Mumps Update

Paul W. Baumert, Jr., M.D., FAAFP

Sports Medicine Rounds

June 1, 2006

MUMPS

Origin of the word is obscure but may be related to the old English verb, which means "grimace, grin, or mumble."

 

 

 

 

Activity Timeline

December 2005-mumps-like illness reported at a university in eastern Iowa, 2 students tested positive for mumps.

January 2006-Sample from unrelated patient virus culture positive for mumps

February 2006-Active surveillance initiated in seven geographical areas across the state including the three largest universities in the state. Increased communication with HCP and LPH, weekly mumps updates, education to colleges, ongoing consultation with CDC. Low level activity.

Activity Timeline

March 2006-Communication to HCP and LPH. Bi-weekly conference calls with counties with cases of mumps then expanded to all counties. Communication with neighboring states. Developed and disseminated HCW fact sheets & exposure/immunity assessment tools, school letters, MMWR released to CDC for nationwide distribution.

Activity timeline

April 2006-

Expanded educational materials on website

Established a mumps call center (received over 250 calls in 3 days)

Implemented emergency incident command management structure within IDPH

Epi-aid staff from CDC in assistance

Daily briefings

Weekly updates by IDPH command, control and operations staff

Cross training of staff to assist in response

Media

Case definition

Clinical case definition: an illness with acute onset of unilateral or bilateral tender, self-limited swelling of the parotid or other salivary gland, lasting greater than 2 days, without other apparent cause.

Probable: meets case definition but is not lab confirmed or epidemiologically linked to a confirmed or probable case.

Confirmed: a case that is lab confirmed, or a case that meets the case definition and is epi-linked to a confirmed or probable, or virus isolation positive.

Disease & Epidemiology

Etiologic Agent: mumps virus, genus Paramyxovirus

Clinical Description: parotitis (swelling of salivary glands), fever, HA, malaise, & anorexia. 40-50% have respiratory symptoms

Complications: CNS involvement (encephalitis), orchitis, pancreatitis, deafness & death. An increase in fetal death has been observed among women who develop mumps during the first trimester of pregnancy.

Swelling of the salivary glands can also be caused by infection with cytomegalovirus, parainfluenza Coxsackie A.

Laboratory Confirmation helps ensure that only true cases are reported

Laboratory tests should be conducted on anyone with symptoms compatible with mumps

All specimens described below should be obtained

Viral culture for mumps from saliva

Viral culture for mumps urine

Serology IgM, IgG

Mumps should not be ruled out in someone who is vaccinated if he/she has clinically consistent symptoms

Transmission: droplet spread or direct contact with nasopharygeal secretions of an infected person. Contagiousness is similar to influenza & rubella, less than measles or varicella.

Incubation Period: 16-18 days, with a range of 14-25 days.

Period of Communicability: from 3 days prior to onset of symptoms to 4 days after (count day of swelling as day zero).

 

Vaccine

1968 mumps vaccine introduced

1971 Jeryl Lynn strain MMR

1977 vaccine in routine use

1988 2nd dose recommended

1991-1992 school year 2nd dose Iowa law

All children K-12 should have received 2 doses of MMR

A cohort of children born between 1967-1977 grew up when the chance of exposure to wild mumps virus for a pre-school age child was markedly declining while the opportunity to receive mumps vaccine was uncertain.

 

 

Vaccine Efficacy

A single dose of mumps vaccine is 95% effective in preventing disease.

The mumps component of MMR is the least efficacious antigen in the combination vaccine.

Outbreak studies have found the vaccine to be lower than original efficacy trials (78-91%) many variables

Mumps Vaccine (MMR) in an outbreak

Mumps vaccine administered after exposure to mumps does not provide clinical protection or alter the severity of disease.

However evidence suggests that mass vaccination during a mumps outbreak may help terminate the outbreak.

Can you get Mumps more than once?

Strain-specific differences in neutralizing activity have been identified & although antigenic differences are minor reinfections have been reported.

Reinfections may be common, usually resulting in asymptomatic rises in antibody but occasionally accompanied by mild illness.

Controlling further Spread

Case patient should self isolate to home for 5 days or until symptoms improve whichever is longer

Opportunity to vaccinate susceptibles in the "identified Community"

HCW guidelines are more stringent

Education on signs & symptoms of disease and personal hygiene

 

 

 

 

 

Outbreak Details

Strain is the same that caused an outbreak in UK (2004-2005) resulting in 56,000 cases

Immunization rates are much lower than U.S.

Not an unusual strain

Strain is covered by the vaccine

Working with CDC

Future

Will likely continue for several months to a year

May move to initiate additional disease prevention measures

CDC will study vaccine coverage and possibly efficacy

IDPH will closely monitor trends, data, and adjust control measures accordingly

Resources

Mumps Call Center (LPH, HCP)

1-866-239-4057

Disease Prevention & Immunization

1-800-831-6292

Center for Acute Disease Emergency response 1-800-362-2736

IDPH Homepage link to mumps information

Questions?