1. Measles, Mumps and Rubella Ruth Carrico PhD RN FSHEA CIC Associate Professor Division of Infectious Diseases University of Louisville Ruth.carrico@louisville.edu

2. Reported Cases of Measles, Mumps, Rubella in the US during 2011 Rubella: 4Measles: 220Mumps: 404 Summary of Notifiable Diseases. MMWR 2013;60(53):1-120

3. Rubella

4. Name derived from a Latin term meaning “little red” Also known as German Measles or 3-day Measles Acute viral illness causing fever and rash Rash [maculopapular] and fever last 2-3 days Transmission via respiratory droplets Incubation period of 17 days [range 12-23 days] Most infectious when rash erupting; can shed virus 7 days before to 7 days after rash onset Most concerning impact is when infection occurs during pregnancy

6. Measles RNA virus; Paramyxovirus Highly contagious viral illness Systemic infection Airborne transmission with the viral particles being rapidly inactivated by heat and light. Survival time <2 hrs on objects and surfaces Preferential toward winter season

9. WHO RegionTotal number of cases CountriesGenotype Identified African2Kenya (1), Nigeria (1)B3 (2) Eastern Mediterranean 2Pakistan (1), Jordan (1)D4 (1) European25France (12), Italy (4), Poland (1), Romania (1), Spain (1), United Kingdom (4), France/United Kingdom*(1), France/Italy/Spain/Germany *(1) D4 (11), G3 (1) Americas1Dominican Republic†(1)D4 (1) South-East Asia16India (15), Indonesia (1)D8 (5), D4 (1) Western Pacific7China (2), Philippines (4), Philippines/Vietnam/Singapore /Malaysia*(1) H1 (1), D9 (2) 70% of importations among U.S. residents traveling abroad *Patient visited more than 1 country during the incubation period † Likely acquired disease from French tourist Measles, United States, January – June 17, 2011 Source of Importations

10. Measles – Outbreak 2011 MMWR May 24, 2011

11. Measles – Outbreak 2011 MMWR May 24, 2011

12. Measles Incubation period 10-12 days [range 7-18 days] Prodrome includes fever of 103 or higher Cough, chorya, conjunctivitis Rash is maculopapular lasting 5-4 days 30% or more who have the disease will have complications

13. Mumps

14. Viral illness caused by a paramyxovirus Classic symptoms include parotitis in about 50% (unilater or bilateral) developing 16-18 day after exposure Nonspecific symptoms (myalgia, malaise, anorexia, fever may precede parotitis. 15-20% of infections are asymptomatic Incubation period 16-18 days [range 12-25 days]. Most infectious 1-2 days before until 5 days after parotitis

15. Mumps Virus replicates in upper respiratory tract Droplet transmission as well as contact with respiratory secretions, saliva or items contaminated with those fluids Severe complications are rare, but adults have higher risk of meningoencephalitis than do children Males may experience orchitis in up to 30-40% of those infected

16. Measles-Mumps-Rubella Vaccine (MMR) Contains live attenuated viruses 1-dose efficacy varies from 80% (mumps) to 95% (measles and rubella) Duration of immunity probably lifelong Schedule is 2 doses, 28 days apart All adults born in 1957 or later should have documentation of 2 doses (or other evidence of immunity)

17. Vaccine uses a diluent Given subcutaneously in the upper arm

18. Adults at High Risk for Measles College students Those living in crowded or congregate settings International travelers Healthcare personnel

19. MMR Vaccine Contraindications Severe allergic reaction to vaccine component or following prior dose Pregnancy Those indicating that pregnancy within the next 4 weeks is likely Immunosuppression (severe)

20. MMR Adverse Reactions Fever5-15% Rash5% Joint Symptoms25% Thrombocytopenia1/30,000 doses ParotitisRare DeafnessRare Encephalopathy1/1,000,000 doses

21. Addressing a Low Incidence Disease Remember why it is low incidence Identify high risk populations for acquisition and transmission Determine populations with opportunity to aid in transmission or be impacted by the disease