Measles, Mumps, Rubella (MMR) and MMR Vaccine

Measles, Mumps, Rubella (MMR) and MMR Vaccine

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Last edited and updated on: by Sagar Aryal

Measles, Mumps, Rubella (MMR) and MMR Vaccine

  • The MMR which is comprised of a 3 in 1 vaccine, is one of the recommended childhood immunizations.
  • It protects children against three highly contagious Viruses which are as follows:
    • Measles
    • Mumps
    • Rubella (German Measles)

Measles, Mumps, Rubella (MMR) and MMR Vaccine

Image Source: NFID and CSC Pharmaceuticals

Measles

Definition

 Measles is “an acute viral infection characterized by a maculopapular rash erupting successively over the neck, Face body and extremities and accompanied by a high fever.”

Etiology

  • Measles virus (MeV) is single stranded, negative sense, enveloped RNA virus.
  • Family: Paramyxoviridae
  • Genus: Morbillivirus
  • Host: Humans are natural hosts of the virus, no animal reservoirs.

Epidemiology

-Endemic worldwide
-Highly contagious (90% of susceptible contact acquire the disease )

  • Reservoir (human)
  • Transmission –Airborne transmission via aerosolized droplet nuclei.
  • Temporal pattern- Peak in late winter-spring
  • Communicability -4 days before to 4 days after the rash.

Host factors

  • Age- 6 months to 3 years even up to 10 years
  • Incidence equal in both sexes
  • Immunity – lifelong immunity
  • vitamin A deficiency and a lack of adequate health care, about 3–6%, of measles cases result in death.

Environmental Factors

  • Winter season
  • overcrowding

Clinical Manifestation

Incubation Period

Measles signs and symptoms appear around 10 to 14 days after exposure to the virus.

Prodromal Period

  • Fever
  • Coryza (Runny nose)
  • Cough
  • Conjunctivitis

Koplik Spots

  • 2-3 days after symptoms come Enanthem tiny white spots may appear inside the mouth.

Eruptive stage

  • 3-5 days after symptoms come Exanthem phase which is red, blotchy Maculopapular rash on the abdomen after 3 days’ rash
  • Flat red spots that appear on the face at the hairline and spread downward to the neck, trunk, arms, legs, and feet
  • About 10-14 days after Developing a rash child is Back to the normal Activity. That is the Post measles stage.

  Diagnosis

  • Isolation of measles virus from a clinical specimen (e.g., nasopharynx, urine)
  • Significant rise in measles IgG by any standard serologic assay (e.g., EIA, HA)
  • Positive serologic test for measles IgM antibody.

 Treatment

  • There is no specific medicine that kills the measles virus.
  • Treatment aims to ease symptoms until the body’s immune system clears the infection.
  • Symptoms will usually disappear within 10 days. Following measures are useful:
    • Supportive care
    • Antipyretics (paracetamol or ibuprofen)
    • Antibiotics are prescribed if complication appears
    • Nutritional support

Mumps

  • The name comes from the British word “to mump”, that is grimace or grin.
  • Mumps is an illness characterized by acute onset of unilateral or bilateral tender, self-limited swelling of the parotid or other salivary glands that lasts at least 2 days and has no other apparent cause.

Etiologic Agent

  • Mumps is caused by a paramyxovirus belongs to family paramyxoviridae with a negative strand, nonsegmented RNA genome.
  • 12 mumps virus genotype has been identified.
  • Incubation Period – 2 to 3 weeks

Transmission

  • Person to person (respiratory secretions e.g. saliva), respiratory droplets, fomites.
  • Closer contact is necessary for the transmission of mumps than for the transmission of measles or varicella.

Risk of disease:> 50% reported cases 5-9yrs but shift to younger children with childcare.

Seasonality: peak late winter and spring

Clinical features

  • Parotid swelling
  • Ovaritis
  • Pancreatitis
  • Earache
  • Orchitis
  • Low-grade fever
  • Headache
  • Malaise

Complications

  • Orchitis
  • Epididymitis
  • Oophoiritis
  • Spontaneous abortion
  • Sensory neural hearing loss, (uni- or bilateral).
  • A mild form of meningitis
  • Encephalitis

Laboratory Diagnosis

  • RT-PCR for the detection of viral RNA.
  • Buccal swabs for detection of virus within 2 days of clinical onset.
  • Mumps virus can also be detected readily in throat swabs and saliva, and in case of meningitis, in CSF.
  • Mumps virus has rarely been detected in the blood.
  • RAPID ELISA

Treatment and prevention 

  • Mumps is a self-limited disease.
  • Treated with bed rest.
  • Use analgesics to relieve pain and reduce fever such as Acetaminophen or Nonsteroidal anti-inflammatory drugs.
  • The complication may require treatment in the hospital.
  • The most preventative measure against mumps is immunization with a mumps vaccine.

Rubella

  • derived from a Latin term meaning “little red.”
  • German measles or 3-day measles
  • Because of typical course off rubella exanthema that starts initially on the face and neck and spreads centrifugally on the trunk and extremities within 24 hours
  • begins to fade on the face on the second day
  • disappears throughout the body by the end of the third day.

Etiology

  • virus (Togo virus family)
  • Genus Rubi virus.
  • single-stranded RNA virus
  • Diameter 50 – 70 nm
  • Enveloped Spherical

Clinical Signs

  • Malaise
  • Low-grade fever
  • Morbilliform rash
  • The rash starts on Face Extremities Rarely lasts more than 5 days.

Rubella during pregnancy:

  • “Rubella infection in pregnant women during the first three months of pregnancy may result in the baby being born with birth defects or congenital rubella syndrome.

Congenital rubella syndrome (CRS)

  • occur in a developing fetus of a pregnant woman who has contracted rubella
  • If infection occurs 0–28 days before conception, the infant has a 43% risk of being affected.
  • Problems rarely occur when rubella is contracted by the mother after 20 weeks of gestation and continues to disseminate the virus after birth.

Classical triad for congenital rubella syndrome

  • the most common and major defects are deafness, cardiac malformations, and cataracts

Diagnosis

  • Throat swab culture for virus isolation and serology.
  • Haemagglutination inhibition test (HAI)
  • Others include the ELISA test and radio-immune assay.

Treatment and Prevention

  • There is no specific treatment for Rubella; management is a matter of responding to symptoms to diminish discomfort.

Measles Vaccine

  • Live attenuated measles virus (Edmonston-Zagreb strain) Propagated on human diploid cell (MRC-5)
  • 5 ml of vaccine
  • Not less than 1000 CCID50 of measles virus
  • 5% of gelatin
  • 5% of sorbitol as stabilizers
  • 5 ml of sterile water
  • Dose – 0.5 ml
  • Route of administration: Subcutaneous
  • 3 to 5 weeks’ antibody level – 200mLU/ml

Mumps Vaccine

  • 10 strains of the mumps virus are in use throughout the world for the preparation of the live attenuated vaccines.
  • 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

Rubella vaccine

  • Target disease Rubella
  • Attenuated virus
  • Trade names Meruvax, other
  • Effectiveness begins about two weeks after a single dose and around 95% of people become immune.
  • It is available either by itself or in combination with other vaccines

Rubella vaccine schedule

  • A dose of the vaccine between 9 and 12 months of age
  • While only one dose is necessary two doses are often given as it usually comes mixed with the measles vaccine e.g. MMR

MMR Vaccine

  • Live attenuated strains of the 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.
  • The reconstituted vaccine contains
    • In a single dose of 0.5 ml. not less than
    • 1000 CCID50 of Measles virus
    • 5000 CCID50 of Mumps virus
    • 1000 CCID50 of the Rubella virus.

Diluent: Sterile water for injection.

 Reconstitution and Storage

  • The vaccine should be reconstituted with the diluents 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.

References

  • https://en.wikipedia.org/wiki/MMR_vaccine
  • https://www.cdc.gov/vaccines/hcp/vis/vis-statements/mmr.html
  • https://www.webmd.com/children/vaccines/measles-mumps-and-rubella-mmr-vaccine
  • https://www.healthychildren.org/English/safety-prevention/immunizations/Pages/Measles-Mumps-Rubella-Vaccines-What-You-Need-to-Know.aspx.
  • https://www.mayoclinic.org/diseases-conditions/measles/symptoms-causes/syc-20374857
  • https://www.nhs.uk/conditions/measles/symptoms/
  • https://en.wikipedia.org/wiki/Mumps
  • https://www.nhs.uk/conditions/mumps/symptoms/
  • https://www.medicalnewstoday.com/articles/164504.php
  • https://www.who.int/news-room/fact-sheets/detail/rubella
  • https://kidshealth.org/en/parents/german-measles.html?WT.ac=ctg
  • https://www.cdc.gov/vaccines/vpd/mmr/public/index.html
  • https://www.slideshare.net/drjyotimdpedia/mmr-42648277
  • https://www.slideshare.net/mgmcricommunitymed/measles-mumps-rubella-59249466.
  • https://www.slideshare.net/cetdmgh/measles-55450409

Internet Sources

  • 9% – http://www.slidesfinder.com/presentation/mmr-measles-mumps-and-rubella-ppt-slides/446.aspx
  • 3% – https://www.slideshare.net/doctorrao/rubella-14532069
  • 2% – https://www.slideshare.net/NeerajSharma576/paramyxo-virus-classification-symptoms-and-lab-diagnosis
  • 2% – https://www.slideshare.net/ManjunathAnvekar/mumps-78545066
  • 2% – https://en.wikipedia.org/wiki/Congenital_rubella_syndrome
  • 2% – http://dbpedia.org/page/Congenital_rubella_syndrome
  • 1% – https://www.slideshare.net/SurajDhara2/virology-194484660
  • 1% – https://vaccinationinformationsource.wordpress.com/mmr-vaccine/
  • 1% – https://issuu.com/benjaminleonzon/docs/immunization_handbook
  • <1% – https://chophealth.com/blog/
  • <1% – http://www0.nih.go.jp/JJID/59/394.pdf
  • <1% – http://www.fast-trackdiagnostics.com/human-line/products/ftd-viral-meningitis/

Measles, Mumps, Rubella (MMR) and MMR Vaccine

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