Measles, Mumps and Rubella

Measles

Mumps

Rubella

Measles

•Highly contagious viral illness

•First described in 7th century

•Near universal infection of childhood in prevaccination

era

•Remains the leading cause of vaccine-preventable

death in children

•Paramyxovirus (RNA)

•Rapidly inactivated by heat and light

Measles

It is an acute viral infection characterized by a final stage with a maculopapular rash erupting successively over the neck and face, trunk, arms, and legs, and accompanied by a high fever.

Measles

✤ 14-day incubation period for respiratory-acquired

infections

✤ 6-10 days if acquired parenterally

✤ remains the leading cause of vaccine-preventable

death in children

Measles Pathogenesis and Clinical Features

• Respiratory transmission of virus

• Replication in nasopharynx and regional lymph nodes

• Primary viremia 2-3 days after exposure

• Secondary viremia 5-7 days after exposure with spread to tissues

• Incubation period 10-12 days

• Stepwise increase in fever to 103°F or higher

• Cough, coryza, conjunctivitis

• Koplik spots

• 2-4 days after prodrome, 14 days after exposure

• Maculopapular, becomes confluent

• Begins on face and head

• Persists 5-6 days

• Fades in order of appearance

✤ Measles has three clinical stages:

1. an incubation stage

2. a prodromal stage with an enanthem (Koplik spots)

and mild symptoms

3. a final stage with a maculopapular rash accompanied

by high fever.

Clinical Manifestations

Measles (cont.)

✤ Symptom

✤ Bloodshot eyes

✤ Cough

✤ Fever

✤ Sensitivity to light

✤ Muscle Pain

✤ Rash (itchy, red areas that spread together)

✤ Redness and/or irritation of the eyes

✤ Runny nose

✤ Sore throat

✤ White spots in the mouth (Koplik’s spots)

Measles (cont.)

✤ Prevention

✤ Routine immunization

✤ serum immune globulin 6 days after exposure

✤ Complications

✤ Bronchitis

✤ Encephalitis

✤ Ear infection

✤ Pneumonia

Measles (cont.)

✤ diagnosis

✤ Serology for measles

✤ Treatment

✤ No specific treatment

✤ vit A

✤ Acetaminophen

✤ Bed rest

✤ Humid air

✤ Fluid and nutrition

Mumps Virus

• Paramyxovirus

• RNA virus

• Rapidly inactivated by chemical agents, heat, and

ultraviolet light

Mumps

✤ Painful swelling of the salivary glands

✤ spread from person-to-person through respiratory droplets (i.e. sneezing)

✤ Incidence

✤ Most common in 2-12 year old

✤ Incubation period - 14-18 days

Mumps (cont.)

✤ Symptoms

✤ Pain in the face

✤ Fever

✤ Headache

✤ Sore throat

✤ Swelling of the salivary glands

✤ Swelling of the jaw

✤ Specific to men:

✤ Testicle pain or lump

✤ Swelling of the scrotum

Mumps Pathogenesis

• Respiratory transmission of virus

• Replication in nasopharynx and regional lymph nodes

• Viremia 12-25 days after exposure with spread to

tissues

• Multiple tissues infected during viremia

Mumps Pathogenesis

✤ Viremia common, leading to organ involvement

✤ salivary glands (parotitis),

✤ meningitis,

✤ orchitis,

✤ endolymph infection leading to deafness

✤ A major cause of permanent, bilateral, sensorineural

deafness in children

✤ Virus shed in saliva and urine for long periods after infection

CNS involvement

Orchitis

Pancreatitis

Deafness

Death

15% of clinical cases

20%-50% in post-

pubertal males

2%-5%

1/20,000

Average 1 per year

(1980 – 1999)

Mumps Complications

Mumps (cont.)

✤ Prevention

✤ MMR immunization between the age of:

✤ 12-15 months

✤ Again between 4-6 years

✤ Again between 11-12 years

Mumps (cont.)

✤ Test

✤ Physically examining the salivary glands for swelling (not test)

✤ Treatment

✤ No specific treatment

✤ Ice or heat packs and acetaminophen for pain

Rubella Virus

• Togavirus

• RNA virus

• Rapidly inactivated by chemical agents, ultraviolet light, low pH, and heat

Rubella

✤ Also known as German measles or three-day measles

✤ Rubella is a virus spread from person-to-person through air or close contact

✤ Incidence

✤ The virus is spread from 1 week before the rash begins, to 1-2 weeks after the rash is gone

Rubella Pathogenesis

• Respiratory transmission of virus

• Replication in nasopharynx and regional lymph nodes

• Viremia 5-7 days after exposure with spread to tissues

• Placenta and fetus infected during viremia

Rubella Clinical Features

• Incubation period 14 days

(range 12-23 days)

• Prodrome of low-grade fever

• Maculopapular rash 14-17 days after exposure

• Usually quite mild

Rubella (cont.)

✤ Symptoms

✤ bloody red eyes

✤ Muscle or joint pain

✤ Bruising is a rare symptom

✤ Fever (adults)

✤ Headache (adults)

✤ Runny nose (adults)

Rubella (cont.)

✤ Test

✤ Nasal or throat swab sent for a culture

✤ Treatment

✤ No specific treatment

✤ Acetaminophen for fever

Rubella (cont.)

✤ Prevention

✤ rubella vaccination to adult and adolescent female

✤ MMR immunization between the age of:

✤ 12-15 months

✤ Again between 4-6 years

Congenital Rubella Syndrome

✤ Infection in first trimester most dangerous

✤ 90% of fetuses likely to have some type of abnormality

✤ Virus disrupts organogenesis

✤ plus more destructive on brain, cochlea, lens, etc.

✤ Virus establishes chronic infection in many cells/organs

✤ virus secretion may persist for years

Congenital Rubella Syndrome

✤ Cataracts

✤ Deafness

✤ Heart malformation

✤ Also:

✤ microcephaly

✤ autism

✤ mental retardation

✤ Diabetes

✤ etc.

Measles, Mumps, Rubella

✤ Common childhood diseases

✤ May be associated with severe complications/death

✤ More often in adults

✤ Measles - pneumonia, encephalitis

✤ Mumps - aseptic meningitis, deafness, orchitis

✤ Rubella - congenital rubella syndrome

✤ Respiratory transmission

Measles Mumps Rubella Vaccine

• 12 -15 months is the recommended and minimum age

(more effective at 15 months)

• MMR given before 12 months should not be counted

as a valid dose

• 2nd dose at 4-6 years

MMR Vaccine

Contraindications and Precautions

• Severe allergic reaction to vaccine component or

following prior dose

• Pregnancy

• Immunosuppression

• Moderate or severe acute illness

• Recent blood product