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1. MMR vaccine for measles, mumps and rubellaPaul R. EarlFacultad de Ciencias BiológicasUniversidad Autónoma de Nuevo LeónSan Nicolás, NL, Mexico

2. Measles is a highly contagious viral childhood disease that affected almost everybody during the prevaccination era. Measles is an RNA negative strand virus belonging to the Mononegavirales of the family Paramyxoviridae. Transmission is primarily by large yet invisible respiratory droplets. The disease typically consists of a high fever, cough, runny nose and a classic rash. Complications such as diarrhea, middle ear infection and pneumonia occur. Infants under one year of age have the highest case fatality rates reaching as high as 20% in epidemics.

3. Regardless, as children are vaccinated for 1/ measles, 2/ mumps and 3/ rubella (German measles) with the same vaccine—MMR—these 3 diseases are taken up together.The MMR vaccine prevents 3 childhood diseases — measles, mumps and rubella. Measles is best known as an illness with rash and high fever, but can also lead to pneumonia or encephalitis and can cause death. Approximately 5% of children with measles will develop pneumonia and more than 3 out of 10,000 can die.

4. Mumpsis a disease caused by the mumps virus. It usually infects children younger than 10 years old and begins with swelling of the salivary glands. The swelling usually lasts for about a week. Mumps can cause deafness, an infection of the lining of the brain (meningitis) and even death.Rubella is usually not a serious disease for children but it almost always causes birth defects when a pregnant woman is infected. Up to 85% of babies whose mothers are infected during pregnancy will have blindness, deafness, heart defects or mental retardation.

5. The vaccine effectively protects against all 3 diseases in at least 95% of children who receive 2 shots. Nearly all children who get the MMR vaccine (more than 80%) will have no side effects at all. Of those children who have a side effect, most will have only a mild reaction. Mild side effects of the vaccine include soreness, redness or swelling where the shot was given, mild rash, mild to moderate fever, swelling of the lymph glands and temporary pain, stiffness or swelling in the joints. In about 0.03% of cases) children have a moderate reaction. This reaction is a seizure related to having a high fever. Ony 0.001% of children have a serious reaction.

7. Regardless, the costs of MMR or other immunizations is the obstacle. The results of benefit–cost analyses may be at 3-6 times, yet difficult to assess in rural countries. Local estimates of disease burden, costs of treatment, costs of vaccination, and the rates of adverse events for the vaccine strain of interest. Some countries as in Africa use monovalent measles vaccine to save money. In other cases like Peru, the government will not spend the money for a healthier country. It is quite obviously important that all national health stations function well with adequate personel and supplies, not true for India which has 1000 million people nor for many other countries.

8. Despite the availability of measles vaccine for the last 3 decades globally, WHO reported 30 million cases of measles with 880,000 deaths in 1998. Of these 85% occur in SE Asia. The coverage figures for measles vaccination have steadily increased and stayed at around 85-90% since 1990. All vaccine percent for India in 2000 was 42%. There is a gap between the official figures and the real coverage. The coverage is especially poor in the rural areas, in tribal populations and inaccessible populations. This has lead to outbreaks of considerable severity. Measles causes substantial mortality, disruption in services, and continues to be a major drain on resources. Epidemics of the disease continue to occur because of poor coverage and an inefficient surveillance system.

9. The WHO/UNICEF Global Measles Strategic Plan 2001–2005 seeks to reduce measles mortality worldwide in a sustainable way by 50% relative to 1999 estimates. WHO=OMS is World Health Organization = Organización Mundial de Salud.

10. Administration Summary. a) Type of vaccine: Live attenuated viral, b) Number of doses: One dose given by the intramuscular or subcutaneous route, with opportunity for a second dose at least one month after the first. c) Schedule: At 9–11 months of age, d) Booster: A second opportunity for immunization is most strongly recommended. e) Contraindications: Severe reaction to previous dose; pregnancy; congenital or acquired immune disorders. f) Adverse reactions: Malaise, fever, rash 5–12 days later; idiopathic thrombocytopenic purpura; rarely, encephalitis or anaphylaxis.

13. Mumps is an acute infectious disease caused by a paramyxovirus closely related to parainfluenza virus. The disease is usually mild and about one-third of cases are asymptomatic. Up to 10% of mumps patients developed aseptic meningitis. A less common but more serious complication is encephalitis which can result in death or disability, including permanent deafness, orchitis and pancreatitis. As of mid1998, mumps vaccine was routinely used by national childhood immunization programs in 82 countries. Where high coverage has been achieved, countries have shown a rapid decline in mumps morbidity especially the near elimination of encephalitis.

15. Rubella. Attention was called to this mild disease in 1942 when Norman Gregg found that first-trimester maternal rubella caused serious birth defects. Much embryopathy was clarified groups: Parkman, Buescher & Artenstein, and Neva & Weller. The severe rubella epidemic of 1964 affected about 1% of pregnancies. Signs neonatal thrombocytopenic purpura, hepatitis, bone lesions and meningoencephalitis as well as late-emerging consequences like diabetes mellitus and progressive rubella panencephalitis also with cataract, heart disease, mental retardation and deafness.

18. Rubella is passed on by direct contact, and by coughing and sneezing the virus into the air. It takes 2-3 weeks to develop symptoms after being infected. Persons are infectious from 1 week before symptoms begin until 5 days after the rash appears. Therefore, affected children should stay away from school and not mix with others for 5 days after the rash starts. Most women are immune due to previous immunization and will not develop rubella. No further action is needed if patients are known to be immune.

19. Eradication of many diseases is currently possible as demonstrated by the conquest of smallpox and polio. Most of these diseases are not technically difficult. The persons who insist that they are have been so informed or brainwashed by higherups who in their turn cannot find the money that is needed for some eradication. If the money does show up, perhaps by magic or the World Bank, it may quietly disappear—anyway. MMR is currently underdosed and undercovered, mainly because of governments too chinzy with their money, except for the Afroasian poor.