2004
MUMPS, MEASLES RUBELLA and human parvovirus
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MEASLES (RUBEOLA) MUMPS RUBELLA
• • • • • • MAN WORLD WIDE SINGLE SEROTYPE OF EACH VIRUS LIVE ATTENUATED VACCINE (MMR) CHILDHOOD DISEASES (PRE-VACCINE) NOTIFIABLE DISEASE
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• PARAMYXOVIRUS FAMILY –MUMPS –MEASLES • TOGAVIRUS FAMILY –RUBELLA
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MEASLES AND MUMPS
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PARAMYXOVIRUSES
pleomorphic
HN/H/G glycoprotein SPIKES F glycoprotein SPIKES helical nucleocapsid (RNA plus NP protein)
lipid bilayer membrane
polymerase complex
M protein
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PARAMYXOVIRUS FAMILY properties of attachment protein
GENUS GLYCOPROTEINS TYPICAL MEMBERS HPIV1, HPIV3
Paramyxovirus genus
HN, F
Rubulavirus Genus
HN, F
HPIV2, HPIV4 mumps virus
Morbillivirus genus
H, F
measles virus
Pneumovirus genus
G, F
respiratory syncytial virus
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MEASLES
2001 >40,000,000 infections world wide >1,000,000 deaths world wide
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VACCINE EFFECTIVENESS
Measles – United States, 1950-2002
900
Cases (thousands)
800 700 600 500 400 300 200 100 0
Vaccine Licensed
1950
1960
1970
1980
1990
2000
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http://www.cdc.gov/nip/ed/slides/slides.htm
Measles Resurgence – United States, 1989-1991
• Cases
• Hospitalizations
55,622
>11,000
• Deaths
123
http://www.cdc.gov/nip/ed/slides/slides.htm
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Measles 1996-2002
• Endemic transmission interrupted
• Record low annual total in 2002 (44 total cases) • Most cases imported or linked to importation
http://www.cdc.gov/nip/ed/slides/slides.htm
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The State, Columbia, S.C. Saturday October 16, 1999
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INFECTION
• AEROSOL • VERY CONTAGIOUS
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viremia
Adapted from Mims, Playfair, Roitt, Wakelin and Williams (1993) Medical Microbiology
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MEASLES - Koplik’s spots
14 Murray et al. Medical Microbiology
DISSEMINATED SPREAD
• LONGER TIME FOR SYMPTOMS • IMMUNE RESPONSE • (IF SYMPTOMS DUE TO IMMUNE RESPONSE, USUALLY INFECTIOUS PRIOR TO SYMPTOMS)
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Adapted from Mims, Playfair, Roitt, Wakelin and Williams (1993) Medical Microbiology
MEASLES - RASH
CDC - B.Rice
16 Murray et al. Medical Microbiology
DISEASE
• STILL INFECTIOUS AFTER SYMPTOMS START • FEVER • RESPIRATORY TRACT SYMPTOMS
• rhinorrhea, cough
• KOPLIK’S SPOTS • MACULOPAPULAR RASH
• T-cells ->endothelial cells
• CONJUNCTIVITIS
• epithelial cells
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RECOVERY
• FAIRLY RAPID
– T-cell response important – agammaglobulinemia – recover – T-cell deficient, may be no rash, may be severe disease (life threatening)
• DISEASE MORE SEVERE IN ADULTS
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COMPLICATIONS
• GIANT CELL PNEUMONIA
Histopathology of measles pneumonia. CDC/Dr. Edwin P. Ewing, Jr. Giant cell with intracytoplasmic inclusions
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COMPLICATIONS
• GIANT CELL PNEUMONIA • SECONDARY BACTERIAL INFECTIONS • MORE SEVERE IF MALNOURISHED AND/OR POOR ACCESS TO MEDICAL CARE
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Mims et al., Medical Microbiology 1993
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PROBLEMS
• vitamin A deficient -> low mucosal defense • low protein, calories -> impaired immunity • lack of antibiotics for secondary infections • lack of vaccination (need cold chain) • poor hygiene
ESTIMATE THAT MEASLES KILLS 1,000,000/YR WORLDWIDE
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COMPLICATIONS
• GIANT CELL PNEUMONIA • SECONDARY BACTERIAL INFECTIONS • MORE SEVERE IF MALNOURISHED AND/OR POOR ACCESS TO MEDICAL CARE • MEASLES ENCEPHALITIS
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MEASLES ENCEPHALITIS
• 1/1000 cases • sequelae
– deafness – seizures – mental disorders
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SSPE
• sub-acute sclerosing panencephalitis
– inflammatory disease – defective virus
• early infection with measles is a risk factor • rare (7/1,000,000 cases of measles) • decrease since vaccination program
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IMMUNOSUPPRESSION AND MEASLES
• TEMPORARY DEPRESSION OF IMMUNE RESPONSE
– Tuberculin +ve individuals may temporarily become -ve
• MAY GET REACTIVATION OF HERPES, TUBERCULOSIS • Don’t see with vaccine strain
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DIAGNOSIS
• Serodiagnosis
– Significant increase in IgG (need two samples) – Positive for IgM
• Isolation • All suspect cases should be confirmed by laboratory
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EPIDEMIOLOGY
• ALMOST ALL INFECTED INDIVIDUALS SHOW DISEASE • ONE SEROTYPE • NATURAL INFECTION GIVES LIFE LONG PROTECTION • MOST CONTAGIOUS BEFORE RASH IS EVIDENT
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PREVENTION
• LIVE ATTENUATED VACCINE
– Does not spread to contacts – Can cause problems in immunosuppressed
• IMMUNE SERUM GLOBULIN
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TREATMENT
• SUPPORTIVE CARE
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PARAMYXOVIRUSES MUMPS
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MUMPS
CDC - B.Rice 32
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Mims et al., Medical Microbiology 1993
Mims et al., Medical Microbiology 1993
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RECOVERY
• CELL MEDIATED IMMUNITY
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DIAGNOSIS
• 30% INFECTIONS SUB-CLINICAL
• SEROLOGY OR ISOLATION
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EPIDEMIOLOGY
• • • •
MAN ONLY HOST ONE SEROTYPE SUB-CLINICAL INFECTIONS CONTAGIOUS BEFORE AND AFTER SYMPTOMS
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PREVENTION
• LIVE ATTENUATED VACCINE • DOES NOT SPREAD TO CONTACTS • Contradindicated in
– immune-suppressed – pregnant women
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RUBELLA VIRUS
glycoprotein
icosahedral nucleocapsid
RNA (single-stranded positive-sense)
lipid bilayer membrane
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RUBELLA VIRUS
• TOGAVIRUS FAMILY
– Alphavirus genus – Rubivirus genus
• AEROSOL • CHILDREN, ADULTS
– mild
• FETUS
– can be severe
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RUBELLA
Murray et al. Medical Microbiology
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SYMPTOMS children and adults
• SORE THROAT, RUNNY NOSE, COUGH • FEVER • RASH, MINOR, IRREGULAR
– lasts 12hour to 5days – not always seen
• ARTHRALGIA, ARTHRITIS
– especially in adults, especially women
• LYMPHOADENOPATHY
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COMPLICATIONS
• ENCEPHALITIS (RARE)
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RECOVERY
• T-CELL
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PROTECTION
• IgG, IgA • IgM may persist
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EFFECTS ON FETUS
• HEARING LOSS • CONGENITAL HEART DEFECTS • NEUROLOGICAL
– PYSCHOMOTOR AND/OR MENTAL RETARDATION
• OPHTHALMIC
– CATARACT, GLAUCOMA, RETINOPATHY
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EFFECTS ON FETUS
• • • • • • thrombocytopenia hepatomegaly splenomegaly intrauterine growth retardation bone lesions pneumonitis
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EFFECTS ON FETUS
• First trimester
– 65-85% of neonates have sequelae
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Epidemic Rubella – United States 1964-1965
• 12.5 million rubella cases
• 2,000 encephalitis cases
• 11,250 abortions (surgical/spontaneous) • 2,100 neonatal deaths • 20,000 CRS (congenital rubella syndrome) cases – Deaf - 11,600 – Blind - 3,580 – Mentally retarded - 1,800
CDC pink book
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EFFECTS ON FETUS
• 1969 to present
– maximum of 67 cases congential rubella/yr
• usually fewer than 10
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CONGENITAL INFECTIONS
• SHED VIRUS FOR A YEAR OR MORE AFTER BIRTH
– nasopharynx, urine, feces
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CONGENITAL INFECTIONS
• EYE PROBLEMS • GLANDULAR COMPLICATIONS
– diabetes – thyroid problems – deficiency growth hormone
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CONGENITAL / VERY EARLY INFECTIONS
• PROGRESSIVE RUBELLA PANENCEPHALITIS
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DIAGNOSIS
• Serology
– Significant rise in IgG – Positive for IgM
• Isolation
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DIAGNOSIS
• ~50% infections sub-clinical • rash not always seen • many other agents cause similar symptoms
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RUBELLA-LIKE SYMPTOMS
• HUMAN PARVOVIRUS • SOME ALPHAVIRUSES • SOME ENTEROVIRUSES
• SOME ADENOVIRUSES • EPSTEIN-BARR VIRUS • SCARLET FEVER • TOXIC DRUG REACTIONS
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PREVENTION
• LIVE ATTENUATED VACCINE
– DOES NOT SPREAD TO FAMILY MEMBERS
– CHILDREN
– SUSCEPTIBLE NON-PREGANT FEMALES
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EPIDEMIOLOGY
• • • • MAN SOLE HOST WORLD WIDE ONE SEROTYPE NATURAL INFECTION PROTECTS FOR LIFE
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PARVOVIRUS (erythrema infectiosum)
Murray et al. Medical Microbiology 60
PARVOVIRUS B19
• very small, non-enveloped, icosahedral, single-stranded DNA virus • erythrema infectiosum, fifth disease
– mild rash, acute arthritis
• replicates in red blood cell precursors
– can cause problems in those with chronic anemia, immune suppression
• May cause spontaneous abortion of fetus
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