MUMPS, MEASLES AND RUBELLA

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MUMPS, MEASLES AND RUBELLA
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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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VACCINE EFFECTIVENESS
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• PARAMYXOVIRUS FAMILY
• MUMPS
• MEASLES

• TOGAVIRUS FAMILY
• RUBELLA

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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
• Rubrivirus genus
• AEROSOL
• CHILDREN, ADULTS
• mild
• FETUS
• can be severe

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RUBELLA
Murray et al. Medical Microbiology
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RUBELLA

• DISEASE IN CHILDREN AND ADULTS

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SYMPTOMS

• SORE THROAT, RUNNY NOSE, COUGH
• FEVER
• RASH, MINOR, IRREGULAR
• lasts 12hour to 5days
• not always seen
• ARTHRALGIA, ARTHRITIS
• 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
• 20,000 infants with permanent problems
• 6,000 to 30,000 spontaneous abortions
• 5,000 therapeutic abortions
• 1969 to present
• maximum of 67 cases congential 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

• 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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PARVOVIRUS (erythrema infectiosum)
Murray et al. Medical Microbiology
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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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DIAGNOSIS

• Serology
• Isolation

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PREVENTION

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

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EPIDEMIOLOGY

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

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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 (2 proteins)
M protein
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PARAMYXOVIRUS FAMILYproperties of attachment
protein
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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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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 - Kopliks spots
Murray et al. Medical Microbiology
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MEASLES - RASH
CDC - B.Rice
Murray et al. Medical Microbiology
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DISEASE

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

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RECOVERY

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

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COMPLICATIONS

• GIANT CELL PNEUMONIA

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MEASLES GIANT CELL PNEUMONIA
Murray et al. Medical Microbiology
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COMPLICATIONS

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

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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 1,000,000/YR
WORLDWIDE
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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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MEASLES ENCEPHALITIS

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

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SUB-ACUTE SCLEROSING PANENCEPHALITIS

• SSPE

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IMMUNOSUPPRESSION AND MEASLES

• TEMPORARY DEPRESSION OF IMMUNE RESPONSE
• MAY GET REACTIVATION OF HERPES, TUBERCULOSIS

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DIAGNOSIS

• Serodiagnosis, isolation
• 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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The State, Columbia, S.C. Saturday October 16,
1999
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The State, Columbia, S.C. Saturday October 16,
1999
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PREVENTION

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

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TREATMENT

• SUPPORTIVE CARE

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PARAMYXOVIRUSESMUMPS
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MUMPS
CDC - B.Rice
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RECOVERY

• CELL MEDIATED IMMUNITY

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DIAGNOSIS

• 30 INFECTIONS SUB-CLINICAL
• SEROLOGY OR ISOLATION

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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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END
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