Measles, mumps & rubella


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brief introduction to epidemiology, epidemiological triad and prevention of measles, mumps & rubella.

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Measles, mumps & rubella

  2. 2.  Occurrence o Worldwide o interruption of transmission achieved in the United States & other parts of the Western Hemisphere.  Reservoir o human disease o no known animal reservoir o asymptomatic carrier state has not been documented.  Transmission o primarily person to person via large respiratory droplets o Airborne transmission via aerosolized droplet nuclei has been documented in closed areas for up to 2 hours after a person with measles occupied the area.  Incubation Period o 7 – 18 days  Communicability o highly communicable, >90% secondary attack rates among susceptible persons. o Infectious period: from 4 days before to 4 days after rash onset o Maximum communicability during prodromal phase
  3. 3.  Agent o Measles virus. • only one antigenic type of measles virus. • rapidly inactivated by heat, light, acidic pH, ether, and trypsin • short survival time (<2 hours) in the air or on objects and surfaces  Host o Human • Unvaccinated young children & pregnant women • Poorly nourish • insufficient vitamin A • Weakened immune systems  Environment o Developing countries – Africa & Asia o Countries with low per capita incomes and weak health infrastructures o Countries experiencing or recovering from a natural disaster or conflict o dry seasons in tropical zones o Overcrowded places
  4. 4.  In developed countries during the pre-vaccine era, o >90% of children acquired measles by age 15. o Following implementation of routine childhood vaccination at age 12 to 15 months, the age of peak measles incidence in the United States shifted to six months of age.  Measles as a significant cause of morbidity and mortality o In 2000, measles was estimated to cause approximately 31 - 39.9 million illnesses worldwide with an estimated 733,000 - 777,000 deaths, making it the 5th most common cause of death in children under five years of age.
  5. 5. Worldwide reported measles incidence rate per 100 000 population, 2004
  6. 6.  Occurrence o worldwide.  Reservoir o human disease o persons with asymptomatic infection can transmit the virus, but no carrier state is known to exist.  Transmission o airborne transmission o direct contact with infected droplet nuclei or saliva.  Incubation Period o 16 - 18 days  Communicability o Contagiousness similar to that of influenza & rubella • less than that for measles & varicella o Infectious period: from 3 days before to the 4th day of onset of symptoms
  7. 7.  Agent o Mumps virus • One antigenic type • rapidly inactivated by formalin, ether, chloroform, heat, and ultraviolet light  Host o Human • Failure to be immunized completely • children between 2-12 years of age • Weakened immune system  Environment o Africa, general Indian subcontinent region, and Southeast Asia- very low rate of vaccination o Late winter & spring o Small, enclosed room o Crowded places
  8. 8.  Occurrence o worldwide.  Reservoir o human disease o Infants with congenital rubella syndrome(CRS) may shed rubella virus for an extended period, • But a true carrier state has not been describe.  Transmission o person to person via airborne transmission o droplets shed from the respiratory secretions of infected persons • asymptomatic cases o no evidence of insect transmission  Incubation Period o 14 – 21 days  Communicability o only moderately contagious. o most contagious when the rash first appears o Infectious period: from 7 days before to 5–7 days or more after rash onset. o Infants with CRS shed virus from body secretions for up to 1 year • may transmit rubella to persons caring
  9. 9.  Agent o rubella virus • Do not require vector • relatively unstable • inactivated by lipid solvents, trypsin, formalin, ultraviolet light, low pH, heat  Host o Human • infants and young toddlers who have not received the vaccine • women of childbearing age do not have immunity to the disease  Environment o WHO African and South-East Asian regions- vaccine coverage is lowest o Late winter early spring o Small, enclosed room o Crowded places o Schools or day care centre o Shopping mall
  10. 10.  Rubella o Rubella vaccine (Meruvax) o Keep distance from infected person  Measles o Measles vaccine • 2 doses • 1st dose at age 12 -15 months • 2nd dose at 4 – 6 years old o Keep distance from infected person  Mumps o Mumps vaccine (Paramyxovirus) • Last at least 12 years o Keep distance from infected person  Combined MMR introduced in Malaysia o 2002
  11. 11.  Epidemiology o o o  WHO Health Topics o o o  Epidemiology and transmission of measles o  Vaccine Knowledge Project o o  Rubella Virus o  WHO Incidence time series for Malaysia o  History of Vaccine o
  12. 12.  Epidemiology and Prevention of Vaccine-Preventable Diseases o o o  Measles Prevention and Control in Malaysia o Prevention%20and%20Control%20in%20Malaysia.pdf  Lippincott’s Guide to Infectious Diseases  Harrison’s Infectious Diseases o By Kasper, D. L., & Fauci, A. S. (2010)