Measles

(ENGLIS MEASLES)
 Agent
Agent- RNA virus ( Paramyxo virus family,
genus Morbillivirus )
Source of infection-cases of measles,
but not carriers.
No animal reservoir
Infective material- Nasal secretion ,Respiratory
tract &Throat
Communicability- Highly infectious during
prodromal period and at the time of eruption.
Secondary attack rate- > 80%
 Host factors
Age- 6 months to 3 years even up to 10
years
Incidence equal in both sexes
Immunity life long immunity
Malnourished children are susceptible
 Environmental factor

Winter season, over crowding

Transmission Droplet infection
4 days before and 4 days after rash
Incubation period- 7 days
Courtesy : Adapted from Mims et al. Medical Microbiology, 1993,
Mosby
 Clinical features
Prodromal stage
Eruptive stage
Post-measles stage
 Clinical features
3 Cs (Cough, Coryza & Conjunctivitis)
Koplik spots
Four days fever (400c)
Generalized, maculopapular,erythematous
rash.
Courtesy : This media comes from the Centers for Disease Control and
Prevention's Public Health Image Library (PHIL), with identification
number #3168
KOPLIK SPOT
 Complication
Diarrhea,
Pneumonia
Otitis media
Convulsions,
SSPE (sub acute sclerosing
panencephalitis)
WHO strategy for control and
prevention of Measles
1) Catch up
2) Keep up
3) Follow up
 Host factors
Age- 6 months to 3 years even up to 10
years
Incidence equal in both sexes
Immunity life long immunity
Malnourished children are susceptible
 Environmental factor

Winter season, over crowding

Transmission Droplet infection
4 days before and 4 days after rash
Incubation period- 7 days
Courtesy : Adapted from Mims et al. Medical Microbiology, 1993,
Mosby
 Clinical features
Prodromal stage
Eruptive stage
Post-measles stage
 Clinical features
3 Cs (Cough, Coryza & Conjunctivitis)
Koplik spots
Four days fever (400c)
Generalized, maculopapular,erythematous
rash.
Courtesy : This media comes from the Centers for Disease Control and
Prevention's Public Health Image Library (PHIL), with identification
number #3168
KOPLIK SPOT
 Complication
Diarrhea,
Pneumonia
Otitis media
Convulsions,
SSPE (sub acute sclerosing
panencephalitis)
WHO strategy for control and
prevention of Measles
1) Catch up
2) Keep up
3) Follow up
German Measles
(Rubella)
German Measles (Rubella)
 German Measles Virus

Icosahedral
shape
Contains RNA
German Measles Symptoms
Rubella comes from
the Latin words for
little red
Creates dense groups
of small skin rash
Produces swollen
lymph nodes, runny
nose, and fever
German Measles Transmission
Spread through
respiratory
droplets from
coughing and
sneezing
Also spread
through body
secretions and
excretions
 Rubella is sometime called German Measles
or 3-day Measles.
The synonym "3-day measles" derives from
the typical course of rubella exanthema that
starts initially on the face and neck and
spreads centrifugally to the trunk and
extremities within 24 hours.
It then begins to fade on the face on the second
day and disappears throughout the body by
the end of the third day.
It is a generally mild disease caused by the
rubella virus.
 Agent RNA virus (Togo virus family),
Genus Rubivirus.
Source of infection Respiratory secretion
Host -3-10 yrs
Immunity life long
Environmental factors winter and spring
season
Transmission droplet, vertical transmission
I.P 2-3 weeks average 18 days
 Eye pain on lateral and upward eye
movement (a particularly troublesome
complaint)
Conjunctivitis
Sore throat
Headache
General body aches
Low-grade fever
Chills
Anorexia
Nausea
 Tender lymphadenopathy (particularly
posterior auricular and suboccipital lymph
nodes)

Forchheimer sign (an enanthem observed in

20% of patients with rubella during the
prodromal period; can be during the initial
phase of the exanthem;
consists of pinpoint or larger petechiae
that usually occur on the soft palate)
Temperature
Fever is usually not higher than 38.5C
(101.5F).
Lymph nodes
Enlarged posterior auricular and suboccipital
lymph nodes are usually found on physical
examination.
Mouth
The Forchheimer sign may still be present on
the soft palate.
Image in a 4-year-old girl with a 4-day history of low-grade fever,
symptoms of an upper respiratory tract infection, and rash.
Courtesy of Pamela L. Dyne, MD.
 INFECTION DURING PREGNANCY.
028 days before conception - 43%
chance
012 weeks after conception - 51%
chance
1326 weeks after conception - 23%
chance
Infants are not generally affected if
rubella is contracted during the third
trimester
Photo source: U.S. Centers for Disease Control and Prevention
 Salt and pepper
retinopathy
Courtesy
http://phil.cdc.gov/phil_images/2003072
4/28/PHIL_4284_lores.jpg

Content Providers(s): CDC Creation

Date: 1976
 COMPLICATION ON FETUS
DURING PREGNANCY
Sensorineural hearing loss 58%
Ocular abnormalities including cataract,
infantile glaucoma, Micro ophthalmia
and pigmentary retinopathy occur in
approximately 43%
Congenital heart disease including patent
ductus arteriosus (PDA) and pulmonary
artery stenosis - 50%
 Measles Vaccine
Composition Live virus
Efficacy 95% (range, 90%-98%)
Duration of
Immunity Lifelong
Schedule 2 doses

Should be administered with mumps and

rubella as MMR or with mumps, rubella
and varicella as MMRV
 Presumptive Evidence of Measles
Immunity
Documentation of adequate vaccination
1 dose of MMR vaccine for preschool-aged
children and for adults not at high risk of
exposure
2 doses for school-aged children (i.e., grades K-
12) and for adults at high risk of exposure
Serologic evidence of immunity
Birth before 1957
Documentation of physician-diagnosed measles
 Measles Vaccine
Indications for Revaccination
Vaccinated before the first birthday
Vaccinated with killed measles vaccine
Vaccinated prior to 1968 with an
unknown type of vaccine
Vaccinated with IG in addition to a
further attenuated strain or vaccine of
unknown type
 Mumps
(Parotitis)
 Mumps Virus

Helical shape
RNA virus
 Mumps Symptoms
Infects salivary glands,
especially the parotid
gland
Primary symptom is
swollen checks
Can also cause fever,
headache, and malaise
Testicular inflammation
is common, ovarian
inflammation can
happen but is rare
Mumps
 Mumps Transmission
Spread through
airborne
transmission of
respiratory droplets
by sneezing and
coughing
Also spread from
direct contact with
saliva
 Agent
Myxovirus parotidis RNA virus
Source of infection Respiratory,
milk
Period of communicability 4-6 days
of onset of symptoms
Secondary attack rate 86%
 Age & sex 5-15 yrs and girls
common
Immunity - life long
Environmental factor winter and
spring season favors
Mode of transmission droplet
I.P - 2 to 3 weeks
 Clinical features

Parotid swelling
Ovaritis
Pancreatitis
Ear ache
Orchitis
 Complications
Orchitis
Epididymitis
Oophoiritis
Spontaneous abortion
Sensori neural hearing loss, (uni- or bilateral).
Mild form of meningitis
Encephalitis
Mumps Vaccine
10 strains of the mumps virus are in use
throughout the world for the preparation of
live attenuated vaccine.
Jeryl Lynn strain which was named after
the child from whom the virus was
isolated.
Leningrad-3 strain
Urabe strain
Hoshino, Torii and NKM - 46 strains
L-Zagreb
MMR Vaccine
Live attenuated strains of Edmonston-Zagreb
Measles virus propagated on human diploid cell
culture,
L-Zagreb Mumps virus propagated on chick
embryo fibroblast cells
Wistar RA 27/3 Rubella virus propagated on
human diploid cell culture.
 The reconstituted vaccine contains, in single dose of 0.5
ml. not less than
1000 CCID50 of Measles virus
5000 CCID50 of Mumps virus
1000 CCID50 of Rubella virus.
Diluent : Sterile water for injection.
The vaccine meets the requirements of USP and WHO
when tested by the methods outlined in USP and WHO,
TRS 840 (1994).
 For active immunization in children of 12 months to 12
years of age against Measles, Mumps and Rubella
infections MMR Vaccine to be given
For immunisation of susceptible non pregnant,
adolescent and adult females, we have to use Rubella
Vaccine)
Measles vaccine has to be given at 9 months,
If Measles vaccine is given ,a 3 months gap is
advisable to give MMR vaccine
MMR vaccine may be given between 12-15 months of
age.
If Measles vaccine was missed , MMR dose replaces
it, when given at or after 12 months.

 A single dose of 0.5 ml should be administered

by deep subcutaneous injection into the upper
arm.

If the vaccine is not used immediately then it

should be stored in the dark at 2 - 8C for no
longer than 8 hours.
 MMR Adverse Reactions
Fever* 5%-15%
Rash* 5%
Joint symptoms 25%
Thrombocytopenia* <1/30,000 doses
Parotitis rare
Deafness rare
Encephalopathy* <1/1,000,000
doses

*reactions usually attributed to the measles component

 MMR Vaccine
Contraindications and Precautions
Severe allergic reaction to vaccine
component or following prior dose
Pregnancy
Immunosuppression
Moderate or severe acute illness
Recent blood product
 MMRV (ProQuad)
Combination measles, mumps, rubella
and varicella vaccine
Approved children 12 months through
12 years of age (up to age 13 years)
Titer of varicella vaccine virus in
MMRV is more than 7 times higher
than standard varicella vaccine
Age Vaccines Note
Deep subcutaneous injection
9 months Measles into the upper arm.

12-15 Deep subcutaneous injection

months MMR -1 into the upper arm.

Deep subcutaneous injection

5 years MMR -2 into the upper arm.
Smallpox
Mumps
 Agent
Myxovirus parotidis RNA virus
Source of infection Respiratory,
milk
Period of communicability 4-6 days
of onset of symptoms
Secondary attack rate 86%
 Age & sex 5-15 yrs and girls
common
Immunity - life long
Environmental factor winter and
spring season favors
Mode of transmission droplet
I.P - 2 to 3 weeks
 Clinical features

Parotid swelling
Ovaritis
Pancreatitis
Ear ache
Orchitis
 Complications
Orchitis
Epididymitis
Oophoiritis
Spontaneous abortion
Sensori neural hearing loss, (uni- or bilateral).
Mild form of meningitis
Encephalitis
Mumps Vaccine
10 strains of the mumps virus are in use
throughout the world for the preparation of
live attenuated vaccine.
Jeryl Lynn strain which was named after
the child from whom the virus was
isolated.
Leningrad-3 strain
Urabe strain
Hoshino, Torii and NKM - 46 strains
L-Zagreb
MMR Vaccine
Live attenuated strains of Edmonston-Zagreb
Measles virus propagated on human diploid cell
culture,
L-Zagreb Mumps virus propagated on chick
embryo fibroblast cells
Wistar RA 27/3 Rubella virus propagated on
human diploid cell culture.
 The reconstituted vaccine contains, in single dose of 0.5
ml. not less than
1000 CCID50 of Measles virus
5000 CCID50 of Mumps virus
1000 CCID50 of Rubella virus.
Diluent : Sterile water for injection.
The vaccine meets the requirements of USP and WHO
when tested by the methods outlined in USP and WHO,
TRS 840 (1994).
 For active immunization in children of 12 months to 12
years of age against Measles, Mumps and Rubella
infections MMR Vaccine to be given
For immunisation of susceptible non pregnant,
adolescent and adult females, we have to use Rubella
Vaccine)
Measles vaccine has to be given at 9 months,
If Measles vaccine is given ,a 3 months gap is
advisable to give MMR vaccine
MMR vaccine may be given between 12-15 months of
age.
If Measles vaccine was missed , MMR dose replaces
it, when given at or after 12 months.

 A single dose of 0.5 ml should be administered

by deep subcutaneous injection into the upper
arm.

If the vaccine is not used immediately then it

should be stored in the dark at 2 - 8C for no
longer than 8 hours.
 MMR Adverse Reactions
Fever* 5%-15%
Rash* 5%
Joint symptoms 25%
Thrombocytopenia* <1/30,000 doses
Parotitis rare
Deafness rare
Encephalopathy* <1/1,000,000
doses

*reactions usually attributed to the measles component

 MMR Vaccine
Contraindications and Precautions
Severe allergic reaction to vaccine
component or following prior dose
Pregnancy
Immunosuppression
Moderate or severe acute illness
Recent blood product
 MMRV (ProQuad)
Combination measles, mumps, rubella
and varicella vaccine
Approved children 12 months through
12 years of age (up to age 13 years)
Titer of varicella vaccine virus in
MMRV is more than 7 times higher
than standard varicella vaccine
Age Vaccines Note
Deep subcutaneous injection
9 months Measles into the upper arm.

12-15 Deep subcutaneous injection

months MMR -1 into the upper arm.

Deep subcutaneous injection

5 years MMR -2 into the upper arm.
Smallpox
 Smallpox Virus
Variola virus
Contains DNA
 Smallpox Symptoms

Pox comes from the

Latin word for spotted
Extensive rash
High fever, malaise,
and body-aches
Elevated, fluid-filled,
cutaneous vesicles
Stages of Smallpox
Rash Distribution
 Smallpox

Complications of
smallpox include
bacterial super-
infections of the skin
and organs,
pneumonia, sepsis,
arthritis, keratitis, and
encephalitis.
Chicken Pox
 Description
Varicella is an acute infectious disease. It is caused by
varicella-zoster virus (VZV),
a DNA virus is a member of the herpesvirus group.

After the primary infection, VZV stays in the body (in

the sensory nerve ganglia) as a latent infection.

Primary infection with VZV causes varicella.

Reactivation of latent infection causes herpes zoster
(shingles).
 Description
It is very contagious and usually occurs
during childhood (normally 5-9) , but you
can get it at any time in your life.
Incubation Period
The incubation period is 14 to 16 days after
exposure to a varicella or a herpes zoster
rash, with a range of 10 to 21 days.
 The most common complications :
bacterial infections of the skin and soft tissues in
children
pneumonia in adults
Severe complications
include septicemia,
toxic shock syndrome,
necrotizing fasciitis,
osteomyelitis, bacterial pneumonia, and septic
arthritis.
cerebellar ataxia, encephalitis, viral pneumonia,
and hemorrhagic conditions.
 Background
Infects about 70% of all children by 18.
The rash and fever last for about five days.
Most children handle the chicken pox well
and recover without any problem within a
week.
 Background continued
Infants less than 6 months old are usually
protected from their mother carries the
antibody to this virus.
A healthy child less then 13 years old
generally has a very mild illness that
insures lifelong immunity .
It is unusual to have chicken pox more
than once.
 Symptoms
Chicken pox often begins with a small
fever, body aches and loss of appetite.
Within 1or 2 days, the rash appears,
normally starting on the chest or back.
At first the rash begins as red spots which
then form blisters and spreads to the rest
of the body.
 Symptoms continued
The blisters open and form a scab within a
few days.
The rash can continue to break out for 4-5
days as older lesions crust and heal.
Itching can accompany the rash along with
fever, swollen lymph nodes, sore throat
and general body aches.

Itchy and Scratchy

 Prevention
Children between 12 and 18 months should
receive
A dose of chickenpox vaccine,
Varicella-zoster immune globulin.
20 states have passed legislation requiring
the chickenpox vaccine for child care and
school entry.
Healthy children older than 13, and
adults who have no history of
chickenpox and have never been
immunized against the disease,
 Autosomal Issue
If a pregnant woman contracts
chickenpox during the first or
second trimester,
is a small risk that her child will be
born with a congenital malformation.
When a pregnant woman contracts
the disease within 5 days of
delivery, there is a high risk of the
 Cures and treatments
Cures
There are no actual cures for it ,can get a vaccine
shot to help prevent it.
Treatments
Baths with uncooked oatmeal, baking soda, or
cornstarch can help relieve itching.
Tylenol is used for fever or pain relief.
(Aspirin should be avoided.)
Antiviral drugs such as Acyclovir may be prescribed.
You can put Calamine lotion on the pocks to help
stop the itching.