Measles, mumps and rubella

Question 1

What causes measles?

Answer 1

RNA morbillivirus

Question 2

How is measles transmitted?

Answer 2

Via respiratory droplets

Question 3

What is the presentation of measles?

Answer 3

Rash for 3 days, fever for 1 day + cough and conjunctivitis

Prodrome period: 2-4 days; Koplik’s spots (inside of mouth), rash, high fever, swelling around eyes and photophobia

Question 4

What is the management of measles?

Answer 4

Refer to GP
Paracetamol/Ibuprofen and fluids
Infection goes on own accord

Question 5

It measles a notifiable disease?

Answer 5

Yes, GP has to inform goverment on each case

Question 6

What are the complications with measles?

Answer 6

Bronchopneumonia
Acute demyelinating encephalitis
Sub-acute sclerosing panencephalitis
Ear infections - permanent loss of hearing
Diarrhoea
Vitamin A deficiency and blindness
Immunodeficiency
Miscarriage, prematurity and low birth weight

Question 7

What causes mumps?

Answer 7

Paramyxovirus

Question 8

What does mumps usually affect?

Answer 8

Salivary glands, pancreas, testes and ovary

Question 9

How is mumps transmitted?

Answer 9

By saliva droplets

Question 10

What is the presentation of mumps?

Answer 10

Swelling on one side of face (parotitis); bilateral, pain near jaw
Asymptomatic or non-specific symptoms (fever, headache, malaise)
Fever, swelling, dry mouth, discomfort
Infertility and deafness later in life

Question 11

How is mumps diagnosed?

Answer 11

Clinical or salivary IgM

Question 12

What is the managment for mumps?

Answer 12

Pain killers, rest and fluid

Question 13

What are the complications with mumps?

Answer 13

Orchitis
Chills, headache, swinging temperature, backache
Swollen scrotum, usually unilateral
Meningitis or encephalitis
Oophoritis
Pancreatitis

Question 14

What is rubella caused by?

Answer 14

Togavirus

Question 15

What is the presentation of rubella?

Answer 15

Low grade fever, malaise, conjunctivitis, lymphadenopathy (swollen glands)
Transitory rash on face and neck

Question 16

How is rubella transmitted?

Answer 16

Via droplets

Question 17

When are patients with rubella infectious?

Answer 17

From 1 week before rash to 4 days after rash appears

Question 18

Diagnosis of rubella?

Answer 18

clinically unreliable

Rubella-specific IgM in saliva

Question 19

What is the managment of rubella?

Answer 19

Antipyretics (paracetamol and ibuprofen)
Exclude from school
Keep away from pregnant women

Question 20

What are the complications with rubella?

Answer 20

Thrombocytopenia
Post-infectious encephalitis
Arthrtis and arthralgia (rare)

Question 21

What is congenital rubella syndrome? (CRS)

Answer 21

Maternal rubella in pregancy: (the baby develops)

• cataracts and other eye diseases
• deafness
• cardiac abnormalities
• microephaly, intelluctual disability
• retardation of intrauterine growth
• inflammation lesions in the brain, liver, bone, and lungs

Question 22

What is the prognosis of CRS?

Answer 22

Up to 4 weeks before conception: 40%
0-12 weeks: 50%
11-16 weeks: 20%
>16>20: deafness is main outcome

Question 23

What is the MMR vaccination?

Answer 23

Combined live vaccine given as a baby at 1 month and on starting school at afe 4-5; then immune for the rest of your life

Question 24

Who else is the MMR vaccine given to?

Answer 24

Rubella seronegative women at child bearing age
Non-immunised adults as health workers
Immigrants arriving at school after immunisation age
Conacts during a measles outbreak

Question 25

What was the controversy with the MMR vaccine?

Answer 25

Dr Andrew wakefield published a paper in 1998 claiming a link between the MMR vaccine and autism or bowel disease, this has now been discredited. However, it caused a lot of people not getting the vaccine, herd immunity was therefore lost and infection rates went up. This was partly due to the media coverage

Question 26

How did the goverment try and come back from the MMR vaccine controversy?

Answer 26

• Discredited the research
• Local and national public health campaign to increase MMR uptake
• Social media campaigns