MMRMeasles, Mumps &Rubella

Measles

DEFINITION• Measles is an acute highly contagious viral

disease caused by measles

• Agent- RNA virus ( Paramyxo virus family, genus Morbillivirus )

Host factors• Age- All age person is susceptible;

90% of contact people acquire the disease 6 months to 3 years even up to 10 years

• Incidence equal in both sexes• Immunity – life long immunity• Malnourished children are susceptible

Measles Epidemiology• Reservoir Human

• Transmission Respiratory Airborne

• Temporal pattern Peak in late winter–spring

• Communicability 4 days before to 4 days after

rash onset

Measles Pathogenesis• 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

Measles Clinical Features• Incubation period 10-12 days

• Stepwise increase in fever to 40°C or higher for 4 days.

• Cough, coryza, conjunctivitis ( 3 Cs )• Koplik spots

Prodrome

Measles Clinical Features

• 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

Rash

DIAGNOSIS• 1 .Epidemiologic data;• 2 .Clinical manifestations; • 3. Laboratory findings:. 3 .1 .Multinucleated giant cells are

detected in nasopharyax mucosa secretions;

• 3 .2 .Measles virus can be isolated in tissues culture;

. 3 .3 . Antibody titer;• 3 .4 . WBC is relative low .

treatment• 1 .General therapy: rest, nursing and

diet • 2. Symptomatic therapy: fever and

cough, • 3.Support threapy:r-globulin traditional chinese herbs may be

used ;• 4.complications of treatment

PREVENTION• 1 .Control source of infection;• 2 .Interruption of transmissions ;• 3 .Protection of the susceptible person: 3.1 . Active immunization Lived attenuated measles vaccine. plan immune:8m,7j epidemic stage:before 2 m contactor:with in 2 days Contraindications:pregnancy 3.2 . Passive immunization placenta globulin or gamma globulin. <5 days prevent onset >5 days relieve symptoms

MUMPS

Introduction Mumps is an acute respiratory tract infectious disease caused by mumps virus, it occurs primarily in school-aged children and adolescents.

The most prominent manifestation is nonsuppurative swelling and tenderness of the salivary glands with one or both parotid glands involved in most cases.

Epidemiology Sources of infection: Patients in early course of the disease, hosts under covert infection.

The period of peak contagion before or at the onset of parotitis.

Route of transmission : Via droplet nuclei or direct contact,fomites

Etiology

Mumps virus (Paramyxovirus parotitis) belongs to Paramyxoviridae family. RNA virus.

Epidemic features: Endemic throughout the world. The peak incidence in winter and spring.

Mode of transmission: dropletAge and gender : 5-15 years School-aged children at high risk and girls common.

Post-infection immunity is stable and long-lasting.

Clinical ManifestationsIncubation period: averages 16 to 18

days with a range of 2 to 4 weeks.

Prodromal symptoms include low- grade fever, anorexia, malaise and headache.

Parotid tenderness and ipsilateral earache within 1 or 2 days after the illness onset,then

parotid is visibly enlarged and go to maximum

size over next 2 to 3 days accompanied severe

pain and normal or high temperature. One parotid enlarges after the other. The orifice of Stensen’s duct is edematous and erythematous. Parotid returns to normal size within a week.

Patients with parotitis have difficulty with

pronunciation and mastication. Citrus fruits and juices exacerbates the pain.

Other salivary glands involved include submandibular adenitis and sublingual adenitis.

Clinical meningitis occurs in 15% of patients with mumps. Its onset averages 4-5 days after parotitis but may before, after or in the absence of parotitis. Clinical features are headache, vomiting, fever and nuchal rigidity.

CSF pleocytosis. Prognosis is benign.

The onset of orchitis is abrupt with high temperature, chills , testicular pain and swelling. Impaired fertility is rare.

DiagnosisIn most instances, the diagnosis of mumps is made on the basis of a exposure history and of parotid swelling and tenderness accompanied

other symptoms.Laboratory confirmation is unnecessary in typical cases, exception the absence or recurrence of parotitis and extrasalivary glands

involved. Serologic tests,viral isolation. Amylase and lipase.

Prognosis

Benign and self-limited Major death causes are severe mumps

encephalitis

treatment

There is no specific anti-viral drug therapy.Treatment is supportive by treating symptoms,

using antipyretics and analgesics.

Child care

The child must rest in bed until the fever goes away.Isolate the child, to prevent spreading the disease to

other.Use analgesics and anti-pyretic to ease symptoms.Avoid food that require chewing.Avoid sour foods that stimulate saliva production.Drink plenty of water.Use cold compress to ease the pain of swelling

glands.

Prevention

A live attenuated vaccine is available (MMR).It contains mumps, measles and rubella

attenuated virus strains.Administered in one dose, intramuscularly or

subcutaneously.The vaccine is protective.

RUBELLA

Rubella is an acute, contagious viral infection. While the illness is generally mild in children, it has serious consequences in pregnant women causing fetal death or congenital defects known as congenital rubella syndrome (CRS).

The name rubella is derived from a Latin term meaning "little red." 

Rubella is sometime called German Measles or 3-day Measles.

The synonym "3-day measles" derives from the typical course of rubella exanthema that starts initially on the face and neck and spreads centrifugally to the trunk and extremities within 24 hours.

It then begins to fade on the face on the second day and disappears throughout the body by the end of the third day.

It is a generally mild disease caused by the rubella virus.

Agent – RNA virus (Togo virus family), Genus Rubivirus. 

Source of infection – Respiratory secretionHost -3-10 yrsImmunity –life longEnvironmental factors –winter and spring seasonTransmission – droplet, vertical transmissionI.P – 2-3 weeks average 18 days

SymptomsIn children, the disease is usually mild, with

symptoms including a rash, low fever (<39°C), nausea and mild conjunctivitis. The rash, which occurs in 50–80% of cases, usually starts on the face and neck before progressing down the body, and lasts 1–3 days. Swollen lymph glands behind the ears and in the neck are the most characteristic clinical feature. Infected adults, more commonly women, may develop arthritis and painful joints that usually last from 3–10 days.

When a woman is infected with the rubella virus early in pregnancy, she has a 90% chance of passing the virus on to her fetus.

Congenital rubella syndrome

Children with CRS can suffer hearing impairments, eye and heart defects and other lifelong disabilities, including autism, diabetes mellitus and thyroid dysfunction – many of which require costly therapy, surgeries and other expensive care.

The highest risk of CRS is in countries where women of childbearing age do not have immunity to the disease (either through vaccination or from having had rubella). Before the introduction of the vaccine, up to 4 babies in every 1000 live births were born with CRS.

0–28 days before conception - 43% chance

0–12 weeks after conception - 51% chance

13–26 weeks after conception - 23% chance

 Infants are not generally affected if rubella is contracted during the third trimester

Vaccination

he rubella vaccine is a live attenuated strain that has been in use for more than 40 years. A single dose gives more than 95% long-lasting immunity, which is similar to that induced by natural infection.

Rubella vaccines are available either in monovalent formulation (vaccine directed at only one pathogen) or more commonly in combinations with other vaccines such as with vaccines against measles (MR), measles and mumps (MMR), or measles, mumps and varicella (MMRV).

THE END