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Measles, Mumps &Rubella
(MMR)
Dr Rajkumar Patil
Professor,Community Medicine
MGMCRI
1
Learning objectives
At the end of the class student should be able to:
• Describe the important agent, host and environmental
factors of Measles, Mumps and Rubella
• Describe the preventive and control measures Measles
,Mumps and Rubella
2
Measles
(Rubeola)
3
Measles-Introduction
• Acute highly infectious disease of childhood caused
by a specific virus (RNA paramyxovirus).
• Characterized by fever and respiratory symptoms
followed by typical rash.
• Associated with high morbidity and mortality in
developing countries.
• 2% of under 5 mortality in India (WHO 2014)
4
Problem statement
• In 2014, there were 114900 measles deaths globally –
about 314 deaths every day or 13 deaths every hour.
• Measles vaccination resulted in a 79% drop in measles
deaths between 2000 and 2014 worldwide.
• Measles is still common in many developing countries –
particularly in parts of Africa and Asia.
5
Agent factors
• Agent- RNA virus
(Paramyxo virus family, genus Morbillivirus)
• Can’t survive outside the human body
• Source of infection: case of measles (no carriers).
• No animal reservoir
6
Agent factors
• Infective material- Secretions of nose, throat and
respiratory tract
• Virus remains active and contagious in the air or on
infected surfaces for up to 2 hours.
• Period of communicability: 4 days before to 4 days
after the appearance of rash
• Highly infectious during prodromal period and at the
time of eruption.
• Secondary Attack Rate(SAR): > 80%
7
Host factors
Age:
• Commonly 6 months to 3 years in developing and
underdeveloped countries
• More than 5 years in developed countries
Sex: Incidence equal in both sexes
Immunity:
• No age is immune if there is no previous immunity
• One attack-life long immunity
Nutrition: Malnourished children highly susceptible,
mortality is more
8
Environmental factors
• In tropical climate: Dry season
• In temperate climate: Winter season, over
crowding
• In India: January to April
9
Transmission:
Droplet infection,droplet nuclei
Portal of entry and exit: Respiratory tract,
Minor- conjunctiva
Incubation period:
10-14 days
10
Clinical features
• Prodromal stage
• Eruptive stage
• Post-measles stage
11
Prodromal stage
• From 10th day of infection to 14th day
• 3 Cs (Cough, Coryza with sneezing and nasal
discharge & Conjunctivitis)
• Lacrimation and photophobia
• Fever for 4 days
• May be- Vomiting or Diarrhoea
• Koplik spots
12
13
Koplik’s spots
• Pathognomic sign
• 1-2 days before appearance of rash
• Small, bluish-white spots over a red base
• On buccal mucosa opposite the first and
second lower molars
14
KOPLIK SPOT
Source:
http://phil.cdc.gov/PHIL_Images/20040908/4f54ee8f0e5f49f58aaa30c1bc6413ba/6111_lo
res.jpg 15
16
Eruptive stage
• Dusky red, generalized, maculopapular, erythematous rash.
• Begins behind the ear and rapidly spreads to face, neck and
extends down the body within 2-3 days.
• In the absence of complications, rash and fever disappears
in 3-4 days.
• Rash fades in the order of appearance.
17
Courtesy : This media comes from the Centers for Disease Control and
Prevention's Public Health Image Library (PHIL), with identification
number #3168
18
Courtesy : Adapted from Mims et al. Medical Microbiology, 1993, Mosby
19
Post Measles Stage
Growth retardation
Susceptibility to other infections
Complications:
• Pneumonia(20-80% in developing countries,
less than 10% in developed)
• Diarrhoea
• Respiratory Infections
• Otitis Media(5-15%)
• Rarely Febrile convulsions, Encephalitis
20
21
What is a probable case of Measles?
In the absence of a more likely diagnosis, an illness
characterized by: Generalized rash lasting ≥3 days; and
Temperature ≥101°F or 38.3°C; and
Cough, coryza, or conjunctivitis; and
No epidemiologic linkage to a confirmed case of measles; &
Non-contributory or no serologic or virologic testing.
22
What is a confirmed case of Measles?
• Laboratory confirmation by any of the following:
• Positive serologic test for measles IgM antibody;
• Isolation of measles virus from a clinical specimen; or
• Detection of measles-virus specific nucleic acid by polymerase chain
reaction (PCR)
(Note: A lab-confirmed case does not have to have generalized rash
lasting ≥3 days; temperature ≥101°F or 38.3°C; cough, coryza, or
conjunctivitis. )
OR
An illness characterized by
• Generalized rash lasting ≥3 days; and
• Temperature ≥101°F or 38.3°C; and
• Cough, coryza, or conjunctivitis; and
• Epidemiologic linkage to a confirmed case of measles.
23
Treatment of Measles
• Isolation for 7 days after the onset of rash
• No specific antiviral treatment.
• Supportive care: good nutrition, adequate fluid intake and
treatment of dehydration.
• Antibiotics: to treat eye and ear infections, and
pneumonia.
• All children diagnosed with measles should receive two
doses of vitamin A supplements, given 24 hours apart.
Vitamin A can help prevent eye damage and blindness.
(Vitamin A supplements reduces the deaths from measles
by 50%)
Prevention of Measles
Immunization:
• Eradication can be achieved by immunization rate of
atleast 96% under one year of age
• Ongoing immunization against measles
• Measles vaccination: live attenuated, subcutaneous,0.5
ml, at 9-12 months, life long immunity in 90-99%;
Reactions: Mild fever
• MMR vaccine
• Immunoglobulin(human):with in 3-4 days of exposure
24
Measles outbreak control
• Isolation for 7 days after the onset of rash
• Active Immunization of contacts within 2 days of
exposure (or passive immunization within 3-4 days)
• Prompt immunization at the beginning of outbreak
25
Enhanced measles eradication strategy-WHO
1) Catch up: First, a one-time-only "catch-up" measles
vaccination campaign is conducted among children aged 9
months to 14 years.
2) Keep up: Efforts are then made to vaccinate through
routine health services ("keep-up") at least 95% of each
newborn cohort at 12 months of age.
3) Follow up: Finally, to assure high population immunity
among preschool-aged children, indiscriminate "follow-up"
measles vaccination campaigns are conducted approximately
every 4 years. 26
Challenges for Measles elimination
• Weak immunization systems
• High infectious nature of measles
• Inaccessible population in certain areas
• Refusal to immunization by some people
• Changing epidemiology(adolescents and adults)
• Catch up immunization to more than 130 million
children in India
• Lack of human and financial resources
27
Mumps
28
Mumps-Introduction
• "to mump" (british word): grimace or grin (as a result of
parotid gland swelling)
• Acute infectious disease due to “myxovirus parotiditis” ;
RNA paramyxovirus (Genus Rubulavirus) affecting
mainly glands and nervous system
• Mortality is negligible
29
Source: Centers for Disease Control and Prevention's Public Health Image
Library (PHIL), with identification number #130 Content Providers: CDC/NIP/Barbara
Rice
30
Agent factors
• Myxovirus parotidis –RNA virus
• Source of infection: Clinical and subclinical cases; mainly
saliva; others:blood,urine,human milk,CSF
• Period of communicability: 4-6 days of onset of symptoms
to 7 days after
(Maximum just before and at the onset of parotid swelling)
• Secondary attack rate: 86%
31
Host factors
• Age: mostly 5-9 yrs, but can be seen in any age
• Sex: females
• Immunity: less than 6 months of age infants are immune,
life long immunity after one infection
Environmental factor
• Any time but peak in winter and spring season
• Overcrowding
Mode of transmission: droplet infection and direct contact
with the infection person
I.P.: 2-4 weeks 32
Clinical features
• One third cases: asymptomatic
• Initial symptoms: ear ache on affected side, pain and
stiffness on opening the mouth
• Pain and swelling due to involvement of parotid, sublingual
and submandibular glands,
• Swelling subsides in 1-2 weeks
• Can affect testes,pancreas,ovaries,prostate,CNS
• Severe cases: Fever 3-5 days
33
Source : Adapted from Mims et al. Medical Microbiology, 1993, Mosby
34
Complications of Mumps
Frequent but not serious:
• Orchitis (25-40%): 7-10 days after parotitis,with high fever
(Unilateral in 75% orchitis cases, Most common extra-salivary gland
manifestation in adults)
• Epididymitis
• Pancreatitis(4%)
• Mild form of meningitis
• Thyroiditis, Neuritis, Hepatitis,Ovaritis,
• Oophoritis (5% adult women)
• Spontaneous abortion(25% in pregnancy)
Rare:
Hearing loss, Polyarthritis, Encephalitis, Cerebellar ataxia
35
Management of Mumps
• Supportive
• Case should be isolated till symptoms subside
• Contacts should be kept under surveillance
36
Prevention of Mumps
Immunization
• Mumps vaccine: Live attenuated,0.5 ml, IM
• MMR vaccine
37
Rubella
(German measles)
38
Introduction-Rubella
• Rubella (Latin term) means "little red."
• It is a generally mild disease caused by the rubella virus.
• Rubella is also known as German Measles or 3-day Measles.
• Typical course of rubella exanthema 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.
39
Agent factors
• Agent: RNA virus (Togo virus family)
• Source of infection: majority subclinical cases, minor-
clinical cases
• Infective material: Respiratory secretions, blood, CSF,
urine
• Period of communicablity: A week before symptoms to a
week after the rash
40
Host factors-
Age: 3-10 yrs(developing countries)
15 years developed countries
Immunity: Life long after first attack,
maternal immunity upto 6 months of age
Environmental factors- winter and spring season,
with epidemics every 4-9 years
Transmission- droplet inf, droplet nuclei, vertical transmission,
portal of entry: respiratory
Incubation period- 2 to 3 weeks (average 18 days)
41
Clinical features
• 50-60% asymptomatic
• Symptoms:
 Prodromal phase(mild): coryza,sore thorat,
low grade fever
 Lymphadenopathy: post auricular and posterior
cervical lymph nodes enlargement
42
Rash:
• Minute,discrete,pinkish,macular
• Starts on face within 24 hours of the onset of the
prodromal symptoms,spreads to trunk and
extremities, clears more rapidly,disappears in 3 days
• Rash absent (25% cases) in subclinical cases
Conjunctivitis may occur.
43
Image in a 4-year-old girl with a 4-day history of low-grade fever,
symptoms of an upper respiratory tract infection, and rash.
Courtesy of Pamela L. Dyne, MD.
44
Complications of Rubella
Rare:
Arthralgia
Thrombocytopenic purpura
Very rare:
Encepahlaitis
45
Diagnosis
• Virus isolation by throat swab culture
• ELISA for IgM antibody
46
Congenital Rubella Syndrome(CRS)
• Due to Rubella infection in pregnancy
• It is a chronic infection of foetus
• First trimester infection- severe
• Foetal death and spontaneous abortion
47
Clinical features of CRS
• Congenital malformations
(Triad of Deafness,Cradiac malformations,cataract)
• Other defects:
Glaucoma,retinopathy,microcephalus,cerebral
palsy,IUGR,LBW,Heapto-splenomegaly,mental and
motor retardation
48
49
Photo source: U.S. Centers for Disease Control and Prevention
50
Salt and pepper retinopathy
Content Providers(s): CDC Creation
Date: 1976
Courtesy
http://phil.cdc.gov/phil_images/2003072
4/28/PHIL_4284_lores.jpg
http://www.kellogg.umich.edu/theeyeshave
it/congenital/retinopathy.html
Courtesy: Jonathan Trobe, M.D. - University
of Michigan Kellogg Eye Center
51
Prevention of Rubella
Immunization
• Rubella vaccine: RA 27/3 strain,0.5 ml, SC,Life
long immunity in 95%
• C/I for immunization: Pregnancy
• Recipients of vaccine should be advised not to
become pregnant in 3 months after getting
vaccine
• MMR vaccine
52
Vaccination strategy for Rubella
• First protect women in 15-39 yr age
• Second interrupt transmission by vaccinating
children aged 1-14 years
• Third,all children at age 1
53
MMR Vaccine
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 CCID50 of Measles virus
5000 CCID50 of Mumps virus
1000 CCID50 of Rubella virus.
54
MMR vaccine contd…
• Diluent: Sterile water for injection.
• MMR vaccine may be given after 12 months of age.
• After reconstitution the vaccine should be used
immediately.
• Dose: 0.5 ml, deep SC in the upper arm.
• If the vaccine is not used immediately then it should be
stored in the dark at 2°- 8°C for no longer than 8 hours.
55
MEASLES, MUMPS & RUBELLA
MEASLES, MUMPS & RUBELLA
58
Global Measles and Rubella Strategic Plan 2012-2020
In 2012, the M&R Initiative launched a new Global Measles and
Rubella Strategic Plan which covers the period 2012-2020.
By the end of 2015 the plan aims:
to reduce global measles deaths by at least 95%
compared with 2000 levels;
to achieve regional measles and rubella/congenital
rubella syndrome (CRS) elimination goals.
By the end of 2020 the plan aims:
to achieve measles and rubella elimination in at least 5
WHO regions.
59
The strategy focuses on the implementation of 5 core components:
• achieve and maintain high vaccination coverage with 2 doses of
measles- and rubella-containing vaccines;
• monitor the disease using effective surveillance, and evaluate
programmatic efforts to ensure progress and the positive impact of
vaccination activities;
• develop and maintain outbreak preparedness, rapid response to
outbreaks and the effective treatment of cases;
• communicate and engage to build public confidence and demand
for immunization; and
• perform the research and development needed to support cost-
effective action and improve vaccination and diagnostic tools.
Thank you
60

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MEASLES, MUMPS & RUBELLA

  • 1. Measles, Mumps &Rubella (MMR) Dr Rajkumar Patil Professor,Community Medicine MGMCRI 1
  • 2. Learning objectives At the end of the class student should be able to: • Describe the important agent, host and environmental factors of Measles, Mumps and Rubella • Describe the preventive and control measures Measles ,Mumps and Rubella 2
  • 4. Measles-Introduction • Acute highly infectious disease of childhood caused by a specific virus (RNA paramyxovirus). • Characterized by fever and respiratory symptoms followed by typical rash. • Associated with high morbidity and mortality in developing countries. • 2% of under 5 mortality in India (WHO 2014) 4
  • 5. Problem statement • In 2014, there were 114900 measles deaths globally – about 314 deaths every day or 13 deaths every hour. • Measles vaccination resulted in a 79% drop in measles deaths between 2000 and 2014 worldwide. • Measles is still common in many developing countries – particularly in parts of Africa and Asia. 5
  • 6. Agent factors • Agent- RNA virus (Paramyxo virus family, genus Morbillivirus) • Can’t survive outside the human body • Source of infection: case of measles (no carriers). • No animal reservoir 6
  • 7. Agent factors • Infective material- Secretions of nose, throat and respiratory tract • Virus remains active and contagious in the air or on infected surfaces for up to 2 hours. • Period of communicability: 4 days before to 4 days after the appearance of rash • Highly infectious during prodromal period and at the time of eruption. • Secondary Attack Rate(SAR): > 80% 7
  • 8. Host factors Age: • Commonly 6 months to 3 years in developing and underdeveloped countries • More than 5 years in developed countries Sex: Incidence equal in both sexes Immunity: • No age is immune if there is no previous immunity • One attack-life long immunity Nutrition: Malnourished children highly susceptible, mortality is more 8
  • 9. Environmental factors • In tropical climate: Dry season • In temperate climate: Winter season, over crowding • In India: January to April 9
  • 10. Transmission: Droplet infection,droplet nuclei Portal of entry and exit: Respiratory tract, Minor- conjunctiva Incubation period: 10-14 days 10
  • 11. Clinical features • Prodromal stage • Eruptive stage • Post-measles stage 11
  • 12. Prodromal stage • From 10th day of infection to 14th day • 3 Cs (Cough, Coryza with sneezing and nasal discharge & Conjunctivitis) • Lacrimation and photophobia • Fever for 4 days • May be- Vomiting or Diarrhoea • Koplik spots 12
  • 13. 13
  • 14. Koplik’s spots • Pathognomic sign • 1-2 days before appearance of rash • Small, bluish-white spots over a red base • On buccal mucosa opposite the first and second lower molars 14
  • 16. 16
  • 17. Eruptive stage • Dusky red, generalized, maculopapular, erythematous rash. • Begins behind the ear and rapidly spreads to face, neck and extends down the body within 2-3 days. • In the absence of complications, rash and fever disappears in 3-4 days. • Rash fades in the order of appearance. 17
  • 18. Courtesy : This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #3168 18
  • 19. Courtesy : Adapted from Mims et al. Medical Microbiology, 1993, Mosby 19
  • 20. Post Measles Stage Growth retardation Susceptibility to other infections Complications: • Pneumonia(20-80% in developing countries, less than 10% in developed) • Diarrhoea • Respiratory Infections • Otitis Media(5-15%) • Rarely Febrile convulsions, Encephalitis 20
  • 21. 21 What is a probable case of Measles? In the absence of a more likely diagnosis, an illness characterized by: Generalized rash lasting ≥3 days; and Temperature ≥101°F or 38.3°C; and Cough, coryza, or conjunctivitis; and No epidemiologic linkage to a confirmed case of measles; & Non-contributory or no serologic or virologic testing.
  • 22. 22 What is a confirmed case of Measles? • Laboratory confirmation by any of the following: • Positive serologic test for measles IgM antibody; • Isolation of measles virus from a clinical specimen; or • Detection of measles-virus specific nucleic acid by polymerase chain reaction (PCR) (Note: A lab-confirmed case does not have to have generalized rash lasting ≥3 days; temperature ≥101°F or 38.3°C; cough, coryza, or conjunctivitis. ) OR An illness characterized by • Generalized rash lasting ≥3 days; and • Temperature ≥101°F or 38.3°C; and • Cough, coryza, or conjunctivitis; and • Epidemiologic linkage to a confirmed case of measles.
  • 23. 23 Treatment of Measles • Isolation for 7 days after the onset of rash • No specific antiviral treatment. • Supportive care: good nutrition, adequate fluid intake and treatment of dehydration. • Antibiotics: to treat eye and ear infections, and pneumonia. • All children diagnosed with measles should receive two doses of vitamin A supplements, given 24 hours apart. Vitamin A can help prevent eye damage and blindness. (Vitamin A supplements reduces the deaths from measles by 50%)
  • 24. Prevention of Measles Immunization: • Eradication can be achieved by immunization rate of atleast 96% under one year of age • Ongoing immunization against measles • Measles vaccination: live attenuated, subcutaneous,0.5 ml, at 9-12 months, life long immunity in 90-99%; Reactions: Mild fever • MMR vaccine • Immunoglobulin(human):with in 3-4 days of exposure 24
  • 25. Measles outbreak control • Isolation for 7 days after the onset of rash • Active Immunization of contacts within 2 days of exposure (or passive immunization within 3-4 days) • Prompt immunization at the beginning of outbreak 25
  • 26. Enhanced measles eradication strategy-WHO 1) Catch up: First, a one-time-only "catch-up" measles vaccination campaign is conducted among children aged 9 months to 14 years. 2) Keep up: Efforts are then made to vaccinate through routine health services ("keep-up") at least 95% of each newborn cohort at 12 months of age. 3) Follow up: Finally, to assure high population immunity among preschool-aged children, indiscriminate "follow-up" measles vaccination campaigns are conducted approximately every 4 years. 26
  • 27. Challenges for Measles elimination • Weak immunization systems • High infectious nature of measles • Inaccessible population in certain areas • Refusal to immunization by some people • Changing epidemiology(adolescents and adults) • Catch up immunization to more than 130 million children in India • Lack of human and financial resources 27
  • 29. Mumps-Introduction • "to mump" (british word): grimace or grin (as a result of parotid gland swelling) • Acute infectious disease due to “myxovirus parotiditis” ; RNA paramyxovirus (Genus Rubulavirus) affecting mainly glands and nervous system • Mortality is negligible 29
  • 30. Source: Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #130 Content Providers: CDC/NIP/Barbara Rice 30
  • 31. Agent factors • Myxovirus parotidis –RNA virus • Source of infection: Clinical and subclinical cases; mainly saliva; others:blood,urine,human milk,CSF • Period of communicability: 4-6 days of onset of symptoms to 7 days after (Maximum just before and at the onset of parotid swelling) • Secondary attack rate: 86% 31
  • 32. Host factors • Age: mostly 5-9 yrs, but can be seen in any age • Sex: females • Immunity: less than 6 months of age infants are immune, life long immunity after one infection Environmental factor • Any time but peak in winter and spring season • Overcrowding Mode of transmission: droplet infection and direct contact with the infection person I.P.: 2-4 weeks 32
  • 33. Clinical features • One third cases: asymptomatic • Initial symptoms: ear ache on affected side, pain and stiffness on opening the mouth • Pain and swelling due to involvement of parotid, sublingual and submandibular glands, • Swelling subsides in 1-2 weeks • Can affect testes,pancreas,ovaries,prostate,CNS • Severe cases: Fever 3-5 days 33
  • 34. Source : Adapted from Mims et al. Medical Microbiology, 1993, Mosby 34
  • 35. Complications of Mumps Frequent but not serious: • Orchitis (25-40%): 7-10 days after parotitis,with high fever (Unilateral in 75% orchitis cases, Most common extra-salivary gland manifestation in adults) • Epididymitis • Pancreatitis(4%) • Mild form of meningitis • Thyroiditis, Neuritis, Hepatitis,Ovaritis, • Oophoritis (5% adult women) • Spontaneous abortion(25% in pregnancy) Rare: Hearing loss, Polyarthritis, Encephalitis, Cerebellar ataxia 35
  • 36. Management of Mumps • Supportive • Case should be isolated till symptoms subside • Contacts should be kept under surveillance 36
  • 37. Prevention of Mumps Immunization • Mumps vaccine: Live attenuated,0.5 ml, IM • MMR vaccine 37
  • 39. Introduction-Rubella • Rubella (Latin term) means "little red." • It is a generally mild disease caused by the rubella virus. • Rubella is also known as German Measles or 3-day Measles. • Typical course of rubella exanthema 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. 39
  • 40. Agent factors • Agent: RNA virus (Togo virus family) • Source of infection: majority subclinical cases, minor- clinical cases • Infective material: Respiratory secretions, blood, CSF, urine • Period of communicablity: A week before symptoms to a week after the rash 40
  • 41. Host factors- Age: 3-10 yrs(developing countries) 15 years developed countries Immunity: Life long after first attack, maternal immunity upto 6 months of age Environmental factors- winter and spring season, with epidemics every 4-9 years Transmission- droplet inf, droplet nuclei, vertical transmission, portal of entry: respiratory Incubation period- 2 to 3 weeks (average 18 days) 41
  • 42. Clinical features • 50-60% asymptomatic • Symptoms:  Prodromal phase(mild): coryza,sore thorat, low grade fever  Lymphadenopathy: post auricular and posterior cervical lymph nodes enlargement 42
  • 43. Rash: • Minute,discrete,pinkish,macular • Starts on face within 24 hours of the onset of the prodromal symptoms,spreads to trunk and extremities, clears more rapidly,disappears in 3 days • Rash absent (25% cases) in subclinical cases Conjunctivitis may occur. 43
  • 44. Image in a 4-year-old girl with a 4-day history of low-grade fever, symptoms of an upper respiratory tract infection, and rash. Courtesy of Pamela L. Dyne, MD. 44
  • 45. Complications of Rubella Rare: Arthralgia Thrombocytopenic purpura Very rare: Encepahlaitis 45
  • 46. Diagnosis • Virus isolation by throat swab culture • ELISA for IgM antibody 46
  • 47. Congenital Rubella Syndrome(CRS) • Due to Rubella infection in pregnancy • It is a chronic infection of foetus • First trimester infection- severe • Foetal death and spontaneous abortion 47
  • 48. Clinical features of CRS • Congenital malformations (Triad of Deafness,Cradiac malformations,cataract) • Other defects: Glaucoma,retinopathy,microcephalus,cerebral palsy,IUGR,LBW,Heapto-splenomegaly,mental and motor retardation 48
  • 49. 49
  • 50. Photo source: U.S. Centers for Disease Control and Prevention 50
  • 51. Salt and pepper retinopathy Content Providers(s): CDC Creation Date: 1976 Courtesy http://phil.cdc.gov/phil_images/2003072 4/28/PHIL_4284_lores.jpg http://www.kellogg.umich.edu/theeyeshave it/congenital/retinopathy.html Courtesy: Jonathan Trobe, M.D. - University of Michigan Kellogg Eye Center 51
  • 52. Prevention of Rubella Immunization • Rubella vaccine: RA 27/3 strain,0.5 ml, SC,Life long immunity in 95% • C/I for immunization: Pregnancy • Recipients of vaccine should be advised not to become pregnant in 3 months after getting vaccine • MMR vaccine 52
  • 53. Vaccination strategy for Rubella • First protect women in 15-39 yr age • Second interrupt transmission by vaccinating children aged 1-14 years • Third,all children at age 1 53
  • 54. MMR Vaccine 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 CCID50 of Measles virus 5000 CCID50 of Mumps virus 1000 CCID50 of Rubella virus. 54
  • 55. MMR vaccine contd… • Diluent: Sterile water for injection. • MMR vaccine may be given after 12 months of age. • After reconstitution the vaccine should be used immediately. • Dose: 0.5 ml, deep SC in the upper arm. • If the vaccine is not used immediately then it should be stored in the dark at 2°- 8°C for no longer than 8 hours. 55
  • 58. 58 Global Measles and Rubella Strategic Plan 2012-2020 In 2012, the M&R Initiative launched a new Global Measles and Rubella Strategic Plan which covers the period 2012-2020. By the end of 2015 the plan aims: to reduce global measles deaths by at least 95% compared with 2000 levels; to achieve regional measles and rubella/congenital rubella syndrome (CRS) elimination goals. By the end of 2020 the plan aims: to achieve measles and rubella elimination in at least 5 WHO regions.
  • 59. 59 The strategy focuses on the implementation of 5 core components: • achieve and maintain high vaccination coverage with 2 doses of measles- and rubella-containing vaccines; • monitor the disease using effective surveillance, and evaluate programmatic efforts to ensure progress and the positive impact of vaccination activities; • develop and maintain outbreak preparedness, rapid response to outbreaks and the effective treatment of cases; • communicate and engage to build public confidence and demand for immunization; and • perform the research and development needed to support cost- effective action and improve vaccination and diagnostic tools.