Measles, Mumps and Rubella

Ruth Carrico PhD RN FSHEA CICAssociate Professor

Division of Infectious DiseasesUniversity of Louisville

Ruth.carrico@louisville.edu

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