SUBJECT: Mumps outbreak in Maine

NH Department of Health and Human Services (NH DHHS) recommends:

Develop awareness of the outbreak of mumps in Maine and knowledge of appropriate sources of information for concerned patients and parents.
Two doses of MMR vaccine for all School Age children.
A second dose of MMR vaccine for all students in postsecondary educational institutions who have not already received two doses.
Immediate reporting any suspected or confirmed cases of mumps to NH DHHS Communicable Disease Control and Surveillance Section at 603- 271-4496 (after hours 800-852-3345 ext. 5300).

The Maine Centers for Disease Control and Prevention (Maine CDC) has confirmed seven cases of mumps in Maine residents since late September 2007, and is currently investigating several dozen suspect cases. In addition, Canada has been experiencing an ongoing outbreak of mumps with over 900 confirmed cases since February of 2007, primarily centered in Nova Scotia and New Brunswick. Of the seven cases in Maine, two are students at the University of Maine. Mumps can spread easily among university students, as evidenced by the 2006 outbreak in the midwestern area of the United States, where over 2500 cases were identified, primarily in college/university students.

Background:

Mumps is an acute viral infection of the salivary glands. Symptoms include fever, headache, muscle aches, and swelling and tenderness of the cheeks. Early symptoms are nonspecific, and may include low-grade fever, muscle aches, decreased appetite, headache, and loss of energy. Cheek swelling usually occurs within the first two days of illness onset, is seen in 30-40% of affected individuals, and may be on one or both sides of the face. Symptoms usually resolve within 10 days. Mumps infection is more severe in adults than in children.

Transmission occurs through sneezing, coughing, contact with saliva (through sharing of utensils, kissing, towels, etc.), or from contact with surfaces that have become contaminated with the mumps virus. The incubation period is 16-18 days, and individuals are considered infectious from 3 days prior to 9 days after onset of symptoms.

In the current setting, school nurses should maintain a high index of suspicion for mumps when they encounter a person with swollen salivary glands, and should refer these individuals to their primary care provider as soon as possible. The NH DHHS Communicable Disease Control Section should be notified of these cases as well.

NH DHHS is providing the following recommendations to schools:

Hand washing: Not only at school but at home as well
Cough Etiquette: Teach children to cough into their shirtsleeves or elbows instead of their hands
Stay at home if sick: Sick children should be kept at home and not sent to school. NH DHHS recommends keeping your child at home if they have a fever with muscle aches and/or swollen cheeks until they have been fever free for 24 hours
See a healthcare provider: If symptoms of fever, muscle aches, and cheek swelling are noted in your child, they should be taken to a healthcare provider immediately for evaluation for mumps infection
Confirmed cases should be excluded for 9 days from the beginning of symptoms
Unvaccinated contacts to cases should be excluded from the 12^th through the 25^th day after exposure

Immunization

Current recommendations from the Advisory Committee on Immunization Practices state that two doses of MMR is indicated for all School Age children. A second dose is also recommended for all individuals who are students in postsecondary educational institutions.

For more information on mumps and the mumps vaccine, visit the CDC website at:

http://www.cdc.gov/vaccines/vpd-vac/mumps/default.htm