MMR
Measles, Mumps &Rubella
By
DR.I.SELVARAJ
B. Sc., M.D., D.P.H., D.I.H.,
PGCH&FW( NIHFW, New Delhi)
Indian Railways Medical Service (Rtd)
Assistant Professor
• This PowerPoint presentation will be an additional
resources for Para medical people Public health
nurses, MBBS students and MD Post graduate
students around the world.
• This droplet infections has to be eradicated. As we are
having effective vaccine against this infections, no
carriers & no animal reservoir and paramedical people
can easily identify the signs & symptoms
• The public health institution has to give more
importance for this infectious diseases to control
• My best wishes to the Supercourse team
Dr.I.Selvaraj
Indian railways Medical service (Rtd)
Measles
(English Measles)
Agent
• Agent- RNA virus ( Paramyxo virus family,
genus Morbillivirus )
• Source of infection-cases of measles,
but not carriers.
• No animal reservoir
• Infective material- Nasal secretion ,Respiratory
tract &Throat
• Communicability- Highly infectious during
prodromal period and at the time of eruption.
• Secondary attack rate- > 80%
Host factors
• Age- 6 months to 3 years even up to 10
years
• Incidence equal in both sexes
• Immunity – life long immunity
• Malnourished children are susceptible
Environmental factor
• Winter season, over crowding
• Transmission – Droplet infection
• 4 days before and 4 days after
rash
• Incubation period- 7 days
Courtesy : Adapted from Mims et al. Medical Microbiology, 1993,
Mosby
Clinical features
• Prodromal stage
• Eruptive stage
• Post-measles stage
Clinical features
•
•
•
•
3 Cs (Cough, Coryza & Conjunctivitis)
Koplik spots
Four days fever (400c)
Generalized, maculopapular,erythematous
rash.
Courtesy : This media comes from the Centers for Disease Control and
Prevention's Public Health Image Library (PHIL), with identification
number #3168
KOPLIK SPOT
Source:
http://phil.cdc.gov/PHIL_Images/20040908/4f54ee8f0e5f49f58aaa30c1bc6413ba/6111_lo
res.jpg
Complication
• Diarrhea,
• Pneumonia
• Otitis media
• Convulsions,
• SSPE (sub acute sclerosing panencephalitis)
WHO strategy for control and
prevention of Measles
1) Catch up
2) Keep up
3) Follow up
Mumps
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
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 Rice
Agent
• Myxovirus parotidis –RNA virus
• Source of infection – Respiratory,
milk
• Period of communicability – 4-6 days
of onset of symptoms
• Secondary attack rate – 86%
• Age & sex 5-15 yrs and girls
common
• Immunity - life long
• Environmental factor – winter and
spring season favors
• Mode of transmission – droplet
• I.P - 2 to 3 weeks
Clinical features
• Parotid swelling
• Ovaritis
• Pancreatitis
• Ear ache
• Orchitis
Courtesy : Adapted from Mims et al.
Medical Microbiology, 1993, Mosby
Complications
•
•
•
•
•
•
•
Orchitis
Epididymitis
Oophoiritis
Spontaneous abortion
Sensori neural hearing loss, (uni- or bilateral).
Mild form of meningitis
Encephalitis
Rubella (German measles)
• 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.
• 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
• Eye pain on lateral and upward eye movement (a particularly
troublesome complaint)
• Conjunctivitis
• Sore throat
• Headache
• General body aches
• Low-grade fever
• Chills
• Anorexia
• Nausea
• Tender lymphadenopathy (particularly posterior auricular and
suboccipital lymph nodes)
• Forchheimer sign (an enanthem observed in 20% of patients
with rubella during the prodromal period; can be present in
some patients during the initial phase of the exanthem; consists
of pinpoint or larger petechiae that usually occur on the soft
palate)
Temperature
• Fever is usually not higher than 38.5°C
(101.5°F).
Lymph nodes
• Enlarged posterior auricular and suboccipital
lymph nodes are usually found on physical
examination.
Mouth
• The Forchheimer sign may still be present on
the soft palate.
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.
• 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
Photo source: U.S. Centers for Disease Control and Prevention
Salt and pepper retinopathy
http://www.kellogg.umich.edu/theeyeshave
it/congenital/retinopathy.html
Courtesy
http://phil.cdc.gov/phil_images/2003072
4/28/PHIL_4284_lores.jpg
Content Providers(s): CDC Creation
Date: 1976
Courtesy: Jonathan Trobe, M.D. - University
of Michigan Kellogg Eye Center
• Sensorineural hearing loss – 58%
• Ocular abnormalities including cataract,
infantile glaucoma, Micro ophthalmia
and pigmentary retinopathy occur in
approximately 43%
• Congenital heart disease including patent
ductus arteriosus (PDA) and pulmonary
artery stenosis - 50%
Measles vaccine
• Live attenuated measles virus (Edmonston-zagreb
strain) Propagated on human diploid cell (MRC-5)
• 0.5 ml of vaccine
• Not less than 1000 CCID50 of measles virus
• 2.5% of gelatin
• 5% of sorbitol as stabilizers
• 0.5 ml of sterile water
• Dose – 0.5 ml
• Route of administration: Sub-cutaneously
• 3 to 5 weeks antibody level – 200mLU/ml
Mumps Vaccine
• 10 strains of the mumps virus are in use
throughout the world for the preparation of
live attenuated vaccine.
• Jeryl Lynn strain which was named after the
child from whom the virus was isolated.
• Leningrad-3 strain
• Urabe strain
• Hoshino, Torii and NKM - 46 strains
• L-Zagreb
MMR Vaccine
• Live attenuated strains of Edmonston-Zagreb
Measles virus propagated on human diploid cell
culture,
• L-Zagreb Mumps virus propagated on chick
embryo fibroblast cells
• Wistar RA 27/3 Rubella virus propagated on
human diploid cell culture.
• 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.
The vaccine meets the requirements of USP and WHO
when tested by the methods outlined in USP and WHO,
TRS 840 (1994).
• For active immunization in children of 12 months to 12
years of age against Measles, Mumps and Rubella
infections –MMR Vaccine to be given
• For immunisation of susceptible non pregnant,
adolescent and adult females, we have to use Rubella
Vaccine)
• Measles vaccine has to be given at 9 months,
• If Measles vaccine is given ,a 3 months gap is
advisable to give MMR vaccine
• MMR vaccine may be given between 12-15 months of
age.
• If Measles vaccine was missed , MMR dose replaces
it, when given at or after 12 months.
•
• The vaccine should be reconstituted with the
diluent supplied (Sterile water for injection) using
a sterile Auto disabled syringe with needle.
• After reconstitution the vaccine should be used
immediately.
• A single dose of 0.5 ml should be administered by
deep subcutaneous injection into the upper arm.
• If the vaccine is not used immediately then it
should be stored in the dark at 2° - 8°C for no
longer than 8 hours.
Age
Vaccines Note
9 months Measles
Deep subcutaneous injection
into the upper arm.
12-15
months
MMR -1
Deep subcutaneous injection
into the upper arm.
MMR -2
Deep subcutaneous injection
into the upper arm.
5 years
• Murray et al., Microbiology
5th Ed., Chapters 56, 59, 63 (pp. 645-648)
• Mims et al. Medical Microbiology, 1993
• K. Park 21st edition
• Text book of community medicine by
Sundarlal, Adarsh, Pankaj