AKT · Infections/Viral infectionslow yield

Measles, mumps & rubella

Paramyxovirus (measles, mumps) / togavirus (rubella) — vaccine-preventable, NOTIFIABLE

Overview

Three vaccine-preventable, NOTIFIABLE viral exanthems, increasingly seen where MMR uptake has fallen. Measles (prodrome + Koplik spots + descending rash, the most dangerous — pneumonia/encephalitis/SSPE), mumps (parotitis ± orchitis/meningitis), and rubella (mild rash + lymphadenopathy, but devastating CONGENITAL rubella syndrome in early pregnancy). Management is supportive; the priorities are notification, isolation, and protecting susceptible contacts (especially pregnant women). Paediatric detail is on child_health.

Recognise

MEASLES: prodrome (cough, coryza, conjunctivitis, fever) + KOPLIK SPOTS (white buccal spots) then a descending maculopapular rash; complications — otitis media, pneumonia, encephalitis, rare late SSPE
MUMPS: fever + parotid swelling (parotitis); complications — orchitis (post-pubertal, subfertility), aseptic meningitis, pancreatitis, deafness
RUBELLA: mild fever + maculopapular rash + post-auricular/suboccipital lymphadenopathy; CONGENITAL RUBELLA SYNDROME (deafness, cataracts, cardiac defects) if infected in early pregnancy

Red flags

Measles in pregnancy/immunosuppressed, or with encephalitis/pneumonia → severe; rubella exposure in a pregnant woman → urgent (congenital rubella risk)
All three are NOTIFIABLE → inform public health

Differentials & how to tell them apart

Other viral exanthemsparvovirus B19 (slapped cheek), roseola, enterovirus, scarlet fever (bacterial)

Drug rash / Kawasaki diseasecontext/criteria differ

Mumps vs bacterial parotitis / sialolithiasisviral bilateral vs bacterial/obstructive

Koplik spots — white buccal spots pathognomonic of measles
CDC / Public domain — Wikimedia Commons

Investigations

Largely clinical; confirm with serology/oral-fluid or PCR (and for notification); pregnancy testing/rubella-immunity status for exposed women; identify and protect susceptible contacts.

Management

Supportive care + NOTIFY + isolate + protect susceptible contacts; MMR prevents

1Recognise clinically (measles — Koplik spots + descending rash; mumps — parotitis; rubella — rash + post-auricular nodes), confirm for notification, and treat supportively. All three are NOTIFIABLE → inform public health and isolate.Gate: Rubella exposure in a pregnant woman is an emergency (congenital rubella syndrome); measles in pregnancy/immunosuppression is severe — protect susceptible contacts with MMR or immunoglobulin per public-health advice.
2Manage complications (measles pneumonia/encephalitis, mumps orchitis/meningitis); MMR vaccination and catch-up are the key prevention. Full paediatric detail on child_health.

Supportive care + NOTIFY public health + isolate — all three are notifiable; isolation prevents spread; supportive treatment (no specific antiviral)

Protect susceptible contacts — MMR or human normal immunoglobulin for vulnerable contacts (pregnant/immunosuppressed/infants) per public-health advice

Vitamin A for measles (in specific settings) + treat complications — manage pneumonia/encephalitis/orchitis; vitamin A reduces measles morbidity in at-risk children

MMR vaccination (prevention) — the key preventive measure; catch-up for the unvaccinated

Key points

Three NOTIFIABLE vaccine-preventable exanthems: MEASLES (Koplik spots + descending rash; pneumonia/encephalitis/SSPE — the dangerous one), MUMPS (parotitis + orchitis/meningitis), RUBELLA (mild, but CONGENITAL RUBELLA SYNDROME in early pregnancy). Supportive + NOTIFY + isolate + protect contacts (esp. pregnant women). MMR prevents. Rising with falling vaccine uptake.

Monitor & prognosis

Complications, contact tracing/notification, pregnancy outcomes for rubella exposure.

Usually self-limiting; measles complications and congenital rubella are the serious outcomes.

Source: UKHSA / Green Book; cross-ref child_health, O&G (congenital rubella)