However, other causes do not produce parotitis on an epidemic scale. Some case-patients or their caregivers may have personal copies of immunization records available that include dates of administration— these are acceptable for reporting purposes.
[40] In the late 1980s and early 1990s, outbreaks were reported among primary and secondary school children who had previously received 1 dose of mumps-containing vaccine. [39] Vaccination recommendations for an outbreak setting, including use of a third dose of MMR vaccine, are discussed in the “Outbreak Control” section later in this chapter. Not all cases of parotitis—especially sporadic ones—are due to mumps infection. Specific instructions for specimen collection and shipping may be obtained from the CDC mumps website or by contacting the CDC Viral Vaccine Preventable Diseases Branch at 404-639-3339. assessment of presumptive evidence of immunity of healthcare personnel, including documented administration of 2 doses of live mumps virus vaccine, laboratory evidence of immunity or laboratory confirmation of disease, or birth before 1957 (refer to next section, “Healthcare personnel: presumptive evidence of immunity” for footnotes); vaccination of those without evidence of immunity; exclusion of healthcare personnel with active mumps illness, as well as healthcare personnel who do not have presumptive evidence of immunity who are exposed to persons with mumps; isolation of patients in whom mumps is suspected; and. Mumps is endemic throughout the world, and achieving elimination was considered difficult in the context of potential for ongoing mumps virus importations and the current 2-dose vaccination program. [58–61] However, persons with a history of mumps vaccination may not have detectable mumps IgM antibody regardless of the timing of specimen collection. They should be educated about symptoms of mumps, including nonspecific presentations, and should notify occupational health if they develop these symptoms. Suspected mumps outbreaks should be confirmed by conducting laboratory investigation on 5-10 cases only. Isolation of mumps virus from an appropriate clinical specimen*, Coronavirus disease outbreak (COVID-2019), Coronavirus disease outbreak (COVID-19) », WHO-recommended standards for surveillance of selected vaccine-preventable diseases, Immunization surveillance, assessment and monitoring, Number of cases by age group and immunization status, month and geographical area, Geographical area (e.g. Territory of Guam also experienced an outbreak, with 505 mumps cases reported; the median age was 12 years with a range of 2 months to 79 years. However, in 2006, another resurgence occurred, with 6,584 reported cases. Most deaths were among children under 5 years of age. In specific situations, viral isolation can be attempted to differentiate meningitis cases that could be related to the wild virus, the vaccine strain or other factors, Designated reporting sites at all levels should report at a specified frequency (e.g. See the “Specimen collection and management” section below. Anti-vax activists appear to have stoked the doubt; Robert F Kennedy Jr, a prominent anti-vaxxer, visited the island in June. The specific criteria for documenting the presence of antibody or an increase in titer depends on the test. This is particularly true when the salivary gland area is massaged approximately 30 seconds prior to swabbing the buccal mucosa/parotid duct, so that the specimen contains the secretions from the parotid or other salivary duct glands. [2] Nonspecific prodromal symptoms may precede parotitis by several days, including low-grade fever which may last 3–4 days, myalgia, anorexia, malaise, and headache. implementation of droplet precautions, in addition to standard precautions. [27] Of the 287 school-aged children 6–18 years of age with reported mumps, 270 (94%) had received at least 2 doses of MMR vaccine. The presumptive evidence of immunity criteria for healthcare personnel differs slightly from the criteria for community settings. Vaccinated persons: In order to optimize virus yield, emphasis should be placed on obtaining mumps clinical specimens from buccal mucosa within 1 to 3 days after onset of symptoms (usually parotitis). [12] Mumps encephalitis accounted for 35.9% of all reported encephalitis cases in the United States in 1967. Identifying contacts (e.g., household, school/college, and other close contacts) and following up with persons without evidence of mumps immunity may reveal previously undiagnosed and unreported cases.

Worldwide, mumps is not as well controlled as measles and rubella; mumps vaccine is only routinely used in 62% of countries in the world. It is very sobering. Unprotected exposures are defined as being within 3 feet of a patient with a diagnosis of mumps without the use of proper personal protective equipment. [56,57] If an acute-phase serum sample collected ≤3 days after parotitis onset is negative for IgM, testing a second sample collected 5–7 days after symptom onset is recommended as the IgM response may require more time to develop.

[25] The incidence was highest among persons 18–24 years of age, many of whom were college students. In very large outbreaks, it may not be possible to thoroughly investigate each reported case. [1] Mumps caused transient deafness in 4.1% of infected adult males in a military population. Outbreak Control). “We are clearly backsliding in terms of progress on measles. The activities listed below can help increase the number of suspected mumps cases that are reported and improve the comprehensiveness and quality of reports that are received. States may also choose to classify cases as “out-of-state-imported” when imported from another state in the United States. Unvaccinated persons: IgM antibody is detectable within 5 days after onset of symptoms, reaches a maximum level about a week after onset, and remains elevated for several weeks or months. “They will be the parents of the future and we really think that there’s a lot that could be done now to essentially immunise young people against misinformation,” she said. decreasing incidence and increasing coverage) and to identify areas at high risk or with poor programme performance. The estimates are from annual modelling carried out by the World Health Organization (WHO) and the US Centers for Disease Control. Between July 2010 and December 2015, at least 23 large outbreaks (defined as ≥20 cases), consisting of 20–485 cases per outbreak were reported in 18 states. CDC is currently updating guidance for use of a third dose of a mumps-containing vaccine during mumps outbreaks.

Successful virus isolation should always be confirmed by immunofluorescence with a mumps-specific monoclonal antibody or by molecular techniques. Identification of suspected or confirmed cases of mumps is important in the initiation of control measures to prevent the spread of the disease among persons who do not have presumptive evidence of immunity. Initial preparation for control activities may need to start before laboratory results are known. During an outbreak, every suspected case should be investigated, as described above. CDC recommends a 5-day period after onset of parotitis for: 1) isolation of persons with mumps in the community and for 2) use of droplet precautions, in addition to standard precautions in healthcare settings.[32]. Following mumps vaccine licensure, reported cases of mumps steadily decreased from more than 152,000 reported cases in 1968 to 2,982 in 1985. Although the case-fatality rate of mumps encephalitis is low and overall mortality is 1/10 000 cases, permanent sequelae occur in about 25% of encephalitis cases. Mumps vaccine effectiveness has been estimated at a median of 78% (range: 49%−91%) for 1 dose[1,42,51–53] and a median of 88% (range: 66%−95%) for 2 doses.[34,53]. Subsequently, the Healthy People 2020 target for mumps is a disease reduction goal (i.e., to have fewer than 500 reported cases of mumps annually), rather than an elimination goal. [64] Facilities are also encouraged to review employee evidence of immunity status for mumps and other vaccine preventable infections. “Hesitancy is high on our radar screen and on our risk register now and into the future. [15,16] In 60% to 83% of males with mumps orchitis, only one testis was affected. [13] Orchitis has been reported in 11.6% to 66% of postpubertal males infected with mumps. Some vaccinated personnel may remain at risk for mumps and steps should be taken to reduce the risk of infection. Samoa is in the grip of an island-wide outbreak that has killed 60 people after parents lost confidence in vaccination following the deaths of two children from a wrongly mixed vaccine last year. If mumps is suspected, laboratory testing should be performed. Mumps case investigations should include complete immunization histories verified by documentation of administration of all doses. district and province), Number of mumps vaccine doses received: 99 = unknown, Results of mumps serology: 1 = positive; 2 = negative; 3 = indeterminate; 4 = no specimens processed; 9 = unknown, Collection of specimen for viral culture/identification: 1 = yes; 2 = no; 9 = unknown, Specimen type: 1 = urine; 2 = throat swab; 3 = CSF; 9 = unknown, Date specimen received for viral culture/identification, Results of mumps viral culture/identification: 1 = positive; 2 = negative; 9 = unknown, Final classification: 1 = clinically confirmed; 2 = laboratory-confirmed; 3 = epidemiologically linked to laboratory-confirmed case, Source of infection identified: 1 = yes; 2 = no; 9 = unknown, Number of cases and incidence rate by month, year and geographical area, Mumps vaccine coverage by year and geographical area, Completeness/timeliness of monthly reporting, Proportion of known outbreaks confirmed by the laboratory, Age-specific, sex-specific, and district-specific incidence rates by month and year, Proportion of cases by age group and immunization status. Final laboratory results may not be available for the initial report but should be submitted via NNDSS when available. Monitor the epidemiology (age groups at risk, interepidemic period, immunization status) of mumps and accelerate immunization activities accordingly to avert a potential outbreak. Other locations experiencing mumps outbreaks during the same time frame among similar populations also showed a decline in attack rates without the third dose intervention (New York City, unpublished data). Monitor vaccine effectiveness. 17,18 The mortality rate for patients presenting with meningoencephalitis has been reported to be up to 1.4%. [48] However, major resurgences in mumps during 2006, 2009, and 2010 highlighted the challenges of obtaining this goal with currently available vaccines and the existing vaccination policy, resulting in re-evaluation of the mumps program goal in the United States. Mumps virus is transmitted person to person through direct contact with saliva or respiratory droplets of a person infected with mumps.
[39] All other adults born during or after 1957 without other evidence of mumps immunity should be vaccinated with 1 dose of MMR vaccine. Two-dose MMR vaccine coverage in the most highly affected schools ranged from 99.3% to 100%.[27].