foodconsumer.org: Update: Mumps Outbreak

Update: Mumps Outbreak
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admin on 02/13/2010 00:01:00
 
UPDATE: MUMPS OUTBREAK --- NEW YORK AND NEW JERSEY, JUNE 2009--JANUARY 2010
WEEKLY
February 12, 2010 / 59(05);125-129
State and local health departments, in collaboration with CDC, continue to
investigate a mumps outbreak that began in New York in June 2009 (1). The index
case occurred in a boy aged 11 years who had returned on June 17 from a trip to
the United Kingdom, where approximately 7,400 reports of laboratory-confirmed
mumps were received by the Health Protection Agency in 2009.* He then attended a
New York summer camp for tradition-observant Jewish boys, where he became
symptomatic on June 28. Subsequently, other camp attendees and a staff member
were reported to have mumps, and transmission continued in multiple locations
when the camp attendees returned home. As of January 29, 2010, a total of 1,521
cases had been reported, with onset dates from June 28, 2009, through January
29, 2010, a substantial increase from the 179 cases reported as of October 30,
2009 (1). The outbreak has remained confined primarily to the
tradition-observant Jewish community, with 6 years (Figure). The median age of
patients is 15 years (range 3 months--90 years) and is similar in all areas with
ongoing transmission except New Jersey, where the median age is 17 years. Of the
1,489 patients whose sex is known, 1,136 (76%) are male. Sixty-five reports of
complications from mumps have been received: orchitis (55 cases), pancreatitis
(five cases), aseptic meningitis (two cases), transient deafness (one case),
Bell's palsy (one case), and oophoritis (one case). Nineteen hospitalizations
from mumps have been reported; no deaths have occurred.
Vaccination status is known for 1,115 patients: 966 (91%) of 1,062 patients aged
≤18 years and 149 (33%) of 456 patients aged ≥19 years (Table). Of these
patients, 976 (88%) had received at least 1 dose of mumps-containing vaccine
before the outbreak, and 839 (75%) had received 2 doses. Among patients aged
7--18 years, the age group with the majority of cases and for whom 2 doses of
MMR vaccine is recommended, 93% had received at least 1 dose, and 85% had
received 2 doses. The vaccination status of the patients varies by location. The
percentage of patients aged >6 years (for whom vaccination status is known) who
had received 2 doses of mumps vaccine is highest in Orange County, New York
(86%), followed by New York City (83%), New Jersey (76%), and Rockland County,
New York (73%).
Public health response measures in all affected areas have continued throughout
the outbreak. Health-care providers have been notified about the ongoing
outbreak, the importance of verifying that children have received all
recommended vaccinations, and the need to offer vaccinations to adults with
unknown vaccination status who do not have a history of mumps. State and local
health departments also have worked with affected schools to enhance vaccination
policies, including policies to exclude unvaccinated children from school during
outbreaks and to isolate children at home for 5 days after onset of parotitis.
Certain jurisdictions have encouraged providers to offer a second dose of MMR
vaccine to children aged 1--4 years; however, this strategy has not been a focus
of the public health response because of the small proportion (4.9%) of cases
reported in this age group.
Beginning on January 19, 2010, in Orange County, New York, public health
officials began offering a third dose of MMR vaccine in three schools where,
despite documentation of a high level of 2-dose coverage among students,
transmission had continued for >2 months. This intervention is being carried out
under an Institutional Review Board--approved protocol that provides for an
evaluation of the impact of the intervention.
REPORTED BY
P High, MHS, Ocean County Health Dept, EF Handschur, MPH, OS Eze, MD, B Montana,
MD, C Robertson, MD, C Tan, MD, New Jersey Dept of Health and Senior Svcs. JB
Rosen, MD, KP Cummings, MPH, MK Doll, MPH, JR Zucker, MD, CM Zimmerman, MD, New
York City Dept of Health and Mental Hygiene; T Dolinsky, Rockland County Dept of
Health; S Goodell, MPH, B Valure, Orange County Health Dept; C Schulte, D Blog,
MD, E Rausch-Phung, MD, P Smith, MD, New York State Dept of Health. A Barskey,
MPH, G Wallace, MD, P Kutty, MD, H McLean, PhD, K Gallagher, DSc, R Harpaz, MD,
GL Armstrong, MD, L Lowe, MS, R McNall, PhD, J Rota, MPH, P Rota, PhD, C
Hickman, PhD, WJ Bellini, PhD, Div of Viral Diseases, National Center for
Immunization and Respiratory Diseases. I Ogbuanu MD, A Apostolou, PhD, EIS
officers, CDC.
EDITORIAL NOTE
The mumps outbreak in the New York-New Jersey area has grown substantially, and
anecdotal reports from certain affected areas suggest that the rate of new cases
is not decreasing; the appearance of a downward trend in recent weeks (Figure)
is partly a result of reporting delays. The outbreak is occurring almost
exclusively in a specific religious community, and no cases outside this
community have resulted in sustained transmission.
Like the mumps outbreaks that occurred in 2006 (2), much of the current outbreak
is occurring in congregate settings, where prolonged, close contact among
persons might be facilitating transmission. Within the affected religious
community, cases have occurred predominantly among school-aged boys, who attend
separate schools from girls. The higher rate among boys might be a result of the
additional hours that boys in this community spend in school compared with
girls, including long periods in large study halls, often face-to-face with a
study partner.
In addition, transmission in the community overall might be facilitated by
relatively large household sizes. According to the 2000 U.S. Census, the mean
household size in one of the affected communities was 5.7, compared with a mean
U.S. household size of 2.6. The limited transmission to persons outside the
community might be a result of the relatively less interpersonal contact between
persons inside and outside the community.
Although the school settings and large household sizes might be promoting
transmission, the high vaccination coverage in the affected community likely is
limiting the size of the outbreak. In addition, high vaccination coverage in
surrounding communities is the most plausible reason that the few cases outside
of the affected community have not caused other outbreaks.
In this outbreak, as in other recent mumps outbreaks among highly vaccinated
populations (3), most cases have occurred in vaccinated persons. The mumps
vaccine has greatly reduced the incidence of mumps in the United States. From
1967, when the mumps vaccine was first licensed, to the early 2000s, the number
of reported cases decreased from 186,000 to