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Mumps and measles


Measles

Measles is a highly infectious disease caused by a virus.

The virus lives in the mucus of the nose and throat of people with this infection. Physical contact, coughing and sneezing can spread the infection. In addition, infected droplets of mucus can remain active and contagious for around two hours. This means that the virus can live outside the body, for example, on surfaces and door handles.

What are the symptoms of measles

Once you are infected with the virus, it multiples in the back of your throat and in your lungs. It then spreads throughout your body. The following are the most common symptoms of measles

  1. A high temperature, sore eyes (conjunctivitis), and a runny nose usually occur first.
  2. Small white spots usually develop inside the mouth a day or so later.
  3. A harsh dry cough is usual.
  4. Going off food, tiredness, and aches and pains are usual.
  5. Diarrhoea and/or vomiting is common.
  6. A red blotchy rash normally develops about 3-4 days after the first symptoms. It usually starts on the head and neck, and spreads down the body. It takes 2-3 days to cover most of the body. The rash often turns a brownish colour and gradually fades over a few days. For websites that give pictures of rashes see Patient.co.uk
  7. You can be quite unwell and miserable for 3-5 days. After this the fever tends to ease, and then the rash fades. The other symptoms gradually ease and go

Most people are better within 7-10 days. An irritating cough may persist for several days after other symptoms have gone. The immune system makes antibodies during the infection. These fight off the virus and then provide lifelong immunity. It is therefore rare to have more than one bout of measles.

How is measles diagnosed?

Your doctor will usually be able to diagnose measles from the combination of your symptoms, especially the characteristic rash and the small spots inside your mouth. However, a simple blood or saliva test may be taken which can confirm the diagnosis.

What are the possible complications of measles?

Complications are more likely in those with a poor immune system (such as those with leukaemia or AIDS), those who are malnourished, and children under five years and adults. Many malnourished children in the world die when they get measles, usually from a 'secondary' pneumonia. There are still the occasional reports of children in the UK who die from complications of measles. These children have usually not been immunised.

More common complications include:

  1. Conjunctivitis (eye infection)
  2. Laryngitis (inflammation of the voicebox)
  3. Ear infection causing earache
  4. Infections of the airways, such as bronchitis and croup, which can be common.

Although these are distressing, they are not usually serious.

Less common complications of measles are listed below:

  1. A febrile convulsion (fit) occurs in about 1 in 200 cases. This can be alarming, but full recovery is usual.
  2. Brain inflammation (encephalitis) is a rare but very serious complication. It occurs in about 1 in 5,000 cases. It typically causes drowsiness, headache and vomiting which starts about 7-10 days after the onset of the rash. Encephalitis may cause brain damage. Some children die from this complication.
  3. Hepatitis (liver infection).
  4. Pneumonia (lung infection) is a serious complication that sometimes develops. Typical symptoms include fast or difficult breathing, chest pains, and generally becoming more ill.
  5. Squint is more common in children who have had measles. The virus may affect the nerve or muscles to the eye.

A very rare brain disease called subacute sclerosing panencephalitis (SSPE) can develop years later in a very small number of people who have had measles. This can sometimes occur several years after getting measles. This condition can be fatal.

What are the treatments for measles?

There is no specific medicine that kills the measles virus. Treatment aims to e ase symptoms until the body's immune system clears the infection. For most cases, rest and simple measures to reduce a fever are all that are needed for a full recovery. Symptoms will usually disappear within 7-10 days.

The following measures are often useful:

  1. Children should drink as much as possible to prevent dehydration. Ice lollies are a useful way of giving extra fluid and keeping cool.
  2. Paracetamol or ibuprofen can be taken to ease fever and aches and pains. You should keep the child cool (but not cold).
  3. Cough remedies have little benefit on any coughs.
  4. Antibiotics do not kill the measles virus and so are not normally given. They may be prescribed if a complication develops, such as a ear infection or pneumonia. Antibiotics kill bacteria and then help in these complications.

When to see a doctor?

A doctor will normally confirm that the illness is measles. However, you should see a doctor again if symptoms get worse, or if you suspect a complication (see above).

The main serious symptoms to look out for are:

  1. Drowsiness.
  2. Dehydration. This may be developing if the child drinks little, passes little urine, has a dry mouth and tongue or becomes drowsy.
  3. Breathing difficulties.
  4. Convulsion (fit).

Is measles infectious?

Yes, it is very infectious. It is passed on by coughing and sneezing the virus into the air. It takes 10-14 days to develop symptoms after being infected. (This is the incubation period.) You are infectious from a day before symptoms begin until about five days after the rash first appears. Therefore, people with measles should not mix with others and should stay off university. Anyone who has not had measles before can be infected. However, cases of re-infection after having had the virus are extremely rare because the body will have built up immunity to the virus.

Measles immunisation

Immunisation is routine in the UK as part of the Measles, Mumps and Rubella ( MMR) vaccine. Two doses are usual - the first for children aged about 13 months and the second about three years later. Immunisation gives excellent protection and so measles is now rare in the UK. However, unfortunately, measles is becoming more common again in children in some areas of the UK. This is due to some children not receiving the MMR vaccine.

Mumps


What is Mumps?

Mumps is an infection caused by a type of virus called a paramyxovirus. It is very contagious and spread in saliva, the same way as a cold or flu. This means it can be caught from an infected person coughing, sneezing, etc. Or, from touching infected objects, for example, door handles. Mumps infection is less common since the introduction of the measles, mumps and rubella (MMR) vaccine in the UK. (See separate leaflet called 'MMR Immunisation' for more information.) Mumps infection is now most common in children who have not received the vaccine.

What are the usual symptoms of mumps?

  1. Swelling and pain of one or both parotid glands are the usual main symptoms. The parotid glands are the main salivary glands. They are just below the ears and you cannot normally see or feel them. The salivary glands make saliva which drains into the mouth.
  2. The mouth may feel dry.
  3. Chewing or swallowing may feel sore.
  4. Fever (high temperature), headache, feeling tired and being off food may develop for a few days.
  5. Mild abdominal (tummy) pain may occur.

The swelling of the parotid glands usually lasts 4-8 days. Mumps is normally a mild illness, but complications sometimes occur. This is why immunisation is important.

There may be no symptoms, or only very minor ones. It is thought that about 3 in 10 people who contract the mumps virus have no symptoms. Rarely, complications alone occur without the usual symptoms occurring first. The immune system makes antibodies during the infection. These clear the virus and then provide lifelong immunity. It is therefore very rare to have more than one episode of mumps.

What are the possible complications of mumps?

The outlook for young children with mumps is very good. Teenagers and adults with mumps are more likely to develop complications, which may include one (or more) of the following:

  1. The testes (testicles) are sometimes affected. One testis may become inflamed, swollen, and painful for about a week. This is uncommon in young children. However, about 1 in 4 males who get mumps over the age of 12 develops a painful swollen testis. Occasionally, both testes are affected. In very rare cases this may cause infertility.
  2. Brain inflammation (encephalitis or meningitis) is an uncommon complication. It typically causes drowsiness, headache, stiff neck, wanting to keep out of the light, and vomiting. Although alarming, meningitis caused by the mumps virus usually clears after a few days without any long-term problems.
  3. Hearing loss can occur in around one in twenty people with mumps. This is usually only transient and usually improves with time. Very rarely, mumps can cause permanent deafness.
  4. Inflammation of the pancreas, heart, and other organs are rare complications.
  5. If you develop mumps in the first 12-16 weeks of a pregnancy, it may increase the risk of miscarriage. (However, the mumps virus is not thought to cause malformations or defects in an unborn baby.)

How is mumps diagnosed?

Mumps is most commonly diagnosed by your symptoms and the type of glands that are enlarged in your body. However, some people have a swab taken from their mouth to obtain some saliva. This is sent to the laboratory to confirm the diagnosis.

What is the treatment for mumps?

There is no drug that kills the mumps virus. TFor most people, mumps improves over a week with no long-term problems.

Treatment aims to ease symptoms until the body's immune system clears the virus.

  1. You do not need any treatment if symptoms are mild
  2. Paracetamol or ibuprofen can be beneficial to ease fever and pain.
  3. Give children lots to drink, particularly if they have a fever. Fruit juice may stimulate the parotid gland to make more saliva, and cause more pain. Water is best if this occurs.
  4. A warm flannel held against a painful parotid gland is soothing.

When to seek medical help?

Most children are back to normal within 7-10 days. Seek medical help if you suspect that a complication is developing (described above).

Should people with mumps keep away from others?

Yes. Mumps is very infectious. It takes 14-21 days to develop symptoms after being infected. Affected people are infectious from about six days before, until about five days after, a parotid gland begins to swell. Children immunised against mumps are unlikely to catch mumps. However, immunisation is not 100% effective. Also, some adults may not be immune and some children may have a poor immune system. So, people with mumps should stay off school, nursery, college or work and avoid other people as much as possible. This is as soon as mumps is suspected and for five days from the onset of parotid gland swelling.

Mumps immunisation

An effective vaccine to prevent mumps is available. It is part of the MMR vaccine. This is routinely offered to all children aged 12-15 months in the UK. A second dose is offered as part of the routine pre-school booster programme at four years of age. A previous history of having mumps does not mean that you do not need MMR vaccine. This is because the diagnosis of mumps is not an easy one to make. For example, someone thought to have had mumps may in fact have had another viral infection. Also, it does not do any harm if you have had mumps in the past and then have the MMR vaccine.

Immunisation gives very good protection, and so mumps is now rare in the UK. However, in recent years there has been an increase in the number of cases of mumps, usually seen in children who have not been immunised with MMR.

For further information visit: mmrthefacts.nhs.uk