rubella introduction and its epidemiology

rubella introduction and its epidemiology

• 2.
  Rubella (German measles)
• 3.
  • The namerubella is derived from a Latin term meaning "little red." • Rubella is sometime called German Measles or 3-day Measles. • The synonym "3-day measles" derives from the typical course of rubella exanthema that starts initially on the face and neck and spreads centrifugally to the trunk and extremities within 24 hours. • It then begins to fade on the face on the second day and disappears throughout the body by the end of the third day. • It is a generally mild disease caused by the rubella virus.
• 4.
  • Agent –RNA virus (Togo virus family), Genus Rubivirus. • Source of infection – Respiratory secretion • Host -3-10 yrs • Immunity –life long • Environmental factors –winter and spring season • Transmission – droplet, vertical transmission • I.P – 2-3 weeks average 18 days
• 5.
  • Eye painon lateral and upward eye movement (a particularly troublesome complaint) • Conjunctivitis • Sore throat • Headache • General body aches • Low-grade fever • Chills • Anorexia • Nausea • Tender lymphadenopathy (particularly posterior auricular and suboccipital lymph nodes) • Forchheimer sign (an enanthem observed in 20% of patients with rubella during the prodromal period; can be present in some patients during the initial phase of the exanthem; consists of pinpoint or larger petechiae that usually occur on the soft palate)
• 6.
  Temperature • Fever isusually not higher than 38.5°C (101.5°F). Lymph nodes • Enlarged posterior auricular and suboccipital lymph nodes are usually found on physical examination. Mouth • The Forchheimer sign may still be present on the soft palate.
• 7.
  Image in a4-year-old girl with a 4-day history of low-grade fever, symptoms of an upper respiratory tract infection, and rash. Courtesy of Pamela L. Dyne, MD.
• 8.
  •0–28 days beforeconception - 43% chance •0–12 weeks after conception - 51% chance •13–26 weeks after conception - 23% chance • Infants are not generally affected if rubella is contracted during the third trimester
• 9.
  Photo source: U.S.Centers for Disease Control and Prevention
• 11.
  Salt and pepperretinopathy Content Providers(s): CDC Creation Date: 1976 Courtesy http://phil.cdc.gov/phil_images/ 20030724/28/PHIL_4284_lores.jpg http://www.kellogg.umich.edu/ theeyeshaveit/congenital/retinopathy.html Courtesy: Jonathan Trobe, M.D. - University of Michigan Kellogg Eye Center
• 12.
  •Sensorineural hearing loss– 58% •Ocular abnormalities including cataract, infantile glaucoma, Micro ophthalmia and pigmentary retinopathy occur in approximately 43% •Congenital heart disease including patent ductus arteriosus (PDA) and pulmonary artery stenosis - 50%
• 13.
  Measles vaccine • Liveattenuated measles virus (Edmonston-zagreb strain) Propagated on human diploid cell (MRC-5) • 0.5 ml of vaccine • Not less than 1000 CCID50 of measles virus • 2.5% of gelatin • 5% of sorbitol as stabilizers • 0.5 ml of sterile water • Dose – 0.5 ml • Route of administration: Sub-cutaneously • 3 to 5 weeks antibody level – 200mLU/ml
• 14.
  Mumps Vaccine • 10strains of the mumps virus are in use throughout the world for the preparation of live attenuated vaccine. • Jeryl Lynn strain which was named after the child from whom the virus was isolated. • Leningrad-3 strain • Urabe strain • Hoshino, Torii and NKM - 46 strains • L-Zagreb
• 15.
  MMR Vaccine • Liveattenuated strains of Edmonston-Zagreb Measles virus propagated on human diploid cell culture, • L-Zagreb Mumps virus propagated on chick embryo fibroblast cells • Wistar RA 27/3 Rubella virus propagated on human diploid cell culture.
• 16.
  • The reconstitutedvaccine contains, in single dose of 0.5 ml. not less than 1000 CCID50 of Measles virus 5000 CCID50 of Mumps virus 1000 CCID50 of Rubella virus. Diluent : Sterile water for injection. The vaccine meets the requirements of USP and WHO when tested by the methods outlined in USP and WHO, TRS 840 (1994).
• 17.
  • For activeimmunization in children of 12 months to 12 years of age against Measles, Mumps and Rubella infections –MMR Vaccine to be given • For immunisation of susceptible non pregnant, adolescent and adult females, we have to use Rubella Vaccine) • Measles vaccine has to be given at 9 months, • If Measles vaccine is given ,a 3 months gap is advisable to give MMR vaccine • MMR vaccine may be given between 12-15 months of age. • If Measles vaccine was missed , MMR dose replaces it, when given at or after 12 months.
• 18.
  • The vaccineshould be reconstituted with the diluent supplied (Sterile water for injection) using a sterile Auto disabled syringe with needle. • After reconstitution the vaccine should be used immediately. • A single dose of 0.5 ml should be administered by deep subcutaneous injection into the upper arm. • If the vaccine is not used immediately then it should be stored in the dark at 2° - 8°C for no longer than 8 hours.
• 19.
  Age Vaccines Note 9months Measles Deep subcutaneous injection into the upper arm. 12-15 months MMR -1 Deep subcutaneous injection into the upper arm. 5 years MMR -2 Deep subcutaneous injection into the upper arm.
• 20.
  • Murray etal., Microbiology 5th Ed., Chapters 56, 59, 63 (pp. 645-648) • Mims et al. Medical Microbiology, 1993 • K. Park 21st edition • Text book of community medicine by Sundarlal, Adarsh, Pankaj