More Mumps in Fraser East

Protect patients and avoid exclusion : ensure you AND your staff are mumps-immune :

• EITHER you have positive mumps IgG
• OR you have been vaccinated

Test ALL suspect cases :

• fever and respiratory illness post mumps-exposure esp. in unvaccinated teen/young adult
• siladenitis (especially parotitis) or orchitis

Give coughing patients surgical masks and:

1. Ask about exposure to mumps or mumps-like illness, or travel to or visitors from Alberta or other areas with mumps activity.
2. Test ALL patients with suspect mumps :
   BUCCAL SWAB : Take a buccal swab at Stenson's duct above the 2nd molar (strip the parotid first if it's not too sore) for mumps PCR using a viral swab kit. Sending a urine sample as well adds about 7% to the detection rate. Keep samples in the fridge, then ship together with a wrapped-up ice pack to the lab. Mark the requisition “MUMPS OUTBREAK” in BIG letters. PCR may be positive in non-immune patients up to 9 days after onset of symptoms, but may go negative earlier in those with partial immunity.
   SEROLOGY: Order acute mumps IgM and IgG at 3-5 days after onset of prodromal symptoms. Also order convalescent serology at 10 days - 3 weeks from onset of symptoms. Mark the requisition “MUMPS OUTBREAK” in BIG letters. For patients going to the lab within 9 days of onset of parotitis, please alert the lab and give any coughing patient a surgical mask to wear. With no mumps immunity, IgM is present by day 5 from symptom onset, peaks ~1 week, and lasts from 6-12 months. With partial immunity, IgM may not be seen and IgG will rise soon after exposure and may already be high by the time acute serology is drawn.
3. Tell the patient to stay home , stay 1 metre away from others, and avoid saliva sharing (coughing into the air, kissing, sharing drinks, etc.) until 9 days after onset of salivary gland swelling (or if there is no siladenitis, until 14 days after onset of first symptoms).
4. Alert your health unit (phone numbers below) to expedite lab tests and follow up contacts.

The infectious period for mumps is from 7 days before to 9 days after parotitis onset , with maximal infectivity from 2 days before to 5 days after . Spread is by respiratory droplets and saliva-sharing.

The incubation period for mumps is 14-25 days (usually 16-18) from an exposure that causes infection.

MMR AND OTHER MUMPS-CONTAINING VACCINE: ARE YOU IMMUNE TO MUMPS?

In BC, TWO doses of MMR are provided free to:

• those ?18 years old,
• women of childbearing age susceptible to rubella,
• health and child care workers born after 1956
• military recruits,
• post-secondary students.

Mumps outbreak prevention tip:
Vaccination after a mumps exposure does not protect a non-immune patient from that exposure, but it will protect against further mumps exposures later on.

ONE dose of MMR is provided free to:

• health care workers born before 1957.

If you or your staff are eligible for free MMR vaccine, please call your health unit to order it.One dose of MMR protects 80% of people who get it and two doses protect 90-95% of people. However, fewer people may be protected in a mumps outbreak: e.g., 64% and 88% of one vs. two dose recipients respectively were protected in a 1998 UK outbreak (Harling 2005). Those born before 1970 are presumed immune due to exposure to wild circulating mumps virus, but evidence shows that some are not. Of those born before 1970, 11% in a BC prenatal serosurvey and 17% tested in the Nova Scotia outbreak were found to be susceptible to mumps.

Health care workers (including physicians) WITHOUT documented immunity (2 documented doses of mumps vaccine OR mumps IgG positive) who are exposed to a case of mumps:

• Get tested (serology for mumps IgG) and get a dose of MMR right away
• If you already have one documented prior dose of mumps vaccine, you can return to work right after you get your MMR (which will be your second documented dose of mumps vaccine)
• If you don’t have any documented prior mumps vaccine and you were born after 1970, OFF WORK from 10th day after first exposure until 26th day after last exposure to mumps (inclusive)
• Back to work sooner if your serology shows you are positive for mumps IgG (= immune)
• If you were born in 1970 or before but are NEGATIVE for mumps IgG, OFF WORK as above

ABOUT MUMPS: Mumps is asymptomatic in roughly 1/3 of cases, causes respiratory tract infection alone in ~1/3, and siladenitis or orchitis in ~1/3. Orchitis, which affects up to 38% of postpubertal men, causes testicular atrophy, affecting fertility when bilateral. Mastitis and/or oophoritis (in women), pancreatitis, thyroiditis, and arthritis can also result. Oophoritis can mimic acute appendicitis. Infection is more often severe in adults and the unvaccinated. Sensorineural hearing loss occurs at any age but is rare. Meningoencephalitis occurs in ~250/100 000 cases, with ~2% mortality. Mumps in the first trimester of pregnancy is linked to an increased rate of spontaneous abortion but not congenital malformation. Treatment is symptomatic.