September 9, 2016
Update on Mumps Outbreak in Northwest Arkansas
The Arkansas Department of Health has sent you this notification, because you are registered with the Arkansas Health Alert Network. We want to update you regarding an outbreak of mumps in northwest Arkansas. Up-to-date information is also found on the ADH website at http://www.healthy.arkansas.gov/programsServices/infectiousDisease/CommunicableDisease/Pages/Mumps.aspx.
As of this morning, there are 89 cases of mumps in the Springdale area. There have been clusters of cases in schools and the community, and we believe we will see additional cases. Please review the following information and notify the ADH Outbreak Response Section urgently at (501) 537-8969, if you become aware of a possible case.
If your clinic or emergency department is in northwest Arkansas, we ask that you take the following steps to limit the transmission of mumps in your clinic and community.
1. Have a plan for triaging patients with possible mumps that minimizes exposure to other patients visiting your facility.
2. Post a sign at the entrance to your clinic asking patients with symptoms of possible mumps to notify you before they come in. A sign is available on the ADH website at http://www.healthy.arkansas.gov/programsServices/infectiousDisease/CommunicableDisease/Pages/Mumps.aspx.
3. If you provide care to a patient with possible mumps, please complete a Communicable Disease Reporting Form with as much information as you can provide, especially the contact information for the patient, and fax the completed form to (501)661-2428. An up-to-date form is available at http://www.healthy.arkansas.gov/programsServices/epidemiology/Documents/CommunicableDiseaseReportingForm.pdf.
4. Contact the ADH Outbreak Response Section, if you have any questions about testing, reporting, etc. Call ADH Outbreak Response Section at (501) 537-8969 during business hours Monday- Friday 8:00-4:30. After hours please call the ADH Emergency Operations Center at 1-800-554-5738, and they will contact the on-call ADH physician or nurse, who will call you back.
Clinical Signs and Symptoms
Mumps is an acute viral illness that is most often associated with inflammation and swelling the salivary glands, usually the parotid glands, which may be unilateral or bilateral. Parotitis, if present, may last 7-10 days. Patients may also have non-specific symptoms of systemic viral illness, such as myalgia, anorexia, malaise, headache, and low-grade fever.
Orchitis is common complication, which occurs in up to 10 percent of postpubertal males infected with mumps. Less than 1 percent of females will have oophoritis, which may mimic appendicitis. In the post-vaccine era, rates of viral meningitis, pancreatitis, and deafness have all been less than 1 percent. A third of infections may be subclinical. Unvaccinated adults may experience more severe manifestations than children.
Transmission and Incubation
Mumps is transmitted by direct contact with respiratory droplets or saliva from an infected person. Humans are the only known hosts. Asymptomatic persons can transmit the virus, but no chronic carrier state exists. The incubation period is 16 to18 days, but may range from 12 to 25 days. Transmission is most likely to occur several days before and after the onset of parotitis.
Diagnosis
The diagnosis of mumps typically involves both clinical criteria and laboratory testing. Clinical criteria are an illness with acute onset of unilateral or bilateral swelling of the parotid or other salivary gland(s), lasting at least 2 days, and without other apparent cause.
Laboratory testing includes the following:
· Isolation of mumps virus from clinical specimen (buccal swab or CSF).
· Detection of mumps nucleic acid, such as standard or real time RT-PCR assays, collected within 2 days of symptom onset.
· Positive mumps specific IgM antibody.
· Demonstration of specific mumps antibody response in absence of recent vaccination, either a four-fold increase in IgG titer as measured by quantitative assays, or a seroconversion from negative to positive using a standard serologic assay of paired acute and convalescent serum specimens.
Treatment
There is no specific treatment for mumps. Vaccination for mumps after exposure will not prevent mumps or lessen the severity of disease. However, if the exposure did not result in infection, vaccination may prevent future infection and serve to shorten the duration of the outbreak.
Prevention
There is a safe and effective mumps vaccine that is available in combination with measles and rubella vaccine as MMR (Measles, Mumps, and Rubella) vaccine. MMR vaccine is a live virus vaccine and is contraindicated for pregnant women or patients with immunosuppression.
If your clinic gives immunizations, ADH is asking your help in getting all children and adults get up-to-date with their MMR vaccines.
The following groups are recommended by CDC to receive routine immunization with the MMR vaccine:
· Children younger than 6 years of age need one dose of MMR vaccine at age 12 through 15 months, followed by a second dose of MMR vaccine at age 4 through 6 years.
· Children age 7 through 18 years not previously vaccinated need one dose of MMR vaccine, followed by a second dose of MMR vaccine at least 4 weeks after the first dose.
· Adults born in 1957 or later and not previously vaccinated need one dose of MMR vaccine. A second dose of MMR vaccine is needed for some adults, who are at high risk for exposure, such as students in college, people who work in a health care facility, or those who travel internationally. The second dose should be given a minimum of 28 days after the first dose.
· Adults born before 1957 are considered to be immune to mumps and do not need to get the MMR vaccine.
In the setting of this outbreak, ADH has made the following recommendation for young children and adults:
· Children less than 4 to 6 years of age, who attend preschool at schools with mumps cases or live in large households, are considered to be at high risk for exposure to mumps. Therefore, those children older than 12 months of age, who have received their first dose of MMR vaccine, should receive their second dose as soon as possible after the minimum interval of 28 days between doses is met.
· Adults, who live in large households or travel internationally, are at increased risk for exposure to mumps. Therefore, those adults born in 1957 or after, who have received their first dose of MMR vaccine, should receive their second dose as soon as possible after the minimum interval of 28 days between doses is met.
ADH is working closely with the Centers for Disease Control and Prevention to obtain the resources needed to address this outbreak. In addition, CDC personnel have arrived in Arkansas to provide technical assistance. In recent outbreaks in other part of the U.S., a targeted third dose of MMR vaccine was recommended. It is possible that such a recommendation will be implemented in Arkansas.
We will continue to send out updates as the outbreak evolves. We sincerely thank you for all you do to keep everyone in Arkansas well.
Dirk Haselow, MD, PhD
Dirk Haselow, MD, PhD
State Epidemiologist and Outbreak Response Medical Director