Who and Where

Beginning in Iowa last year, a very large outbreak of mumps has occurred in the Midwest, and more and more cases have been identified in Illinois and the Chicago metropolitan area. Just recently during the 2006/2007 academic year, Wheaton College experienced an epidemic of mumps, with at least 60 students affected. The majority of those affected have been persons 18-25 years of age, many of whom had been vaccinated against mumps as children.

Cause

Mumps is an acute viral infection that principally affects the salivary glands but can affect many other parts of the body.

Transmission and Incubation Period

Mumps is as contagious as the flu, and like the flu, it is primarily spread through respiratory droplets as well as by saliva or contact with contaminated objects such as silverware or cups.

The incubation period is generally 16-18 days after exposure to onset of symptoms. Persons with mumps are typically contagious from 3 days before symptoms begin to about a week after the onset of salivary gland swelling.

Symptoms

The typical onset of mumps consists of a non-specific prodrome that includes malaise (a general feeling of sickness), loss of appetite, muscle aches, headache, and fever. This is usually followed within 24 hours by swelling of the salivary glands, particularly the parotid glands in front and below the ears, although such swelling may be delayed for as long as a week. Swelling usually, but not always, occurs on both sides of the face, but one side may swell before the other. Parotid gland swelling is accompanied by tenderness, and patients frequently report an earache and may find it difficult to eat, swallow, or talk. The swelling typically begins to resolve within 2-3 days.

Complications

In addition to the parotids, other salivary glands may be involved. For postpubertal men, the most common manifestation of mumps after parotid swelling is inflammation of one or both testicles resulting in pain, tenderness, enlargement to several times normal size, and accompanying fever. Other potential complications are meningitis (inflammation of the covering of the brain and spinal cord), encephalitis (inflammation of the brain), and, less commonly, inflammation of the ovaries or breasts, pancreas, joints, and other body organs. Permanent hearing loss, when it occurs, is more common in children than adults. The good news is that the disease is rarely fatal.

Diagnosis

The diagnosis of mumps is usually made by history and typical symptoms, especially parotid gland swelling. Confirmation requires blood tests, viral cultures, or other special laboratory tests and takes at least several days. Unfortunately, neither age nor history of immunity ensure that one cannot acquire mumps. As noted above, many recent cases involved those who had been previously immunized.

Treatment

There is no specific medication effective against mumps so treatment is primarily supportiv e: Tylenol, aspirin, or non-steroidal anti-inflammatory drugs for pain and fever, hot or cold compresses applied to the parotid glands, and cold compresses and support for inflamed testicles.

Protective Steps and Outbreak Control

Basic hygiene

Since mumps is primarily spread by direct contact with respiratory droplets, persons may decrease the risk of spreading or contracting mumps with a few simple actions:

1) All students should be up to date with their immunizations. Please discuss your vaccination history with the University Health Service and/or your personal physician.

2) Cover your nose and mouth with a tissue when you cough or sneeze, and throw the tissue away after use.

3) Wash your hands often with soap and water, especially after you cough or sneeze. If water is not near, use an alcohol-based hand cleaner.

4) Do not share eating utensils or drinking containers.

5) Refrain from close contact with individuals who are sick/experiencing symptoms.

6) Avoid touching your eyes, nose, or mouth. )Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.)

Vaccination

Vaccination remains the best option for mumps prevention, although it is not 100% effective. One vaccination typically provides at least 80% immunity, while a second vaccination boosts immunity to greater than 90%. It may require 2-4 weeks after vaccination for full immunity to develop, so newly vaccinated persons may develop mumps as long as a month after vaccination.

All full-time students at Northwestern should have presented evidence of mumps vaccination, documented immunity, or known illness as part of their Admission Health Record when first matriculating at the University. For those who satisfied their admission health requirements by proof of vaccination, Northwestern required evidence of only one mumps vaccination; in reality, however, most American children receive two doses, one at 12-15 months of age and another some time between 4-12 years of age. The vaccine used is typically the MMR (measles-mumps-rubella) which combines vaccination for all three of these illnesses. Part-time or other students not required to complete admission health requirements should check their immunization status and make sure that they are up to date on their vaccinations.

In addition to the general recommendations for mumps vaccination, the Illinois Department of Public Health and the Centers for Disease Control and Prevention recommend a second dose of mumps vaccine for those who have had only 1 dose, as 2 doses are more effective.

No significant adverse reactions have been associated with MMR immunization of those who are already immune. However, the mumps vaccine is not recommended for pregnant women or immunocompromised individuals (e.g., persons taking steroids or cancer chemotherapy). The cost of the MMR vaccine at the University Health Service is $52.00.

Isolation

If you suspect you have mumps, ISOLATE YOURSELF until you have an opportunity to speak with a Health Service physician. Do not go to classes, work, or social activities, and ask roommates or friends to bring you meals rather than go to the dining halls.

The Illinois Department of Public Health and the Centers for Disease Control and Prevention recommend that persons suspected of having mumps be isolated for 9 days after the onset of symptoms . Students should remain in their rooms (and, if necessary, be transferred to single rooms) as much as possible. When leaving their rooms, (e.g., for necessary washroom activities), masks should be worn. The University will provide meals to such students in their rooms rather than have them eat with other students. ISOLATION IS AN EXTREMELY IMPORTANT PUBLIC HEALTH MEASURE THAT WILL HELP LIMIT THE SPREAD OF ILLNESS TO OTHERS.

In addition, the above agencies recommend that “persons without evidence of immunity to mumps should be excluded from university settings if a mumps outbreak occurs. Once vaccinated, such students can be admitted to school. The period of exclusion of those that remain unvaccinated should be at least 25 days after the onset of parotid inflammation in the last person with mumps in the affected institution.”

Questions

For more information or to ask specific questions, please call the University Health Service at 847-491-2118.