Health Communication Priorities for Recent Rise in Mumps Outbreaks

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Mumps

Author: Dr. Robert C. Chandler

Mumps is a highly contagious disease caused by a virus. It typically starts with a few days of fever, headache, muscle aches, tiredness and loss of appetite, followed by swollen salivary glands. Mumps is best known for the puffy cheeks and swollen jaw that it causes. This is a result of swollen salivary glands. Mumps spreads through saliva or mucus from the mouth, nose or throat. An infected person can spread the virus by coughing, sneezing or talking, sharing items, such as cups or eating utensils, with others, and touching objects or surfaces with unwashed hands that are then touched by others.

Contagiousness is similar to that of influenza and rubella, but is less than that for measles or varicella. Although mumps virus has been isolated from seven days before, through 11–14 days after parotitis onset, the highest percentage of positive isolations and the highest virus loads occur closest to parotitis onset and decrease rapidly thereafter. Mumps is therefore most infectious in the several days before and after parotitis onset. Most transmission likely occurs several days before and after parotitis onset. Transmission also likely occurs from persons with asymptomatic infections and from persons with prodromal symptoms.

History of the Disease

Mumps is an acute viral illness. Parotitis and orchitis were described by Hippocrates in the 5th century BCE. In 1934, Johnson and Goodpasture showed that mumps could be transmitted from infected patients to rhesus monkeys and demonstrated that mumps was caused by a filterable agent present in saliva. This agent was later shown to be a virus. Mumps was a frequent cause of outbreaks among military personnel in the pre-vaccine era, and was one of the most common causes of aseptic meningitis and sensorineural deafness in childhood. During World War I, only influenza and gonorrhea were more common causes of hospitalization among soldiers. Mumps virus was isolated in 1945, and an inactivated vaccine was developed in 1948. This vaccine produced only short-lasting immunity, and its use was discontinued in the mid-1970s. The currently used Jeryl Lynn strain of live attenuated mumps virus vaccine was licensed in December 1967. The vaccine was first recommended for routine use in the United States in 1977.

This figure provides the number of mumps cases in the United States from 1968 through 2011 – CDC

In 2006, a multi-state mumps outbreak in the American Midwest resulted in more than 6,000 reported cases. During 2009-2010, two large outbreaks occurred: one among Orthodox Jewish communities in the Northeast with 3,502 reported cases and the other on the U.S. Territory of Guam with 505 mumps cases reported.

Symptoms of Mumps

Mumps likely spreads before the salivary glands begin to swell and up to five days after the swelling begins. The most common symptoms include:

• Fever
• Headache
• Muscle aches
• Tiredness
• Loss of appetite
• Swollen and tender salivary glands under the ears on one or both sides (parotitis)

Symptoms typically appear 16-18 days after infection, but this period can range from 12-25 days after infection. Mumps occurs in the United States, and the MMR (measles-mumps-rubella) vaccine is the best way to prevent the disease.

Mumps can occasionally cause complications, especially in adults.

Complications include:

• inflammation of the testicles (orchitis) in males who have reached puberty; rarely does this lead to fertility problems
• inflammation of the brain (encephalitis)
• inflammation of the tissue covering the brain and spinal cord (meningitis)
• inflammation of the ovaries (oophoritis) and/or breast tissue (mastitis)
• deafness

Recent New Mumps Outbreaks

As the Wall Street Journal reported, 2016 was the worst year for mumps outbreaks in a decade. Despite widespread vaccination requirements, college campuses are bearing the brunt of the attack as students live in close quarters and don’t always maintain the healthiest lifestyles.

Korin Miller writing in an article in SELF (Mumps Cases Are The Highest They’ve Been In 10 Years) reports that according to government data, the U.S. is experienced more mumps cases in 2016 than the country has seen annually in a decade. The Centers for Disease Control and Prevention reports that, as of November 5, 2016, the U.S. has seen 2,879 cases of mumps in 45 states and Washington, D.C., this year. By comparison, there were a little over 1,000 cases reported in 2015.

According to Miller, mumps used to cause up to 186,000 cases a year, but the measles, mumps, and rubella vaccine—better known as the MMR vaccine— has brought numbers down, the CDC says. The CDC recommends that children get two doses of the MMR vaccine, but notes that it’s not 100 percent effective.

Image: CDC

People who contract mumps typically develop puffy cheeks and a swollen jaw due to swollen salivary glands, but they also may have a fever, headache, muscle aches, fatigue, and loss of appetite. Symptoms usually appear up to 18 days after a person is infected, and most people recover completely in a few weeks, the CDC reports.

Why the Sudden Increase in Cases 2016?

Miller cites Richard Watkins, M.D., an infectious disease specialist at Cleveland Clinic Akron General Medical Center, who says that there may be several possible reasons. One is that some outbreaks may occur because parents made the decision not to vaccinate their children, leaving them more susceptible to contracting the virus, he says. The other is likely due to what he calls “waning immunity.” The CDC recommends that children get two doses of the MMR vaccine, with the first dose at 12 to 15 months of age, and the second anywhere between four and six, he explains. Typically, the vaccine’s effectiveness starts to decline 10 years after the last vaccine, he says. It’s soon after this time that people go to college, where they may be exposed to mumps from unvaccinated peers, or students who attend school from abroad, where the MMR vaccine isn’t as popular, said William Schaffner, M.D., an infectious disease specialist and professor at the Vanderbilt University School of Medicine. “If you were vaccinated against mumps and you get exposed to it in your teenage years and into young adulthood when immunity wanes, particularly in close face-to-face contact with someone, you can get a milder case of it,” Schaffner explains.

Mumps Vaccine

Mumps can be prevented with MMR vaccine. The vaccine protects against three diseases: measles, mumps, and rubella. CDC recommends children get two doses of MMR vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Teens and adults also should also be up to date on their MMR vaccination.

MMR vaccine is very safe and effective. The mumps component of the MMR vaccine is about 88% (range: 66-95%) effective when a person gets two doses; one dose is about 78% (range: 49%−92%) effective.

Mumps Vaccine Composition

Live virus (Jeryl Lynn strain)

Effectiveness

88% (Range, 66%-95%) – With 2 doses

Duration of Immunity

lifelong

Schedule

at least 1 dose

should be administered with measles and rubella (MMR) or with measles, rubella and varicella (MMRV)

Single-antigen vaccine not available in the United States

Children may also get MMRV vaccine, which protects against measles, mumps, rubella, and varicella (chickenpox). This vaccine is only licensed for use in children who are 12 months through 12 years of age.

Before the U.S. mumps vaccination program started in 1967, mumps was a universal disease of childhood. Since the pre-vaccine era, there has been a more than 99% decrease in mumps cases in the United States. Mumps outbreaks can still occur in highly vaccinated U.S. communities, particularly in close-contact settings such as schools, colleges, and camps. However, high vaccination coverage helps to limit the size, duration, and spread of mumps outbreaks.

The CDC admits that the MMR vaccine isn’t perfect. “MMR vaccine prevents most, but not all, cases of mumps and complications caused by the disease,” the agency says on its website. Two doses of the vaccine are 88 percent effective at protecting against mumps, and one dose is 78 percent effective, the CDC says. That’s why outbreaks can still occur in communities where people are vaccinated—however, high vaccination rates limit the size, duration, and spread of mumps outbreaks.

Public Health Implications

Most mumps outbreaks in 2016 have been on college campuses, board-certified infectious disease specialist Amesh A. Adalja, M.D., an assistant professor at the University of Pittsburgh Medical Center, tells SELF. “The nature of a university campus tends to allow for bigger outbreaks,” he says. “It really allows the virus to find enough hosts to get to these types of numbers.” (Harvard, for example, experienced an outbreak this spring.)

When these outbreaks do occur, people may be offered a third dose of the MMR vaccine to try to boost their immunity. “That may be something that has an increased role that we continue to see,” Adalja says. In fact, the Advisory Committee on Immunization Practices (a panel of health experts who give vaccination guidance for the U.S.) is considering recommendation of a third dose of vaccine for everyone as part of the MMR schedule, per CNN. However, they haven’t said for what age they would recommend the third vaccine.

If a mumps outbreak occurs nearby, try to avoid contact with infected people, if possible. “It’s spread by direct person-to-person contact and respiratory droplets,” Watkins says (think: being sneezed or coughed on, or through kissing). You’re especially at risk if you get within three feet of someone who has the virus, Schaffner says, particularly if you’re in close prolonged contact, like being in a class together or work setting with them.

Image: CDC

Recommendations

In response to a mumps outbreak in the Midwest, college students and health care workers in particular are encouraged to make sure they’ve had two doses of the MMR vaccine. A single dose doesn’t appear to offer sufficient protection during an outbreak. Since the recommendation for a second dose didn’t begin until the late 1980s or early 1990s, many young adults may not have received their second dose and should have one now.

Renewed efforts for health communication about the risks and preventative measures concerning Mumps are needed. This includes more effective messages targeting the most at-risk populations. Specifically, MMR vaccination should be encouraged. higher vaccination rates would limit the size, duration, and spread of mumps outbreaks and provide increased wellness generally in addition to the specific at-risk populations.

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