Comprehensive Guide to Measles, Mumps, and Rubella: Symptoms, Diagnosis, and Prevention

Discover – Comprehensive Guide to Measles, Mumps, and Rubella: Symptoms, Diagnosis, and Prevention: This Ready Reckoner has been designed to provide medical students with a quick and comprehensive reference for three significant childhood viral infections: Measles, Mumps, and Rubella. As part of their clinical education, students are often tasked with diagnosing and managing these common infections. The reckoner simplifies and condenses the essential clinical features, complications, diagnostic methods, and prevention strategies for each disease, enabling students to quickly review key concepts before exams or clinical rounds. It also serves as an aid in understanding the differential diagnosis of fever with rash in children, a crucial skill in pediatric and infectious disease management. By bridging theory with clinical practice, this resource equips students to recognize these conditions and make informed decisions in real-world scenarios.

Measles (Rubeola)

1. Causative Agent:
   • RNA paramyxovirus, single serotype.
2. Transmission:
   • Highly contagious, spread by respiratory droplets (sneezing, coughing), direct contact with nasal or throat secretions.
   • Infectious period: 4 days before rash appears to 4 days after.
3. Incubation Period:
   • 10 days for fever, 14 days for rash.
4. Clinical Features:
   • Prodromal Phase (10-14 days): Fever, cough, runny nose, conjunctivitis, Koplik’s spots (bluish-white spots inside the mouth).
   • Eruptive Phase: Dusky-red maculopapular rash starting behind the ears, spreading downwards to the body. Rash fades in the same order of appearance.
5. Complications:
   • Otitis media, pneumonia, diarrhea, encephalitis, subacute sclerosing panencephalitis (SSPE), especially in malnourished and immunocompromised individuals.
6. Diagnosis:
   • Clinical features (Koplik’s spots, characteristic rash).
   • Laboratory: IgM antibodies (ELISA), RT-PCR for viral RNA.
7. Treatment:
   • Supportive care: Hydration, nutritional support, vitamin A supplementation.
   • No specific antiviral therapy.
8. Prevention:
   • Vaccination: Two doses of MCV (Measles Containing Vaccine) – first at 9-12 months, second at 15-18 months.
   • Achieve over 95% vaccination coverage for herd immunity.

Mumps

1. Causative Agent:
   • RNA virus from the Rubulavirus genus, single serotype.
2. Transmission:
   • Spread by respiratory droplets and direct contact with infected saliva.
   • Infectious period: 4-6 days before symptoms and up to 1 week after parotitis onset.
3. Incubation Period:
   • 14-18 days.
4. Clinical Features:
   • Fever, headache, muscle aches, fatigue, followed by painful swelling of one or both parotid glands.
   • Swelling of submandibular and sublingual glands, earache on the affected side, pain while chewing.
5. Complications:
   • Orchitis (inflammation of the testicles), oophoritis (inflammation of the ovaries), pancreatitis, meningitis, sensorineural deafness, encephalitis.
6. Diagnosis:
   • Clinical features (parotitis).
   • Laboratory: IgM antibody detection, viral isolation from saliva, urine, or CSF.
7. Treatment:
   • Supportive care: Analgesics, hydration, rest.
8. Prevention:
   • Vaccination: Mumps vaccine (part of MMR) given at 9-12 months and 16-24 months
   • Lifelong immunity after infection or vaccination.

Rubella (German Measles)

1. Causative Agent:
   • RNA virus from the Togavirus family, single antigenic type.
2. Transmission:
   • Spread by respiratory droplets and direct contact with nasopharyngeal secretions.
   • Infectious period: 1 week before and 1 week after rash onset.
   • Can cross the placenta and cause congenital rubella syndrome (CRS).
3. Incubation Period:
   • 2-3 weeks (average 18 days).
4. Clinical Features:
   • Low-grade fever, mild rash (pink maculopapular), swollen lymph nodes (postauricular, occipital), conjunctivitis.
   • Rash spreads from face to trunk, clears within 3 days.
5. Complications:
   • In pregnant women, CRS can cause deafness, heart defects, cataracts, and developmental delays.
   • Arthralgia, encephalitis, thrombocytopenic purpura (rare).
6. Diagnosis:
   • Serology: Detection of rubella-specific IgM antibodies, virus isolation from nasopharyngeal swabs.
7. Treatment:
   • Supportive care, no specific antiviral treatment.
8. Prevention:
   • Vaccination: MMR vaccine at 12-15 months, with a booster at 4-6 years.
   • Important to vaccinate non-pregnant women of reproductive age to prevent CRS.

Key Differences Between Measles, Mumps, and Rubella

Feature	Measles	Mumps	Rubella
Agent	RNA paramyxovirus	RNA virus from Rubulavirus genus	RNA virus from Togavirus family
Transmission	Respiratory droplets	Respiratory droplets, contact with saliva	Respiratory droplets, direct contact
Incubation Period	10-14 days	14-18 days	14-21 days
Clinical Features	High fever, cough, coryza, Koplik’s spots, rash	Swelling of parotid glands, fever	Mild fever, rash, swollen lymph nodes
Complications	Pneumonia, encephalitis, SSPE	Orchitis, pancreatitis, meningitis	CRS in pregnancy, arthralgia
Vaccine	MMR (Measles, Mumps, Rubella)	MMR (Measles, Mumps, Rubella)	MMR (Measles, Mumps, Rubella)
Prevention	95% vaccination coverage	95% vaccination coverage	95% vaccination coverage

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Important Points to Remember

• Measles is highly contagious and poses a significant risk of complications, especially in malnourished children.
• Mumps can lead to orchitis in males and pancreatitis, but it is generally self-limited.
• Rubella is mild but dangerous for pregnant women due to the risk of CRS.
• MMR Vaccine is the cornerstone of prevention, providing protection against all three diseases.