MMR

Question 1

Are MMR vaccines part of the National Childhood Immunisation Schedule?

Answer 1

Yes

Question 1

Do MMR vaccines confer life-long immunity?

Answer 1

Yes

Question 2

What virus types are MMR?

Answer 2

Measles and Mumps are -ssRNA
Rubella is +ssRNA

Question 3

What are the symptoms of a Measles infection?

Answer 3

1) Fever, conjunctivitis, rhinorrhoea, cough
2) Koplik’s spots (arnd parotid duct orifices → rash onset
3) Maculopapular rash (from face to entire body)
4) Temporary/transient skin hypopigmentation

Question 4

What are the possible complications of a Measles infection?

Answer 4

1) mucosal infections (conjunctivitis, otitis media)
2) Respi (eg. broncho pneumonia, giant cell pneumonia)
3) Diarrhoea
4) Encephalitis
5) Sub-acute sclerosing panencephalitis (develops long after apparent recovery)

Question 5

What is the pathology of a Measles infection?

Answer 5

Viraemia (replication) in respiratory epithelium → spread thru blood and lymphatics → skin (rash)

Question 6

What kind of virus is Measles?

Answer 6

Paramyxovirus (-ssRNA) w an envelope

Question 7

How is Measles spread?

Answer 7

Aerosol

Question 8

Is Measles highly contagious?

Answer 8

Yes

Question 9

How is Measles infection diagnosed?

Answer 9

1) Grow virus from pharynx, conjunctiva or urine on monkey kidney cells (will form multinucleated giant cells)
2) RT-PCR
3) Serology (IgM recent, IgG past)

Question 10

What type of vaccine is the MMR vaccine?

Answer 10

Live attenutated

Question 11

When is the MMR vaccine contraindictated?

Answer 11

Malnourished, immunocompromised children and pregnant women

Question 12

What do you do with a immunodeficient person who has had close contact with someone with Measles?

Answer 12

Passive immunisation w immune IgG

Question 13

What type of virus is Mumps?

Answer 13

Paramyxovirus (-ssRNA) with envelope

Question 14

What are the symptoms of Mumps infection?

Answer 14

1) Salivary gland enlargement (esp. parotid) + pain aggravated by eating
2) Fever, malaise
3) Tender cervical lymphadenopathy

Question 15

How is Mumps transmitted?

Answer 15

Respiratory droplets

Question 16

What are some typical complications of Mumps infection?

Answer 16

1) Aseptic meningitis (common but mild)
2) Orchiditis (usually unilateral and can cause infertility)
3) Pancreatitis (10%)

Question 17

How is Mumps diagnosed?

Answer 17

Specimen from: Saliva, Throat washings, urine, CSF
1) RT-PCR
2) Culture with hen eggs
(CPE → rounding of cells, multinucleated syncytial formation and eosinophilic inclusions)
3) Serology

Question 18

What type of virus is Rubella?

Answer 18

Rubivirus (+ssRNA) w envelope

Question 19

Why do people only get Rubella once in their life?

Answer 19

There is only 1 serotype

Question 20

How is Rubella transmitted?

Answer 20

Respiratory droplets

Question 21

What type of side effects do MMR vaccines cause?

Answer 21

Mild pyrexia

(only rare lymphadenopathy, arthralgia, arthritis, or polyneuropathy)

Question 22

What anti-virals should you use for MMR infections?

Answer 22

None available :(

Question 23

What is the pathology of Mumps?

Answer 23

It replicated in URT → spreads via blood (to parotid gland, gonads, pancreas, meninges)

Question 24

What are the symptoms of Rubella infection?

Answer 24

1) Forschheimer's spots (rose spot on palate → herald rash) 2) German measles/typical rubella rash (maculopapular rash) - early lesions discrete → coalesce 3) Constitutional symptoms (eg. fever, headache, malaise, conjunctivitis) 4) Tender lymphadenopathy (eg. suboccipital, postauricular, cervical nodes)

Question 25

What are the possible complications of a Rubella infection?

Answer 25

1) Arthralgia and arthritis (when rash subsides) 2) Encephalitis 3) Purpura and Petechiae (thrombocytopaenia) 4) Congenital Rubella Syndrome - teratogenic in 1st semester - ↑defect in organogenesis - still births/spontaneous abortion - Birth defects (eg. Ocular lesions, Sensorineural deafness, CNS, CVS, Interstitial Pneumonitis, Type 1 DM, Hepatosplenomegaly, Thrombocytopenia, Metaphyseal osteitis)

Question 26

How is a Rubella infection diagnosed?

Answer 26

No culture → time consuming 1) Serology (eg. IgM or TRCHES IgG panel)

Question 27

How do you prevent the spread of Rubella?

Answer 27

1) Herd immunity 2) Quarantine 3) Screen pregnant mothers antenatally for Rubella Abs 4) Prophylactic IgG early after exposure