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MMR
This document discusses measles, mumps, and rubella. It describes how each disease is caused by a virus, spreads through respiratory droplets, and causes specific symptoms. Measles, mumps, and rubella can lead to severe complications and are vaccine-preventable. The MMR vaccine is recommended as a routine childhood immunization at 12-15 months and again at 4-6 years.
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MMR
- 1. Measles, Mumps andRubella
- 2.
- 3. Measles •Highly contagiousviral 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
- 4. Measles It isan 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.
- 5. Measles ✤ 14-dayincubation period for respiratory-acquired infections ✤ 6-10 days if acquired parenterally ✤ remains the leading cause of vaccine-preventable death in children
- 6. Measles Pathogenesis andClinical 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
- 7. Clinical Manifestations ✤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.
- 8. 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)
- 15. Measles (cont.) ✤Prevention ✤ Routine immunization ✤ serum immune globulin 6 days after exposure ✤ Complications ✤ Bronchitis ✤ Encephalitis ✤ Ear infection ✤ Pneumonia
- 16. Measles (cont.) ✤diagnosis ✤ Serology for measles ✤ Treatment ✤ No specific treatment ✤ vit A ✤ Acetaminophen ✤ Bed rest ✤ Humid air ✤ Fluid and nutrition
- 17. Mumps Virus •Paramyxovirus • RNA virus • Rapidly inactivated by chemical agents, heat, and ultraviolet light
- 18. Mumps ✤ Painfulswelling 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
- 21. 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
- 22. 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
- 23. 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
- 24. Mumps Complications CNSinvolvement 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)
- 25. Mumps (cont.) ✤Prevention ✤ MMR immunization between the age of: ✤ 12-15 months ✤ Again between 4-6 years ✤ Again between 11-12 years
- 26. Mumps (cont.) ✤Test ✤ Physically examining the salivary glands for swelling (not test) ✤ Treatment ✤ No specific treatment ✤ Ice or heat packs and acetaminophen for pain
- 27. Rubella Virus •Togavirus • RNA virus • Rapidly inactivated by chemical agents, ultraviolet light, low pH, and heat
- 28. Rubella ✤ Alsoknown 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
- 29. 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
- 30. 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
- 31. Rubella (cont.) ✤Symptoms ✤ bloody red eyes ✤ Muscle or joint pain ✤ Bruising is a rare symptom ✤ Fever (adults) ✤ Headache (adults) ✤ Runny nose (adults)
- 32. Rubella (cont.) ✤Test ✤ Nasal or throat swab sent for a culture ✤ Treatment ✤ No specific treatment ✤ Acetaminophen for fever
- 33. Rubella (cont.) ✤Prevention ✤ rubella vaccination to adult and adolescent female ✤ MMR immunization between the age of: ✤ 12-15 months ✤ Again between 4-6 years
- 34. 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
- 35. Congenital Rubella Syndrome ✤ Cataracts ✤ Deafness ✤ Heart malformation ✤ Also: ✤ microcephaly ✤ autism ✤ mental retardation ✤ Diabetes ✤ etc.
- 38. 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
- 39. Measles Mumps RubellaVaccine • 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
- 40. MMR Vaccine Contraindicationsand Precautions • Severe allergic reaction to vaccine component or following prior dose • Pregnancy • Immunosuppression • Moderate or severe acute illness • Recent blood product