Update on Mumps and Current Status of Outbreak

Update on Mumps and Current Status of Outbreak in NW Arkansas Cat Waters, BSN Outbreak Response Section Chief Arkansas Department of Health 1

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 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 3

Mumps Virus • Paramyxovirus • Enveloped RNA virus • One antigenic type • Rapidly inactivated by UV light, heat, and various chemical agents 4

Mumps Laboratory Diagnosis • Isolation of mumps virus • Detection of RNA via PCR • Serologic testing – positive Ig. M antibody – significant increase in Ig. G antibody between acute and convalescent specimens 5

Mumps virus 6

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 2 o attack rate of 31% 7

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 8

Mumps Epidemiology • Reservoir Human • Temporal pattern Peak in late winter and spring • Communicability Three days before to four days after onset of active disease 9

Mumps – United States, 1968 - 2005* *2005 provisional data 10

Mumps – United States, 1980 -2011 11

Mumps - United States, 1980 -2003 Age Distribution of Reported Cases 12

Mumps Immunity • Born before 1957 • Documentation of physician- diagnosed mumps • Serologic evidence of mumps immunity • Documentation of adequate vaccination 13

Common Symptoms • Parotitis: Inflammation of the salivary glands under the ear • Fever • Headache • Muscle Aches • Fatigue • Loss of Appetite CDC 14

Classic Swelling of Cheek and Neck (Parotitis) Seen with Mumps CDC Public Health Image Library 15

Rare but Serious Complications • Inflammation of the: – – Testicles Pancreas Ovaries Breast • Encephalitis or Meningitis • Deafness • Male infertility CDC 16

Mumps Complications CNS involvement 15% of clinical cases Orchitis 20%-50% in postpubertal males Pancreatitis 2%-5% Deafness 1/20, 000 Death 1 -3/10, 000 17

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 1 st dose at 12 -15 months, 2 nd after age 4 and for adults at higher risk • Administered with measles and rubella (MMR) • Developed from the Jeryl Lynn strain (genotype B) 19

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) 20

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Current Status of Outbreak N=769 N=1, 270 as asofof 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 N/A 59. 1% 95. 0% 41. 2% 78. 7% % Up-to-date There are 81 more cases under investigation whose vaccine status is not known 23

Benefits of 2 nd (or 3 rd) MMR shot • 9 fold lower risk of illness • Milder disease if you do get mumps • Much less likely to transmit to others 24

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 25

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Questions / Comments • Appreciation to those that have been involved in the outbreak response! 27

Cost-Benefit Analysis of Commonly Used Vaccines (Saving per $ invested) Vaccine • DTa. P • MMR • Hib • Polio vaccine • Varicella • Hepatitis B Medical Dollars Saved 8. 50 10. 30 1. 40 3. 03 0. 90 2. 30 Societal* Dollars Saved 24. 00 13. 50 2. 00 6. 10 5. 40 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)