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)
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
19.
20.
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
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
