Last Updated on January 22, 2020 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:
- Rubella (German Measles)
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.”
- 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.
-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.
- 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.
- Winter season
Measles signs and symptoms appear around 10 to 14 days after exposure to the virus.
- Coryza (Runny nose)
- 2-3 days after symptoms come Enanthem tiny white spots may appear inside the mouth.
- 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.
- 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.
- 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
- 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.
- 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
- 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
- Parotid swelling
- Low-grade fever
- Spontaneous abortion
- Sensory neural hearing loss, (uni- or bilateral).
- A mild form of meningitis
- 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.
- 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.
- virus (Togo virus family)
- Genus Rubi virus.
- single-stranded RNA virus
- Diameter 50 – 70 nm
- Enveloped Spherical
- 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
- 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.
- 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
- 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
- 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
- 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.
- 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/