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Mumps.ppt
1. 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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2. Vaccine infographic
created by Leon Farrant
Vaccines have been
proven to prevent millions
of illnesses and
thousands of deaths each
year in the United States
>5,000,000 31,036
3. 3
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
4. 4
Mumps Virus
• Paramyxovirus
• Enveloped RNA virus
• One antigenic type
• Rapidly inactivated by UV light, heat, and
various chemical agents
5. 5
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
7. 7
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%
8. 8
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
9. 9
Mumps Epidemiology
• Reservoir Human
• Temporal pattern Peak in late winter and spring
• Communicability Three days before to four
days after onset of active
disease
12. 12
Mumps - United States, 1980-2003
Age Distribution of Reported Cases
13. 13
Mumps Immunity
• Born before 1957
• Documentation of physician- diagnosed
mumps
• Serologic evidence of mumps immunity
• Documentation of adequate vaccination
14. Common Symptoms
• Parotitis: Inflammation of the salivary glands
under the ear
• Fever
• Headache
• Muscle Aches
• Fatigue
• Loss of Appetite
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CDC
15. 15
Classic Swelling of Cheek and
Neck (Parotitis) Seen with Mumps
CDC Public Health Image Library
16. Rare but Serious Complications
• Inflammation of the:
– Testicles
– Pancreas
– Ovaries
– Breast
• Encephalitis or Meningitis
• Deafness
• Male infertility
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CDC
18. 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
19. 19
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)
20. 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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22. Current Status of Outbreak
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* Numbers for most recent week are provisional
N=769
as of
10/26
N=1,270
as of
11/15
23. 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%
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There are 81 more cases under investigation whose vaccine status is not known
24. 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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25. 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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27. Questions / Comments
• Appreciation to those that have been
involved in the outbreak response!
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28. 28
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
Cost-Benefit Analysis of Commonly
Used Vaccines
(Saving per $ invested)
29. 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)
