Health

Alert

DPH INVESTIGATING MUMPS OUTBREAK ASSOCIATED WITH FEBRUARY 10, 2018 BAILE MEXICANO DANCE AT CHASE CENTER, WILMINGTON

Summary

The Delaware Division of Public Health (DPH) is issuing this health advisory to alert health

care providers of an outbreak of mumps in New Castle County and to provide guidance on mumps

clinical features, laboratory testing, prevention, and reporting. DPH urges providers to:

1. Report patients with a clinical picture compatible with mumps to DPH as soon as possibleand without waiting for the return of laboratory results.
2. Offer MMR vaccination to persons who report attending the Baile Mexicano dance that washeld at the Chase Center on the Riverfront in Wilmington on February 10, 2018, as long as

   there are no contraindications. Those who are not up to date on MMR vaccination should be

   brought up to date. Also consider offering a third dose to those who are up to date.

3. Offer MMR vaccination to household contacts of persons with confirmed mumps as long asthere are no contraindications to vaccination. This includes those who are not up to date

   on their mumps vaccinations as well as those who are up to date (to whom a third dose of

   MMR should be offered).

Background

As of March 20, 2018, there are three known cases of mumps (one confirmed and two probable

cases) with a fourth case being investigated. The three cases identified so far are all known

to have attended a social dance (Baile Mexicano or Mexican Dance) that took place at the Chase

Center on the Riverfront in Wilmington on February 10, 2018. DPH is sharing information about

mumps with health care providers to help identify others who may have been exposed to mumps at

this event. The Centers for Disease Control and Prevention (CDC) notes that a substantial

increase in the number of mumps outbreaks and outbreak-associated cases have occurred in the

United States since late 2015.

Clinical manifestations

Mumps is an acute viral infection characterized by a non-specific prodrome including myalgia,

anorexia, malaise, headache, and fever, followed by acute onset of unilateral or bilateral tender

swelling of parotid or other salivary glands. Mumps infection may on occasion present with only

respiratory symptoms, or may be asymptomatic. Previously vaccinated persons are less likely to

present with severe symptoms or complications than under-vaccinated or unvaccinated persons.

Complications of mumps infection can include deafness, orchitis, oophoritis meningitis and

encephalitis. Complications of mumps tend to occur more frequently among adults than children.

According to the CDC, death from mumps is exceedingly rare.

Transmission

Transmission of mumps virus occurs by direct contact with respiratory droplets, saliva, or

contact with contaminated fomites. The incubation period is generally 16 to18 days (ranging from

12 to 25 days) from exposure to onset of symptoms. Mumps is most infectious from two days before,

to five days after, symptom onset but asymptomatic people can transmit the disease.

Diagnosis

Laboratory testing for mumps may be done by testing blood specimens sent for serology and by

polymerase chain reaction (PCR) testing of buccal swabs. Urine is a less reliable specimen for

testing, but is an option.

For serology testing, acute phase serum should be obtained as soon as possible and convalescent

serum should be obtained two to three weeks later. Buccal swabs for PCR testing are collected by

massaging the parotid gland prior to swabbing the area around the Stensen’s duct. Swabs should be

collected using synthetic swabs; not with cotton swabs. A video from the CDC on how to collect

buccal samples is listed under “Additional Information.” Information on how to transport specimens

is also listed under “Additional Information.”

Note that in patients with a compatible clinical syndrome and in the right epidemiologic context

(attendance at the Baile Mexicano dance or contact with persons who attended the dance), mumps should

not be ruled out on the basis of negative laboratory results. Serologic tests should be interpreted with

caution particularly in those previously vaccinated against mumps, as false negative IgM results

(negative IgM in person with mumps) may occur.

Prevention

The principal strategy to prevent mumps is to achieve and maintain high immunization levels. Mumps

can be prevented with the MMR vaccine. This protects against three diseases: measles, mumps, and rubella.

The CDC recommends children get two doses of MMR vaccine, starting with the first dose at 12 to 15 months

of age, and the second dose at four to six years. Teens and adults who did not get the recommended MMR

vaccines per the above schedule should be vaccinated so they are up-to-date.

During mumps outbreaks, the Advisory Committee on Immunization Practices recommends that persons previously

vaccinated with two doses of a mumps virus-containing vaccine (MMR or MMRV) who are identified by public health

authorities as being part of a group or population at increased risk for acquiring mumps because of an outbreak

should receive a third dose of a mumps virus-containing vaccine to improve protection against mumps disease and

related complications.

As such, DPH is recommending that patients who identify as having attended the Baile Mexicano dance at the

Chase Center on the Riverfront in Wilmington, on February 10, 2018, be offered a dose of MMR. In addition,

household contacts of persons diagnosed with mumps should be vaccinated with MMR regardless of whether or not

these household contacts are up to date on their vaccines.

Those patients who attended the Baile Mexicano or are household contacts of persons with mumps and who do not

have health insurance or whose insurance does not cover MMR, should call the DPH’s New Castle County location

at the Hudson State Service Center Immunization Clinic at 302-283-7587, (and select option #2), for an appointment

to get an MMR vaccine. Patients who live in Kent County and need vaccination may call DPH’s Kent County Immunization

Clinic at 302-857-5140 and those in Sussex County may call DPH’s Georgetown Immunization Clinic at 302-515-3220

Patients suspected of having mumps should be instructed to self-isolate at home for five days after symptom onset

and should be advised to stay away from work and school.

Reporting

Mumps is a rapidly reportable disease in Delaware. Suspected cases of mumps should be reported to DPH via fax

at 302-223-1540; email at reportdisease@delaware.gov; or phone, 302-744-4990. Do not wait for laboratory test results

to return before reporting.

Additional Information

1. Video on collection of buccal swab https://www.youtube.com/watch?v=ThvoJBjsUvQ
2. Specimen transport https://www.cdc.gov/mumps/lab/specimen-collect.html
3. CDC information for providers https://www.cdc.gov/mumps/hcp.html
4. Guidance on administration of third dose of MMR during outbreaks https://www.cdc.gov/mmwr/volumes/67/wr/mm6701a7.htm

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