Highly contagious viral illness

First described in 7th century

Near universal infection of childhood in prevaccination era

Common and often fatal in developing areas

Paramyxovirus (RNA)

Rapidly inactivated by heat and light

Respiratory transmission of virus

Replication in nasopharynx and regional lymph nodes

Primary viremia 2-3 days after exposure

Secondary viremia 5-7 days after exposure with spread to tissues

Incubation period 10-12 days

Stepwise increase in fever to
103°F or higher

Cough, coryza, conjunctivitis

Koplik spots

2-4 days after prodrome, 14 days after exposure

Maculopapular, becomes confluent

Begins on face and head

Persists 5-6 days

Fades in order of appearance

Diarrhea

Otitis media

Pneumonia

Encephalitis

Hospitalization

Death

Reservoir Human

Transmission Respiratory Airborne

Temporal pattern Peak in late winter–spring

Communicability 4 days before to 4 days after
rash onset

Vaccine Licensed

Composition Live virus

Efficacy 95% (range, 90%-98%)

Duration of
Immunity Lifelong

Schedule 2 doses

Should be administered with mumps and rubella as MMR, or with mumps, rubella and varicella as MMRV

Measles, mumps, or rubella disease (or lack of immunity) in a previously vaccinated person

2%-5% of recipients do not respond to the first dose

Caused by antibody, damaged vaccine, record errors

Most persons with vaccine failure will respond to second dose

12 -15 months is the recommended and minimum age (more effective at 15 months)

MMR given before 12 months should not be counted as a valid dose

2^nd dose at 4-6 years

Intended to produce measles immunity in persons who failed to respond to the first dose (primary vaccine failure)

May boost antibody titers in some persons

Vaccinated before the first birthday

Vaccinated with killed measles vaccine

Vaccinated prior to 1968 with an unknown type of vaccine

Vaccinated with IG in addition to a further attenuated strain or vaccine of unknown type

Fever 5%-15%

Rash 5%

Joint symptoms 25%

Parotitis rare

Deafness rare

Severe allergic reaction to vaccine component or following prior dose

Pregnancy

Immunosuppression

Moderate or severe acute illness

Recent blood product

Measles and mumps viruses grown in chick embryo fibroblast culture

Studies have demonstrated safety of MMR in egg allergic children

Vaccinate without testing

MMR recommended for persons with asymptomatic and mildly symptomatic HIV infection

NOT recommended for those with evidence of severe immuno- suppression

Store 35^o - 46^oF (2^o - 8^oC) (may be stored in the freezer)

Store diluent at room temperature or refrigerate

Protect vaccine from light

Discard if not used within 8 hours reconstitution

Acute viral illness

Parotitis and orchitis described by Hippocrates in 5th century BC

Viral etiology described by Johnson and Goodpasture in 1934

Frequent cause of outbreaks among military personnel in prevaccine era

Paramyxovirus

RNA virus

One antigenic type

Rapidly inactivated by chemical agents, heat, and ultraviolet light

Respiratory transmission of virus

Replication in nasopharynx and regional lymph nodes

Viremia 12-25 days after exposure with spread to tissues

Multiple tissues infected during viremia

Incubation period 14-18 days

Nonspecific prodrome of myalgia, malaise, headache, low-grade fever

Parotitis in 30%-40%

Up to 20% of infections asymptomatic

Reservoir Human
Asymptomatic infections
may transmit

Transmission Respiratory drop nuclei

Temporal pattern Peak in late winter and spring

Communicability Three days before to four days after onset of active
disease

Source of the initial cases unknown

Outbreak peaked in mid-April

Median age of persons reported with mumps was 22 years

Highest incidence was among young adults 18-24 years of age, many of whom were college students

Transmission of mumps virus occurred in many settings, including college dormitories and healthcare facilities

College campus environment

Lack of a 2-dose MMR college entry requirement or lack of enforcement of a requirement

Delayed recognition and diagnosis of mumps

Mumps vaccine failure

Vaccine might be less effective in preventing asymptomatic infection or atypical mumps than in preventing parotitis

Waning immunity

Composition Live virus (Jeryl Lynn strain)

Efficacy 95% (Range, 90%-97%)

Duration of
Immunity Lifelong

Schedule >1 Dose

Should be administered with measles and rubella (MMR) or with measles, rubella and varicella (MMRV)

From Latin meaning "little red"

Discovered in 18th century - thought to be variant of measles

First described as distinct clinical entity in German literature

Congenital rubella syndrome (CRS) described by Gregg in 1941

Togavirus

RNA virus

One antigenic type

Rapidly inactivated by chemical agents, ultraviolet light, low pH, and heat

Respiratory transmission of virus

Replication in nasopharynx and regional lymph nodes

Viremia 5-7 days after exposure with spread to tissues

Placenta and fetus infected during viremia

Incubation period 14 days

(range 12-23 days)

Prodrome of low-grade fever

Maculopapular rash 14-17 days after exposure

Usually quite mild

12.5 million rubella cases

2,000 encephalitis cases

11,250 abortions (surgical/spontaneous)

2,100 neonatal deaths

20,000 CRS cases

deaf - 11,600

blind - 3,580

mentally retarded - 1,800

Infection may affect all organs

May lead to fetal death or premature delivery

Severity of damage to fetus depends on gestational age

Up to 85% of infants affected if infected during first trimester

Deafness

Cataracts

Heart defects

Microcephaly

Mental retardation

Bone alterations

Liver and spleen damage

Reservoir Human

Transmission Respiratory Subclinical cases may transmit

Temporal pattern Peak in late winter and spring

Communicability 7 days before to 5-7 days

after rash onset
Infants with CRS may shed virus for a year or more

Rubella - United States, 1966-2005

Composition Live virus (RA 27/3 strain)

Efficacy 95% (Range, 90%-97%)

Duration of
Immunity Lifelong

Schedule At least 1 dose

Should be administered with measles and mumps as MMR or with measles, mumps and varicella as MMRV

Acute arthralgia in about 25% of vaccinated, susceptible adult women

Acute arthritis-like signs and symptoms occurs in about 10% of recipients

Rare reports of chronic or persistent symptoms

Population-based studies have not confirmed an association with rubella vaccine

Ask if pregnant or likely to become so in next 4 weeks

Exclude those who say "yes"

For others

explain theoretical risks

vaccinate

321 women vaccinated

324 live births

No observed CRS

95% confidence limits 0%-1.2%