MUMPS, MEASLES RUBELLA and human parvovirus

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MUMPS, MEASLES RUBELLA and human parvovirus
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MEASLES (RUBEOLA)MUMPSRUBELLA

• MAN
• WORLD WIDE
• SINGLE SEROTYPE OF EACH VIRUS
• LIVE ATTENUATED VACCINE (MMR)
• CHILDHOOD DISEASES (PRE-VACCINE)
• NOTIFIABLE DISEASE

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• PARAMYXOVIRUS FAMILY
• MUMPS
• MEASLES

• TOGAVIRUS FAMILY
• RUBELLA

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MEASLES AND MUMPS
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PARAMYXOVIRUSES
HN/H/G glycoprotein SPIKES
pleomorphic
F glycoprotein SPIKES
helical nucleocapsid (RNA plus NP protein)
lipid bilayer membrane
polymerase complex
M protein
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(No Transcript)
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MEASLES (Rubeola)

• 2001
• gt40,000,000 infections world wide
• gt1,000,000 deaths world wide
• 2004
• 20,000,000 infections world wide
• 240,000 deaths world wide

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VACCINE EFFECTIVENESS
http//www.cdc.gov/nip/ed/slides/slides.htm
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Measles 1996-present

• Endemic transmission interrupted
• Only 44 cases in US in 2002 - but 131 cases
  Jan-Jul 2008
• Most cases imported or linked to importation

http//www.cdc.gov/nip/ed/slides/slides.htm
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INFECTION

• AEROSOL
• VERY CONTAGIOUS

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viremia
Adapted from Mims, Playfair, Roitt, Wakelin and
Williams (1993) Medical Microbiology
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MEASLES - Kopliks spots
Murray et al. Medical Microbiology
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DISSEMINATED SPREAD

• LONGER TIME FOR SYMPTOMS
• IMMUNE RESPONSE
• (IF SYMPTOMS DUE TO IMMUNE RESPONSE, USUALLY
  INFECTIOUS PRIOR TO SYMPTOMS)

Adapted from Mims, Playfair, Roitt, Wakelin and
Williams (1993) Medical Microbiology
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MEASLES - RASH
CDC - B.Rice
Murray et al. Medical Microbiology
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DISEASE

• STILL INFECTIOUS AFTER SYMPTOMS START
• FEVER
• RESPIRATORY TRACT SYMPTOMS
• rhinorrhea, cough
• KOPLIKS SPOTS
• MACULOPAPULAR RASH
• T-cells -gtendothelial cells
• CONJUNCTIVITIS
• epithelial cells

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RECOVERY

• FAIRLY RAPID
• T-cell response important
• agammaglobulinemia recover
• T-cell deficient, may be no rash, may be severe
  disease (life threatening)
• DISEASE MORE SEVERE IN ADULTS

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COMPLICATIONS

• GIANT CELL PNEUMONIA

Histopathology of measles pneumonia. CDC/Dr.
Edwin P. Ewing, Jr. Giant cell with
intracytoplasmic inclusions
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COMPLICATIONS

• GIANT CELL PNEUMONIA
• SECONDARY BACTERIAL INFECTIONS
• MORE SEVERE IF MALNOURISHED AND/OR POOR ACCESS TO
  MEDICAL CARE
• MEASLES ENCEPHALITIS

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Mims et al., Medical Microbiology 1993
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PROBLEMS

• vitamin A deficient -gt low mucosal defense
• low protein, calories -gt impaired immunity
• lack of antibiotics for secondary infections
• lack of vaccination (need cold chain)
• poor hygiene

ESTIMATE THAT MEASLES KILLS 240,000/YR WORLDWIDE
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MEASLES ENCEPHALITIS

• 1/1000 cases
• sequelae
• deafness
• seizures
• mental disorders

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SSPE

• sub-acute sclerosing panencephalitis
• inflammatory disease
• defective virus (often lacking M protein)
• early infection with measles is a risk factor
• rare (7/1,000,000 cases of measles)
• decrease since vaccination program

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IMMUNOSUPPRESSION AND MEASLES

• TEMPORARY DEPRESSION OF IMMUNE RESPONSE
• Tuberculin ve individuals may temporarily become
  -ve
• MAY GET REACTIVATION OF HERPES, TUBERCULOSIS
• Dont see with vaccine strain

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DIAGNOSIS

• Serodiagnosis
• Significant increase in IgG (need two samples)
• Positive for IgM
• Isolation
• RT-PCR
• All suspect cases should be confirmed by
  laboratory

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EPIDEMIOLOGY

• ALMOST ALL INFECTED INDIVIDUALS SHOW DISEASE
• ONE SEROTYPE
• NATURAL INFECTION GIVES LIFE LONG PROTECTION
• MOST CONTAGIOUS BEFORE RASH IS EVIDENT

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PREVENTION

• LIVE ATTENUATED VACCINE
• Does not spread to contacts
• Can cause problems in immuno-suppressed
• IMMUNE SERUM GLOBULIN

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TREATMENT

• SUPPORTIVE CARE

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PARAMYXOVIRUSESMUMPS
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• Mumps Outbreak United States 2006

Total reported cases 4,602
4
193
1
650
85
1,921
349
501
3
134
782
1
2
In PA, 14 of the 85 cases are considered
outbreak-associated.

• Provisional Number of Cases by State as of June
  20, 2006

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MUMPS
CDC - B.Rice
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Mims et al., Medical Microbiology 1993
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Mims et al., Medical Microbiology 1993
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RECOVERY

• CELL MEDIATED IMMUNITY

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DIAGNOSIS

• 30 INFECTIONS SUB-CLINICAL
• SEROLOGY OR ISOLATION
• RT-PCR

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EPIDEMIOLOGY

• MAN ONLY HOST
• ONE SEROTYPE
• SUB-CLINICAL INFECTIONS
• CONTAGIOUS BEFORE AND AFTER SYMPTOMS

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PREVENTION

• LIVE ATTENUATED VACCINE
• DOES NOT SPREAD TO CONTACTS
• Contradindicated in
• immune-suppressed
• pregnant women

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RUBELLA VIRUS
glycoprotein
icosahedral nucleocapsid
RNA (single-stranded positive-sense)
lipid bilayer membrane
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RUBELLA VIRUS

• TOGAVIRUS FAMILY
• Alphavirus genus
• Rubivirus genus
• AEROSOL
• CHILDREN, ADULTS
• mild
• FETUS
• can be severe

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RUBELLA (German measles)
Murray et al. Medical Microbiology
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(No Transcript)
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SYMPTOMSchildren and adults

• SORE THROAT, RUNNY NOSE, COUGH
• FEVER
• RASH, MINOR, IRREGULAR
• lasts 12hour to 5days
• not always seen
• ARTHRALGIA, ARTHRITIS
• especially in adults, especially women
• LYMPHOADENOPATHY

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COMPLICATIONS

• ENCEPHALITIS (RARE)

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RECOVERY

• T-CELL

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PROTECTION

• IgG, IgA
• IgM may persist

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EFFECTS ON FETUS

• HEARING LOSS
• CONGENITAL HEART DEFECTS
• NEUROLOGICAL
• PYSCHOMOTOR AND/OR MENTAL RETARDATION
• OPHTHALMIC
• CATARACT, GLAUCOMA, RETINOPATHY

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EFFECTS ON FETUS

• thrombocytopenia
• hepatomegaly
• splenomegaly
• intrauterine growth retardation
• bone lesions
• pneumonitis

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EFFECTS ON FETUS

• First trimester
• 65-85 of neonates have sequelae

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EFFECTS ON FETUS

• 1964-65 season (pre-vaccine)
• congenital rubella syndrome (CRS) cases 20,000
• Deaf 11,600
• Blind 3,580
• Mentally retarded 1,800
• Abortions (spontaneous/surgical) 11,250
• Neonatal deaths 2,100
• 1969 to present
• maximum of 67 cases congenital rubella/yr
• usually fewer than 10

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CONGENITAL INFECTIONS

• SHED VIRUS FOR A YEAR OR MORE AFTER BIRTH
• nasopharynx, urine, feces

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CONGENITAL INFECTIONS

• EYE PROBLEMS
• GLANDULAR COMPLICATIONS
• diabetes
• thyroid problems
• deficiency growth hormone

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CONGENITAL / VERY EARLY INFECTIONS

• PROGRESSIVE RUBELLA PANENCEPHALITIS

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DIAGNOSIS

• Serology
• Significant rise in IgG
• Positive for IgM
• Isolation
• RT-PCR

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DIAGNOSIS

• 50 infections sub-clinical
• rash not always seen
• many other agents cause similar symptoms

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RUBELLA-LIKE SYMPTOMS
OTHER CAUSES INCLUDE

• HUMAN PARVOVIRUS
• SOME ALPHAVIRUSES
• SOME ENTEROVIRUSES

• SOME ADENOVIRUSES
• EPSTEIN-BARR VIRUS
• SCARLET FEVER
• TOXIC DRUG REACTIONS

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PREVENTION

• LIVE ATTENUATED VACCINE
• DOES NOT SPREAD TO FAMILY MEMBERS
• CHILDREN
• SUSCEPTIBLE NON-PREGNANT FEMALES

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EPIDEMIOLOGY

• MAN SOLE HOST
• WORLD WIDE
• ONE SEROTYPE
• NATURAL INFECTION PROTECTS FOR LIFE

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PARVOVIRUS B-19 (erythrema infectiosum)
Murray et al. Medical Microbiology
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PARVOVIRUS B19

• very small, non-enveloped, icosahedral,
  single-stranded DNA virus
• erythrema infectiosum, fifth disease
• mild rash, acute arthralgia
• replicates in red blood cell precursors
• can cause problems in those with chronic anemia,
  immune suppression
• May cause spontaneous abortion of fetus (anemia)