Fast Facts For Your Patients Measles Mumps Rubella Continuing Education
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Measles, Mumps, Rubella Vaccination and Autism: A Nationwide Cohort Study (3/05/2019)
Fast Facts
Measles:
- The measles virus causes rash, cough, runny nose, eye irritation, and fever.
- It can lead to ear infection, pneumonia, seizures, brain damage, and death.
- It is spread through the air.
Mumps:
- The mumps virus causes fever, headaches, muscle aches, and loss of appetite.
- This usually leads to swelling of salivary glands (causing puffy checks and a tender, swollen jaw).
- It is spread through close contact with infected people.
Rubella:
- The rubella virus causes a mild, low grade fever, sore throat, and a rash that starts on the face and spreads to the rest of the body.
- It may also cause headache, pink eye, and general discomfort.
- Rubella can cause miscarriage, or serious birth defects if the mother is infected while pregnant (congenital rubella syndrome).
National Immunization Survey Data:
Percent of Children 19-35 Months Who Have Received > 1 MMR
(2020 Goal: 90.0%)
| Year | Nationally | Delaware |
|---|---|---|
| 2008 | 92.1 | 93.1 |
| 2009 | 90.0 | 90.2 |
| 2010 | 91.5 | 94.0 |
| 2011 | 91.6 | 90.6 |
| 2012 | 90.8 | 94.4 |
| 2013 | 91.9 | 94.8 |
| 2014 | 91.5 | 90.8 |
| 2015 | 91.9 | 97.2 |
CDC changed the way that NIS results are reported starting in 2019. In the past, results were reported for children 19-35 months of age at the time of the survey. Now, results for most vaccines are reported at 24 months of age by birth year. Exemptions to this are the hepatitis B birth dose and Rotavirus vaccines which are reported at younger ages because they are completed before 24 months
Percent of Children at 24 Months Who Received > 1 MMR
(2030 Goal: 90.8%)
| Birth Year | Nationally | Delaware |
|---|---|---|
| 2015-16 | 90.4 | 89.9 |
| 2016-17 | 90.7 | 92.3 |
| 2017-18 | 91.6 | 91.4 |
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For Your Patients
Children should get 2 doses of the MMR vaccine: 1st at 12-15 months, 2nd at 4-6 years (or 28 days after the 1st)
Anyone 18+ and born after 1956 should get at least one dose of MMR vaccine unless they can prove vaccination or illness.
Children may instead receive 2 doses of the MMRV vaccine: 1st at 12-15 months, 2nd at 4-6 year. This protects against Measles, Mumps, Rubella, and Varicella.
Dear Provider Letter (CDC): Dear Provider
MMR Vaccine Information Statement: English | Spanish
MMRV Vaccine Information Statement: English | Spanish
MMR: What everyone should know.
CDC Fact Sheet: Measles | Mumps | Rubella
Make sure your child is immunized.
Infographics: Measles | Mumps | Rubella
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From the CDC’s Pink Book:
Measles
Measles is an acute viral infectious disease.
Before a vaccine was available, infection with measles virus was nearly universal during childhood, and more than 90% of persons were immune by age 15 years. Measles is still a common and often fatal disease in developing countries. The World Health Organization estimates there were 145,700 deaths globally from measles in 2013.
Measles is a systemic infection. The primary site of infection is the respiratory epithelium of the nasopharynx. Two to three days after invasion and replication in the respiratory epithelium and regional lymph nodes, a primary viremia occurs with subsequent infection of the reticuloendothelial system. Following further viral replication in regional and distal reticuloendothelial sites, a second viremia occurs 5–7 days after initial infection. During this viremia, there may be infection of the respiratory tract and other organs. Measles virus is shed from the nasopharynx beginning with the prodrome until 3–4 days after rash onset.
The incubation period of measles, from exposure to prodrome, averages 10–12 days. From exposure to rash onset averages 14 days (range, 7–21 days).
The prodrome lasts 2–4 days (range 1–7 days). It is characterized by fever, which increases in stepwise fashion, often peaking as high as 103°F –105°F. This is followed by the onset of cough, coryza (runny nose), or conjunctivitis.
Koplik spots, a rash present on mucous membranes, is considered to be pathognomonic for measles. It occurs 1–2 days before the rash to 1–2 days after the rash, and appears as punctate blue-white spots on the bright red background of the buccal mucosa. The measles rash is a maculopapular eruption that usually lasts 5–6 days. It begins at the hairline, then involves the face and upper neck. During the next 3 days, the rash gradually proceeds downward and outward, reaching the hands and feet.
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Mumps
Mumps is an acute viral illness.
Mumps was a frequent cause of outbreaks among military personnel in the prevaccine era, and was one of the most common causes of aseptic meningitis and sensorineural deafness in childhood. During World War I, only influenza and gonorrhea were more common causes of hospitalization among soldiers.
The virus is acquired by respiratory droplets. It replicates in the nasopharynx and regional lymph nodes. After 12 to 25 days a viremia occurs, which lasts from 3 to 5 days. During the viremia, the virus spreads to multiple tissues, including the meninges, and glands such as the salivary, pancreas, testes, and ovaries. Inflammation in infected tissues leads to characteristic symptoms of parotitis and aseptic meningitis.
The incubation period of mumps is 12 to 25 days, but parotitis typically develops 16 to 18 days after exposure to mumps virus. The prodromal symptoms are nonspecific, and include myalgia, anorexia, malaise, headache, and low-grade fever.
Parotitis is the most common manifestation. Parotitis may be unilateral or bilateral, and any combination of single or multiple salivary glands may be affected. Parotitis tends to occur within the first 2 days and may first be noted as earache and tenderness on palpation of the angle of the jaw. Symptoms tend to decrease after one week and usually resolve after 10 days.
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Rubella
The name rubella is derived from Latin, meaning “little red.” Rubella was initially considered to be a variant of measles or scarlet fever and was called “third disease”. It was not until 1814 that it was first described as a separate disease in the German medical literature, hence the common name “German measles”.
Following respiratory transmission of rubella virus, replication of the virus is thought to occur in the nasopharynx and regional lymph nodes. A viremia occurs 5 to 7 days after exposure with spread of the virus throughout the body. Transplacental infection of the fetus occurs during viremia. Fetal damage occurs through destruction of cells as well as mitotic arrest.
Acquired Rubella: The incubation period of rubella is 14 days, with a range of 12 to 23 days. Symptoms are often mild, and up to 50% of infections may be subclinical or inapparent. In children, rash is usually the first manifestation and a prodrome is rare. In older children and adults, there is often a 1 to 5 day prodrome with low-grade fever, malaise, lymphadenopathy, and upper respiratory symptoms preceding the rash. The rash of rubella is maculopapular and occurs 14 to 17 days after exposure. The rash usually occurs initially on the face and then progresses from head to foot. It lasts about 3 days and is occasionally pruritic. The rash is fainter than measles rash and does not coalesce. The rash is often more prominent after a hot shower or bath. Lymphadenopathy may begin a week before the rash and last several weeks. Postauricular, posterior cervical, and suboccipital nodes are commonly involved. Arthralgia and arthritis occur so frequently in adults that they are considered by many to be an integral part of the illness rather than a complication. Other symptoms of rubella include conjunctivitis, testalgia, or orchitis. Forschheimer spots may be noted on the soft palate but are not diagnostic for rubella.
Congenital Rubella: Infection with rubella virus is most severe in early gestation. The virus may affect all organs and cause a variety of congenital defects. Infection may lead to fetal death, spontaneous abortion, or preterm delivery. The severity of the effects of rubella virus on the fetus depends largely on the time of gestation at which infection occurs. As many as 85% of infants infected in the first trimester of pregnancy will be found to be affected if followed after birth. While fetal infection may occur throughout pregnancy, defects are rare when infection occurs after the 20th week of gestation. The overall risk of defects during the third trimester is probably no greater than that associated with uncomplicated pregnancies.
Congenital infection with rubella virus can affect virtually all organ systems. Deafness is the most common and often the sole manifestation of congenital rubella infection, especially after the fourth month of gestation. Eye defects, including cataracts, glaucoma, retinopathy, and microphthalmia may occur. Cardiac defects such as patent ductus arteriosus, ventricular septal defect, pulmonic stenosis, and coarctation of the aorta are possible. Neurologic abnormalities, including microcephaly and mental retardation, and other abnormalities, including bone lesions, splenomegaly, hepatitis, and thrombocytopenia with purpura may occur.
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Continuing Education
You Call The Shots (MMR), expires 1/14/2023
ACIP MMR Vaccine Recommendations
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