MMR epidemiological study and its features
- 3. 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%
- 4. 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
- 5. Environmental factor • Winter season, over crowding • Transmission – Droplet infection • 4 days before and 4 days after rash • Incubation period- 7 days
- 6. Courtesy : Adapted from Mims et al. Medical Microbiology, 1993, Mosby
- 7. Clinical features • Prodromal stage • Eruptive stage • Post-measles stage
- 8. Clinical features • 3 Cs (Cough, Coryza & Conjunctivitis) • Koplik spots • Four days fever (400 c) • Generalized, maculopapular,erythematous rash.
- 9. Courtesy : This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #3168
- 12. Complication • Diarrhea, • Pneumonia • Otitis media • Convulsions, • SSPE (sub acute sclerosing panencephalitis)
- 13. WHO strategy for control and prevention of Measles 1) Catch up 2) Keep up 3) Follow up
- 14. Clinical features • Parotid swelling • Ovaritis • Pancreatitis • Ear ache • Orchitis
- 15. Courtesy : Adapted from Mims et al. Medical Microbiology, 1993, Mosby
- 17. • 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.
- 18. • 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
- 19. • 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)
- 20. 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.
- 21. 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.
- 22. • 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
- 23. Photo source: U.S. Centers for Disease Control and Prevention
- 25. Salt and pepper retinopathy Content Providers(s): CDC Creation Date: 1976 Courtesy http://phil.cdc.gov/phil_images/2003072 4/28/PHIL_4284_lores.jpg http://www.kellogg.umich.edu/ theeyeshaveit/congenital/retinopathy.html Courtesy: Jonathan Trobe, M.D. - University of Michigan Kellogg Eye Center
- 26. • 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%
- 27. 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
- 28. 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
- 29. 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.
- 30. • 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).
- 31. • 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. •
- 32. • 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.
- 33. 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. 5 years MMR -2 Deep subcutaneous injection into the upper arm.
- 34. • 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
- 36. Photo source: U.S. Centers for Disease Control and Prevention
- 38. Salt and pepper retinopathy Content Providers(s): CDC Creation Date: 1976 Courtesy http://phil.cdc.gov/phil_images/2003072 4/28/PHIL_4284_lores.jpg http://www.kellogg.umich.edu/ theeyeshaveit/congenital/retinopathy.html Courtesy: Jonathan Trobe, M.D. - University of Michigan Kellogg Eye Center