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

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

3. Agent Host
Environment
Epidemiological
triad

4. CHICKEN POX

5. CHICKEN POX
• Also called as varicella
• Fever, malaise and rash
• Chicken pox and herpes zoster
• Case fatality rate is low

6. Varicella
zoster virus
Children,
pregnancy
Seasonal trend
Chicken pox

7. Period of infectivity

8. STAGES OF CHICKEN POX

9. CHARACTERISTICS OF RASH
CrustingCrusting
Vesicle“dew drops”Vesicle“dew drops”
PapulePapule

10. DISTRIBUTION OF RASH

11. COMPLICATIONS OF CHICKEN
POX
• Varicella haemorrhagica
• Pneumonia
• Encephalitis
• Acute cerebellar ataxia
• Reye’s 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

13. IMMUNIZATION

14. MEASLES

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

19. Period of infectivity

20. CHARACTERISTICS OF RASH
Initial symptoms : high fever (103-105°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

21. KOPLIK’S SPOTS

22. RASH IN MEASLES

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

31. RUBELLA

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.

36. Rubella
Microcephaly
Congenital
Cataract
Deafness

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

41. MR/MMR VACCINE

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

45. SUMMARY

46. THANK YOU