Preparing for a possible return of mumps
The largest outbreak of mumps in more than 20 years is sending many doctors and other health professionals in the Midwest back to their textbooks to refresh their knowledge on how to recognize and treat this age-old viral infection.
In the past five months, more than 2,000 people have developed mumps in nine Midwestern states centered on Iowa. And the epidemic shows no sign of abating. Should we be concerned in California?
Mumps has been so well-controlled by vaccination in the United States that many young clinicians here have never seen a case, and most older ones haven’t thought about it for years. But viruses have a way of staging comebacks just when we stop thinking about them, and the mumps virus is no exception.
So far no cases linked to the Midwest outbreak have been detected in California, but it would be no surprise if mumps turned up here one day soon. It’s time for everyone to get familiar with mumps and make sure they are protected from it.
For most people a mumps infection is not a serious setback. Symptoms of fever, headaches, fatigue and muscle aches typically precede an acute swelling of the salivary glands, particularly the parotid glands located over the corners of the jaw. Patients complain that they look like chipmunks, and while they may feel awful for a few days, most recover completely.
Mumps is a public health concern because in a few cases there are serious complications, including meningitis, pancreatitis and inflammation of the testes in boys and men, which can lead to infertility.
At least 20 people in the current outbreak have been hospitalized. None has died so far.
The mumps virus spreads rapidly from person to person through respiratory droplets, the fine sprays we emit when we cough or sneeze. Mumps also spreads by direct contact when we don’t wash our hands, or through contaminated objects such as soiled tissues. It spreads most easily in places where people live close together, as they often do in college dormitories and institutions. It also spreads fast in health care settings.
Mumps is preventable with the Measles-Mumps-Rubella (MMR) vaccine that we now give routinely to young children in two doses. This vaccine offers lifelong immunity against mumps, along with protection against measles and rubella, in about 80 percent of those who receive one dose and 90 percent of those who get two.
Most cases in the Midwest outbreak have occurred in college students and other young adults who had been vaccinated as children. This doesn’t mean that the vaccine is wearing off.
When today’s college students were born only one dose of MMR was recommended. (The two-dose schedule was adopted in 1989). In the crowded conditions of a college dormitory, infections among the large percentage of students who were vaccinated once but are still susceptible to mumps are giving the virus a foothold to infect others, including the smaller fraction who aren’t immune even after two doses.
So the Midwest epidemic isn’t due to a failure of the vaccine. It’s due to a failure to vaccinate enough people with enough doses.
We can prevent extension of this epidemic into our county if we ensure that people most at risk for mumps have received two doses of MMR. These include young people bound for college and other institutional settings, and health care workers born since 1957 who do not have a history of mumps. (People born before that year are probably immune due to natural infection.)
If you think that you or someone in your family may be at risk of getting mumps, ask your doctor about getting another dose of MMR vaccine.
– Jason Eberhart-Phillips, MD, is health officer for El Dorado County and a regular contributor to the Tribune’s health page.
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