Update

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Mumps Outbreak in Iowa 2006

• 1,487 cases reported (1,094 additional cases in
  CO, IL, KS, MO, MN, NE, PA, SD, WI, MS)
• 287 of these are mumps infections
• Some hospitalizations for mumps complications
• Median age 22 years (range lt1-85 yrs)
• 25 of cases among college students
• 54 of reported cases received 2 doses of MMR
• Source unknown but virus similar to that
  responsible for a 2005 outbreak in the United
  Kingdom (G genotype)

As of May 2nd, 2006. Iowa Dept of Public
Health. Updates available at www.idph.state.ia.us
/adper/mumps.asp
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• Mumps Outbreak United States 2006

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27
176
1047
22
201
224
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77
371
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Mumps Among Vaccinated Persons

• Protection after 1 dose 80
• Protection after 2 doses 90 (i.e., 10 are not
  protected)
• On a college campus with 10,000 students, all
  with 2 doses of MMR, there will be 1,000
  susceptible students (10 of students)
• In a mumps outbreak on this campus 100 of cases
  will have a history of 2 doses of MMR

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Mumps

• Incubation period 16-18 days (range 12-25 days)
• Infectious 3 days before to 9 days after onset of
  symptoms
• Clinical presentation (pre-vaccine era)
• 50 have parotitis (unilateral or bilateral)
• 30 have only nonspecific respiratory/influenza-li
  ke symptoms
• 20 asymptomatic

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• Mumps United States, 1968- 2005

2005 provisional data
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U.S. Mumps Cases

• 2005 265 cases (provisional)
• 2004 258 cases
• 2002 270 cases
• 1996 751 cases
• 1993 1,692 cases
• 2010 Health Objective is to eliminate indigenous
  mumps by 2010

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• Mumps United States
• 1980- May 2006

2-dose schedule
2005 provisional data
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• Mumps - United States, 1980-2005
• Age Distribution of Reported Cases

2-dose schedule
5-14 yrs
15-39 yrs
lt5 yrs
gt40 yrs
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History of Mumps Vaccines in US
1967 Licensed live, attenuated mumps
vaccine 1971 Licensure of combined measles-
mumps-rubella vaccine (MMR1) 1977 Routine
childhood recommendation 1989 Two-dose MMR
schedule
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Mumps Vaccine

• Composition Live virus (Jeryl Lynn strain)
• Efficacy
• (clinical trials) 95 (Range, 90 - 97)
• Effectiveness 1 dose 70-90
• 2 doses 90 (limited data)
• Duration ofImmunity Lifelong
• Schedule 2 Doses (as MMR)
• Should be administered with measles and rubella
  (MMR)

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Mumps Vaccine (MMR) Indications

• All infants gt12 months of age
• Susceptible adolescents and adults without
  documented evidence of immunity

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Second Dose Recommendations

• First dose of MMR at 12-15 months
• Second dose of MMR at 4-6 years
• Second dose may be given any time gt4 weeks after
  the first dose

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Mumps Outbreak RecommendationsMumps Prevention

• Implement existing vaccine policy
  recommendations
• 1 dose as close to 12 months as possible
• 2 doses
• school children
• post high school educational facilities
• health care workers
• 1 dose to other adults

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Mumps Outbreak RecommendationsMumps Control

• Active implementation existing vaccine policy
  recommendations
• 1 dose as close to 12 months as possible
• 2 doses
• school children
• post high school educational facilities
• health care workers (birth before 1957 only
  presumptive evidence immunity)
• 1 dose to other adults (birth before 1957 only
  presumptive evidence immunity)
• Other as indicated by outbreak epidemiology
• 2nd dose to 1-4 year old children
• 2 doses for other adults

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Prevention of Mumps Transmission in Healthcare
Settings

• Assessment of evidence of immunity of healthcare
  workers
• Vaccination (2 doses MMR) of those who do not
  have evidence of immunity
• Exclusion of healthcare workers with mumps
  illness as well as non-immune healthcare workers
  exposed to confirmed or suspected mumps patients
• Isolation of patients in whom mumps is suspected

CDC recommendations will be posted on web today
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Mumps Immunity

• Usual (no outbreak) conditions
• Documented physician-diagnosed mumps
• Birth before 1957
• Positive mumps IgG
• At least 1 dose of MMR
• Outbreak conditions
• Documented physician-diagnosed mumps
• Positive mumps IgG
• Two doses of MMR vaccine

NCIRD draft recommendations
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Healthcare Worker Exclusion

• Healthcare workers with mumps illness should be
  excluded until 9 days after the onset of
  parotitis
• A diagnosis of mumps should be considered in
  non-immune healthcare workers who develop
  non-specific respiratory infection symptoms
  during the incubation period after exposure to
  mumps, even in the absence of parotitis

NCIRD draft recommendations
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Healthcare Worker Exclusion

• Non-immune personnel should be excluded from duty
  from the 12th day after the first exposure to
  mumps through the 26th day after the last exposure

NCIRD draft recommendations
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Mumps Outbreak - 2006

• CDC Website http//www.cdc.gov/nip/diseases/mumps
  /default.htm
• Information for the public
• Information for public health staff and health
  care providers
• Reporting, case definitions and classifications,
  forms
• Laboratory
• Clinical
• Health care workers and infection control
• MMWRs, scientific documents
• Q and As