PPT

1. Presented by
Dr. Daulal Chouhan
2nd yr resident
PSM Dept.
Dr. SNMC, Jodhpur

2.  Acute infectious, viral disease of older children
and young adults, characterized by mild
prodromal symptoms, typical rash and painful
cervical lymphadenopathy

3.  In 1938 , the etiology was established by Hiro
and Tasaka
 In 1941 Normal Gregg, reported the terotogenic
property of virus
 In 1962, the virus was isolated
 In 1966, the virus was attenuated
 In 1967, live attenuated vaccine was prepared

4.  World wide in distribution
 Sporadically, often in epidemics, once in 6-8
years in a cyclic trend
 Common in children ages 5-10 years old
 Infection during pregnancy causes Congenital
Rubella Syndrome
 WHO estimates that 100,000 cases of CRS
occur in developing countries

5.  The 2008 estimates suggest that the highest CRS
burden is in South East Asia (approximately 48%),
India being a major contributor, and Africa
(approximately 38%)
 Developing country have incidence rates of 0.6-4.1 per
1000 live births
 In 2012 and 2013 (till 31st May) India reported 28 and 48
rubella outbreaks.
 Ministry of Health estimates that around 30,ooo
abnormal children are being born annually because of
rubella

6. Agent Factors
 Agent
- Rubella virus, RNA virus (Toga virus family)
- One antigenic type
- Rapidly inactivated by chemical agents, low Ph ,
and UV light
 Reservoir –> Humans only, No known carrier state
 Source of Infection –> Majority subclinical cases,
minor clinical cases
 Infective material –> Respiratory and throat secretions
 Period of communicability –> 1 week before and 1 week
after the appearance of the rash

7. Host Factors
 Age –> 3-10 yrs ( developing countries)
15 yrs ( developed countries)
- Both sexes are susceptible to infection
 Immunity – Life long after first attack
- Maternal immunity up to 6 months of age
Environmental Factors
- Occurs in seasonal pattern, during winter and
spring season
Transmission
- Droplet infection, droplet nuclei, vertical
transmission, portal of entry : respiratory
Incubation Period
- 2 to 3 weeks ( average 18 days)

8.  Post natal rubella occurs in neonates and childhood
 50-65% asymptomatic
 Prodermal phase (mild) :- Coryza, sore throat,
low grade fever and dry cough lasting for a day or two
 Lymphadenopathy :- Post auricular and
posterior cervical lymph nodes enlarge slightly one
week before the appearance of rash and persist for
about 10-15 days after the disappearance of rashes
- Not tender among children but tender among adults

9.  Exanthematous stage :-
- Fine maculopapular rash
- Minute, discrete and pinkish
- Starts on face within 24 hours of the onset of the
prodermal symptoms, spreads to trunk on 2nd
day and extremities on 3rd day
- Clears more rapidly, disappears in 3 days
- So it is also called as 3-day measles
- Rash absent (25% cases) in subclinical cases
 Conjunctivitis may occur

10. <- Newborn with
postnatal rubella
Post auricular lymph ->
node enlargement
<- Rubella infection in
pregnancy

11.  Arthritis and arthralgia common among women
 Thrombocytopenic purpura
 Encephalitis is very rare
 Common dreadful complication is congenital
malformations of the fetus in a pregnant mother

12.  Virus isolation from throat swab
 Serological confirmation can be done by
hemagglutination inhibition test
 Sensitive serological tests are ELISA and RIA

13.  Infants born with a number of defects due to
intrauterine infection with rubella virus
 Congenital rubella is a chronic infection while
acquired rubella is an acute infection
 First trimester of pregnancy is most disastrous
time for the fetus , because it is in the stage
organogenesis
 Foetal death and spontaneous abortion

14.  The risk and severity of abnormalities varies
with the time of infection in pregnancy
Stage of gestation Risk of abnormalities in
the infant (% of cases)
First trimester 85
Second trimester 16
After 20 weeks Birth defects are
uncommon

15.  Congenital malformations
- Triad of Deafness, Cardiac (PDA) and Cataract
 Other defects
- Glaucoma, retinopathy, micocephalus, cerebral
palsy, IUGR, LBW, hepato-splenomegaly, mental
and motor retardation

16. Control
 Mild self limited illness
 Isolation of case in good ventilation room
 No specific treatment or Antiviral
treatment is indicated
 Encourage the patient to rest
 Increase fluid intake
 Provide health teaching about rubella
(cause, immunization)

17. Prevention
Active Immunization
 Monovalent Rubella vaccine
 Wistar RA 27/3 strain, propagated on human diploid
cell
 Live attenuated vaccine
 Freeze dried vaccine, supplied along with diluent
sterile distilled water
 Dose :- 0.5 ml , SC in upper arm
 Storage temperature :- 2-8° C
 Preferred age for immunization is 15-18 months, single
dose
 Efficacy rate is 95%
 Immunity lasts for at least 15 years, probably lifelong

18.  Pregnancy is an absolute contraindication
 Recipients of vaccine should be advised not to
become pregnant in 3 months after getting
vaccine
 Combined vaccine:- MR, MMR

19.  First protect women in 15-39 year age
 Second interrupt transmission by vaccinating
children aged 1-14 years
 Third, all children at age 1 year

20.  Live attenuated strains of :-
- Edmonston-Zagreb Measles virus
- L-Zagreb Mumps virus
- Wistar RA 27/3 Rubella virus
 The reconstituted vaccine contains, in single
dose of 0.5 ml not less than
- 1000 TCID50 of Measles virus
- 5000 TCID50 of Mumps virus
- 1000 TCID50 of Rubella virus

21.  Dose – 0.5 ml, SC in upper arm
 Schedule – Two doses, 1st at the age of 12-15
months and 2nd at school entry (4-6 years)
 Freeze dried vaccine, supplied along with
diluent sterile distilled water
 Reconstituted vaccine
-> Destroyed by light, heat labile, susceptible
to contamination (No preservative )
-> Protected from light, kept at 2-8°C and use
within 4 hrs of reconstitution

22.  Fever
 Rash
 Joint symptoms
 Thrombocytopenia
 Parotiditis
 Deafness
 Encephlapathy

23.  Sever allergic reaction to prior dose or vaccine
component
 Pregnancy
 Immunosuppression
 Sever acute illness
 Recent blood product

24. Passive Immunization
 Using Human normal immunoglobulin
 Given to those who are at risk, such as young
close contacts and infected pregnant
mothers, preferably within 2-3 days of exposure
 It prevents or modifies the course of illness
 Dose -> 20 ml IM
 Therapeutic abortion is better way of
prevention of congenital rubella

25.  In 2012 the M&R Initiative launched a new
Global Measles and Rubella Strategic Plan
which covers the period 2012-20
Vision
-> Achieve and maintain a world without measles,
rubella and CRS

26. Goals
By end 2015
 Reduce global measles mortality by at least
95% compared with 2000 estimates
 Achieve regional measles and rubella/CRS
elimination goals
By end 2020
 Achieve measles and rubella elimination
in at least 5 WHO regions

27.  The strategy focuses on the implementation of
5 core components :-
1) Achieve and maintain high vaccination
coverage with 2 doses of measles and rubella
containing vaccines
2) Monitor the disease using effective surveillance
and evaluate programmatic efforts to ensure
progress and the positive impact of vaccination
activities

28. 3) Develop and maintain outbreak preparedness,
rapid response to outbreaks and the effective
treatment of cases
4) Communicate and engage to build public
confidence and demand for immunization
5) Perform the research and development needed
to support cost-effective action and improve
vaccination and diagnostic tools

29.  7 Feb. 2017 - India has launched one of
the world’s largest vaccination campaigns
against measles and rubella
 The campaign to vaccinate more than 410
million children aged 9 months to 15
years over the next 2 years is a big step
towards improving child survival and
preventing birth defects

30. Thank You
Polio is gone
Measles and
Rubella is Next..