Friday, April 7, 2017

SAMHD Health Advisory


San Antonio Metropolitan Health District

HEALTH ADVISORY UPDATE: MUMPS

April 7, 2017
As of April 7, 2017, Bexar County has reported 9 cases of mumps in 2017, compared to 1 reported each year for the previous 2 years. According to the Centers for Disease Control and Prevention, 37 states are reporting over 1,100 cases of mumps so far this year.

Due to the communicable nature of this disease, please consider mumps as a diagnosis for any patient presenting with the following symptoms: Unilateral or bilateral swelling of the parotid or salivary glands preceded by a lowgrade fever, myalgia, malaise, or headache. Complications of mumps include: orchitis, encephalitis, meningitis, oophoritis and/or mastitis, and deafness.

Diagnostic Testing:

All individuals suspected of having mumps should be tested and reported to the local health department. Individuals previously vaccinated may not develop detectable IgM antibodies; therefore collecting a buccal swab for RT-PCR testing is preferred. PCR specimen should be collected as soon as mumps is suspected (maximum 7 days after parotitis onset). PCR testing for mumps is available through commercial laboratories. Massage the parotid gland area for 30 seconds before swabbing.

Testing Method among Individuals Vaccinated Against Mumps

Testing Method
Ideal Collection Time Frame
Notes
PCR
1- 3 days after parotitis and up to 7 days
Not affected by previous vaccination. Directly detects viral RNA and is not immune response dependant.
IgG
NA
IgG may peak a very high response prior to IgM response in vaccinated individuals if collected within 3 days of parotitis onset; must interpret carefully and look at timing of collection from onset of symptoms.
IgM
3-5 days after parotitis onset
IgM collected prior to 3 days after onset may be negative and
should not be used to rule out mumps.


Interpretation of Serology Results for Mumps

Mumps exposure history
IgM
IgG
Comments
References

Unvaccinated; no history of mumps


+


+ or −
IgM may be detected for weeks to months, 80 – 100% of serum samples IgM positive; low levels of IgG may be present at symptom onset.
Meurman et al. 1982; Sakata et al. 1985; Rota et al. 2013


1–dose vaccine history


+ or


Likely
+
Approximately 50% of serum samples collected 1–10 days after symptom onset were IgM- positive; 50%–80% of serum samples collected >10 days after symptom onset were IgM- positive.

Narita et al. 1998; Jin et al. 2004; Krause et al. 2007; Rota et al. 2013


2–dose vaccine history


+ or


Likely
+
13%–46% of serum samples collected less than 3 days after symptom onset were IgM- positive.  71% of serum samples collected >3 days were IgM positive.

Bitsko et al. 2008; Rota et al. 2009

Reporting:

Healthcare providers and laboratories should promptly report all suspected cases of mumps to the respective local health department prior to receiving laboratory results:

Bexar County Residents:            Other County Residents:

San Antonio Metropolitan Health District          Texas Department of State Health Services Phone: (210) 207-8876                                             Health Service Region 8
Fax: (210) 207-8807                                                 Phone: (210) 949-2000 or (210) 949-2121

Infection Control:

Mumps is transmitted from person to person by respiratory droplets or saliva. The incubation period is 16-18 days (range of 12-25 days) from exposure to onset of parotitis. Persons are contagious from 3 days before to 5 days after onset of parotitis.


People suspected of having mumps should be told to stay home from work, school, daycare, and any public outings (e.g., church, grocery store) until 5 days have passed since onset of parotitis. Mumps can be prevented with 2 doses of MMR vaccine. All healthcare facilities should ensure that they have updated documentation of mumps immunity status for all staff, not just healthcare providers. Documentation of immunity includes written record of receipt of 2 MMRs, positive serological titers, or birth prior to 1957 (although healthcare facilities should consider vaccinating unvaccinated personnel born before 1957 who do not have laboratory evidence of mumps immunity).