1. MMR Measles, Mumps &Rubella

2. Measles

3. DEFINITION Measles is an acute highly contagious viral disease caused by measles Agent- RNA virus ( Paramyxo virus family, genus Morbillivirus )

4. Host factors Age- All age person is susceptible; 90% of contact people acquire the disease 6 months to 3 years even up to 10 years Incidence equal in both sexes Immunity – life long immunity Malnourished children are susceptible

5. Measles Epidemiology Reservoir Human Transmission Respiratory Airborne Temporal pattern Peak in late winter–spring Communicability 4 days before to 4 days after rash onset

6. Measles Pathogenesis 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

7. Measles Clinical Features Incubation period 10-12 days Stepwise increase in fever to 40°C or higher for 4 days. Cough, coryza, conjunctivitis ( 3 Cs ) Koplik spots Prodrome

8. Measles Clinical Features 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 Rash

9. DIAGNOSIS 1.Epidemiologic data; 2.Clinical manifestations; 3. Laboratory findings:. 3.1.Multinucleated giant cells are detected in nasopharyax mucosa secretions; 3.2.Measles virus can be isolated in tissues culture;. 3.3. Antibody titer; 3.4. WBC is relative low.

10. treatment 1.General therapy: rest, nursing and diet 2. Symptomatic therapy: fever and cough, 3.Support threapy:r-globulin traditional chinese herbs may be used ; 4.complications of treatment

11. PREVENTION 1.Control source of infection; 2.Interruption of transmissions ; 3.Protection of the susceptible person: 3.1. Active immunization Lived attenuated measles vaccine. plan immune:8m,7j epidemic stage:before 2 m contactor:with in 2 days Contraindications:pregnancy 3.2. Passive immunization placenta globulin or gamma globulin. <5 days prevent onset >5 days relieve symptoms yy:yy: yy:yy:

13. Introduction Mumps is an acute respiratory tract infectious disease caused by mumps virus, it occurs primarily in school-aged children and adolescents. The most prominent manifestation is nonsuppurative swelling and tenderness of the salivary glands with one or both parotid glands involved in most cases.

14. Epidemiology Sources of infection: Patients in early course of the disease, hosts under covert infection. The period of peak contagion before or at the onset of parotitis. Route of transmission : Via droplet nuclei or direct contact,fomites

15. Etiology Mumps virus (Paramyxovirus parotitis) belongs to Paramyxoviridae family. RNA virus.

16. Epidemic features: Endemic throughout the world. The peak incidence in winter and spring. Mode of transmission: droplet Age and gender : 5-15 years School-aged children at high risk and girls common. Post-infection immunity is stable and long-lasting.

17. Clinical Manifestations Incubation period: averages 16 to 18 days with a range of 2 to 4 weeks. Prodromal symptoms include low- grade fever, anorexia, malaise and headache. Parotid tenderness and ipsilateral earache within 1 or 2 days after the illness onset,then parotid is visibly enlarged and go to maximum

18. size over next 2 to 3 days accompanied severe pain and normal or high temperature. One parotid enlarges after the other. The orifice of Stensen’s duct is edematous and erythematous. Parotid returns to normal size within a week. Patients with parotitis have difficulty with pronunciation and mastication. Citrus fruits and juices exacerbates the pain. Other salivary glands involved include submandibular adenitis and sublingual adenitis.

19. Clinical meningitis occurs in 15% of patients with mumps. Its onset averages 4-5 days after parotitis but may before, after or in the absence of parotitis. Clinical features are headache, vomiting, fever and nuchal rigidity. CSF pleocytosis. Prognosis is benign. The onset of orchitis is abrupt with high temperature, chills, testicular pain and swelling. Impaired fertility is rare.

20. Diagnosis In most instances, the diagnosis of mumps is made on the basis of a exposure history and of parotid swelling and tenderness accompanied other symptoms. Laboratory confirmation is unnecessary in typical cases, exception the absence or recurrence of parotitis and extrasalivary glands involved. Serologic tests,viral isolation. Amylase and lipase.

21. Prognosis Benign and self-limited Major death causes are severe mumps encephalitis

22. treatment There is no specific anti-viral drug therapy. Treatment is supportive by treating symptoms, using antipyretics and analgesics.

23. Child care The child must rest in bed until the fever goes away. Isolate the child, to prevent spreading the disease to other. Use analgesics and anti-pyretic to ease symptoms. Avoid food that require chewing. Avoid sour foods that stimulate saliva production. Drink plenty of water. Use cold compress to ease the pain of swelling glands.

24. Prevention A live attenuated vaccine is available (MMR). It contains mumps, measles and rubella attenuated virus strains. Administered in one dose, intramuscularly or subcutaneously. The vaccine is protective.

26. Rubella is an acute, contagious viral infection. While the illness is generally mild in children, it has serious consequences in pregnant women causing fetal death or congenital defects known as congenital rubella syndrome (CRS).

27. The name rubella is derived from a Latin term meaning "little red." Rubella is sometime called German Measles or 3-day Measles. The synonym "3-day measles" derives from the typical course of rubella exanthema that starts initially on the face and neck and spreads centrifugally to the trunk and extremities within 24 hours. It then begins to fade on the face on the second day and disappears throughout the body by the end of the third day. It is a generally mild disease caused by the rubella virus.

28. Agent – RNA virus (Togo virus family), Genus Rubivirus. Source of infection – Respiratory secretion Host -3-10 yrs Immunity –life long Environmental factors –winter and spring season Transmission – droplet, vertical transmission I.P – 2-3 weeks average 18 days

29. Symptoms In children, the disease is usually mild, with symptoms including a rash, low fever (<39°C), nausea and mild conjunctivitis. The rash, which occurs in 50–80% of cases, usually starts on the face and neck before progressing down the body, and lasts 1–3 days. Swollen lymph glands behind the ears and in the neck are the most characteristic clinical feature. Infected adults, more commonly women, may develop arthritis and painful joints that usually last from 3–10 days. When a woman is infected with the rubella virus early in pregnancy, she has a 90% chance of passing the virus on to her fetus.

30. Congenital rubella syndrome Children with CRS can suffer hearing impairments, eye and heart defects and other lifelong disabilities, including autism, diabetes mellitus and thyroid dysfunction – many of which require costly therapy, surgeries and other expensive care. The highest risk of CRS is in countries where women of childbearing age do not have immunity to the disease (either through vaccination or from having had rubella). Before the introduction of the vaccine, up to 4 babies in every 1000 live births were born with CRS.

31. 0–28 days before conception - 43% chance 0–12 weeks after conception - 51% chance 13–26 weeks after conception - 23% chance Infants are not generally affected if rubella is contracted during the third trimester

32. Vaccination he rubella vaccine is a live attenuated strain that has been in use for more than 40 years. A single dose gives more than 95% long-lasting immunity, which is similar to that induced by natural infection. Rubella vaccines are available either in monovalent formulation (vaccine directed at only one pathogen) or more commonly in combinations with other vaccines such as with vaccines against measles (MR), measles and mumps (MMR), or measles, mumps and varicella (MMRV).