2. • Infections with measles, mumps and rubella
viruses are confined to man and occur worldwide.
• Spread primarily via the aerosol route.
• Each of these viruses exists as a single serotype
• MMR vaccine contains all three of these viruses
• .Measles & Mumps belong to family
Paramyxovirus
• RNA enveloped viruses
Measles & Mumps
3. MEASLES (RUBEOLA)
PATHOGENESIS AND DISEASE
• The word measles is derived from German word for
blister
• Respiratory droplet infection.
• Virus replicates in the upper/lower respiratory tract and
lymphoid tissues leading to viremia and then growth in
a variety of epithelial sites.
• The virus is very contagious: maximum contagiousness
is 2 to 3 days before onset of the rash.
• The disease develops 1 - 2 weeks after infection.
5. Clinical Features
• Measles is still a major killer in
underdeveloped countries
• Fever of 101o
F (38.3o
C) or above
• Running nose (coryza) and cough
• Conjunctivitis
• Koplik's spots on mucosal
membranes - small (1 - 3mm),
irregular, bright red spots, with
bluish-white speck at center.
6. • Maculopapular rash which extends
from face to the extremities.
• The infection is prostrating but
recovery is usually rapid
Clinical Features
7. Complications of Measles
• Secondary bacterial infections: otitis
media and bacterial pneumonia.
• Pneumonia accounts for 60% of deaths from
measles
• Encephalitis (1 in 1000 cases) a few days
after the rash disappears.
8. Subacute Sclerosing Pan encephalitis
• Very rare (7 in 1,000,000 cases)
• Develops 1 to 10 years after the initial infection.
• Behavioral changes.
• Impaired speech, vision and swallowing
• A progressive, usually fatal disease
• SSPE is associated with defective forms of the
virus in the brain
Complications of Measles
9. • Measles can cause temporary defects in
the immune response; e.g. tuberculin-
positive individuals may temporarily
give a negative response.
Complications of Measles
10. LAB DIAGNOSIS
• The clinical picture
• Serodiagnosis
o IgM & IgG levels
• Virus isolation in cell culture
o The large syncytia, or multinucleated
giant cells, result from fusion of cell
membranes
o Inclusion bodies, eosinophilic areas
of altered staining in the cytoplasm
11. EPIDEMIOLOGY
• Almost all infected individuals show signs
of disease.
• Only one serotype of measles and a single
natural infection gives life-long protection.
12. MMR Vaccine
• Is a live, attenuated combined vaccine to
prevent measles, mumps and rubella.
• Two doses are given to pre-school
children:
o The first dose at 12-15 months
o The second booster dose at 3-5 years
PREVENTION
13. PREVENTION & TREATMENT
• Immune serum globulin: for at risk
patients during an outbreak i.e. those <1 year
with impaired cellular immunity
o No antiviral therapy available for primary
disease. Complications should be treated
appropriately
14. MUMPS
• The name comes from the British
word "to mump", that is grimace
• Clinically, mumps is an acute
unilateral or bilateral parotid
gland swelling that lasts for more
than two days with no other
apparent cause.
Other agents can also cause
parotitis
16. Mumps Epidemiology
Reservoir Human
Transmission Respiratory droplet infection
Communicability 7 days before to 9 days after
onset of active disease
• Worldwide distribution
•Many (30%) infections are sub-clinical
•No 'carrier state'.
18. Mumps Complications
CNS involvement 15% of clinical cases
Orchitis 20-50% in
post-pubertal males
Pancreatitis 2-5%
Deafness 1/20,000
Death 1-3/10,000
19. MMR Vaccine
• Is a live, attenuated combined vaccine to
prevent measles, mumps and rubella.
• Two doses are given to pre-school
children:
o The first dose at 12-15 months
o The second booster dose at 3-5 years
PREVENTION & TREATMENT
20. Rubella (German Measles(
History
1881Rubella accepted as a distinct disease
1941Associated with congenital disease
Rubella virus first isolated 1961
1967Serological tests available
1969Rubella vaccines available
21. Rubella Virus
RNA enveloped virus
Member of the togavirus family
Spreads by respiratory droplets
In the pre-vaccination era, 80% of women
were already infected by childbearing age
24. Risks of Rubella Infection
During Pregnancy
Preconception :Minimal risk
0-12weeks: 100% risk of fetus being congenitally
infected
resulting in major congenital abnormalities.
Spontaneous abortion occurs in 20% of cases.
13-16weeks: Deafness and retinopathy 15%
After 16 weeks: Normal development, slight risk
of deafness and retinopathy
27. Outcome
1/3rd will lead normal independent lives
1/3rd will live with parents
1/3rd will be institutionalised
The only effective way to prevent CRS is to
terminate the pregnancy
29. Typical Serological Events following
acute rubella infection
Note that in reinfection, IgM is usually absent or only present transiently at a low level
30. Prevention
Antenatal screening
Screening of all pregnant women attending antenatal
clinics for immune status against rubella.
Non-immune women are vaccinated in the immediate
post partum period.
31. Prevention
Since 1968, a highly effective live attenuated
vaccine has been available with 95% efficacy
Universal vaccination is now offered to all
infants as part of the MMR regimen in the
USA, UK and a number of other countries.
Vaccination of schoolgirls before they reach
childbearing age.