As of September 9, 2016, there were 89 cases of mumps in the Springdale area. There have been clusters of cases in schools and the community, and we believe we will see additional cases. Please review the following information and notify the ADH Outbreak Response Section urgently at (501) 537-8969, if you become aware of a possible case.

If your clinic or emergency department is in northwest Arkansas, we ask that you take the following steps to limit the transmission of mumps in your clinic and community.

1. Have a plan for triaging patients with possible mumps that minimizes exposure to other patients visiting your facility.
2. Post a sign at the entrance to your clinic asking patients with symptoms of possible mumps to notify you before they come in. A sign is available on the ADH website at http://www.healthy.arkansas.gov/programsServices/infectiousDisease/CommunicableDisease/Pages/Mumps.aspx.
3. If you provide care to a patient with possible mumps, please complete a Communicable Disease Reporting Form with as much information as you can provide, especially the contact information for the patient, and fax the completed form to (501)661-2428. An up-to-date form is available at http://www.healthy.arkansas.gov/programsServices/epidemiology/Documents/CommunicableDiseaseReportingForm.pdf.
4. Contact the ADH Outbreak Response Section, if you have any questions about testing, reporting, etc. Call ADH Outbreak Response Section at (501) 537-8969 during business hours Monday- Friday 8:00-4:30. After hours please call the ADH Emergency Operations Center at 1-800-554-5738, and they will contact the on-call ADH physician or nurse, who will call you back.

Original Alert:

As of today, August 31, 2016, the Arkansas Department of Health is aware of two confirmed cases and seven suspected cases of mumps in the Springdale area. School and community transmission has occurred and is likely to continue to be recognized. Please review the following information and notify the ADH Outbreak Response Section urgently at (501) 537-8969, if you become aware of a possible case.

Clinical Signs and Symptoms

Mumps is an acute viral illness that most often affects the salivary glands, usually the parotid glands, which may be unilateral or bilateral.  Patients may also have non-specific symptoms of systemic viral illness, such as myalgia, anorexia, malaise, headache, and low-grade fever.  Parotitis, if present, may last 7-10 days.

Orchitis is a common complication of mumps, which occurs in up to 10 percent of postpubertal males infected with mumps. Less than 1 percent of females will have oophoritis, which may mimic appendicitis. In the post-vaccine era, rates of viral meningitis, pancreatitis, and deafness have all been less than 1 percent. A third of infections may be subclinical. Unvaccinated adults may experience more severe manifestations than children.

Transmission and Incubation

Mumps is transmitted by direct contact with respiratory droplets or saliva from an infected person. Humans are the only known hosts. Asymptomatic persons can transmit the virus, but no chronic carrier state exists. The incubation period is 16 to18 days, but may range from 12 to 25 days. Transmission is most likely to occur several days before and after the onset of parotitis.

Diagnosis

The diagnosis of mumps typically involves both clinical criteria and laboratory testing.

Clinical criteria are an illness with acute onset of unilateral or bilateral swelling of the parotid or other salivary gland(s), lasting at least 2 days and without other apparent cause.

Laboratory testing includes the following:

• Isolation of mumps virus from clinical specimen (buccal swab or CSF)
• Detection of mumps nucleic acid, such as standard or real time RT-PCR assays, collected within 2 days of symptom onset
• Positive mumps specific IgM antibody
• Demonstration of specific mumps antibody response in absence of recent vaccination, either a four-fold increase in IgG titer as measured by quantitative assays, or a seroconversion from negative to positive using a standard serologic assay of paired acute and convalescent serum specimens.

Treatment

There is no specific treatment for mumps. Vaccination for mumps after exposure will not prevent infection. However, if the exposure did not result in infection, vaccination may prevent future infection and serve to shorten the duration of the outbreak.

Prevention

There is a safe and effective mumps vaccine that is available in combination with measles and rubella vaccine as MMR (Measles, Mumps, and Rubella) vaccine. Two doses of MMR vaccine is 88 percent effective in preventing mumps. In the setting of a persistent outbreak, a third dose of MMR vaccine has occasionally been recommended. MMR vaccine is a live virus vaccine and is contraindicated for pregnant women or patients with immunosuppression. Adults born before 1957 are generally considered to be immune to mumps and are not included in the MMR vaccination recommendations.

The current CDC recommendations for MMR vaccination are as follows:

• For children younger than 6 years of age, one dose of MMR vaccine or MMRV (Measles, Mumps, Rubella, and Varicella) vaccine at age 12-15 months, followed by a second dose of either MMR vaccine or MMRV vaccine at age 4-6 years.
• For children age 7 through 18 years not previously vaccinated, one dose of MMR vaccine or MMRV vaccine, followed by a second dose of either MMR vaccine or MMRV vaccine at least 4 weeks after the first dose.
• For adults born in 1957 or later and not previously vaccinated, one dose of MMR vaccine.
• A second dose of MMR vaccine is recommended for adults, who are students in a post-secondary educational institution, work in a health care facility, or plan to travel internationally. The second dose should be administered a minimum of 28 days after the first dose.

To assist in responding to this outbreak, we ask that medical clinics take these steps.

1. Ensure your clinic has posted a list of reportable diseases. An up-to-date list is available online at http://www.healthy.arkansas.gov/programsServices/epidemiology/Documents/ReportableDisease.pdf.
2. Ensure your clinic has the Communicable Disease Reporting Form available to staff responsible for submitting reports. An up-to-date form is available at http://www.healthy.arkansas.gov/programsServices/epidemiology/Documents/CommunicableDiseaseReportingForm.pdf. ADH needs you to complete this form with as much information as you can provide, especially the contact information for the patient. Fax the completed form to (501)661-2428.
3. Ensure your clinic is signed up for the Health Alert Network (HAN) communications. ADH uses this network to send urgent notices to health care providers. http://www.healthy.arkansas.gov/programsServices/preparedness/Pages/HAN.aspx.
4. Ensure your clinic has a copy of the ‘Red Book’ for guidance on infectious diseases available as a reference to clinic staff. Information about this book can be found at http://redbook.solutions.aap.org/redbook.aspx.
5. If you have any questions about testing, reporting, etc. please contact the ADH Outbreak Response Section at (501) 537-8969 during business hours Monday- Friday 8:00-4:30. After hours please call the ADH Emergency Operations Center at 1-800-554-5738 and they will contact the on-call ADH physician or nurse, who will call you back.

Dirk Haselow, MD, PhD

State Epidemiologist and Outbreak Response Medical Director

Arkansas Department of Health