• measles
• Rubella (German measles)
• Erythema infectiosum (Fifth disease)
• Mumps
• Varicella-Zoster (Chickenpox and shingles)
• Coxsackievirus and Echovirus associated infections (hand-food-and-mouth disease)

Measles: structure

• paramyxovirus (related to mumps and RSV)

Measles: occurance

• world wide occurance, epidemics common in NA pre-vaccination but rare now
• larger outbreaks in Canada in recent years

• instituted in 1963
• 2nd dose vaccine implemented in 1980s when we failed to eliminate completely

• airborne transmission
• initial replication in respiratory tract and then disseminates (viremia)

• 2 weeks to develop the rash
• maculopapular rash evolves from face to trunk to extremities (including palms and soles)
• Fever and the three Cs: cough, coryza and conjunctivitis
• Koplik spots (sugary spots on mucosa next to molar teeth)

• otitis media
• pneumonia
• encephalitis
• death

third world thousands kids die yearly; common in kids and adults where malnutrition (especially vitamin A) is prevalent

RNA virus - Togavirus

spread by respiratory droplets and vertically to fetus

• rash develops after 2-3 weeks
• infection may be sub-clinical esp in young kids
• rash often mistaken for other rashes and drug rxns
• adenopathy (swollen lymph nodes)
• adults may get mild arthritis

congenital rubella

- most occur in first 16 wks of pregnancy (85% transmission rate to fetus)

• cardiac abnormalities
• cataracts
• deafness
• brain, liver and organ damage

• respiratory droplets and vertical (mom to fetus)
• world wide, very common in early childhoot (50% infected by age 19)

• "slapped cheek"
• lacy pink rash of extremities
• misscarriage or fetal abnormalities (severe anemia leading to heart failure of fetus)

• symptom of erythema infectiosum
• distinct facial rash sparing the mouth area

paramyxovirus

droplets and fomites contaminated by saliva

occurs world wide, uncommon because of vaccine and especially after second dose MMR

- incubation 2-3 weeks

Mumps: complications and symptoms

• parotid gland swelling (95%)
• other salivatory gland in 10%
• occasionally: orchitis, meningitis in 15% --> deafness, encephalitis and pancreatitis are rare

• member of herpesviridae (large icosahedral DNA double stranded)
• airborne route primarily

What are the usual characteristics of chickenpox?

Where does virus replication and movement take place?

• fever and generalized vesicular eruption
• replicated in throught and spread through viremia to skin, reticuloendothelial tissue and rarely to lungs and brain

• incubation = 11-13 days
• progression = macule, papule, vesicle, pustule, ulcer, crust

• pneumonia (15% adults w/ chickenpox)
• disseminated infections of immuno-compromised
• severe infections in newborns (mother not immune)
• CNS involvement (rare: 1:200)
• bacterial superinfection (S. aureus, S. pyogenes)

• becomes latent in dorsal root and cranial nerve ganglia, reactivating later in life
• inflammation of sensory nerve and their ganglia and a localized vesicular rash along the distribution of that nerve

• clinical syndrome recognition
• electron microscopy (all herpesviridae look alike)
• virus culture
• viral serology not necessary!
• antibody measurement useful to determine immune status of exposed individual

• YES!
• Chicken pox vaccine 
• shingles vaccine
• VZ immune globulin (VZIG): post exposure prophylaxis (congenital or acquired immunodeficiency)

• airborne precautions
• ACYCLOVIR or cousine for immune-compromised or pneumonia/CNS infection

• picornavirus
• summer and fall
• fecal-oral

• 50-80% asymptomatic
• skin rash and can mimic other viral infections
• common cause of meningitis, myocarditis
• hand-foot-and-mouth disease

- mostly in kids

- usually Coxsackie A16

- sore throat, vesicles, fever, cutaneous lesions including hand and feet