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measles, mumps, rubella and varicella Vaccine Question #1:

What is measles, mumps, rubella and varicella?

Measles infection can result in hospitalization. Severe complications, while rare, can also result in death.

Mumps sometimes causes complications in children and adults including inflammation of testicles, breasts, ovaries, the brain. spinal cord and permanent deafness.

In adults, serious complications from rubella serious such as thrombocytopenia, encephalitis and progressive rubella panencephalitis are rare.

The varicella defining symptom is a characteristic blister-like rash and most children have a relatively mild illness, but severe illness may occur in adults and people with depressed immunity.

Measles

Symptoms can appear 7 to 21 days after being infected with the measles virus. Initial symptoms include fever, cough, runny nose and red, watery eyes. About 3 to 7 days after symptoms begin, a rash appears. This rash looks like red spots and blotchy patches that start on the face, and then spread down the body, arms and legs. The rash can last 4 to 7 days.

Most people recover from measles within 2 or 3 weeks; however, common complications from measles include an ear infection, pneumonia and diarrhea.

Measles infection can result in hospitalization. Severe complications, while rare, can also result from a measles infection, such as respiratory failure, inflammation and swelling of the brain (encephalitis) and death.

Long-term complications of acute encephalitis can include blindness, deafness and brain injury

It's also possible to develop a neurological condition called subacute sclerosing panencephalitis (SSPE) 7 to 10 years after recovering from measles. It affects the brain and can develop even if it looks like you've fully recovered from the initial infection. The condition is rare, but fatal. The risk of developing this condition may be higher if you have measles before 2 years of age.

People who get measles while pregnant may have a miscarriage, go into premature labour and give birth to an infant with low birth weight

Mumps

Mumps is an infection caused by a virus. It is highly contagious and passes easily from person to person, so prevention is very important. The mumps vaccine is the best way to prevent mumps.

The main symptom of mumps is painful swelling in the cheeks and neck. Symptoms can also include a fever, headache, earache, tiredness, sore muscles, dry mouth, and trouble talking, chewing or swallowing, or loss of appetite.

Although most people fully recover from mumps within 7 to 10 days, in rare cases the virus may cause complications. Mumps is not usually serious, but sometimes the virus may cause complications in children and adults. These include the following conditions, most of which are rare:

  • inflammation of the testicles (orchitis), leading to potential infertility

  • inflammation of the breasts (mastitis),

  • inflammation of the ovaries (oophoritis),

  • inflammation of the brain (encephalitis),

  • inflammation of the tissue covering the brain and spinal cord (meningitis),

  • temporary hearing loss or permanent deafness, or

  • fetal loss during the first three months of pregnancy.

There is no specific cure for mumps.

Rubella

Rubella is caused by the rubella virus. This virus is an enveloped, positive-sense, single-stranded ribonucleic acid virus. It belongs to the Rubivirus genus of the Togaviridae family.

It is a highly infectious disease. The incubation period for rubella is generally 14 to 17 days, but can range from 12 to 21 days.

In children, symptoms are often mild, and up to 50% of infections are subclinical. Symptoms include a transient erythematous rash, post-auricular and suboccipital lymphadenopathy and low-grade fever.

Since most symptoms are non-specific, rubella can be mistaken for infection caused by other viruses such as parvovirus, adenovirus or enterovirus.

In adults, rubella is often accompanied by transient polyarthralgia or polyarthritis. Serious complications such as thrombocytopenia, encephalitis and progressive rubella panencephalitis are rare.

In susceptible pregnant women (inadequately immunized and without a history of infection), it can result in, miscarriage, stillbirth, congenital rubella infection (CRI) and congenital rubella syndrome (CRS)

Rubella infection during pregnancy often results in CRI of the unborn child. The infection affects all organs of the fetus and results in CRS, causing abnormalities, miscarriage or stillbirth.

Fetal infection can occur at any stage of pregnancy. The risk of fetal damage following maternal infection is particularly high in the earliest months after conception (85% in the first trimester). The risk decreases as the pregnancy progresses. Fetal abnormalities are rare if infected after 20 weeks of gestation.

Manifestations of CRS can include

  • congenital heart disease

  • cataracts, glaucoma or retinitis

  • microphthalmia

  • cochlear deafness or central auditory imperception

  • patent ductus arteriosus or peripheral pulmonic artery stenosis

  • encephalitis

  • microcephaly

Other manifestations include:

  • mental retardation

  • autism

  • intra-uterine growth retardation

  • metaphysical rarefactions

  • hepatosplenomegaly

  • thrombocytopenic purpura

  • interstitial pneumonitis

Some manifestations of CRS, including diabetes mellitus, thyroid abnormalities and neurological disorders, may become apparent later in life.

Varicella

The first noticeable symptom is the onset of a slight fever, which is usually followed by some mild constitutional symptoms, such as a headache, runny nose and a general feeling of malaise.

The defining symptom of varicella is the eruption of skin lesions on all areas of the body, including on the scalp and on the mucous membranes of the mouth and upper respiratory tract. These fluid-filled lesions or vesicles occur in "crops", so that several stages of old and new lesions will be present at the same time. Varicella varies in severity from very mild, with just a few spots, to severe, with fever and a widespread rash. The more severe form is seen more often in adults.

Following the initial varicella illness, varicella-zoster virus establishes latency in the sensory nerve ganglia, which may be reactivated later in life as herpes zoster (also known as shingles).

It may take 10 to 21 days for symptoms to appear after infection has occurred. A person is most contagious from 1 to 2 days before to shortly after the onset of rash. Contagiousness persists until the skin lesions crust over.

The complications of varicella include secondary bacterial skin and soft tissue infections, otitis media, bacteremia, pneumonia, osteomyelitis, septic arthritis, endocarditis, necrotizing fasciitis, toxic shock-like syndrome, hepatitis, thrombocytopenia, cerebellar ataxia, stroke and encephalitis. Varicella increases the risk of severe invasive group A streptococcal infection in previously healthy children by 40- to 60-fold. Complications are more common in adolescents, adults and immunocompromised people, who have higher rates of pneumonia, encephalitis and death. Congenital varicella syndrome is rare when infection occurs before the 13th or after the 20th week of gestation.

Sources:

Government of Canada: Measles: Symptoms and treatment
Government of Canada: Mumps
Government of Canada: For health professionals: Rubella
Government of Canada: Varicella (Chickenpox)