1. بسم الله الرحمن الرحيم

2. Measles Agent- RNA virus ( Paramyxo virus family, genus Morbillivirus )

3. Environmental factor Winter season, over crowding Transmission – Droplet infection, direct contact with nasal or throat secretions of infected persons, 4 days before and 4 days after rash. Incubation period- about 10 days (7 to 18 days)…

4. Clinical features 3 Cs (Cough, Coryza & Conjunctivitis) Koplik spots Four days fever (40 0 c) Generalized maculopapular,erythematous rash. The rash begins on face then becomes generalized, lasts for 4-7 days.

5. Courtesy : This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #3168Centers for Disease Control and PreventionPublic Health Image Library#3168

6. KOPLIK SPOT Source: http://phil.cdc.gov/PHIL_Images/20040908/4f54ee8f0e5f49f58aaa30c1bc6413ba/6111_lo res.jpg

8. Complication Diarrhea, Pneumonia Laryngotracheobronchitis Otitis media Convulsions, Encephalitis, SSPE ( sub acute sclerosing panencephalitis) (rarely)

9. Diagnosis of Measles Ask questions about: Symptoms Current medical conditions Current medications Family history of medical conditions Serology- detect the presence of antibodies against a microorganism certain microorganisms stimulate the body to produce antibodies during an active infection 9

10. Mumps (Infectious parotitis)

11. Mumps Acute viral diseases.. Myxovirus parotidis –RNA virus. The name comes from the British word "to mump", that is grimace or grin. The appearance of the patient as a result of parotid gland swelling seems to be in grin.

12. Courtesey: This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #130 Content Providers: CDC/NIP/Barbara RiceCenters for Disease Control and PreventionPublic Health Image Library#130

13. Immunity - life long Environmental factor – winter and spring are peak seasons. Reservoir : Humans. Mode of transmission – airborne transmission, droplet spread, direct contact with salivary of infected person.

14. I.P - 16-18 days. Period of communicability: Virus has been isolated from saliva (7 days before to 9 days after the onset of parotitis ) and from urine (6 days before to 15 days after the onset parotitis). Maximum infectiousness occurs between 2 days before, 4 days after onset of illness.

15. Clinical features Fever Swelling & tenderness of one or more salivary glads, usually parotid. Orchitis most commonly unilateral (postpubertal males)

16. Courtesy : Adapted from Mims et al. Medical Microbiology, 1993, Mosby

17. Complications Orchitis Oophoiritis Spontaneous abortion. Sensory neural hearing loss, (uni- or bilateral). Mild form of meningitis. Encephalitis. Pancreatitis usually mild, 4% of cases Symptomatic aseptic meningitis up to 10 % of cases

18. Acute mumps infection can be confirmed by : -A positive serological test for specific- mumps IgM. - A significant ( at least 4 folds ) rise in serum mumps IgG. -Isolation of mumps virus.

19. Rubella (German measles)

20. Agent – RNA virus (Togo virus family), Genus Rubivirus. Source of infection – Respiratory secretion Reservoir : Human Immunity –life long Environmental factors –winter and spring season Transmission – droplet, direct contact with patient, vertical transmission I.P 14-17 days. Period of communicability 1 week before and at least 4 days after onset of rashes.

21. Clinical feature: Low-grade fever Conjunctivitis Mild coryza. Tender lymphadenopathy (particularly posterior auricular and ooccipital, posterior cervical lymph nodes). Leukopenia is common. Body rashes, Maculo-papular rashes

22. Complications Encephalitis Intrauterine death Spontaneous abortion Congenital rubella syndrome (CRS) up to 90% of infants born to infected mothers. Include : - Deafness, cataract, congenital glaucoma, microcephaly, meningoencephalitis, mental retardation, patent ductus arteriosis, arterial septal defect, hepatosplenomegaly.

23. Image in a 4-year-old girl with a 4-day history of low-grade fever, symptoms of an upper respiratory tract infection, and rash. Courtesy of Pamela L. Dyne, MD.

24. Photo source: U.S. Centers for Disease Control and Prevention

26. Salt and pepper retinopathy Content Providers(s): CDC Creation Date: 1976 Courtesy http://phil.cdc.gov/phil_images/2003072 4/28/PHIL_4284_lores.jpg http://www.kellogg.umich.edu/theeyeshave it/congenital/retinopathy.html Courtesy: Jonathan Trobe, M.D. - University of Michigan Kellogg Eye Center

27. Prevention Public education by health departments and physicians for encouraging immunization. MMR vaccine: Live attenuated virus vaccine helps prevent measles, mumps, and rubella. Children 1 year of age and older get dose given between ages 15 and 18 months and again between ages 4 and 6 years Taking serum immune globulin 6 days after being exposed to the measles virus can reduce the risk in contacts, or can make the disease less severe U.S. Dept. of Health & Human Services, Wikimedia CommonsWikimedia Commons 27

28. Vitamin A supplements: reduce the risk of death and complications in children in less developed countries People who lack vitamin A are more likely to get infections, including measles. Prevention 28

29. Control of patients and contacts -Report to local health authority.. -Respiratory Isolation for known cases.. -Concurrent disinfection … -Investigation of contacts and source of infection…

30. Isolation Precautions Respiratory isolation- airborne precautions- are used for those patients who have or are suspected of having infections transmitted by the airborne route This means that the bacteria or virus causing their disease is so small that it can be suspended in the air for periods of time Examples of diseases: tuberculosis (TB), varicella (chickenpox), zoster (shingles), and measles Children with measles should kept out of school 30

31. AgeVaccinesNote 9 monthsMeasles Deep subcutaneous injection into the upper arm. 12-15 monthsMMR -1 Deep subcutaneous injection into the upper arm. 5 yearsMMR -2 Deep subcutaneous injection into the upper arm.

32. Contraindication for live virus vaccine -Patient with primary immune deficiency: e.g. lymphoma, leukemia.. -Patient with sever acute illness: e.g. upper respiratory disease. - Patient with anaphylactic hypersensitivity. -Vaccine should be given at least 14 days before IG or blood transfusion.

33. Chicken pox

34. Chicken pox is acute, generalized disease caused by a virus called varicella zoster.

35. Varicella Zoster Virus Herpes virus (DNA) Primary infection results in varicella (chickenpox) Recurrent infection results in herpes zoster (shingles) Short survival in environment

36. Varicella Pathogenesis Respiratory transmission of virus Replication in nasopharynx and regional lymph nodes Repeated episodes of viremia Multiple tissues, including sensory ganglia, infected during viremia

37. Varicella Clinical Features Incubation period 14-16 days (range 2-3 weeks) Mild prodrome for 1-2 days Generally appear first on head; most concentrated on trunk Successive crops (2-4 days) of pruritic vesicles

38. Varicella Epidemiology Reservoir Human Transmission Air droplet, Direct contact with lesion. Communicability 1-2 days before, to 4-5 days after onset of rash..

39. Varicella Vaccine CompositionLive virus (Oka-Merck strain) Efficacy95% (Range, 65%-100%) Duration of >7 years Immunity Schedule1 Dose (<13 years of age) May be administered simultaneously with measles- mumps-rubella (MMR) vaccine

40. Whooping cough (Bordetella pertussis) http://www.hhmi.princeton.edu/sw/2002/psidelsk/Microlinks.htm

41. Whooping Cough (Pertussis) Acute bacterial infection of respiratory tract… Bordetella pertussis, aerobic, gram negative coccobacillus …. Specific to Humans… Colonizes the respiratory tract http://microvet.arizona.edu/Courses/MIC420/lecture_notes/bordetella_pertussis/ gram_pertussis.html

42. Clinical Features Incubation period 9-10 days (range 6-20days) 3 Stages – 1 st Stage- Catarrhal Stage insidious onset with an irritating cough… – 2 nd Stage- Paroxysmal Stage repeated violent cough… – 3 rd Stage- Covalescent Stage weeks-months http://www.cdc.gov/nip/publications/pertussis/chapter1.pdf

43. Transmission Very Contagious Transmission occurs via respiratory droplets Reservoir Human Period of communicability Highly during catarrhal stage & at beginning of paroxysmal stage(1-2 weeks) http://www.ratbags.com/rsoles/history/2000/12december.htm http://www.universityscience.ie/imgs/scientists/whoopingcough.gif

44. Diagnosis Isolation by culture PCR Serological testing http://medinfo.ufl.edu/year2/mmid/bms5300/images/d7053.jpg

45. Pertussis Vaccine 1st Pertussis vaccine- whole cell A cellular vaccine now used (contain 1-5 different component of bacteria… http://www.nfid.org/publications/clinicalupdates/pediatric/pertussis.html http://www.tdh.state.tx.us/immunize/providers.htm

46. Control of patients and contacts -Report to local health authority.. -Respiratory Isolation for known cases.. -Concurrent disinfection … -Investigation of contacts and source of infection…

47. THANK YOU