Measles Mumps and Rubella - Vaccine and Ethics Flashcards
What kind of virus is measles?
RNA morbillivirus
How is measles transmitted?
Transmission via respiratory droplets
Incubation period of 10-12 days
Infective from 4 days until rash appears and 4 days after it has disappeared.
What is the presentation of measles?
Rash for 3 days
Fever for 1 day (may also have a cough, coryza (catarrhal inflammation of nose mucos) or conjunctivitis)
What are the symptoms of measles prodrome?
2-4 days, Koplik’s spots, rash, high fever, swelling around the eyes / photophobia
How is measles diagnosed?
Lab confirmation via salivary IgM or RNA, buccal scrapings
How is measles managed?
Uncomplicated and self limiting;
paracetamol, ibuprofen and fluids
Post exposure prophylaxis and vaccine
What are the complications that can arise from measles?
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
What is the causative organism of mumps?
Paramyxovirus
What is the medical title for mumps?
Epidemic parotitis
Which organs are affected by mumps virus?
Salivary glands, pancreas, testes, ovary
How is mumps virus (paramyxovirus) transmitted?
Saliva droplets
Incubation period 14-25 days
Highly infectious
What is the presentation of mumps?
Asymptomatic or non-specific symptoms such as fever, headache, malaise, then parotits
Then fever swelling distortion dry mouth discomfort
What is parotits?
Usually bilateral pain near the angle of the jaw
How are mumps diagnosed?
Clinical diagnosis of salivary IgM
How are mumps managed?
Symptomatic analgesia, rest and fluid
What are the complications associated with mumps?
Orchitis in men
Chills, headache, backache, swinging temperature
Swollen scrotum, usually unilateral
Subfertility rare (worse in women)
Meningitis or encephalitis
Oophoritis
Pancreatitis
Deafness
What is the virus that causes Rubella (German Measles)?
Togavirus
What are the presenting features of rubella?
Low grade fever, malaise, coryza, mild conjunctivitis, followed by lymphadenopathy then transitory rash on face and neck
How is rubella transmitted?
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
How is rubella diagnosed?
Clinical diagnosis is unreliable
Rubella specific IgM in saliva
How is rubella managed?
Antipyretics
Exclude from school and keep away from pregnant women
What are the complications associated with rubella?
Thrombocytopenia (low platelets)
Post infectious encephalitis
Arthritis and arthralgia
Why is rubella particularly dangerous in pregnancy?
20% miscarriage
Congenital rubella syndrome (CRS) is a particular concern
What is congenital rubella syndrome?
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)
When are babies most at risk from maternal rubella?
4 wks before conception - 12 weeks after conception 40-50% affected.
After 16 wks the main outcome in babies is deafness.
What kind of vaccine is the MMR vaccine?
Combined live vaccine - 2 doses
When is the MMR vaccine given?
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.
What is the controversy surrounding the MMR vaccine?
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.
What were the repercussions of the MMR vaccine controversy?
MMR vaccine rates dropped in 1990s and 2000s
Herd immunity was lost
Infection rates went up
What was done in order to quash the misinformation of the MMR vaccine controversy?
Discrediting research
Local and national campaigns to increase uptake
Social media campaigns
What are the arguments FOR making MMR vaccination compulsory?
Producing benefits
Avoiding preventing or removing harm
Producing the maximum balance benefit over harms and other costs
What are the main arguments AGAINST making MMR vaccination compulsory?
Respecting autonomous decisions and actions
Protecting privacy and confidentiality
What are the main components of The Anti-Vaccine Movement ?
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.
