Mumps.ppt

mumps in usa

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

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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 2
o
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

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

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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

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

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

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Mumps Vaccine
•Effectiveness88% 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)

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 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
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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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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)