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Marissa Hampton RN, BSN, SNNP and Gabriela Olivas RN, BSN, SNNP

Texas immunizations Advanced newborn health assessment GNRS 5303 University of Texas Medical Branch in Galveston. Marissa Hampton RN, BSN, SNNP and Gabriela Olivas RN, BSN, SNNP. Goals. Objective To describe each disease process for immunization

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Marissa Hampton RN, BSN, SNNP and Gabriela Olivas RN, BSN, SNNP

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  1. Texas immunizationsAdvanced newborn health assessmentGNRS 5303University of Texas Medical Branch in Galveston Marissa Hampton RN, BSN, SNNP and Gabriela Olivas RN, BSN, SNNP

  2. Goals Objective • To describe each disease process for immunization • To discuss the origin and history of vaccination, particularly in Texas • To detail each part of immunization and its purpose • To provide evidence based practices of immunization • To identify any long term outcome or management issues if vaccination is not provided

  3. Definitions • Immunization: The method in which a person becomes protected from a disease process. • Vaccination: Injection of a killed or weakened infectious organism in order to prevent the disease. • Vaccine: A product that produces immunity against the disease. (Centers for Diseases Control and Prevention [CDC], 2012c)

  4. How do immunizations work? • When bacteria/virus enter the body, they multiple and attack healthy cells. • The immune system fights invaders and makes memory cells to recognize them so the body can fight if ever attacked again. • Vaccines develop immunity by imitating infection. This imitation does not cause illness, but instead helps the individual to build an immunity. If exposed again, the body will use memory cells to fight the infection. (CDC, 2012b)

  5. Recommended immunizations by the Center for Disease Control and Prevention

  6. Immunizations as recommended from the state of Texas

  7. Vaccine administration (Immunization Action Coalition, 2012)

  8. Hepatitis B • Viral disease that is spread via puncture wounds through the skin or through blood and body fluid secretions • Signs and symptoms: • Vary with age • Most newly infected patients and infants are asymptomatic • Fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, joint pain, jaundice • High risk individuals: • Include sex with an infected partner , injection drug use or needle sticks, an infant born to an infected mother or contact with blood or open sores of infected person • Acute Hepatitis B: at time of initial infection • Chronic Hepatitis B: Progressive worsening of liver disease; Chronic patients may continue to have signs and symptoms, further complications and cause infection in others. • Persons with chronic HBV infection might be asymptomatic, have no evidence of liver disease, or have a spectrum of disease ranging from chronic hepatitis to cirrhosis or hepatocellular carcinoma (a type of liver cancer). (Texas Department State of Health Services, 2013a)

  9. Hepatitis B History United States • Before 1982: 200,000 to 300,000 people infected including 20,000 children • 90 % chance transmission from + mother to infant without prophylaxis • 25 % infected at childhood will die from cirrhosis • No method for pre exposure prophylaxis • 1984: Advisory committee on immunization practices (ACIP) recommends testing for high risk individuals • 1988: ACIP recommends screening pregnant women for Hepatitis B • 1991: ACIP recommends comprehensive strategy: prenatal screening, prophylaxis treatment of infants from + mothers, universal childhood vaccination Texas • 1991: Texas implemented recommendations from CDC into state law • Vaccination is required prior to day care and school admission in Texas (Morbidity and Mortality Weekly Report, 2002) (Wasley, Kruszon-Moran, Kuhnert, Simard, Finelli, McQuillan,& Bell, 2012) (Texas Department State of Health Services, 2013a)

  10. Hepatitis B Vaccine Heptavax-B, Recombivax HB, Engerix-B • Indication and Use: Immunization against infection caused by all known subtypes of hepatitis B virus in individuals • Actions: Promotes immunity by inducing the production of specific antibodies to the virus • Dosage: • Infants born to hepatitis B surface antigen(HBsAg)-positive mothers: First does within the first 12 hours of life even if premature and regardless of birth weight (hepatitis immune globulin should also be administered at the same tie/different site); second dose at 1-2 months of age; third dose at 6 months. Check anti-HBs and HBsAg at 9-15 months of age. IF anti-HBs and HBsAg are negative, reimmunize with 3 doses 2 months apart and reassess. • Infants born to HBsAg-negative mothers: First dose prior to discharge; however, the first dose may be given at 1-2 months of age. Another dose given 1-2 months later, and a final dose at 6 months of age. A total of 4 doses of vaccine may be given if a “birth dose” is administered and a combination vaccine is used to complete the series. • Infants born to mothers whose HBsAg status is unknown at birth: first dose within 12 hours of birth even if premature, regardless of birth weight; second dose following 1-2 months later, and a final dose at 6 months of age. If the mother’s blood HBsAg test is positive, the infant should receive hepatitis immune globulin as soon as possible (no later than 1 week (Cunningham, Eyal & Gomella, 2013)

  11. Effects of Hepatitis B Vaccine United States • 1990-2004: Hepatitis B rates have declined by 94% in children due to screening, universal vaccination and prophylaxis, if needed. Texas • 1991- 2012: Steady decline of Hepatitis B rates in Texas • In 2012 , 170 reportable cases of acute Hepatitis B, lowest rates in history. • Overall decline was greatest among children and adolescents under 18 years. (Texas Department State of Health Services, 2013a)

  12. Long term outcome or management if untreated • Treatment • No specific therapy for acute HBV infection. • Treatment is supportive. • Interferon is the most effective treatment for chronic HBV infection and is successful in 25% to 50% of cases. • Hepatitis B complications • Fulminant hepatitis, hospitalization, cirrhosis, hepatocellular carcinoma, death Female patient from Cambodia with a heptoma due to chronic Hepatitis B infection. (CDC, 1995c) (CDC, 2012a)

  13. Rotavirus • Leading cause of gastroenteritis in infants and children under age 5 • Prior to vaccination 4 out 5 children will be infected by age 5 • Transmitted Fecal- Oral Route • Signs and Symptoms • Fever, vomiting, diarrhea, abdominal pain, loss of appetite, dehydration. • Dehydration may be severe; may cause electrolyte imbalance, shock and death (Morbidity and Mortality Weekly Report, 2009) (CDC, 2011c)

  14. Rotavirus • State of Texas does not currently recommend immunization against rotavirus • RotaTeq® [RV5] • 3 dose series licensed in 2006 • Given at 2, 4, 6 months • Recommended by ACIP for all infants • Rotarix® [RV1] • 2 dose series licensed in 2008 • Given at 2, 4 months • Recommended by ACIP to replace previous vaccine (Morbidity and Mortality Weekly Report, 2009)

  15. Long term outcome and management if untreated • For persons with healthy immune systems, rotavirus gastroenteritis is a self-limited illness, lasting for only a few days. Treatment is nonspecific and consists of oral rehydration therapy to prevent dehydration. About 1 out of 70 children with rotavirus gastroenteritis will require hospitalization for intravenous fluids. • (CDC, 2011c)

  16. DTaP • Diphtheria • Infection caused by Corynebacterium diphtheriaebacteria • Spread by respiratory droplets or contaminated objects • Bacteria invades the respiratory system and produces toxins • Cause weakness, sore throat, fever, swollen glands in the neck, pseudomembrane- build up of dead tissue that causes difficulty breathing • Toxins damages the heart, kidneys and nerves • Tetanus • Infection caused by bacteria Clostridium tetani. • Enters the body through broken skin, from contaminated objects. • Causes headache, jaw cramping, sudden, involuntary muscle tightening – often in the stomach (muscle spasms), painful muscle stiffness, difficulty swallowing, seizures, fever, sweating, high blood pressure and fast heart rate • Pertussis • Infectious disease caused by the bacterium Bordetella pertussis. • Early symptoms: runny nose, low-grade fever, mild, occasional cough , apnea, • With progression, traditional symptoms appear: Many, rapid coughs followed by a high-pitched "whoop“, vomiting, exhaustion after coughing fits. Coughing fits can go on for up to 10 weeks or more. (CDC, 2011a) (CDC, 2013d) (CDC, 2012d)

  17. DTaP History Diphtheria • Early 1900s: First prophylaxis was attempted • 1921: toxoid was developed but not used until 1930 • 1940: Vaccine was incorporated with tetanus toxoid and pertussis. Tetanus • 1914- 1919: World War I- passive immunity used for treatment and prophylaxis • 1920: Inactivating tetanus toxin process • 1924: Development of tetanus toxid; widely used in World War II • 1940’s: Tetanus toxid introduced into routine childhood immunizations • Tetanus became nationally notifiable; 500-600 cases annually Pertussis • 1906: First isolated organism • 1940: Development of pertussis vaccine • 200,000 cases reported annually

  18. DTaP vaccine • 4 combination vaccines: DTaP, Tdap, DT, and Td. • DTaP and DT are given to children younger than 7 years of age • Tdap and Td are given to older children and adults. • DTaP • Children should get 5 doses of DTaP, one dose at each of the following ages: 2, 4, 6, and 15-18 months and 4-6 years. • Vaccines approved for ages 6 weeks and older: Infanrix, Tripedia and Daptacel • DT • Vaccine does not contain pertussis • Used in children who can not tolerate pertussis vaccine (CDC, 2007)

  19. Effects of DTaP Vaccine Diphtheria United States • Rapid decline in rates since vaccination • Began in 1940 • 1970-1979: 196 reportable cases • 1980-2004: 57 reportable cases Texas • According to Texas Health services website, there have been no reportable cases in years, but is still considered a reportable rare disease Child with diphtheria presented with a characteristic swollen neck, sometimes referred to as “bull neck”. (CDC, 1995b)

  20. Effects of DTaP Tetanus United States • Steady decrease since vaccine introduced into routine childhood vaccination in 1940 • 2001-2008: 233 cases of reported tetanus, averaging 29 cases annually. • Neonatal tetanus is rare, two cases reported since 1989. Texas • Rare. Most reported cases are unvaccinated individuals or those who have not received booster shot in the following 10 years. • Since 2008 only 5 reported cases, one of which was fatal. Body rigidity from neonatal tetanus (CDC, 1995d) (CDC, 2013d) (Texas Department of State Health Services, 2013)

  21. Effects of DTaP vaccine Pertussis • United States • 1940: Following introduction of vaccine, rates gradually declined • 1980–1990: An average of 2,900 cases per year were reported • 2001-2003: Average annual cases began to rise once again • Texas • Pertussis rates in Texas historically climbs every 3 to 5 years then sharply declines. • Documented outbreaks occurred in 2005 and 2008. • 2012: There were 2,218 reported cases, doubling the 2011 count of 961. • 2013: Outbreak of Pertussis continues with 2,652 pertussis cases reported in Texas. • 2000-2012, a total of 43 deaths were attributed to pertussis in Texas, with most deaths under the age of 1. Pertussis rates: United States 1940-2009 (CDC, 2012 e) (Texas Department of State Health Services, 2013b) (CDC, 2012e)

  22. Long term outcome and management if untreated Diphtheria • Treatment: Diphtheria antitoxin to neutralize toxins produced by bacteria. Antibiotics are used, patients are kept in isolation for 48 hours after antibiotic treatment begins. • Complications: Blocked airway, myocarditis, polyneuropathy, Paralysis, Pneumonia or respiratory failure. Tetanus • Treatment:Tetanus is a medical emergency requiring hospitalization, immediate treatment with human tetanus immune globulin (TIG) , a tetanus toxoid booster, wound care and antibiotics. • Complications:Uncontrolled/involuntary muscular contraction of the vocal cords, fracture, nosocomial infections, pulmonary embolism, aspiration pneumonia, difficulty breathing, death (CDC, 2011a) (CDC, 2013d)

  23. Long term outcome and management if untreated Pertussis • Complications: • Serious and potentially life-threatening complications in unvaccinated infants: Apnea, pneumonia, seizures, encephalopathy and death • More than half of infants who acquire pertussis and are younger than 12 months of age must be hospitalized. • Hospitalization is common in infants younger than 6 months of age. • Other complications: • Anorexia, dehydration, difficulty sleeping, epistaxis, hernias, otitis media, and urinary incontinence • More severe complications include pneumothorax, rectal prolapse, and subdural hematomas. (CDC, 2012e)

  24. Haemophilus influenzae type B(Hib) • 6 types of Haemophilus influenzae bacteria • Haemophilus influenzae bacterium may cause severe infection; occurs mostly in infants and children younger than five. • Haemophilus influenzae type b (Hib) bacteria causes: • Pneumonia, bacteremia, meningitis, epiglottitis, septic arthritis, cellulitis, otitis media, purulent pericarditis, endocarditis and osteomyelitis. • Transmission occurs through direct contact with respiratory droplets. • Neonates can acquire infection by aspiration of amniotic fluid or contact with genital tract secretions containing the bacteria. (CDC, 2012d) Infant with severe vasculitis with disseminated intravascular coagulation (DIC) with gangrene of the hand secondary to Hib septicemia (American Academy of Pediatrics, n.d.).

  25. Hib History United States • Before vaccination era, Hib was the leading cause of bacterial meningitis in children younger than 5 • 1930: 1 in 200 children developed Hib • Two thirds in children younger than 18 months. • Peak age of occurrence among children 6- 11 months • 1980’s: Estimated 20,000 cases of Hib occurred in the US • 1985: A pure polysaccharide vaccine (HbPV) was licensed in the U.S. • Not effective in children younger than 18 months of age. • 1987: First conjugate vaccine licensed in U.S. (CDC, 2012d)

  26. Hib Vaccine Hib vaccine • Infant primary series is given in 3 doses at 2, 4, 6 months or 2 doses at 2, 4 months • Booster dose is needed at 12 to 15 months. • 2 monovalent conjugate Hib vaccines • PRP-OMP (PedvaxHIB) vaccine is 2 doses • PRP-T (ActHIB) is 3 doses • 2 combination conjugate Hib vaccines • DTaP-IPV/Hib: Pentacel • Hepatitis B-Hib: Comvax (CDC, 2012d)

  27. Effects of Hib vaccine United States • Late 1980’s: Rates of Hib infection decreased by 99 percent as compared to pre-vaccine era. • 1991: Hib infections became nationally reportable. • 1996-2000: 341 confirmed cases of Hib reported • Approximately 22 percent within children less than 5 years old. Texas • Rare in Texas • Average of 8 cases reported annually (CDC, 2012) (Texas Department of State Health Services, 2013)

  28. Long term outcome and management if untreated • Invasive Hib • Hospitalization • Antimicrobial therapy • Third-generation cephalosporin (cefotaxime or ceftriaxone) • Chloramphenicol in combination with ampicillin • Treatment is 10 days. (CDC, 2012d)

  29. Pneumococcal Disease • Streptococcus pneumoniae causes an acute bacterial infection. • Transmission of S. pneumoniae occurs as the result of direct person-to-person contact via respiratory droplets and by autoinoculation in persons carrying the bacteria in their upper respiratory tract.  • The major clinical syndromes of pneumococcal disease are pneumonia, bacteremia, and meningitis. • The immunologic mechanism that allows disease to occur in a carrier is not clearly understood. • Disease most often occurs when a predisposing condition exists, particularly pulmonary disease. (CDC, 2012g)

  30. This ventral view of a human brain depicts a purulent basilar meningitis infection due to Streptococcus pneumoniae bacteria. Though S. pneumoniae in a normally occurring floral inhabitant of the human upper respiratory tract, in cases where an individual’s immune system is compromised, it is responsible for causing paranasal sinusitis, middle ear infections (otitis media), and lobar pneumonia, as well as meningitis secondary to these primary respiratory infections (CDC, 1995e).

  31. Pneumococcal History • 1911: First developments in creating a pneumococcal vaccine • 1940: Penicillin development; Vaccine developments stopped • 1960’s: Increased mortality despite antibiotic therapy • Efforts made toward development of vaccine • 1977: First Pneumococcal vaccine licensed • 1998: 24 cases per year of Pneumococcal Disease, highest rates in children under 2 years of age • 2000: First conjugate pneumococcal vaccine licensed Texas • 2005: Texas mandates pneumococcal requirement for children 5 years and younger (CDC, 2012g)

  32. Pneumococcal 13-velent conjugate vaccine (Prevnar) Prevnar • Protects against: Streptococcus pneumoniae • Indication and use: for active immunization of infants/toddlers against Streptococcus pneumoniae invasive disease caused by the 13 capsular serotypes in the vaccine for all children 2-23 months of age. It is also recommended for certain children 24-59 months of age. • Administered at 2, 4, 6, and 12-15 months of age. Shake well before administration. • Adverse effects: decreased appetite, drowsiness, irritability, fever and injection site local tenderness, redness and edema. Not a treatment of active infection. Use of this vaccine does not replace the use of the 23-valent pneumococcal polysaccharide vaccine in children> 24 month old with sickle cell disease, chronic illness, asplenia, HIV, or those who are immunocompromised. (Cunningham, Eyal & Gomella, 2013, pg.991)

  33. Effects of Pneumococcal Vaccine United States • 1998-1999: In children 5 and younger, reported 99 cases per 100,000 of pneumococcal disease • 2008: Reported 21 cases per 100,000 in same age group Texas • No information found on reportable cases for pneumococcal related disease

  34. Long term outcome or management if untreated What does S.Pneumoniae cause if patient infected? • Causes invasive infections • Bacteremia, meningitis, pneumonia, otitis media and sinusitis • Leading cause of bacterial meningitis among children <5 years of age • Disease complications: • Bacteremia, meningitis, death • Treatment: • Resistance to penicillin and other antibiotics is common. • In some areas of the United States, up to 40% of invasive pneumococcal isolates are resistant to penicillin. • Treatment will usually include a broad-spectrum cephalosporin, and often vancomycin, until results of antibiotic sensitivity testing are available. (CDC,2012g)

  35. Poliomyelitis • Enterovirus • Enters through the mouth • Implants and replicates in the gastrointestinal tract • Migrates to the nervous system to destroy motor neurons • Excreted in feces (CDC, 2012f)

  36. Poliomyelitis History United States • First outbreaks recorded in 1843 • Epidemic outbreaks for the next century • 1952: Outbreaks peaked in the U.S. • More than 21,000 paralytic cases reported • 1955: Introduction of inactivated polio vaccine (IPV) • Following introduction of vaccine rates declined dramatically • 1961: Introduction of oral polio vaccine (OPV) • 1979: Last reported case of polio (CDC, 2012f)

  37. Poliomyelitis vaccine • Two types of polio vaccines: oral and inactive • Inactivated Polio Vaccine (IPV) • Highly effective in producing immunity to poliovirus • 90% immune after 2 doses • 99% immune after 3 doses • Duration of immunity not known with certainty • Only effective treatment recommended against polio • Vaccinations due at 2, 4 months, between 6-18 months and at age 4. • May be given as a combination vaccine • Oral Polio Vaccine(OPV) • Highly effective in producing immunity to poliovirus. • Approximately 50% immune after 1 dose. • More than 95% immune after 3 doses. • Immunity probably lifelong • Shed in stool for up to 6 weeks following vaccination • OPV not used due to increased risk for vaccine associated paralytic polio. (CDC, 2012f)

  38. Effects of Poliomyelitis vaccine United States • 1955: Dramatic decrease in rates after IPV introduced • 1960: 2,525 reported cases of paralytic polio • 1961: Introduction of OPV introduction • 1965: 61 reported cases of paralytic polio • 1979: Last reported case of polio, found in Midwestern states Texas • Reportable in Texas, but has not occurred in years • 1970: Last reported cases of polio affected 22 children, all under age of 4. (CDC, 2012f) (Texas Department of Heath Services, 2013) Poliomyelitis - United States, 1940-1995

  39. Long-term outcome or management if untreated • Disease is rare • Response to polio infection is variable • Up to 95 % of cases maybe asymptomatic • Paralytic polio • Symptoms last 1-7 days • Fever, loss of superficial reflexes, initially increased deep tendon reflexes, severe muscle aches and spasms in the limbs or back. • Paralysis is commonly asymmetrical, strength returns • 3 types depending on level of involvement: Spinal, Bulbo, Bulbospinal • Maybe fatal in 2-3 percent of infant cases • Non paralytic polio • Symptoms will last 2 to 10 days • stiffness of the neck, back, legs, usually following several days after “minor illness” Infant with affected lower limb from Poliomyelitis infection (CDC, 1995a) (CDC, 2012f)

  40. Influenza • Single stranded RNA virus • Acquired via droplets, invades respiratory system and replicates • Incubation period is 1- 4 days • Symptoms • “Classic” symptoms abrupt onset of fever, myalgia, sore throat, nonproductive cough, headache and fever. • 3 strains: • Type A- moderate to sever illness, all ages • Type B- mild illness, primarily children • Type C- rare (CDC, 2013c)

  41. Influenza History United States • Children 0–4 years of age, hospital rates vary from 100 to 500 per 100,000 healthy children • Hospitalization rates for children 24 months of age and younger are comparable to rates for persons 65 and older. • 1940: Trivalent inactivated influenza vaccine (TIV) is available • Contains three inactivated viruses: type A (H1N1), type A (H3N2), and type B • 2003: First live attenuated influenza vaccine Texas • Texas follows current recommendations for annual flu vaccine

  42. Influenza vaccine • Vaccine protects against influenza • Spread by air, direct contact • 2 initial doses • First dose at 6 months • Second dose at 28 days after first dose • Once a year immunizations thereafter • Contraindications: • Infants with moderate-to-severe illness with or without a fever • People with a history of Guillain-BarréSyndrome that occurred after receiving influenza vaccine • Special Considerations regarding egg allergy • People who have ever had a severe allergic reaction to eggs may be advised not to get vaccinated. • People who have had a mild reaction to egg—that is, one which only involved hives—may receive a flu shot with additional precautions. (CDC, 2013c)

  43. Effects of Influenza vaccine United States • Reporting season for influenza: October to May • Vaccine effectiveness depends on the strains and patient health status • With similar strains, vaccines are up to 90% effective in protecting individuals Texas • Influenza peaks in January/February • Individual cases of influenza are not tracked

  44. Long term outcome and management if untreated • Most people who get influenza will recover in a few days to less than two weeks. • Symptoms: fever, muscle pain, sore throat, cough , extreme fatigue • Complications: Bronchitis, sinus, ear infections, pneumonia which can be fatal • Treatment: • Antiviral medications with activity against influenza viruses, antiviral prescription drugs can be used for prevention • Influenza vaccine • Two FDA-approved influenza antiviral medications: Oseltamivir (Tamiflu®) and Zanamivir (Relenza®). • Oseltamivir and Zanamivir are chemically related antiviral medications that have activity against both influenza A and B viruses. • Antiviral resistance to oseltamivir and zanamivir among circulating influenza viruses is currently low. (CDC, 2013c)

  45. MMR Measles • Measles (Rubeola) virus grows in the cells of the throat and lungs. • Spread through droplet and direct contact • Highly contagious • Signs and Symptoms: • Mild to moderate fever, cough, runny nose, red eyes, and sore throat. • Kopliks spots: Tiny white spots appear inside the mouth 2 to 3 days after infection. • Complications: • Diarrhea, pneumonia, otitis media with hearing loss, death. • Leading cause of blindness in African children • Related to vitamin A deficiency in malnourished children. (CDC, 2009a) (CDC, n.d)

  46. MMR • Mumps virus is a paramyxovirus in the same group as parainfluenza and Newcastle disease. • Up to half of people who get mumps have very mild or no symptoms, and therefore do not know they were infected with mumps. • Disease symptoms: swollen salivary glands, fever, headache, tiredness, muscle pain • The virus is acquired by respiratory droplets and direct contact. • It replicates in the nasopharynx and regional lymph nodes. After 12 to 25 days a viremia occurs, which lasts from 3 to 5 days. During the viremia, the virus spreads to multiple tissues,including the meninges, and glands such as the salivary, pancreas, testes, and ovaries. Inflammation in infected tissues leads to characteristic symptoms of parotitis and aseptic meningitis. • Most mumps transmission likely occurs before the salivary glands begin to swell and within the 5 days after the swelling begins. Therefore, CDC recommends isolating mumps patients for 5 days after their glands begin to swell. • Currently, there is no specific treatment for mumps. Supportive care should be given as needed. (CDC, 2010)

  47. MMR • Rubella, also known as German Measles, or 3 day measles • Rubella is a viral illness caused by a togavirus of the genus Rubivirus and is characterized by a mild, maculopapular rash. • Respiratory transmission of rubella virus, replication of the virus is thought to occur in the nasopharynx and regional lymph nodes. A viremia occurs 5 to 7 days after exposure with spread of the virus throughout the body. Transplacental infection of the fetus occurs during viremia. Fetal damage occurs through destruction of cells. • The incubation period of rubella is 14 days, with a range of 12 to 23 days. Symptoms are often mild, and up to 50% of infections may be subclinical or inapparent. • The signs and symptoms of rubella are often so mild that they're difficult to notice, especially in children. If signs and symptoms do occur, they generally appear between two and three weeks after exposure to the virus. They typically last about two to three days and may include: Mild fever of 102 F, headache, stuffy or runny nose, inflamed red eyes, enlarged, tender lymph nodes at the base of the skull, the back of the neck and behind the ears, fine, pink rash that begins on the face and quickly spreads to the trunk and then the arms and legs, before disappearing in the same sequence, and aching joints, especially in young women • (CDC,2009b)

  48. MMR History: United States Measles • 1954: Measles virus isolated from human tissue • 1963: First live attenuated vaccine licensed • Prevaccine era • 500,000 reported cases annually, 500 of which were fatal • Epidemic cycles noted every 2 to 3 years Texas • 1958: 85,862 reportable cases of measles

  49. MMR History United States Mumps • Prevaccine Era: Mumps was cause of frequent outbreaks in military • Most common cause of aseptic meningitis and sensorineural deafness in childhood • 1934: mumps discovered • 1945: Virus isolated • 1948: Short lasting vaccine developed • Used until 1970’s • 1964: 212,000 reported cases of mumps • 1967:Development of live attenuated mumps vaccine • 1968: Nationally reportable disease Mumps infection with characteristic swollen neck region due to an enlargement of the boy’s salivary glands (CDC, 2005)

  50. MMR History: United States Rubella • 1940: Widespread Rubella infection • 1941: 78 cases of congenital cataracts from infants born to mothers with rubella infection early in pregnancy • 1962: Rubella isolated • 1964-1965: 12.5 million reported cases • 20,000 newborns with congenital rubella syndrome causing deafness, blindness and mental retardation • 2,100 neonatal deaths • 1969: First rubella vaccine licensed Pictured at top right: Infant with blueberry spots from Congenital Rubella Syndrome (CDC, 1978) (CDC, 2012)

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