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MUMPS, MEASLES RUBELLA and human parvovirus

MUMPS, MEASLES RUBELLA and human parvovirus. MEASLES (RUBEOLA) MUMPS RUBELLA. MAN WORLD WIDE SINGLE SEROTYPE OF EACH VIRUS LIVE ATTENUATED VACCINE (MMR) CHILDHOOD DISEASES (PRE-VACCINE) NOTIFIABLE DISEASE. PARAMYXOVIRUS FAMILY MUMPS MEASLES. TOGAVIRUS FAMILY RUBELLA.

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MUMPS, MEASLES RUBELLA and human parvovirus

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  1. MUMPS, MEASLES RUBELLA and human parvovirus

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

  3. PARAMYXOVIRUS FAMILY • MUMPS • MEASLES • TOGAVIRUS FAMILY • RUBELLA

  4. MEASLES AND MUMPS

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

  6. PARAMYXOVIRUS FAMILYSURFACE GLYCOPROTEINS GENUS GLYCOPROTEINS TYPICAL MEMBERS PARAMYXOVIRUS SUBFAMILY Paramyxovirus HN, F HPIV1, HPIV3 Rubulavirus HN, F HPIV2, HPIV4, mumps virus Morbillivirus H, F measles virus PNEUMOVIRUS SUBFAMILY Pneumovirus G, F respiratory syncytial virus Metapneumovirus G, F metapneumoviruses

  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

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

  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

  10. INFECTION • AEROSOL • VERY CONTAGIOUS

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

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

  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

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

  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

  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

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

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

  19. Mims et al., Medical Microbiology 1993

  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%

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

  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

  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

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

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

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

  27. TREATMENT • SUPPORTIVE CARE

  28. PARAMYXOVIRUSESMUMPS

  29. Total reported cases 4,602 Mumps Outbreak United States 2006* 4 193 1 650 85* 1,921 349 501 3 134 782 1 2 *In PA, 14 of the 85 cases are considered outbreak-associated. *Provisional Number of Cases by State as of June 20, 2006

  30. MUMPS CDC - B.Rice

  31. Mims et al., Medical Microbiology 1993

  32. Mims et al., Medical Microbiology 1993

  33. RECOVERY • CELL MEDIATED IMMUNITY

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

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

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

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

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

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

  40. 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

  41. COMPLICATIONS • ENCEPHALITIS (RARE)

  42. RECOVERY • T-CELL

  43. PROTECTION • IgG, IgA • IgM may persist

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

  45. EFFECTS ON FETUS • thrombocytopenia • hepatomegaly • splenomegaly • intrauterine growth retardation • bone lesions • pneumonitis

  46. EFFECTS ON FETUS • First trimester • 65-85% of neonates have sequelae

  47. 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

  48. CONGENITAL INFECTIONS • SHED VIRUS FOR A YEAR OR MORE AFTER BIRTH • nasopharynx, urine, feces

  49. CONGENITAL INFECTIONS • EYE PROBLEMS • GLANDULAR COMPLICATIONS • diabetes • thyroid problems • deficiency growth hormone

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