Two Suspect Mumps Cases in Fraser Health

From the office of the Medical Health Officer

Two People in Fraser Health Now Suspected of Having Mumps

The mumps outbreak in the Maritimes may have arrived here via Winnipeg. We have two people in Fraser Health – one in Fraser North and one in Fraser East – who are suspected of having mumps. One of them may have been exposed to a Maritimes student at a sports tournament in Winnipeg, as were three other BC residents who may also have mumps. There are also new instructions on lab testing for mumps. Therefore, stock your fridge freezer up with ice packs, and -

If you see a patient with sialadenitis, particularly parotitis:

1. Ask about travel or exposure to travellers AND ask about exposure to anyone who might have had mumps. Currently most Canadian cases have been young adults (of university age), but as time goes by we expect to see infections in non-immune people in other age groups.
2. Take a buccal swab or throat swab for mumps PCR when you see the patient. Use a viral swab kit. Keep the sample in the fridge until transfer to the lab, then wrap it up with an ice pack for transfer. Avoid freeze-thaw cycles. Mark the requisition “FOR MUMPS VIRUS ISOLATION” in BIG letters.
   PCR may be positive in non-immune patients up to 9 days after onset of symptoms, but may become negative much earlier in patients with partial immunity.
3. Order acute IgM and IgG to be done 5 days after onset of symptoms to be sent EMERGENT to the BCCDC laboratory. Also order convalescent serology to be done 2-3 weeks from onset of symptoms. Mark the requisition “SUSPECT MUMPS” in BIG letters. When the patient is going to the lab within 9 days of onset of parotitis, please alert the lab, and if the patient is coughing, please give him/her a surgical mask to wear.
   
   In people with no immunity to mumps, IgM is present by day 5 from symptom onset, peaks at about 1 week, and can be present for at least 6 weeks. In those with pre-existing immunity, IgM response to mumps infection is highly variable and may be absent. Existing IgG begins to rise soon after exposure and infection, and may already be high by the time acute serology is drawn.
4. Tell the patient to avoid others until 9 days have passed from onset of salivary gland swelling.
5. Alert your local public health unit (phone numbers below) to expedite lab test results and follow up contacts.
   
   Mumps is infectious from 7 days before to 9 days after parotitis onset, and most contagious from 2 days before to 4 days after onset of illness. Spread is via saliva-sharing as well as by respiratory droplets and airborne transmission. The incubation period for mumps is 14-25 days (usually 16-18).

ARE YOU AND YOUR PATIENTS IMMUNE TO MUMPS?

In BC, 2 doses of MMR vaccine are recommended and provided free to those ?18 years old, women of childbearing age who are susceptible to rubella, health and child care workers born after 1956, military recruits, and students attending post-secondary institutions. A second dose of MMR is also recommended but not provided free for travellers >18 years old born after 1956.

ABOUT MUMPS

Mumps is a systemic viral illness characterized by swelling of one or more salivary glands, usually the parotid(s). Infection in adults is more likely to be severe. About one-third of mumps infections do not involve clinical siladenitis and present as respiratory tract infections. Ten per cent of people with mumps have CNS symptoms. Orchitis is common after puberty; sterility is rare but there may be a link with testicular cancer. Mumps may cause sensorineural hearing loss in both children and adults. Pancreatitis, usually mild, occurs in about 4% of cases. Mumps in the first trimester of pregnancy is associated with increased rate of spontaneous abortion, but there is no evidence of any increase in congenital malformation. Treatment is symptomatic.