Update on Mumps and Current

Status of Outbreak in NW Arkansas

Cat Waters, BSN

Outbreak Response Section Chief

Arkansas Department of Health

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 Vaccines have been
proven to prevent millions
of illnesses and
thousands of deaths each
year in the United States

Vaccine infographic
created by Leon Farrant

>5,000,000 31,036
 Mumps
• Major cause of outbreaks in pre-vaccine era

• Vaccination has reduced mumps by 99% in the US

• Recently, a few outbreaks have centered around

colleges and schools
– Particularly in dormitory settings and dense housing
– Also in the National Hockey League

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 Mumps Virus
• Paramyxovirus

• Enveloped RNA virus

• One antigenic type

• Rapidly inactivated by UV light, heat, and

various chemical agents

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Mumps Laboratory Diagnosis

• Isolation of mumps virus

• Detection of RNA via PCR

• Serologic testing
– positive IgM antibody
– significant increase in IgG antibody between acute
and convalescent specimens

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Mumps virus

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 Mumps Pathogenesis
• Respiratory transmission of virus
– (droplet nuclei)
– Subclinical infections may transmit

• Replication in nasopharynx and regional lymph nodes

• Viremia 12-25 days after exposure with spread to tissues

• Infective dose – medium. Typical 2o attack rate of 31%

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 Mumps Clinical Features
• Incubation period 14-18 days

• Nonspecific prodrome of low-grade fever,

headache, malaise, myalgias

• Parotitis in 30%-40%

• Up to 20% of infections asymptomatic

• May present as lower respiratory illness,

particularly in preschool-aged children
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 Mumps Epidemiology
• Reservoir Human

• Temporal pattern Peak in late winter and spring

• Communicability Three days before to four

days after onset of active
disease

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Mumps – United States, 1968- 2005*

*2005 provisional data

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Mumps – United States, 1980-2011

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Mumps - United States, 1980-2003
Age Distribution of Reported Cases

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 Mumps Immunity

• Born before 1957

• Documentation of physician- diagnosed
mumps
• Serologic evidence of mumps immunity
• Documentation of adequate vaccination

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 Common Symptoms

• Parotitis: Inflammation of the salivary glands

under the ear
• Fever
• Headache
• Muscle Aches
• Fatigue
• Loss of Appetite

CDC
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 Classic Swelling of Cheek and
Neck (Parotitis) Seen with Mumps

CDC Public Health Image Library

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 Rare but Serious Complications

• Inflammation of the:
– Testicles
– Pancreas
– Ovaries
– Breast
• Encephalitis or Meningitis
• Deafness
• Male infertility

CDC
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 Mumps Complications
CNS involvement 15% of clinical cases

Orchitis 20%-50% in post-

pubertal males

Pancreatitis 2%-5%

Deafness 1/20,000
Death 1-3/10,000
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 Epidemiological Characteristics
• Persistence in Environment:
– Readily inactivated by UV light, formalin, heat, acid

• High risk groups:

– Post pubertal males – orchitis, atrophy, cancer?
– Persons with diabetes

• Epidemic Potential:
– High – epidemic parotitis

• Challenges
– Imported cases
– immunity may not be lifelong
 Mumps Vaccine
• Effectiveness 88% after two doses

• Duration of
Immunity Generally lifelong

• Schedule 1st dose at 12-15 months, 2nd after age 4

and for adults at higher risk

• Administered with measles and rubella (MMR)

• Developed from the Jeryl Lynn strain (genotype B)

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 Vaccine Side Effects
• Brief achy joints (up to 25% of women)
– Uncommon in children
• Uncommon symptoms (less than 1%)
– Fever
– Rash
– Itching
• Extremely rare events (less than 1/100,000)
– Brief orchitis
– Mild parotitis
• Encephalitis (~1 in 800,000 doses)
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 Current Status of Outbreak

N=769
N=1,270
as of
as of
10/26
11/15
* Numbers for most recent week are provisional 22
 Vaccination Status Among Those
Who Have Been Investigated
Age Groups
Vaccination
Status of Cases
<1 1-4 5 - 17 18+ Total

0 MMR 3 18 25 191 237

1 MMR 0 18 16 36 70

2+ MMR 0 8 775 98 881

Total 3 44 816 325 1188

Total Up-to-date 0 26 775 134 935

% Up-to-date N/A 59.1% 95.0% 41.2% 78.7%

There are 81 more cases under investigation whose vaccine status is not known 23
 Benefits of 2nd (or 3rd) MMR shot

• 9 fold lower risk of illness

• Milder disease if you do get mumps

• Much less likely to transmit to others

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 What is ADH Doing?
• Using the best evidence to control the
outbreak
• Interviewing all suspect cases and contacts
• Excluding under-vaccinated kids from school
• Performing vaccination clinics (65 complete,
4 others scheduled)
– 4,622 vaccines provided to date
• Providing advice to doctors and schools
• Communicating to many audiences
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 Questions / Comments

• Appreciation to those that have been

involved in the outbreak response!

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 Cost-Benefit Analysis of Commonly
Used Vaccines
(Saving per $ invested)
Medical Societal*
Dollars Dollars
Vaccine Saved Saved
•DTaP 8.50 24.00
•MMR 10.30 13.50
•Hib 1.40 2.00
•Polio vaccine 3.03 6.10
•Varicella 0.90 5.40
•Hepatitis B 2.30 19.80

*Includes work loss, disability and death

•Source: CDC, ASTHO 28
 Adult Immunization
Recommendations from ACIP
• Generally recommended for all adults
– Influenza (every year)
– Tdap (once as adult then Td booster every ten years
– Chickenpox (AKA varicella)
• Need physician diagnosed illness, immunity, or 2 doses
– HPV (up to 26 years old, 3 doses)
– Shingles (AKA zoster) (once ≥ 60 years old)
– MMR (up to 59 years old)
• Immunity or 2 doses after 1967, unless born prior to 1957
– Pneumococcal vaccine (two different vaccines ≥ 65 years old)

• Recommended for certain subgroups (see CDC website for detail)

– Hepatitis A (2 doses)
– Hepatitis B (3 doses)
– Pneumococcal vaccine (below age 65)
– Meningococcal vaccine (2 doses)