INF2 - A. MMR AND VACCINATION ETHICS-COVERED Flashcards
what does measles present as
- 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
epidemiology of measles
- 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
diagnosis of measles
- lab confirmation: salivary IgM or RNA, buccal scrapings
- notifiable disease
management of measles
- fluids
- bed rest
- paracetamol/ibuprofen
complications of measles
- 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
epidemiology of mumps
- 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
what does mumps present as
- 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
diagnosis of mumps
- clinical or salivary IgM
- notifiable disease
management of mumps
paracetamol
fluids
bed rest
complications of mumps
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
epidemiology of rubella
togavirus (likes warm and humid environments - winter, indoors)
what does rubella present as
- 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
diagnosis of rubella
- clinical unreliable
- rubella-specific IgM in saliva
- notifiable disease
management of rubella
- 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
complications of rubella
- 1/3000 thrombocytopenia
- 1/6000 post-infectious encephalitis
- rare: arthritis and arthralgia
what if a pregnant woman has rubella
- 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
what is the MMR vaccine
- 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
who is the MMR vaccine given to
- 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
is there a link between the MMR vaccine and autism or bowel disease
NO
what effects did the controversy have
- drop in vaccine uptake between 1990s and 2000s
- herd immunity lost and infection rates went up
what is herd immunity
- 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
should MMR vaccine be compulsory? what principles are relevant to this
- 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
what did the anti-vaccination movement believe
- heretical to inject animal matter into humans
- concerns over effect on genetic make up of humans
