INF2 - A. MMR AND VACCINATION ETHICS-COVERED

Question 1

what does measles present as

Answer 1

• red, blotchy rash (raised)
• no blisters
• all over body
• prodrome 2-4 days: fever for 1 day and (cough, coryza, conjunctivitis)
• rash for 3 days
• koplik’s spots (white/grey spots around mucous membrane of mouth) - differentiates from rubella
• high fever
• swelling around eyes
• photophobia

*meningitis has similar symptoms - glass test: if goes white then measles/rubella

Question 2

epidemiology of measles

Answer 2

• RNA morbillivirus
• transmitted by respiratory droplets
• incubation period of 10-12 days, infectivity from 4 days before to 4 days after rash appears
• 91% vaccine uptake (excellent - want 90% for herd immunity)
• small, localised outbreaks nowadays due to herd immunity

Question 3

diagnosis of measles

Answer 3

• lab confirmation: salivary IgM or RNA, buccal scrapings
• notifiable disease

Question 4

management of measles

Answer 4

• fluids
• bed rest
• paracetamol/ibuprofen

Question 5

complications of measles

Answer 5

• 1/20 bronchopneumonia
• 1/1000 acute demyelinating encephalitis
• 1/25000 sub-acute sclerosis panencephalitis
• 1/10 ear infections, risk of permanent loss of hearing
• diarrhoea
• vitamin A deficiency and blindness
• immunodeficiency
• miscarriage, prematurity, LBW

Question 6

epidemiology of mumps

Answer 6

• least fatal, less complications
• causes parotitis, caused by paramyxovirus: swelling of parotid glands on one side of neck
• affects salivary glands, pancreas, testes, ovaries
• incubation period of 14-25 days
• highly infectious, transmission by saliva droplets
• mumps on one side, can be reinfected later on other side

Question 7

what does mumps present as

Answer 7

• asymptomatic or non-specific symptoms: fever, headache, malaise
• then parotitis (bilateral, pain near angle of jaw)
• fever, swelling, distortion, dry mouth, discomfort in parotid and maybe submaxillary sublingual salivary glands

Question 8

diagnosis of mumps

Answer 8

• clinical or salivary IgM
• notifiable disease

Question 9

management of mumps

Answer 9

paracetamol
fluids
bed rest

Question 10

complications of mumps

Answer 10

Due to swelling of other glands and inflam can cause infertility

• 1/4 men: orchitis
• chills, backache, headache, swinging temp, swollen scrotum, unilateral
• sub fertility is rare
• 6/100 meningitis or encephalitis
• 5/100 oophoritis
• 4/100 pancreatitis
• 1/15000 deafness

Question 11

epidemiology of rubella

Answer 11

togavirus (likes warm and humid environments - winter, indoors)

Question 12

what does rubella present as

Answer 12

• low grade fever, malaise, coryza, mild conjunctivitis
• then lymphadenopathy then transitory rash on face and neck
• droplet transmission
• incubation period of 14-21 days, rash 14-17 days after exposure
• infectious 1 week before rash and 4 days after rash appears

Question 13

diagnosis of rubella

Answer 13

• clinical unreliable
• rubella-specific IgM in saliva
• notifiable disease

Question 14

management of rubella

Answer 14

• antipyretics
• exclude from school
• keep away from pregnant women
• bed rest
• fluids
• GP if otherwise looks well
• A&E if child with high temp >39 degrees Celsius as risk of fitting due to fitting and needs fluids from dehydration

Question 15

complications of rubella

Answer 15

• 1/3000 thrombocytopenia
• 1/6000 post-infectious encephalitis
• rare: arthritis and arthralgia

Question 16

what if a pregnant woman has rubella

Answer 16

• 20% miscarriage
• CRS
  cataracts and eye diseases
  deafness
  cardiac abnormalities
  microcephaly, intellectual disability
  retardation of intrauterine growth hence LBW
  inflam lesions (brain, liver, lung etc)
• 4 weeks before conception: 40% affected - miscarriage
• 0-12 weeks: 50% surviving infants affected - in womb and after birth
• 11-16 weeks: 20% surviving infants affected - no miscarriage
• 16-20 weeks: deafness main outcome

Question 17

what is the MMR vaccine

Answer 17

• triple vaccine
• combined live vaccine hence why pregnant can’t have
• 1st dose: babies given at 12 months
• 2nd dose: 3 years and 4 months

*not contra-indicated in true egg allergy ie - not produced using ova

Question 18

who is the MMR vaccine given to

Answer 18

• babies and children
• rubella seronegative women of childbearing age
• non-immunised adults working as health workers
• immigrants arriving after school immunisation age
• contacts during measles outbreak
• unimmunised travellers to endemic areas

*NOT to immunocompromised children, adults, pregnant women as may contract the disease

Question 19

is there a link between the MMR vaccine and autism or bowel disease

Answer 19

NO

Question 20

what effects did the controversy have

Answer 20

• drop in vaccine uptake between 1990s and 2000s
• herd immunity lost and infection rates went up

Question 21

what is herd immunity

Answer 21

• when majority of the population are vaccinated, society is protected as a whole as some can’t get vaccinated and virus is contained and spreads little
• 90% or over have to be vaccinated

Question 22

should MMR vaccine be compulsory? what principles are relevant to this

Answer 22

• produce benefits: beneficence
• avoid, prevent and remove harms: non-maleficence
• produce max balance of benefit over harms and other costs: utility
• distribute benefits and burdens fairly and insure public participation including participation of affected parties: justice
• respect autonomous choices and actions including liberty of action: autonomy
• protect privacy and confidentiality
• keep promises and commitments
• disclose info as well as speak honestly and truthfully
  build and maintain trust

Question 23

what did the anti-vaccination movement believe

Answer 23

• heretical to inject animal matter into humans
• concerns over effect on genetic make up of humans