Adapted from books and internet sources For education purpose

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