MMR

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. 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. Clinical Manifestations

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)

9. Measles (cont.) Prevention Routine immunization serum immune globulin 6 days after exposure Complications Bronchitis Encephalitis Ear infection Pneumonia

10. Measles (cont.) diagnosis Serology for measles Treatment No specific treatment vit A Acetaminophen Bed rest Humid air Fluid and nutrition

11. Mumps Virus Paramyxovirus RNA virus Rapidly inactivated by chemical agents, heat, and ultraviolet light

12. 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

13. 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

14. 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

15. 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

16. 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) Mumps Complications

17. Mumps (cont.) Prevention MMR immunization between the age of: 12-15 months Again between 4-6 years Again between 11-12 years

18. Mumps (cont.) Test Physically examining the salivary glands for swelling (not test) Treatment No specific treatment Ice or heat packs and acetaminophen for pain

19. Rubella Virus Togavirus RNA virus Rapidly inactivated by chemical agents, ultraviolet light, low pH, and heat

20. 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

21. 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

22. 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

23. Rubella (cont.) Symptoms bloody red eyes Muscle or joint pain Bruising is a rare symptom Fever (adults) Headache (adults) Runny nose (adults)

24. Rubella (cont.) Test Nasal or throat swab sent for a culture Treatment No specific treatment Acetaminophen for fever

25. Rubella (cont.) Prevention rubella vaccination to adult and adolescent female MMR immunization between the age of: 12-15 months Again between 4-6 years

26. 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

27. Congenital Rubella Syndrome Cataracts Deafness Heart malformation Also: microcephaly autism mental retardation Diabetes etc.

28. 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

29. 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 2 nd dose at 4-6 years

30. 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