildren;theprimarymedicaldangerofrubellaistheinfectionofpregnantwomenbecauseitcancausecongenitalrubellasyndromeindevelopingbabies.Beforea

vaccine

againstrubellabecameavailablein1969,rubellaepidemicsoccurredevery6-9years,mostoftenamongkids5to9yearsold.Manycasesofcongenitalrubellaoccurredaswell.Thankstoimmunization,therearefarfewercasesofrubellaandcongenitalrubella.Mostrubellainfectionstodayappearinyoung,non-immunizedadultsratherthaninkids.Infact,expertsestimatethat10%ofyoungadultsarecurrentlysusceptibletorubella,whichcouldposeadangertochildrentheymighthavesomeday.AboutRubella關于風疹風疹是由風疹病毒引起的一種常見的急性傳染病，以低熱、全身皮疹為特征，常伴有耳后、枕部淋巴結腫大。由于全身癥狀輕，病程短，往往認為本病無關緊要，但是近年來在風疹暴發(fā)流行中，重癥病例屢有報道。如果妊娠早期婦女感染風疹，將會嚴重損害胎兒，引起先天性風疹綜合征(congenitalrubellasyndrome，CRS)。中醫(yī)學稱本病為風疹、風痧、隱疹。認為系感受風熱時邪，發(fā)于膚表所致。潛伏期16～21天，平均18天，學齡前兒童和青少年感染風疹病毒后常有發(fā)熱、頭痛、咽痛、流涕等輕微前驅癥狀和枕骨下、耳后、頸部淋巴結腫大，約1～2天從面頸部開始出現淡紅色斑疹、斑丘疹，24h內蔓延軀干、四肢。皮疹特點是歷時短、消失快。軀干部皮疹可融合，四肢皮疹散在不融合。一般第3天皮疹迅速消退，不留痕跡，有時可有輕度脫屑。軟腭可見針頭大小的紅色瘀點，皮疹一出現前驅癥即消失，但淋巴結腫大持續(xù)時間長，伴觸痛，但不化膿。風疹是良性傳染病，一般預后良好。并發(fā)癥少見，有時可并發(fā)氣管炎、中耳炎、關節(jié)痛、紫癜等。孕婦在早期妊娠(4個月內)如患風疹后可致流產、早產、死產及胎兒畸形(先天性風疹綜合征)(表1)。癥狀體征ContagiousnessThe

rubella

virus

passes

from

person

to

person

through

tinydrops

of

fluid

from

the

nose

and

throat.

People

who

have

rubellaare

most

contagious

from

1

week

before

to

1

week

after

the

rashappears.

Someone

who

is

infected

but

has

no

symptoms

can

stillspread

the

virus.Infants

who

have

congenital

rubella

syndrome

can

shed

the

virusin

urine

and

fluid

from

the

nose

and

throat

for

a

year

or

more

andmay

pass

the

virus

to

people

who

have

not

been

immunized.virusin生詞本英

['v?r?s?n]美

['v?r?s?n]n.病毒菌素urine生詞本去背誦英

[?j??r?n]美

[?j?r?n]n.尿；

小便；

下泉PreventionRubella

can

be

prevented

by

the

rubella

vaccine.

Widespreadimmunization

against

rubella

is

critical

to

controlling

the

spread

ofthe

disease,

thereby

preventing

birth

defects

caused

bycongenital

rubella

syndrome.The

vaccine

is

usually

given

to

children

at

12-15

months

of

age

aspart

of

the

scheduled

measles-mumps-rubella

(MMR)immunization.

A

second

dose

of

MMR

is

generally

given

at

4-6years

of

age.

As

is

the

case

with

all

immunization

schedules,there

are

important

exceptions

and

special

circumstances.

Forexample,

if

your

child

will

be

traveling

outside

the

United

States,the

vaccine

can

be

given

as

early

as

6

months

of

age.

Talk

to

yourchild’s

doctor

to

see

when

the

vaccine

is

needed.The

rubella

vaccine

should

not

be

given

to

pregnant

women

or

toa

woman

who

may

become

pregnant

within

1

month

of

receivingthe

vaccine.

If

you

are

thinking

about

becoming

pregnant,

makesure

that

you're

immune

to

rubella

through

a

blood

test

or

proofof

immunization.

If

you're

not

immune,

you

should

receive

thevaccine

at

least

1

month

before

you

become

pregnant.Pregnant

women

who

are

not

immune

should

avoid

anyone

whohas

the

illness

and

should

be

vaccinated

after

delivery

so

thatthey

will

be

immune

during

any

future

pregnancies.因本病癥狀多輕，一般預后良好，故似不需要特別預防，但先天性風疹危害大，可造成死胎、早產或多種先天畸形，因此預防應著重在先天性風疹。1.隔離檢疫

病人應隔離至出疹后5天。但本病癥狀輕微，隱性感染者多，故易被忽略，不易做到全部隔離。一般接觸者可不進行檢疫，但妊娠期，特別妊娠早期的孕婦在風疹流行期間應盡量避免接觸風疹患者。2.自動免疫

國際上經過10余年來廣泛應用風疹減毒活疫苗，均證明為安全有效，接種后抗體陽轉率在95%以上，接種后僅極個別有短期發(fā)熱、皮疹，淋巴結腫大及關節(jié)腫痛等反應，免疫后抗體持久性大多可維持在7年以上。接種對象方面不同國家尚不統(tǒng)一，例如美國主張1歲至青春期的青少年，特別是幼兒園和小學中的兒童為主要免疫對象，因為小兒風疹發(fā)病率最多，且可傳給孕婦等成人。青春期及成年婦女，也應接種，接種后先天性風疹已明顯減少。盡管目前關于風疹疫苗病毒株對人體、胎兒的影響了解得不夠，但活疫苗的弱病毒確能通過胎盤感染胎兒畸形，因此孕婦不宜接受此類活疫苗。風疹疫苗早已與麻疹、腮腺炎疫苗聯合使用。我國有些地方如上海、武漢、山東早已能制備風疹減毒活疫苗，均可產生較高的抗體陽性率。上海已開始使用風疹減毒活疫苗并將逐步納入計劃免疫執(zhí)行，重點免疫對象中除小兒外還包括婚前育齡婦女，含高、初中畢業(yè)班女生。有關風疹疫苗的保護效果、維持時間等研究還在不斷深入。

預防護理DurationTherubellarashusuallylasts3days.Lymphnodesmayremainswollenforaweekormore,andjointpaincanlastformorethan2weeks.Childrenwhohaverubellausuallyrecoverwithin1week,butadultsmaytakelonger.TreatmentRubellacannotbetreatedwithantibioticsbecausetheydonotworkagainstviralinfections.Unlesstherearecomplications,rubellawillresolveonitsown.Anypregnantwomanwhohasbeenexposedtorubellashouldcontactherobstetricianimmediately.Rubellaistypicallymildinkids,whooftencanbecaredforathome.Monitoryourchild'stemperatureandcallthedoctorifthefeve