Mumps - Technical Information

Mumps in the Midwest

December 2005 saw the beginning of a mumps outbreak in Iowa that soon spread to multiple other states. As of October 2006, over 5,783 confirmed and probable cases of mumps have been detected across 45 states in conjunction with the outbreak. Arizona was not part of this outbreak. Mumps cases peaked in late April and the number of reported cases per week decreased from that point through September. With the return of students to college, however, new clusters were reported at three campuses in the Midwest.

Due to the size of the Midwest mumps outbreak and the potential for spread to Arizona, ADHS has provided guidance to define mumps cases, guide surveillance, assist in diagnosis, give recommendations for excluding cases and unvaccinated children from school, and give immunization recommendations for children, teachers, health care workers, and the general public.

Though the median number of confirmed mumps cases in Arizona over the last five years is only one case, Arizona had three confirmed cases of mumps reported between January and October 1, 2006. This increase is likely due to the enhanced surveillance for mumps that has taken place in response to the outbreak in the Midwest.

• ADHS Mumps Recommendations

Reporting Requirements

• Health Care Providers, Health Care Institutions, and Correctional Facilities
• Clinical Laboratories
• Schools, Child Care Establishments, and Shelters

Characteristics

• Infectious Agent: The mumps virus is a paramyxovirus in the same group as influenza.
• Mode of Transmission: Direct or droplet contact with respiratory secretions of an infected person.
• Communicability:  The infectious period is considered to be from 2 days before parotitis onset to 9 days after parotitis onset.
• Incubation Period:  12-25 days, though symptoms typically appear 16-18 days after infection 
• Clinical Features
• Subclinical Infection:
• Up to 20% of persons infected with mumps are asymptomatic.  An additional 40-50% may have only nonspecific or mild respiratory problems.
• Prodrome:
• Prodromal symptoms are nonspecific and include myalgia, anorexia, malaise, headache, and low-grade fever.
• Parotitis:
• A swelling of the parotid glands, which may be noted as earache or tenderness on touching the angle of the jaw.  Unilateral or bilateral, affecting any combination or single or multiple salivary glands, occurs in 30-40% of infected persons.  Symptoms tend to decrease after one week and are usually gone by 10 days.

Arizona Administrative Code: R9-6-349

1. Case control measures
   1. An administrator of a school or child care establishment, either personally or through a representative, shall exclude a mumps case from the school or child care establishment for nine days after the onset of glandular swelling.
   2. A health care provider shall use droplet precautions with a mumps case for nine days after the onset of glandular swelling.
   3. A local health agency shall conduct an epidemiologic investigation of each reported mumps case or suspect case. For each mumps case, a local health agency shall complete and submit to the Department within 10 working days after completing an epidemiologic investigation:
      1. A Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, "Mumps Surveillance Worksheet" (May 1998), which is incorporated by reference, on file with the Department, and available from the Centers for Disease Control and Prevention, Division of Viral and Rickettsial Diseases, 1600 Clifton Rd., NE, Mailstop A-30, Atlanta, GA 30333, including no future editions or amendments; or
      2. An electronic equivalent to the "Mumps Surveillance Worksheet" [PDF 67K] provided by the Department.
2. Contact control measures: When a mumps case has been at a school or child care establishment, the administrator of the school or child care establishment, either personally or through a representative, shall:
   1. Consult with the local health agency to determine who shall be excluded and how long each individual shall be excluded from the school or child care establishment, and
   2. Comply with the local health agency’s recommendations for exclusion.