MMR

Measles, Mumps &Rubella

By
DR.I.SELVARAJ
B. Sc., M.D., D.P.H., D.I.H.,
PGCH&FW( NIHFW, New Delhi)
Indian Railways Medical
Service (Rtd)
Assistant Professor
 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)
Measles
(English
Measles)
 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%
 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
 Environmental factor
Winter season, over crowding
Transmission Droplet infection
4 days before and 4 days after
rash
Incubation period- 7 days
Courtesy : Adapted from Mims et al. Medical
Microbiology, 1993, Mosby
 Clinical features
Prodromal stage
Eruptive stage
Post-measles stage
 Clinical features
3 Cs (Cough, Coryza & Conjunctivitis)
Koplik spots
Four days fever (400c)
Generalized, maculopapular,erythematous
rash.
Courtesy : This media comes from the
Centers for Disease Control and Prevention'sPublic
Health Image Library(PHIL), with identification
number#3168
 KOPLIK SPOT
Source:
http://phil.cdc.gov/PHIL_Images/20040908/4f54ee8f0e5f49f58aaa30c1bc
6413ba/6111_lores.jpg
 Complication
Diarrhea,
Pneumonia
Otitis media
Convulsions,
SSPE (sub acute sclerosing
panencephalitis)
WHO strategy for control
and prevention of Measles
1) Catch up
2) Keep up
3) Follow up
 Mumps
The 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
 Courtesey: This media comes from theCenters for
Disease Control and Prevention'sPublic Health Image
Library(PHIL), with identification number#130 Content
Providers: CDC/NIP/Barbara Rice
 Agent
Myxovirus parotidis RNA virus
Source of infection Respiratory,
milk
Period of communicability 4-6
days of onset of symptoms
Secondary attack rate 86%
 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
 Clinical features

Parotid swelling
Ovaritis
Pancreatitis
Ear ache
Orchitis
Courtesy : Adapted from Mims et
al. Medical Microbiology, 1993,
 Complications
Orchitis
Epididymitis
Oophoiritis
Spontaneous abortion
Sensori neural hearing loss, (uni- or bilateral).
Mild form of meningitis
Encephalitis
Rubella (German
measles)
 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.
 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
 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)
Temperature
Fever is usually not higher than 38.5C
(101.5F).
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.
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.
 028 days before conception - 43%
chance
012 weeks after conception - 51%
chance
1326 weeks after conception - 23%
chance
Infants are not generally affected if
rubella is contracted during the third
trimester
Photo source: U.S. Centers for Disease Control and
Prevention
 Salt and pepper
retinopathy
http://www.kellogg.umich.edu/theey
eshaveit/congenital/retinopathy.htm
l
Courtesy Courtesy: Jonathan Trobe, M.D. -
http://phil.cdc.gov/phil_images/20 University of Michigan Kellogg Eye
030724/28/PHIL_4284_lores.jpg Center

Content Providers(s): CDC

Creation Date: 1976
 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%
 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
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
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.
 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).
 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.

 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 - 8C for no
longer than 8 hours.
 Vaccine
Age s Note
Deep subcutaneous
9 injection into the upper
months Measles arm.

Deep subcutaneous
12-15 injection into the upper
months MMR -1 arm.

Deep subcutaneous
injection into the upper
5 years MMR -2 arm.
 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