mmr measles, mumps &rubella by dr.i.selvaraj. this powerpoint presentation will be an additional...
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Measles (English Measles)TRANSCRIPT
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MMRMeasles, Mumps &Rubella
By DR.I.SELVARAJ
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• This PowerPoint presentation will be an additional resources for Para medical people Public health nurses, MBBS students and MD Post graduate students around the world.
• This droplet infections has to be eradicated. As we are having effective vaccine against this infections, no carriers & no animal reservoir and paramedical people can easily identify the signs & symptoms
• The public health institution has to give more importance for this infectious diseases to control
• My best wishes to the Supercourse team Dr.I.Selvaraj Indian railways Medical service (Rtd)
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Measles(English Measles)
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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%
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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
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Environmental factor
• Winter season, over crowding• Transmission – Droplet infection• 4 days before and 4 days after
rash• Incubation period- 7 days
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Courtesy : Adapted from Mims et al. Medical Microbiology, 1993, Mosby
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Clinical features• Prodromal stage• Eruptive stage
• Post-measles stage
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Clinical features• 3 Cs (Cough, Coryza & Conjunctivitis)• Koplik spots• Four days fever (400c)• Generalized, maculopapular,erythematous rash.
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Courtesy : This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #3168
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KOPLIK SPOTSource: http://phil.cdc.gov/PHIL_Images/20040908/4f54ee8f0e5f49f58aaa30c1bc6413ba/6111_lores.jpg
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Complication • Diarrhea,• Pneumonia• Otitis media• Convulsions,• SSPE (sub acute sclerosing panencephalitis)
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WHO strategy for control and prevention of Measles
1) Catch up2) Keep up3) Follow up
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MumpsThe name comes from the British word "to mump", that is grimace or grin. The appearance of the patient as a result of parotid gland swelling seems to be in grin
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Courtesey: This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #130 Content Providers: CDC/NIP/Barbara Rice
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Agent
• Myxovirus parotidis –RNA virus• Source of infection – Respiratory,
milk• Period of communicability – 4-6 days
of onset of symptoms• Secondary attack rate – 86%
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• Age & sex 5-15 yrs and girls common• Immunity - life long• Environmental factor – winter and
spring season favors• Mode of transmission – droplet• I.P - 2 to 3 weeks
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Clinical features
• Parotid swelling•Ovaritis• Pancreatitis• Ear ache•Orchitis
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Courtesy : Adapted from Mims et al. Medical Microbiology, 1993, Mosby
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Complications
• Orchitis• Epididymitis• Oophoiritis• Spontaneous abortion• Sensori neural hearing loss, (uni- or bilateral).• Mild form of meningitis• Encephalitis
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Rubella (German measles)
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• 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.
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• 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
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• 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)
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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.
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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.
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• 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
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Photo source: U.S. Centers for Disease Control and Prevention
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Salt and pepper retinopathy
Content Providers(s): CDC Creation Date: 1976
Courtesy http://phil.cdc.gov/phil_images/20030724/28/PHIL_4284_lores.jpg
http://www.kellogg.umich.edu/theeyeshaveit/congenital/retinopathy.html
Courtesy: Jonathan Trobe, M.D. - University of Michigan Kellogg Eye Center
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• 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%
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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
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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
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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.
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• 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).
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• 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. •
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• 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.
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AgeVaccines 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.
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• 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