Measles, Mumps & Rubella

Izatty Lim0308188

13 June 2014

EPIDEMIOLOGICAL TRIAD

DISTRIBUTION PREVENTION

MEASLES Occurrence

o Worldwideo interruption of transmission achieved in the United States & other parts of the

Western Hemisphere.

Reservoiro human diseaseo no known animal reservoiro asymptomatic carrier state has not been documented.

Transmissiono primarily person to person via large respiratory dropletso Airborne transmission via aerosolized droplet nuclei has been documented in

closed areas for up to 2 hours after a person with measles occupied the area.

Incubation Period o 7 – 18 days

Communicabilityo highly communicable, >90% secondary attack rates among susceptible persons. o Infectious period: from 4 days before to 4 days after rash onseto Maximum communicability during prodromal phase

EPIDEMIOLOGICAL TRIAD OF MEASLES

Agento Measles virus.

• only one antigenic type of measles virus.

• rapidly inactivated by heat, light, acidic pH, ether, and trypsin

• short survival time (<2 hours) in the air or on objects and surfaces

Hosto Human

• Unvaccinated young children & pregnant women• Poorly nourish• insufficient vitamin A• Weakened immune systems

Environmento Developing countries – Africa & Asiao Countries with low per capita incomes and weak

health infrastructureso Countries experiencing or recovering from a

natural disaster or conflicto  dry seasons in tropical zoneso Overcrowded places

DISTRIBUTION In developed countries during the pre-vaccine era,

o >90% of children acquired measles by age 15. o Following implementation of routine childhood vaccination at age 12 to 15 months,

the age of peak measles incidence in the United States shifted to six months of age.

Measles as a significant cause of morbidity and mortalityo In 2000, measles was estimated to cause approximately 31 - 39.9 million illnesses

worldwide with an estimated 733,000 - 777,000 deaths, making it the 5th most common cause of death in children under five years of age.

DISTRIBUTION

Worldwide reported measles incidence rate per 100 000 population, 2004

DISTRIBUTION

MUMPS Occurrence

o worldwide.

Reservoiro human diseaseo persons with asymptomatic infection can transmit the virus, but

no carrier state is known to exist.

Transmissiono airborne transmission o direct contact with infected droplet nuclei or saliva.

Incubation Periodo 16 - 18 days

Communicabilityo Contagiousness similar to that of influenza & rubella

• less than that for measles & varicellao Infectious period: from 3 days before to the 4th day of onset of

symptoms

EPIDEMIOLOGICAL TRIAD OF MUMPS

Agento Mumps virus

• One antigenic type• rapidly inactivated by

formalin, ether, chloroform, heat, and ultraviolet light

Hosto Human

• Failure to be immunized completely 

• children between 2-12 years of age

• Weakened immune system Environment

o Africa, general Indian subcontinent region, and Southeast Asia- very low rate of vaccination

o Late winter & springo Small, enclosed roomo Crowded places

RUBELLA Occurrence

o worldwide.

Reservoiro human diseaseo Infants with congenital rubella syndrome(CRS) may shed rubella virus for an

extended period, • But a true carrier state has not been describe.

Transmissiono person to person via airborne transmissiono droplets shed from the respiratory secretions of infected persons

• asymptomatic cases o no evidence of insect transmission

Incubation Periodo 14 – 21 days

Communicabilityo only moderately contagious. o most contagious when the rash first appearso Infectious period: from 7 days before to 5–7 days or more after rash onset.o Infants with CRS shed virus from body secretions for up to 1 year

• may transmit rubella to persons caring

EPIDEMIOLOGICAL TRIAD OF RUBELLA

Agento rubella virus

• Do not require vector• relatively unstable • inactivated by lipid solvents,

trypsin, formalin, ultraviolet light, low pH, heat

Hosto Human

• infants and young toddlers who have not received the vaccine

• women of childbearing age do not have immunity to the disease

Environmento WHO African and South-East Asian

regions- vaccine coverage is lowesto Late winter early springo Small, enclosed roomo Crowded placeso Schools or day care centre o Shopping mall

DISTRIBUTION

PREVENTION

Rubellao Rubella vaccine (Meruvax)o Keep distance from infected

person

Measleso Measles vaccine

• 2 doses • 1st dose at age 12 -15 months• 2nd dose at 4 – 6 years old

o Keep distance from infected person

Mumpso Mumps vaccine (Paramyxovirus)

• Last at least 12 yearso Keep distance from infected person

Combined MMR introduced in Malaysiao 2002

INCIDENCE TIME SERIES FOR MALAYSIA

References Epidemiology

o https://sites.google.com/site/epidemiology12/measleso https://sites.google.com/site/epidemiology12/rubellao https://sites.google.com/site/epidemiology12/mumps

WHO Health Topicso http://www.emro.who.int/health-topics/measles/disease-and-epidemiology.html o http://www.emro.who.int/health-topics/rubella/disease-and-epidemiology.html o http://www.who.int/topics/mumps/en/

Epidemiology and transmission of measleso http://www.uptodate.com/contents/epidemiology-and-transmission-of-measles

Vaccine Knowledge Project o http://www.ovg.ox.ac.uk/measleso http://www.ovg.ox.ac.uk/rubella

Rubella Viruso http://www.stanford.edu/group/virus/toga/2000/c.html

WHO Incidence time series for Malaysiao http://apps.who.int/immunization_monitoring/globalsummary/incidences?c=MYS

History of Vaccineo http://www.historyofvaccines.org/content/articles/mumps

References Epidemiology and Prevention of Vaccine-

Preventable Diseaseso http://www.cdc.gov/vaccines/pubs/pinkbook/meas.htmlo http://www.cdc.gov/vaccines/pubs/pinkbook/rubella.htmlo http://www.cdc.gov/vaccines/pubs/pinkbook/mumps.html

Measles Prevention and Control in Malaysiao http://jknns.moh.gov.my/v1/images/borang/cdc/

r.Measles-Prevention%20and%20Control%20in%20Malaysia.pdf

Lippincott’s Guide to Infectious Diseases Harrison’s Infectious Diseases

o By Kasper, D. L., & Fauci, A. S. (2010)

THANK YOU