This document provides information on Mumps, Measles, and Rubella. It discusses the causative agents, hosts, environments, pathogenesis, clinical manifestations, diagnosis, treatment, prevention, and vaccination for each disease. Mumps is caused by a paramyxovirus and presents with parotid gland swelling. Measles is caused by a morbillivirus and presents with a rash and Koplik's spots. Rubella is caused by a togavirus and often presents asymptomatically or with mild symptoms and rash. Complications can include encephalitis, deafness, and congenital rubella syndrome. Diagnosis involves virus detection and serology. Treatment is supportive. Prevention relies on vaccination with the

1. MUMPS, MEASLES & RUBELLA
DR SHAHANA

2. MUMPS
EPIDEMIC PAROTITIS

3. AGENT
• RNA virus
• Genus: Rubula
• Family: Paramyxoviridae
• Only one serotype; No carriers
• Incubation period: 16-18 days
• Communicable period: from 6 days before to 9 days after facial swelling is
apparent.
HOST
• Man
• Maternal antibody is protective for the infant in the first 6 months
ENVIRONMENT
• Late winter and spring
• Crowded places

4. Direct contact
Air borne droplets
Fomites contaminated
by saliva Initial multiplication in
respiratory tract
Blood borne to many
tissues
More to salivary glands&
lymphoid tissues
Viremia
Spread throughout the
body
PATHOGENESIS

5. CLINICAL MANIFESTATIONS
Approximately 1/3rd - asymptomatic (subclinical)
Nonspecific prodromal symptoms :
• Myalgia
• Malaise
• Head ache
• Low-grade fever
precede the parotid swelling by 12 to 24 hours
Parotitis - 30%-40%
• Unilateral or bilateral
• Self limiting
• Swollen parotid gland lifts the earlobe upward outward, &the angle of the
mandible is obscured
Other salivary glands maybe involved

8. OTHER COMPLICATIONS
• Oophoritis
• Arthritis
• Thyroiditis
• Glomerulonephritis
• Myocarditis

9. • Routine laboratory tests are nonspecific
• Leukopenia- relative lymphocytosis.
• Rise in serum amylase level
parallels the parotid swelling
return to normal within 2 week
• Samples collected from:
buccal swabs (stensons duct exudates)
throat washings
saliva
spinal fluid
• Virus isolation from Saliva – 7 days before through 8 days after the onset of swelling
• Detection of mumps antigen by PCR
• Serologic testing:
Mumps specific IgM antibody
Significant increase in IgG antibody between acute &convalescent specimens
DIAGNOSIS

10. TREATMENT
• No specific antiviral therapy;
• Entirely supportive (Antipyretics, bed rest)
• MMR vaccination
PREVENTION

11. MEASLES
RUBEOLA

12. AGENT
• RNA virus
• Genus: Morbillivirus
• Family: Paramyxoviridae
• Only one serotype; Can’t survive outside the human body; No carriers
• Incubation period: 10-14 days
• Period of communicability: 4 days before to 4 days after appearance of rash
• Secondary Attack Rate(SAR): > 80% (Probability that infection occurs in susceptible,
within an incubation period, following a known contact with an infectious source)
HOST
• Age group: commonly 6 months - 3 years
• One attack-life long immunity
• Malnourished children highly susceptible
• Maternal antibody is protective for the infant in the first 6 month of life
ENVIRONMENT
• Over crowding
• January to April

13. PATHOGENESIS

15. PRODROMAL PHASE
From 10th day of infection to 14th day
3 Cs (Cough, Coryza & Conjunctivitis)
Lacrimation and photophobia
Fever
May be- vomiting or diarrhea
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& second lower molars

16. ERUPTIVE PHASE
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
Leaving behind branny desquamation
and brownish discoloration

17. POST MEASLES PHASE

18. COMPLICATIONS
• Otitis media
• Interstitial pneumonitis  Hecht giant cell pneumonia
• Bronchopneumonia  secondary bacterial infection
• Encephalomyelitis  perivascular demyelination in brain and
spinal cord
• Subacute sclerosing pan encephalitis (SSPE)- degeneration of
the cortex and white matter with intranuclear and
intracytoplasmic inclusion bodies

19. DIAGNOSIS
Usually clinical diagnosis; laboratory confirmation is rarely needed
Isolation of measles virus by tissue culture in human embryonic or
rhesus monkey kidney cells
Demonstration of cytopathic changes with multinucleated giant cells
(Warthin Finkeldey), during prodromal stage, in smears of nasal mucosa
Serology
Measles IgM antibodies when the rash appears
Testing of acute and convalescent sera demonstrates the
diagnostic seroconversion or fourfold increase in titer

20. TREATMENT
No specific antiviral therapy
Entirely supportive (Antipyretics, bed rest, good nutrition, adequate fluid
intake, humidification, protection from exposure to sunlight)
Bacterial complications of otitis media and bronchopneumonia require
appropriate antimicrobial therapy
Vitamin A supplementation for
6 months- 2 years of age who are hospitalized for measles &its complications
>6 months of age with measles and immunodeficiency
Recommended regimen : single dose of
100,000 IU orally - 6 month to 1 year
200,000 IU orally - >1 year of age
Children with ophthalmologic evidence of vitamin A deficiency 
additional doses the next day and 4 weeks later

21. PREVENTION
• Isolation from 7th day of exposure to 5 days after appearance of rash
• Maternal antibody protection till 6 months of life
• Measles vaccine at 9 months or 270 completed days, 0.5ml, s.c.
• Seroconversion rate : 95-98%
• Catch up vaccination
• Beyond 12 months  MMR
• Measles vaccine administered during outbreaks aged 6 through 11 months
• Revaccinated with 2 doses of measles vaccine
• First, at ages 12 through 15 months, at least 4 weeks after the previous dose
• Second, at ages 4 through 6 years

23. POST EXPOSURE PROPHYLAXIS
• Passive immunization with immune globulin is effective for
prevention and attenuation of measles.
• Immuno compromised persons should receive immune globulin (0.5
mL/kg; maximum: 15 mL) intramuscularly regardless of immunization
status.
• Infants 6 months of age or younger born to non-immune mothers
Immune globulin
• Infants 6 months of age or younger born to immune mothers  by
maternal antibody
• 6-12 months Measles vaccine within 72 hours of exposure
• >12 months Measles or MMR vaccine within 72 hours of exposure.

24. RUBELLA
GERMAN MEASLES/ three-day measles

25. AGENT
• RNA virus
• Family: Togo virus
• Source of infection: majority subclinical cases, minorclinical cases
• Transmission- droplets, vertical transmission
• Portal of entry: respiratory
• Incubation period: 2 to 3 weeks (average 18 days)
• Period of communicability: A week before to a week after the rash
HOST
• 3-10 years of age
• Life long immunity after first attack
• Maternal immunity up to 6 months of age
ENVIRONMENT
• Winter and spring season, with epidemics every 4-9 years

26. PATHOGENESIS
Rubella virus
Via respiratory
droplets
Infects cells in upper
respiratory tract
Virus multiplies
Extends to regional
lymph nodes
Virus replicates via
nasopharynx
Infection established
in skin &other tissues
Rash develops, cough
etc

27. CLINICAL FEATURES
• 50-60% asymptomatic
• Prodromal phase(mild): coryza, sore throat, low grade fever
• Lymphadenopathy- post auricular &posterior cervical lymph nodes
• Rash
Minute, discrete, pinkish, macular
Starts on face within 24 hours of onset of the prodromal symptoms
Spreads to trunk and extremities
Clears more rapidly in 3 days
Absent in 25% of subclinical cases

29. DIAGNOSIS
Virus isolation by throat or nasal swab cell culture
Detection of rubella virus RNA by RT PCR
Serology
Four fold increase in antibody titer
Seroconversion between acute and convalescent Ig G titers

30. TREATMENT
• No antiviral therapy
• Supportive measures

31. CONGENITAL RUBELLA SYNDROME
Due to Rubella infection in pregnancy

32. RATE OF ORGAN ANOMALIES
1- 8 WEEKS
• Cardiac defect & hearing impairment
• 80%
9-12 WEEKS
• Hearing impairment & features of CRS
• 50%
13- 16 WEEKS
• Hearing loss is prominent than others
• 30%
>20 WEEKS
• Chances of fetal damage is minimal to none

34. BLUEBERRY MUFFIN RASH

35. DIAGNOSIS
• ELISA for IgM antibody  at birth till 3 months of life
• Followed by stable increase in rubella specific IgG over several
months

36. TREATMENT
• Treatment is supportive.
• Provide vision screening and hearing screening  asymptomatic
newborns.
• Treatment of symptomatic newborns is as follows:
• Provide careful evaluation of the eyes ophthalmology referral corneal
clouding, cataract, and retinopathy. Corneal clouding may indicate infantile
glaucoma.
• Hepatosplenomegaly is monitored clinically. No intervention is required.
• Hyperbilirubinemia phototherapy or exchange transfusions if jaundice is
severe to prevent kernicterus.
• Severe thrombocytopenia IVIG. Corticosteroids are not indicated.
• Heart abnormality carefully observed for signs of congestive heart failure
Echocardiography

37. MMR VACCINE

38. • 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
• Diluent: Sterile water for injection.
• Minimum age: 12 months of age.
• Dose: 0.5 ml, deep SC in the upper arm
• First dose: 12 through 18 months, 4 weeks apart,
• Second dose: 4 through 6 years

39. • After reconstitution the vaccine should be used immediately
• If the vaccine is not used immediately then it should be stored
in the dark at 2°- 8°C, for no longer than 8 hour
• Catch up
• All school aged children & adolescents
• 2 doses, 4 weeks apart
• One dose if previously vaccinated

40. THANK YOU