1. Measles, Mumps and Rubella

2. Measles
Mumps
Rubella

3. Measles
•Highly contagious viral 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 is an 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-day incubation period for respiratory-acquired
infections
✤ 6-10 days if acquired parenterally
✤ remains the leading cause of vaccine-preventable
death in children

6. Measles Pathogenesis and Clinical 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
✤ Painful swelling 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
CNS involvement
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
✤ Also known 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 Rubella Vaccine
• 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
Contraindications and Precautions
• Severe allergic reaction to vaccine component or
following prior dose
• Pregnancy
• Immunosuppression
• Moderate or severe acute illness
• Recent blood product