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Measles, Mumps and Rubella
Ruth Carrico PhD RN FSHEA CICAssociate Professor
Division of Infectious DiseasesUniversity of Louisville
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
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, United States, January – June 17, 2011 Source of Importations
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 ReactionsFever 5-15%Rash 5%Joint Symptoms 25%Thrombocytopenia 1/30,000 dosesParotitis RareDeafness RareEncephalopathy 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