Measles, Mumps, Rubella and MMR Vaccine

Measles, mumps, and rubella are viral diseases that can be life-threatening in extreme cases. These three diseases are all very contagious and mostly affect infants, children and young adults. The measles, mumps, rubella vaccine (MMR vaccine) is one vaccine that protects against all three diseases.

What is measles?

Measles, also known as morbilli, English measles or rubeola (not to be confused with rubella or roseola) is an infection of the respiratory system caused by the measles virus. The measles virus, which is a paramyxovirus (from Greek para-, beyond, -myxo-, mucus or slime) of the Morbillivirus genus, normally grows in the cells that line the back of the throat and lungs. Complications from measles include ear infections, pneumonia, encephalitis and death. The disease is very rare in countries and areas where vaccination coverage is high; yet, it still kills an estimated 164,000 people per year.

What is mumps?

Mumps or epidemic parotitis is an infectious disease that leads to painful swelling of the salivary glands. The disease is caused by the mumps virus which is a paramyxovirus of the Rubulavirus genus. Mumps normally subsides by itself, while there is no specific treatment available. The outcome is normally good, but complications may include infection of the testes, spontaneous abortion in pregnant women, meningitis, pancreatitis and encephalitis. Before routine vaccination programs were introduced, mumps was a common illness among infants, children and young adults. Nowadays, it is very rare in the United States.

What is rubella?

Rubella, also known as German measles or three-day measles, is an infectious disease caused by the rubella virus, a togavirus of the genus Rubivirus, that leads to fever and rash. Rubella is derived from Latin, meaning “little red”. It mostly affects children and young adults. This disease is often mild and attacks often pass unnoticed, while typically not lasting longer than 3 days. However, infection of a pregnant woman can be very serious: if the woman is within the first 20 weeks of pregnancy, the child may be born with congenital rubella syndrome (CRS) which includes multiple serious ailments.

Where does measles come from?

The earliest report of measles came from an Arab physician of the 9th century who described the differences between measles and smallpox in his medical report. In 1757, Scottish physician Francis Home showed that measles was caused by an infectious agent present in patients’ blood. In 1954 the virus that causes measles was isolated in Boston, Massachusetts, by John F. Enders and Thomas C. Peebles.

Where does mumps come from?

The first descriptions of mumps were provided by Hippocrates in the 5th century BC, when the Greek physician described the typical symptoms of the disease, such as swelling of the face and throat, as well as the occasional swelling of the testes. Mumps outbreaks occurred widely during the 18th and 19th century around the world, especially in places where people lived in close spaces like military barracks, boarding schools or prisons. In 1934, Claud D. Johnson and Ernest W. Goodpasture discovered that mumps is caused by a virus they found in saliva samples.

Where does rubella come from?

Rubella was first described in 1740 century by Friedrich Hoffmann, a discovery later confirmed by other German physicians in the 1750s. In 1814, George de Maton first suggested that the disease is different from both measles and scarlet fever. As all these physicians were German, the disease was known as Rötheln (contemporary German Röteln, derived from the German word for red, rot), hence the common name of “German measles”. Henry Veale coined the term rubella in 1866. In 1914, Alfred Fabian Hess hypothesized that the disease is caused by a virus, which was confirmed in 1938. In 1962, the virus was first isolated by Paul D. Parkman and Thomas H. Weller.

How is measles transmitted?

Measles is spread to others from 4 days before to 4 days after the rash appears. In fact, measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected. The disease is spread by contact with droplets from the nose, mouth, or throat of an infected person. The measles virus lives in the mucus of the nose and throat of the infected person. Direct contact with the virus typically occurs through sneezing and coughing, which sprays contaminated droplets into the air. These droplets can infiltrate other people’s noses and throats when they breathe or touch their mouth or nose after touching contaminated surface (where the virus can live up to 2 hours).

How is mumps transmitted?

Mumps is spread through droplets of saliva or mucus from the mouth, nose, or throat of an infected person. This occurs usually when the infected person coughs, sneezes, or talks, and the other person breathes in the droplets containing the mumps virus. A person can also get infected if they share and item, like eating or drinking utensils, with an infected person. Moreover, a person can also get infected if the touch contaminated surfaces and subsequently touch their mouth or nose. Most mumps transmission likely occur before the salivary glands begin to swell and up to 5 days after the swelling begins.

How is rubella transmitted?

Rubella is spread through the air or by close contact. The rubella virus replicates in the nasopharyngeal mucosa and local lymph nodes of an infected person, and usually infects people that breath in droplets sprayed in the air through coughing and sneezing. Rubella is most contagious from 1 week before to 1 week after the rash appears. Infants who have congenital rubella syndrome can shed the virus in urine and fluid from the nose and throat for a year or more and may pass the virus to people who have not been immunized.

What are measles symptoms?

Symptoms usually begin 8 – 12 days after exposure to the virus and include bloodshot eyes, cough, fever, photophobia, muscle pain, rash, conjunctivitis, runny nose, sore throat and Koplik’s spots (tiny white spots inside the mouth). The rash normally appears 3-5 days after the first symptoms of sickness, and lasts about 4-7 days. It typically starts on the head and spreads down to other parts of the body. The rash can appear as flat, discolored areas (macules) and as solid, red, raised areas (papules). The rash is itchy.

What are mumps symptoms?

Mumps symptoms include face pain, fever, headache, sore throat, swelling of the parotid glands (the largest salivary glands, located between the ear and the jaw), and swelling of the temples or jaw (temporomandibular area). Swelling of the parotid glands (parotitis), while the most recognizable mumps symptom, actually only affects 30-40% of cases. In male patients, symptoms may also include testicular lumps, testicle pain and scrotal swelling. Other patients may have nonspecific symptoms, and up to 20% of infected individuals may experience no symptoms at all. Symptoms normally appear 2 to 3 weeks after exposure to the virus.

What are rubella symptoms?

Rubella symptoms normally include low-grade fever, respiratory problems, and most remarkably a rash of pink or light red spots that typically starts on the face and spreads downward. The rash occurs about two to three weeks after exposure to the virus. While children usually experience mild symptoms, adults may suffer from complications like arthritis, encephalitis, and neuritis. A woman who contracts rubella during pregnancy and passes the virus to the fetus can experience complications like a spontaneous abortion or premature birth. If the fetus survives, the child may have a number of birth defects like deafness, eye defects, cardiac defects, mental retardation and bone lesions.

What is the MMR vaccine?

The MMR vaccine is a combination vaccine that protects against the three viral diseases. The vaccine contains live, attenuated viruses of each disease, and is given via subcutaneous injection. The MMR vaccine cannot cause measles, mumps or rubella. MMR vaccination is recommended in 2 doses for children, with the first dose administered at ages 12-15 months and the second dose administered at ages 4-6 years. Nearly 10 million doses of MMR vaccine are distributed each year in the United States alone. The first measles vaccine was introduced in 1963, while the first mumps vaccine became available in 1967 and the first rubella vaccine in 1969. The three vaccines were combined in 1971.

What are the MMR vaccine side effects?

The MMR vaccine side effects are normally rare and very mild. They may include fever, mild rash and swelling of glands in the cheek or neck. Moderate symptoms may include seizure, pain and stiffness in the joints and low platelet count. The symptoms occur usually within 6-14 days after the shot, if at all. Some people who are allergic to any of the components in the vaccine might be at risk for experiencing a severe allergic reaction like deafness, long-term seizures, coma and permanent brain damage. It is also not clear whether these severe symptoms are caused by the vaccine. However, generally speaking, getting MMR vaccine is much safer than getting measles, mumps or rubella. The MMR-vaccine-autism relation has been extensively studied and there is no scientific evidence that MMR vaccine causes autism.

Who should not get the MMR vaccine?

Anybody with a life-threatening reaction to the antibiotic neomycin, or any other component of MMR vaccine, should not get the vaccine. People who had a life-threatening allergic reaction to a previous dose of MMR or MMRV vaccine should not get another dose. People who are sick at the time of the scheduled vaccination should wait. Pregnant women should not get MMR vaccine and should wait until after giving birth. Anyone with HIV/AIDS, under treatment with immunosuppressive drugs like steroids, who has cancer and/or is treated for cancer, who has had low platelet count, who has had a recent blood transfusion or received other blood products or who has received another vaccine within the last 4 weeks should consult with a doctor before getting the MMR vaccine.

Sources:

http://www.historyofvaccines.org/content/articles/rubella

http://www.cdc.gov/mumps/about/transmission.html

http://www.who.int/ith/diseases/rubella/en/

http://pediatrics.aappublications.org/content/40/3/420.abstract

http://www.cdc.gov/vaccines/hcp/vis/vis-statements/mmr.html#risks

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