Download Measles, Mumps and Rubella

Measles, Mumps and Rubella
Ruth Carrico PhD RN FSHEA CIC
Associate Professor
Division of Infectious Diseases
University of Louisville
[email protected]
Reported Cases of Measles, Mumps,
Rubella in the US during 2011
Rubella: 4
Measles: 220
Mumps: 404
Summary of Notifiable Diseases. MMWR 2013;60(53):1-120
Rubella
Rubella
•
•
•
•
•
•
•
Name derived from a Latin term meaning “little red”
Also known as German Measles or 3-day Measles
Acute viral illness causing fever and rash
Rash [maculopapular] and fever last 2-3 days
Transmission via respiratory droplets
Incubation period of 17 days [range 12-23 days]
Most infectious when rash erupting; can shed virus 7
days before to 7 days after rash onset
• Most concerning impact is when infection occurs
during pregnancy
Measles
•
•
•
•
RNA virus; Paramyxovirus
Highly contagious viral illness
Systemic infection
Airborne transmission with the viral particles
being rapidly inactivated by heat and light.
Survival time <2 hrs on objects and surfaces
• Preferential toward winter season
Measles, United States, January – June 17, 2011
Source of Importations
WHO Region
Total number
of cases
Countries
Genotype
Identified
African
2
Kenya (1), Nigeria (1)
B3 (2)
Eastern
Mediterranean
2
Pakistan (1), Jordan (1)
D4 (1)
European
25
France (12), Italy (4), Poland
(1), Romania (1), Spain (1),
United Kingdom (4),
France/United Kingdom*(1),
France/Italy/Spain/Germany
*(1)
D4 (11), G3
(1)
Americas
1
Dominican Republic†(1)
D4 (1)
South-East Asia
16
India (15), Indonesia (1)
D8 (5), D4 (1)
Western Pacific
7
China (2), Philippines (4),
Philippines/Vietnam/Singapore
/Malaysia*(1)
H1 (1), D9 (2)
70% of importations among U.S. residents traveling abroad
*Patient visited more than 1 country during the incubation period
† Likely acquired disease from French tourist
Measles – Outbreak 2011
MMWR May 24, 2011
Measles – Outbreak 2011
MMWR May 24, 2011
Measles
• Incubation period 10-12 days [range 7-18
days]
• Prodrome includes fever of 103 or higher
• Cough, chorya, conjunctivitis
• Rash is maculopapular lasting 5-4 days
• 30% or more who have the disease will have
complications
Mumps
Mumps
• Viral illness caused by a paramyxovirus
• Classic symptoms include parotitis in about 50%
(unilater or bilateral) developing 16-18 day after
exposure
• Nonspecific symptoms (myalgia, malaise,
anorexia, fever may precede parotitis.
• 15-20% of infections are asymptomatic
• Incubation period 16-18 days [range 12-25 days].
• Most infectious 1-2 days before until 5 days after
parotitis
Mumps
• Virus replicates in upper respiratory tract
• Droplet transmission as well as contact with
respiratory secretions, saliva or items
contaminated with those fluids
• Severe complications are rare, but adults have
higher risk of meningoencephalitis than do
children
• Males may experience orchitis in up to 30-40%
of those infected
Measles-Mumps-Rubella Vaccine (MMR)
• Contains live attenuated viruses
• 1-dose efficacy varies from 80% (mumps) to
95% (measles and rubella)
• Duration of immunity probably lifelong
• Schedule is 2 doses, 28 days apart
• All adults born in 1957 or later should have
documentation of 2 doses (or other
evidence of immunity)
Vaccine uses a diluent
Given subcutaneously
in the upper arm
Adults at High Risk for Measles
•
•
•
•
College students
Those living in crowded or congregate settings
International travelers
Healthcare personnel
MMR Vaccine Contraindications
• Severe allergic reaction to vaccine component
or following prior dose
• Pregnancy
• Those indicating that pregnancy within the
next 4 weeks is likely
• Immunosuppression (severe)
MMR Adverse Reactions
Fever
Rash
Joint Symptoms
Thrombocytopenia
Parotitis
Deafness
Encephalopathy
5-15%
5%
25%
1/30,000 doses
Rare
Rare
1/1,000,000 doses
Addressing a Low Incidence Disease
• Remember why it is low incidence
• Identify high risk populations for acquisition
and transmission
• Determine populations with opportunity to
aid in transmission or be impacted by the
disease