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Mumps Outbreaks in Several US Cities -- A Cause for Alarm?

MAR 01, 2016 | SARAH ANWAR
Updated: 3/30/2016 at 1:43 PM EST

Recent outbreaks of mumps in 14 US cities have prompted health alerts from local officials.
 
On February 26, 2016, the St. Anselm College in Goffstown, NH confirmed two cases of mumps and three suspected cases, from members of the college’s men’s hockey team. All of the infected students are confirmed to have received at least one vaccination for the disease. When asked about the status of the remaining three cases, Dr. Benjamin Chan, MD, MPH, State Epidemiologist of New Hampshire explained to Contagion® that once an individual who had prior contact with an infected patient starts to show symptoms, they are considered to be infected as well.
 
Commenting on behalf of the New Hampshire Department of Health (NHDH), Dr. Chan said that “the initial source of the mumps has not been identified, however, there have been no reported cases outside of the hockey team.” Dr. Chan confirmed that the NHDH has been working with the college to stop the spread of the disease by trying to identify individuals who had been close to the infected patients and following up with them about the school’s required vaccinations.
 
The main concern surrounding this outbreak is that the infection has occurred right before St. Anselm’s spring break, which is alarming since students’ travel plans may aid in the spread of infection.
 
A recent resurgence in mumps cases has been seen at several US universities: 
  1. University of Louisville - Kentucky (1 case)
  2. University of Kentucky - Kentucky (3 cases)
  3. St. Anselm College - New Hampshire (2 cases)
  4. Belgrade Schools - Montana (3 Cases)
  5. Harvard University - Massachusetts (16 cases)
  6. Iowa State University - Iowa (9 cases)
  7. Indiana University - Indiana (5 cases)
  8. Butler University - Indiana (21 cases)
  9. Lowes Corp HQ - North Carolina (2 cases)
  10. Colorado Department of Health - Colorado (6 cases)
  11. University of Southern Maine - Maine (1 case)
  12. University of North Carolina at Charlotte - North Carolina (1 case)
  13. University of Massachusetts (Boston) - Massachusetts (1 case)
  14. University of San Diego - California (5 cases)
  15. Boston University - Massachusetts (3 cases)*
  16. Indiana University (Purdue University) - Indiana (3 cases)*
  17. Tufts University - Massachusetts (5 cases)*
*most recent cases

Previously, on February 23, 2016, the Colorado Department of Public Health and Environment sent out a health alert of an outbreak of 6 cases of mumps in adults. Investigators believe that the source of the recent infections is an individual who moved from Iowa (which has had an ongoing outbreak since July 2015) to Colorado.
 
The individual is said to have experienced “fever and bilateral swelling under his ears that extended under his mandibles” in early January. As a result of the diagnoses, a group of the individual’s friends who all experienced parotitis, were tested at the Denver Health Adult Urgent Care Clinic on February 2. Two of the individuals tested PCR positive, with one testing IgM negative, indicating that the patient is not experiencing a recent infection, and one IgM positive, indicating a recent infection. The third individual was not tested. Three of the group’s health staff at the clinic, who had previously been vaccinated, also started experiencing mumps symptoms. Other personnel who may have been exposed to the virus are being contacted.
 
As defined by the Centers of Disease Control and Prevention (CDC), mumps is caused by a paramyxovirus infection, which leads to extreme swelling of one or both parotid salivary glands (25% of patients only experience swelling on one side of the face), usually after 1-3 days of initial infection and lasts for about a week. The swelling may cause the jawbone to not be visible. It is spread through direct contact with saliva, and nasal and throat discharges, which can occur during talking, coughing, or sneezing. Mumps can also be spread through contaminated surfaces, as well as by the sharing of cups or utensils.
 
The CDC lists the main symptoms of mumps infection as:
  • Fever for 3-4 days
  • Muscle pain
  • Malaise
  • Parotitis for 2-10 days
  • Loss of appetite
  • Headache
While some may only experience respiratory symptoms, others are asymptomatic.
 
According to the CDC, the disease is contagious and may spread before the individual experiences swelling (usually 16-18 days after initial contact with the virus) and up to five days after symptoms.
 
Vaccination is recommended for children starting at 1 year of age, with a second dose at 4 to 6 years of age, however, individuals of any age who are uncertain about whether or not they received the vaccination [usually administered as a MMR (measles, mumps, rubella) combination], should get vaccinated.
 
“Unfortunately, as with these cases, two doses of mumps vaccinations are only 88% effective.” said Dr. Chan. Prior diagnosis of mumps renders individuals immune to the disease.
 
Dr. Chan noted that everyone has a role to keep in terms of infection outbreak: the college, the students and staff, and the Department of Health. In order to stop the spread of infections, individuals who feel sick or show symptoms should notify their healthcare provider immediately. Infected individuals are urged to stay home until properly treated (which may take up to two weeks). Dr. Chan encourages healthcare providers to remind individuals to always cover their mouths while sneezing or coughing, and frequently wash their hands prior to contact with others.
 
The CDPHE recommends that all suspected mumps cases be reported to a local health agency immediately. In hospital settings, patients with suspected mumps should be placed in respiratory isolation, while in clinical settings, patients should be in private rooms and provided surgical masks. Only those with immunity should be allowed to care for or treat diagnosed patients.
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