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Measles, Mumps, Rubella, Chicken pox

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Gracy Paulin

This powerpoint is about measles, mumps, rubella and chicken pox - epidemiolgy, clinical features and immunizations

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MMR & CHICKEN POX Dr. Gracy Paulin Assistant Professor Department of community medicine Government Thoothukudi Medical College
Outline Epidemiology triad Chicken pox Measles Mumps Rubella MR/MMR vaccines Small pox
Agent Host Environment Epidemiological triad
CHICKEN POX
CHICKEN POX Also called as varicella Fever, malaise and rash Chicken pox and herpes zoster Case fatality rate is low
Varicella zoster virus Children, pregnancy Seasonal trend Chicken pox
Period of infectivity
STAGES OF CHICKEN POX
CHARACTERISTICS OF RASH CrustingCrusting Vesicledew dropsVesicledew drops PapulePapule
DISTRIBUTION OF RASH
COMPLICATIONS OF CHICKEN POX Varicella haemorrhagica Pneumonia Encephalitis Acute cerebellar ataxia Reyes syndrome Acute retinal necrosis Pitted scars Secondary bacterial infections Congenital varicella syndrome
LAB DIAGNOSIS & CONTROL Usually clinical Detecting viral DNA using PCR or through isolation Control: notification, isolation and disinfection Treatment: Acyclovir
IMMUNIZATION
MEASLES
MEASLES Measles is a leading cause of childhood deaths in developing countries Annually around 30 million cases of Measles are seen and about 9 lakh children die because of Measles Measles still kills about million people, annually
MEASLES (contd) Next disease amenable for eradication Challenges in elimination: Weak immunization system High infectious nature Inaccessible population Increasing refusal of immunization Changing epidemiology Gaps in human and financial resources
MEASLES IN INDIA Major cause of childhood mortality and morbidity 2% of under 5 mortality in India Most cases in tribal and remote areas go unreported Incidence is steadily declining
RNA paramyxovirus 6 months To 3 years Seasonal trend Measles
Period of infectivity
CHARACTERISTICS OF RASH Initial symptoms : high fever (103-105属F) & skin rash Followed by cough, runny nose, and/or conjunctivitis Rash usually appears about 14 days after exposure and lasts 5 - 6 days It begins at the hairline, then involves the face and upper neck Over next 3 days, rash gradually proceeds downward & outward, reaching hands & feet becomes confluent
KOPLIKS SPOTS
RASH IN MEASLES
Measles, Mumps, Rubella, Chicken pox
1. Respiratory Otitis media, pneumonia, sec. bact. pneumonia Laryngitis, croup, bronchitis 2. CNS Encephalitis head ache, convulsions, coma SSPE slow, months after, MR 3. Gastro-intestinal Gastro-enteritis, Heapatitis, mescentric adenitis. Complications of Measles
CONTROL OF AN OUTBREAK Isolation of cases for 7 days after rash Immunization of contacts Immunization at the beginning of an epidemic
MUMPS
Mumps More than 85% of children become susceptible to mumps by the age of 9-12 months and continue to be so in the first 5 years of life It is estimated that about 8.5 - 9 lakh cases of mumps occur in our country every year.
Myxovirus parotiditis 5 to 9 years children Seasonal trend Mumps
Obvious sign of mumps is swelling of parotid region, because of Acute parotitis. Swelling usually lasts for 10 days with fever, Ear-ache, difficulty to talk, eat, open the mouth for 1-6 days. Affects various organs like salivary glands - Parotid glands, kidneys, testicles (Males), ovaries (females), pancreas, breast and joints The symptoms- signs of Mumps
About 20% people who get mumps develop a painful swelling of testicles (Orchitis) and 50% will end up with testicular atrophy. Only 15% of cases of orchitis are bilateral in which case may leads to infertility. Mumps can also affect reproductive organs in females - oophoritis Sensori-neural (SN) deafness is a chronic compllication Mumps can also cause Asceptic Meningitis, joint pain, pancreatitis, myocarditis and mastitis Complications of Mumps
RUBELLA
Measles, Mumps, Rubella, Chicken pox
RNA virus Togavirusfamily 3 to 10 years children Seasonal trend Rubella
Rubella - PNAR Sub-clinical, very mild viral illness, Dx. often missed Post auricular, sub occipital or cervical adenopathy Rash mainly face, never confluent, later extends body Fever may or may not occur, usually low grade, mild Complications rare arthritis, TCP, Haeg., Encephalt. Rubella in during pregnancy may lead to miscarriage.
Measles, Mumps, Rubella, Chicken pox
Rubella Microcephaly Congenital Cataract Deafness
The incidence of deformities in the various stages of pregnancy 3-11 weeks 100% infected fetus 12 weeks 80% infected fetus 13-14 weeks 54% infected fetus 15-16 weeks 35% infected fetus 23-26 weeks 25% infected fetus Time of maternal infection Result
The incidence of deformities in India Several studies have clearly shown the link between congenital defects and Rubella in Indian Children Study Defect Incidence due to Rubella Chennai Congenital deafness 29% Madurai Congenital cataract 26.3% Delhi Congenital malformations 21% (12000 samples)
The treatment for Rubella Unfortunately there is no treatment for Rubella. Vaccination is the only way to prevent all these complications In fact, 123 countries i.e. more than 57% of the countries include Rubella vaccine in their schedule Sri Lanka has already included the vaccine in their EPI program
Rubella vaccine should be given to All girls at puberty (9 years and above) All women of child bearing age and Hospital workers After vaccination at least of 3 months of contraception if missed, Post delivery to protect subsequent pregnancies
MR/MMR VACCINE
1. To ensure adequate protection against Measles to all children, the WHO, American Academy of Paediatrics (AAP) and also the Indian Academy of Paediatrics (IAP) recommend use of two doses of Measles vaccine. 2. As perthe recommendation of the IAP, the first dose should be given at 9 months and the second dose should be given at 16 to 24 months Recommendations
Vaccine schedule Measles Vaccine at the age of 9 months MMR Vaccine at 12-15 months If missed any time up to 13 years of age
Small pox Last known case in India May 1975 Eradication April 1977 Government research centres in Russia and US Potential biological weapon
SUMMARY
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Measles, Mumps, Rubella, Chicken pox

  • 1. MMR & CHICKEN POX Dr. Gracy Paulin Assistant Professor Department of community medicine Government Thoothukudi Medical College
  • 2. Outline Epidemiology triad Chicken pox Measles Mumps Rubella MR/MMR vaccines Small pox
  • 5. CHICKEN POX Also called as varicella Fever, malaise and rash Chicken pox and herpes zoster Case fatality rate is low
  • 9. CHARACTERISTICS OF RASH CrustingCrusting Vesicledew dropsVesicledew drops PapulePapule
  • 11. COMPLICATIONS OF CHICKEN POX Varicella haemorrhagica Pneumonia Encephalitis Acute cerebellar ataxia Reyes syndrome Acute retinal necrosis Pitted scars Secondary bacterial infections Congenital varicella syndrome
  • 12. LAB DIAGNOSIS & CONTROL Usually clinical Detecting viral DNA using PCR or through isolation Control: notification, isolation and disinfection Treatment: Acyclovir
  • 15. MEASLES Measles is a leading cause of childhood deaths in developing countries Annually around 30 million cases of Measles are seen and about 9 lakh children die because of Measles Measles still kills about million people, annually
  • 16. MEASLES (contd) Next disease amenable for eradication Challenges in elimination: Weak immunization system High infectious nature Inaccessible population Increasing refusal of immunization Changing epidemiology Gaps in human and financial resources
  • 17. MEASLES IN INDIA Major cause of childhood mortality and morbidity 2% of under 5 mortality in India Most cases in tribal and remote areas go unreported Incidence is steadily declining
  • 18. RNA paramyxovirus 6 months To 3 years Seasonal trend Measles
  • 20. CHARACTERISTICS OF RASH Initial symptoms : high fever (103-105属F) & skin rash Followed by cough, runny nose, and/or conjunctivitis Rash usually appears about 14 days after exposure and lasts 5 - 6 days It begins at the hairline, then involves the face and upper neck Over next 3 days, rash gradually proceeds downward & outward, reaching hands & feet becomes confluent
  • 24. 1. Respiratory Otitis media, pneumonia, sec. bact. pneumonia Laryngitis, croup, bronchitis 2. CNS Encephalitis head ache, convulsions, coma SSPE slow, months after, MR 3. Gastro-intestinal Gastro-enteritis, Heapatitis, mescentric adenitis. Complications of Measles
  • 25. CONTROL OF AN OUTBREAK Isolation of cases for 7 days after rash Immunization of contacts Immunization at the beginning of an epidemic
  • 26. MUMPS
  • 27. Mumps More than 85% of children become susceptible to mumps by the age of 9-12 months and continue to be so in the first 5 years of life It is estimated that about 8.5 - 9 lakh cases of mumps occur in our country every year.
  • 28. Myxovirus parotiditis 5 to 9 years children Seasonal trend Mumps
  • 29. Obvious sign of mumps is swelling of parotid region, because of Acute parotitis. Swelling usually lasts for 10 days with fever, Ear-ache, difficulty to talk, eat, open the mouth for 1-6 days. Affects various organs like salivary glands - Parotid glands, kidneys, testicles (Males), ovaries (females), pancreas, breast and joints The symptoms- signs of Mumps
  • 30. About 20% people who get mumps develop a painful swelling of testicles (Orchitis) and 50% will end up with testicular atrophy. Only 15% of cases of orchitis are bilateral in which case may leads to infertility. Mumps can also affect reproductive organs in females - oophoritis Sensori-neural (SN) deafness is a chronic compllication Mumps can also cause Asceptic Meningitis, joint pain, pancreatitis, myocarditis and mastitis Complications of Mumps
  • 33. RNA virus Togavirusfamily 3 to 10 years children Seasonal trend Rubella
  • 34. Rubella - PNAR Sub-clinical, very mild viral illness, Dx. often missed Post auricular, sub occipital or cervical adenopathy Rash mainly face, never confluent, later extends body Fever may or may not occur, usually low grade, mild Complications rare arthritis, TCP, Haeg., Encephalt. Rubella in during pregnancy may lead to miscarriage.
  • 37. The incidence of deformities in the various stages of pregnancy 3-11 weeks 100% infected fetus 12 weeks 80% infected fetus 13-14 weeks 54% infected fetus 15-16 weeks 35% infected fetus 23-26 weeks 25% infected fetus Time of maternal infection Result
  • 38. The incidence of deformities in India Several studies have clearly shown the link between congenital defects and Rubella in Indian Children Study Defect Incidence due to Rubella Chennai Congenital deafness 29% Madurai Congenital cataract 26.3% Delhi Congenital malformations 21% (12000 samples)
  • 39. The treatment for Rubella Unfortunately there is no treatment for Rubella. Vaccination is the only way to prevent all these complications In fact, 123 countries i.e. more than 57% of the countries include Rubella vaccine in their schedule Sri Lanka has already included the vaccine in their EPI program
  • 40. Rubella vaccine should be given to All girls at puberty (9 years and above) All women of child bearing age and Hospital workers After vaccination at least of 3 months of contraception if missed, Post delivery to protect subsequent pregnancies
  • 42. 1. To ensure adequate protection against Measles to all children, the WHO, American Academy of Paediatrics (AAP) and also the Indian Academy of Paediatrics (IAP) recommend use of two doses of Measles vaccine. 2. As perthe recommendation of the IAP, the first dose should be given at 9 months and the second dose should be given at 16 to 24 months Recommendations
  • 43. Vaccine schedule Measles Vaccine at the age of 9 months MMR Vaccine at 12-15 months If missed any time up to 13 years of age
  • 44. Small pox Last known case in India May 1975 Eradication April 1977 Government research centres in Russia and US Potential biological weapon

Editor's Notes

  • #6: Herpes zoster occurs in aged individuals when cell mediated immunity declines due to reactivation of latent varicella virus. Severe in pregnant women, infants and immunocompromised individuals.
  • #7: Mode of transmission contagious disease and through oropharyngeal secretions, droplet nuclei Life long immunity Secondary attack rate 90% Period of infectivity next slide. Host: children; life long immunity; pregnancy less than 20 weeks - congenital varicella syndrome; Environment: winter, spring, coolest, driest months. Heat labile.
  • #11: Centrifugal in distribution; absent in palms and soles; may involve axilla, buccal mucosa
  • #12: Reyes syndrome: acute encephalopathy with fatty degeneration of liver Cogenital varicella syndrome: foetal wastage, cutaneous scars, atrophied limbs, microcephaly, chorioretinitis, deafness, cerebro-cortical atrophy
  • #14: Age: 12 to 18 months VZIG: given within 72 hours of exposure; intramuscular route;
  • #19: Mode of transmission contagious disease and through oropharyngeal secretions, droplet nuclei Life long immunity Secondary attack rate 90% Period of infectivity next slide. Host: children; life long immunity; malnourished children Environment: winter, spring, coolest, driest months. Overcrowding
  • #28: Although the morbidity of mumps is high, the mortality due to this disease is negligible.
  • #29: Subclinical infections occur. Mode of transmission contagious disease and through oropharyngeal secretions, droplet nuclei Life long immunity Secondary attack rate 90% Period of infectivity next slide. Host: children; life long immunity; malnourished children; Pregnancy spontaneous abortion in 25% cases Environment: winter, spring, coolest, driest months. Overcrowding
  • #34: Subclinical infections occur. Major difference between measles and rubella. Mode of transmission contagious disease and through oropharyngeal secretions, droplet nuclei Life long immunity Secondary attack rate is low Host: children; life long immunity; Pregnancy 40% are susceptible Environment: winter, spring, coolest, driest months. Overcrowding
  • #45: Caused by variola virus. Characterized by sudden onset of fever, headache, backache, vomiting and convulsions. Rash 3rd day of fever. By eradicating small pox, we have prevented 2 million deaths per year. Despite the eradication of small pox, surveillance is still going on. WHO reserves a stock of vaccine sufficient for 200 million people, if an emergency arises.