MUMPS MEASLES AND RUBELLA PowerPoint Presentation

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1 MUMPS, MEASLES RUBELLA and human parvovirus

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2 MEASLES (RUBEOLA)MUMPSRUBELLA MAN WORLD WIDE SINGLE SEROTYPE OF EACH VIRUS LIVE ATTENUATED VACCINE (MMR) CHILDHOOD DISEASES (PRE-VACCINE) NOTIFIABLE DISEASE

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3 PARAMYXOVIRUS FAMILY MUMPS MEASLES TOGAVIRUS FAMILY RUBELLA

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4 MEASLES AND MUMPS

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5 M protein helical nucleocapsid (RNA plus NP protein) HN/H/G glycoprotein SPIKES polymerase complex lipid bilayer membrane F glycoprotein SPIKES PARAMYXOVIRUSES pleomorphic

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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

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8 VACCINE EFFECTIVENESS http://www.cdc.gov/nip/ed/slides/slides.htm

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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

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10 INFECTION AEROSOL VERY CONTAGIOUS

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11 Adapted from Mims, Playfair, Roitt, Wakelin and Williams (1993) Medical Microbiology viremia

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12 MEASLES - Koplik’s spots Murray et al. Medical Microbiology

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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

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14 MEASLES - RASH CDC - B.Rice Murray et al. Medical Microbiology

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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

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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

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17 COMPLICATIONS GIANT CELL PNEUMONIA Histopathology of measles pneumonia. CDC/Dr. Edwin P. Ewing, Jr. Giant cell with intracytoplasmic inclusions

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18 COMPLICATIONS GIANT CELL PNEUMONIA SECONDARY BACTERIAL INFECTIONS MORE SEVERE IF MALNOURISHED AND/OR POOR ACCESS TO MEDICAL CARE MEASLES ENCEPHALITIS

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19 Mims et al., Medical Microbiology 1993

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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%

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21 MEASLES ENCEPHALITIS 1/1000 cases sequelae deafness seizures mental disorders

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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

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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

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24 DIAGNOSIS Serodiagnosis Significant increase in IgG (need two samples) Positive for IgM Isolation RT-PCR All suspect cases should be confirmed by laboratory

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25 EPIDEMIOLOGY ALMOST ALL INFECTED INDIVIDUALS SHOW DISEASE ONE SEROTYPE NATURAL INFECTION GIVES LIFE LONG PROTECTION MOST CONTAGIOUS BEFORE RASH IS EVIDENT

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26 PREVENTION LIVE ATTENUATED VACCINE Does not spread to contacts Can cause problems in immuno-suppressed IMMUNE SERUM GLOBULIN

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27 TREATMENT SUPPORTIVE CARE

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28 PARAMYXOVIRUSESMUMPS

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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

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30 MUMPS CDC - B.Rice

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31 Mims et al., Medical Microbiology 1993

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32 Mims et al., Medical Microbiology 1993

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33 RECOVERY CELL MEDIATED IMMUNITY

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34 DIAGNOSIS 30% INFECTIONS SUB-CLINICAL SEROLOGY OR ISOLATION RT-PCR

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35 EPIDEMIOLOGY MAN ONLY HOST ONE SEROTYPE SUB-CLINICAL INFECTIONS CONTAGIOUS BEFORE AND AFTER SYMPTOMS

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36 PREVENTION LIVE ATTENUATED VACCINE DOES NOT SPREAD TO CONTACTS Contradindicated in immune-suppressed pregnant women

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37 RUBELLA VIRUS icosahedral nucleocapsid lipid bilayer membrane glycoprotein RNA (single-stranded positive-sense)

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38 RUBELLA VIRUS TOGAVIRUS FAMILY Alphavirus genus Rubivirus genus AEROSOL CHILDREN, ADULTS mild FETUS can be severe

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39 RUBELLA (German measles) Murray et al. Medical Microbiology

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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

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42 COMPLICATIONS ENCEPHALITIS (RARE)

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43 RECOVERY T-CELL

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44 PROTECTION IgG, IgA IgM may persist

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45 EFFECTS ON FETUS HEARING LOSS CONGENITAL HEART DEFECTS NEUROLOGICAL PYSCHOMOTOR AND/OR MENTAL RETARDATION OPHTHALMIC CATARACT, GLAUCOMA, RETINOPATHY

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46 EFFECTS ON FETUS thrombocytopenia hepatomegaly splenomegaly intrauterine growth retardation bone lesions pneumonitis

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47 EFFECTS ON FETUS First trimester 65-85% of neonates have sequelae

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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

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49 CONGENITAL INFECTIONS SHED VIRUS FOR A YEAR OR MORE AFTER BIRTH nasopharynx, urine, feces

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50 CONGENITAL INFECTIONS EYE PROBLEMS GLANDULAR COMPLICATIONS diabetes thyroid problems deficiency growth hormone

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51 CONGENITAL / VERY EARLY INFECTIONS PROGRESSIVE RUBELLA PANENCEPHALITIS

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52 DIAGNOSIS Serology Significant rise in IgG Positive for IgM Isolation RT-PCR

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53 DIAGNOSIS ~50% infections sub-clinical rash not always seen many other agents cause similar symptoms

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54 RUBELLA-LIKE SYMPTOMS HUMAN PARVOVIRUS SOME ALPHAVIRUSES SOME ENTEROVIRUSES SOME ADENOVIRUSES EPSTEIN-BARR VIRUS SCARLET FEVER TOXIC DRUG REACTIONS OTHER CAUSES INCLUDE:

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55 PREVENTION LIVE ATTENUATED VACCINE DOES NOT SPREAD TO FAMILY MEMBERS CHILDREN SUSCEPTIBLE NON-PREGNANT FEMALES

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56 EPIDEMIOLOGY MAN SOLE HOST WORLD WIDE ONE SEROTYPE NATURAL INFECTION PROTECTS FOR LIFE

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57 PARVOVIRUS B-19 (erythrema infectiosum) Murray et al. Medical Microbiology

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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)