Measles Mumps and Rubella - Vaccine and Ethics

Question 1

What kind of virus is measles?

Answer 1

RNA morbillivirus

Question 2

How is measles transmitted?

Answer 2

Transmission via respiratory droplets
Incubation period of 10-12 days
Infective from 4 days until rash appears and 4 days after it has disappeared.

Question 3

What is the presentation of measles?

Answer 3

Rash for 3 days

Fever for 1 day (may also have a cough, coryza (catarrhal inflammation of nose mucos) or conjunctivitis)

Question 4

What are the symptoms of measles prodrome?

Answer 4

2-4 days, Koplik’s spots, rash, high fever, swelling around the eyes / photophobia

Question 5

How is measles diagnosed?

Answer 5

Lab confirmation via salivary IgM or RNA, buccal scrapings

Question 6

How is measles managed?

Answer 6

Uncomplicated and self limiting;
paracetamol, ibuprofen and fluids
Post exposure prophylaxis and vaccine

Question 7

What are the complications that can arise from measles?

Answer 7

Bronchopneumonia (main cause of death)
Acute demyelinating encephalitis
Sub-acute sclerosing panencephalitis, untreatable and fatal
Ear infections - risk of permanent hearing loss
Diarrhoea
Vit A deficiency and blindness
Immunodeficiency
Miscarriage, prematurity, low birth weight

Question 8

What is the causative organism of mumps?

Answer 8

Paramyxovirus

Question 9

What is the medical title for mumps?

Answer 9

Epidemic parotitis

Question 10

Which organs are affected by mumps virus?

Answer 10

Salivary glands, pancreas, testes, ovary

Question 11

How is mumps virus (paramyxovirus) transmitted?

Answer 11

Saliva droplets
Incubation period 14-25 days
Highly infectious

Question 12

What is the presentation of mumps?

Answer 12

Asymptomatic or non-specific symptoms such as fever, headache, malaise, then parotits
Then fever swelling distortion dry mouth discomfort

Question 13

What is parotits?

Answer 13

Usually bilateral pain near the angle of the jaw

Question 14

How are mumps diagnosed?

Answer 14

Clinical diagnosis of salivary IgM

Question 15

How are mumps managed?

Answer 15

Symptomatic analgesia, rest and fluid

Question 16

What are the complications associated with mumps?

Answer 16

Orchitis in men
Chills, headache, backache, swinging temperature
Swollen scrotum, usually unilateral
Subfertility rare (worse in women)

Meningitis or encephalitis
Oophoritis
Pancreatitis
Deafness

Question 17

What is the virus that causes Rubella (German Measles)?

Answer 17

Togavirus

Question 18

What are the presenting features of rubella?

Answer 18

Low grade fever, malaise, coryza, mild conjunctivitis, followed by lymphadenopathy then transitory rash on face and neck

Question 19

How is rubella transmitted?

Answer 19

Droplet transmission
Incubation period 14-21 days rash 14-17 days post exposure
Infectious from 1 week before rash to 4 days after rash appears

Question 20

How is rubella diagnosed?

Answer 20

Clinical diagnosis is unreliable

Rubella specific IgM in saliva

Question 21

How is rubella managed?

Answer 21

Antipyretics

Exclude from school and keep away from pregnant women

Question 22

What are the complications associated with rubella?

Answer 22

Thrombocytopenia (low platelets)
Post infectious encephalitis
Arthritis and arthralgia

Question 23

Why is rubella particularly dangerous in pregnancy?

Answer 23

20% miscarriage

Congenital rubella syndrome (CRS) is a particular concern

Question 24

What is congenital rubella syndrome?

Answer 24

Maternal rubella in pregnancy can cause CRS
Cataracts and other eye diseases
Deafness
Cardiac abnormalities
Microcephaly, intellectual disability
Retardation of the intrauterine growth
Inflammatory lesions (brain, liver, lungs, bone marrow)

Question 25

When are babies most at risk from maternal rubella?

Answer 25

4 wks before conception - 12 weeks after conception 40-50% affected.

After 16 wks the main outcome in babies is deafness.

Question 26

What kind of vaccine is the MMR vaccine?

Answer 26

Combined live vaccine - 2 doses

Question 27

When is the MMR vaccine given?

Answer 27

Rubella seronegative women in childbearing age
Non-immunised adults working as health workers
Immigrants arriving after school immunisation age
Contacts during a measles outbreak
Unimunised travellers to endemic areas
Immunocompromised, children and adults or pregnant women.

Question 28

What is the controversy surrounding the MMR vaccine?

Answer 28

The Lancet / Dr Andrew Wakefield
Paper claiming a link between the vaccine and autism or bowel disease

Work has since been completely discredited and he has been struck off as a doctor in the UK.

Question 29

What were the repercussions of the MMR vaccine controversy?

Answer 29

MMR vaccine rates dropped in 1990s and 2000s
Herd immunity was lost
Infection rates went up

Question 30

What was done in order to quash the misinformation of the MMR vaccine controversy?

Answer 30

Discrediting research
Local and national campaigns to increase uptake
Social media campaigns

Question 31

What are the arguments FOR making MMR vaccination compulsory?

Answer 31

Producing benefits
Avoiding preventing or removing harm
Producing the maximum balance benefit over harms and other costs

Question 32

What are the main arguments AGAINST making MMR vaccination compulsory?

Answer 32

Respecting autonomous decisions and actions

Protecting privacy and confidentiality

Question 33

What are the main components of The Anti-Vaccine Movement ?

Answer 33

Considered heretical to inject animal matter into humans

Concerns over the effect on the genetic make up of humans by introducing foreign RNA into human genome.