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MUMPS MEASLES AND RUBELLA

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Slide 1 - 1 MUMPS, MEASLES RUBELLA and human parvovirus
Slide 2 - 2 MEASLES (RUBEOLA)MUMPSRUBELLA MAN WORLD WIDE SINGLE SEROTYPE OF EACH VIRUS LIVE ATTENUATED VACCINE (MMR) CHILDHOOD DISEASES (PRE-VACCINE) NOTIFIABLE DISEASE
Slide 3 - 3 PARAMYXOVIRUS FAMILY MUMPS MEASLES TOGAVIRUS FAMILY RUBELLA
Slide 4 - 4 MEASLES AND MUMPS
Slide 5 - 5 M protein helical nucleocapsid (RNA plus NP protein) HN/H/G glycoprotein SPIKES polymerase complex lipid bilayer membrane F glycoprotein SPIKES PARAMYXOVIRUSES pleomorphic
Slide 6 - 6
Slide 7 - 7 MEASLES (Rubeola) 2001 >40,000,000 infections world wide >1,000,000 deaths world wide 2004 ~20,000,000 infections world wide ~240,000 deaths world wide
Slide 8 - 8 VACCINE EFFECTIVENESS http://www.cdc.gov/nip/ed/slides/slides.htm
Slide 9 - 9 Measles 1996-present Endemic transmission interrupted Only 44 cases in US in 2002 - but 132 cases 2008 Most cases imported or linked to importation http://www.cdc.gov/nip/ed/slides/slides.htm
Slide 10 - 10 INFECTION AEROSOL VERY CONTAGIOUS
Slide 11 - 11 Adapted from Mims, Playfair, Roitt, Wakelin and Williams (1993) Medical Microbiology viremia
Slide 12 - 12 MEASLES - Koplik’s spots Murray et al. Medical Microbiology
Slide 13 - 13 DISSEMINATED SPREAD LONGER TIME FOR SYMPTOMS IMMUNE RESPONSE (IF SYMPTOMS DUE TO IMMUNE RESPONSE, USUALLY INFECTIOUS PRIOR TO SYMPTOMS) Adapted from Mims, Playfair, Roitt, Wakelin and Williams (1993) Medical Microbiology
Slide 14 - 14 MEASLES - RASH CDC - B.Rice Murray et al. Medical Microbiology
Slide 15 - 15 DISEASE STILL INFECTIOUS AFTER SYMPTOMS START FEVER RESPIRATORY TRACT SYMPTOMS rhinorrhea, cough KOPLIK’S SPOTS MACULOPAPULAR RASH T-cells ->endothelial cells CONJUNCTIVITIS epithelial cells
Slide 16 - 16 RECOVERY FAIRLY RAPID T-cell response important agammaglobulinemia – recover T-cell deficient, may be no rash, may be severe disease (life threatening) DISEASE MORE SEVERE IN ADULTS
Slide 17 - 17 COMPLICATIONS GIANT CELL PNEUMONIA Histopathology of measles pneumonia. CDC/Dr. Edwin P. Ewing, Jr. Giant cell with intracytoplasmic inclusions
Slide 18 - 18 COMPLICATIONS GIANT CELL PNEUMONIA SECONDARY BACTERIAL INFECTIONS MORE SEVERE IF MALNOURISHED AND/OR POOR ACCESS TO MEDICAL CARE MEASLES ENCEPHALITIS
Slide 19 - 19 Mims et al., Medical Microbiology 1993
Slide 20 - 20 PROBLEMS vitamin A deficient -> low mucosal defense low protein, calories -> impaired immunity lack of antibiotics for secondary infections lack of vaccination (need cold chain) poor hygiene Deaths due to measles 2000: ~757,000 Deaths due to measles 2007: ~197,000 Case fatality rates in displaced populations can reach 25%
Slide 21 - 21 MEASLES ENCEPHALITIS 1/1000 cases sequelae deafness seizures mental disorders
Slide 22 - 22 SSPE sub-acute sclerosing panencephalitis inflammatory disease defective virus (often lacking M protein) early infection with measles is a risk factor rare (7/1,000,000 cases of measles) decrease since vaccination program
Slide 23 - 23 IMMUNOSUPPRESSION AND MEASLES TEMPORARY DEPRESSION OF IMMUNE RESPONSE Tuberculin +ve individuals may temporarily become -ve MAY GET REACTIVATION OF HERPES, TUBERCULOSIS Don’t see with vaccine strain
Slide 24 - 24 DIAGNOSIS Serodiagnosis Significant increase in IgG (need two samples) Positive for IgM Isolation RT-PCR All suspect cases should be confirmed by laboratory
Slide 25 - 25 EPIDEMIOLOGY ALMOST ALL INFECTED INDIVIDUALS SHOW DISEASE ONE SEROTYPE NATURAL INFECTION GIVES LIFE LONG PROTECTION MOST CONTAGIOUS BEFORE RASH IS EVIDENT
Slide 26 - 26 PREVENTION LIVE ATTENUATED VACCINE Does not spread to contacts Can cause problems in immuno-suppressed IMMUNE SERUM GLOBULIN
Slide 27 - 27 TREATMENT SUPPORTIVE CARE
Slide 28 - 28 PARAMYXOVIRUSESMUMPS
Slide 29 - 29 Mumps Outbreak United States 2006* 1,921 4 134 650 85* 501 193 349 3 782 2 1 1 Total reported cases 4,602 *In PA, 14 of the 85 cases are considered outbreak-associated. *Provisional Number of Cases by State as of June 20, 2006
Slide 30 - 30 MUMPS CDC - B.Rice
Slide 31 - 31 Mims et al., Medical Microbiology 1993
Slide 32 - 32 Mims et al., Medical Microbiology 1993
Slide 33 - 33 RECOVERY CELL MEDIATED IMMUNITY
Slide 34 - 34 DIAGNOSIS 30% INFECTIONS SUB-CLINICAL SEROLOGY OR ISOLATION RT-PCR
Slide 35 - 35 EPIDEMIOLOGY MAN ONLY HOST ONE SEROTYPE SUB-CLINICAL INFECTIONS CONTAGIOUS BEFORE AND AFTER SYMPTOMS
Slide 36 - 36 PREVENTION LIVE ATTENUATED VACCINE DOES NOT SPREAD TO CONTACTS Contradindicated in immune-suppressed pregnant women
Slide 37 - 37 RUBELLA VIRUS icosahedral nucleocapsid lipid bilayer membrane glycoprotein RNA (single-stranded positive-sense)
Slide 38 - 38 RUBELLA VIRUS TOGAVIRUS FAMILY Alphavirus genus Rubivirus genus AEROSOL CHILDREN, ADULTS mild FETUS can be severe
Slide 39 - 39 RUBELLA (German measles) Murray et al. Medical Microbiology
Slide 40 - 40
Slide 41 - 41 SYMPTOMSchildren and adults SORE THROAT, RUNNY NOSE, COUGH FEVER RASH, MINOR, IRREGULAR lasts 12hour to 5days not always seen ARTHRALGIA, ARTHRITIS especially in adults, especially women LYMPHOADENOPATHY
Slide 42 - 42 COMPLICATIONS ENCEPHALITIS (RARE)
Slide 43 - 43 RECOVERY T-CELL
Slide 44 - 44 PROTECTION IgG, IgA IgM may persist
Slide 45 - 45 EFFECTS ON FETUS HEARING LOSS CONGENITAL HEART DEFECTS NEUROLOGICAL PYSCHOMOTOR AND/OR MENTAL RETARDATION OPHTHALMIC CATARACT, GLAUCOMA, RETINOPATHY
Slide 46 - 46 EFFECTS ON FETUS thrombocytopenia hepatomegaly splenomegaly intrauterine growth retardation bone lesions pneumonitis
Slide 47 - 47 EFFECTS ON FETUS First trimester 65-85% of neonates have sequelae
Slide 48 - 48 EFFECTS ON FETUS 1964-65 season (pre-vaccine) congenital rubella syndrome (CRS) cases ~20,000 Deaf ~11,600 Blind ~3,580 Mentally retarded ~1,800 Abortions (spontaneous/surgical) ~11,250 Neonatal deaths ~2,100 1969 to present maximum of 67 cases congenital rubella/yr usually fewer than 10
Slide 49 - 49 CONGENITAL INFECTIONS SHED VIRUS FOR A YEAR OR MORE AFTER BIRTH nasopharynx, urine, feces
Slide 50 - 50 CONGENITAL INFECTIONS EYE PROBLEMS GLANDULAR COMPLICATIONS diabetes thyroid problems deficiency growth hormone
Slide 51 - 51 CONGENITAL / VERY EARLY INFECTIONS PROGRESSIVE RUBELLA PANENCEPHALITIS
Slide 52 - 52 DIAGNOSIS Serology Significant rise in IgG Positive for IgM Isolation RT-PCR
Slide 53 - 53 DIAGNOSIS ~50% infections sub-clinical rash not always seen many other agents cause similar symptoms
Slide 54 - 54 RUBELLA-LIKE SYMPTOMS HUMAN PARVOVIRUS SOME ALPHAVIRUSES SOME ENTEROVIRUSES SOME ADENOVIRUSES EPSTEIN-BARR VIRUS SCARLET FEVER TOXIC DRUG REACTIONS OTHER CAUSES INCLUDE:
Slide 55 - 55 PREVENTION LIVE ATTENUATED VACCINE DOES NOT SPREAD TO FAMILY MEMBERS CHILDREN SUSCEPTIBLE NON-PREGNANT FEMALES
Slide 56 - 56 EPIDEMIOLOGY MAN SOLE HOST WORLD WIDE ONE SEROTYPE NATURAL INFECTION PROTECTS FOR LIFE
Slide 57 - 57 PARVOVIRUS B-19 (erythrema infectiosum) Murray et al. Medical Microbiology
Slide 58 - 58 PARVOVIRUS B19 very small, non-enveloped, icosahedral, single-stranded DNA virus erythrema infectiosum, fifth disease mild rash, acute arthralgia replicates in red blood cell precursors can cause problems in those with chronic anemia, immune suppression May cause spontaneous abortion of fetus (anemia)