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Indiana State Department of Health

Epidemiology Resource Center Home > Surveillance and Investigation > Surveillance and Investigation Division > Newsletters > Indiana Epidemiology Archived Newsletters > Epi_Newsletter_November_2006-Page2 New Mumps Laboratory Recommendations

Indiana Epidemiology Newsletter
November 2006

Wayne Staggs, MS
Epidemiologist

The Centers for Disease Control and Prevention (CDC) recently issued modified laboratory recommendations for testing of persons suspected of having mumps. These recommendations were published in the MMWR on October 27, 2006. The changes in the recommendations are excerpted from the article as follows:

“Health-care providers should continue to remain alert for suspected mumps cases, conduct appropriate diagnostic testing, and report these cases to local or state health departments. At the initial visit, recommended specimens for laboratory testing include serum to test for mumps immunoglobulin M (IgM) antibodies and a swab from the parotid duct or other affected salivary gland ducts for viral isolation, reverse transcriptase-polymerase chain reaction testing, or both. Parotid duct swab is the preferred viral sample for mumps; urine samples are no longer recommended. The first (acute) serum specimen should be collected within 5 days of illness onset. If the IgM antibody titer is negative, a second (convalescent) serum specimen for IgM antibodies is recommended 2-3 weeks after onset of signs (e.g., parotitis) or symptoms; a delayed IgM response has been observed in patients with confirmed cases of mumps, especially in vaccinated persons. The paired serum specimens also can be used to detect a significant rise (as defined by the testing kit instructions) in immunoglobulin G (IgG seroconversion) if measured by enzyme-linked immunosorbent assay or a fourfold rise in titer if measured using plaque-reduction neutralization assays or similar quantitative assay.”

The entire MMWR article entitled “Brief Report: Update: Mumps Activity - United States, January 1-October 7, 2006” is available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5542a3.htm.

Effective immediately, the ISDH will implement these recommendations. In addition to the above recommendations regarding serologic analysis, the ISDH encourages convalescent specimens on all patients even if the acute specimen result is positive. The recommendations from the ISDH are summarized as follows:

  • Oral fluid from the parotid duct or other affected salivary gland ducts (buccal swabs) are the preferred specimen for viral isolation and PCR testing of mumps. Urine specimens should no longer be collected.
     
  • Acute and convalescent serologic specimens should be collected on patients suspected of having mumps. The acute specimen should be collected within 5 days of onset of symptoms, and the convalescent should be collected 2-3 weeks following onset of symptoms.
     
  • Specimens should be submitted to the ISDH Laboratory. Detailed instructions for collection, handling and shipping of specimens are available at the Indiana State Department of Health Web site, http://www.in.gov/isdh/. Click on Health Professionals and then Disease Information.

These new recommendations are posted on the ISDH Web site (same address as above) and are included below so you will have immediate access to them.

Mumps Specimen Collection and Analysis: For laboratory confirmation of the diagnosis of mumps, the ISDH recommends that health care providers collect buccal swabs for viral culture/PCR testing and paired sera for immunologic analysis.

Indiana State Department of Health Laboratory Testing Services

Clinical Specimens

Clinical specimens should be collected from all suspected cases. Clinical specimens (buccal swab and throat swab) should be obtained for viral isolation in cell culture within 1-4 days after onset of symptoms if possible. However, specimens collected up to 9 days post-onset may be acceptable. Keep the samples cold (4C) or frozen (-70C). Avoid freeze-thaw cycles.

Parotid gland/buccal swabs of oral secretions may provide the best viral samples (urine specimens are no longer recommended). Use a plastic shaft/Dacron tip swab for collecting swab samples. Massage the parotid gland area (the space between the cheek and teeth just below the ear) for about 30 seconds prior to collection of the buccal secretions. The parotid duct (Stensen's duct) drains in this space near the upper rear molars. A throat swab (oropharyngeal or nasopharyngeal swab with a wire shaft/Dacron tip) can also be collected and added with the buccal swab. Place swab(s) in a tube containing 2-3 mls of viral transport medium (VTM) or other sterile isotonic solution (phosphate buffered saline or cell culture medium). Swabs can be frozen at -70C or held at 4C until shipment.

The Virology/Immunology Request Form, State Form 35212 (R3/5-03), available at http://www.IN.gov/isdh/healthinfo/westnile/35212.pdf, should be completed and sent with the specimens. Please complete a separate form for each specimen. Specimens should be shipped in an insulated container using ice packs or dry ice. If clinical specimens for viral isolation will be delivered via courier, pack specimens according to the shipping requirements for Category B Infectious Substances and route to:

Indiana State Department of Health Laboratories
Attn: Virology Lab
7230 Western Select Drive
Indianapolis, Indiana 46219

If specimens will be delivered via U.S. Postal Service, pack specimens according to U.S. Postal Service shipping requirements for diagnostic/clinical specimens and route to:

Indiana State Department of Health Laboratories
Attn: Virology Lab
P.O. Box 7203
Indianapolis, Indiana 46207-7203

Serologic Specimens

Acute and convalescent serologic specimens should be collected on patients suspected of having mumps. The acute specimen should be collected as soon as possible after onset of symptoms (within 5 days is preferred) and submitted to the ISDH Laboratory after collection for initial IgM and IgG analysis. The convalescent serum specimen should be obtained 2-3 weeks after onset. For both specimens, submit at least 3 ml of serum in the plastic screw-capped vial provided in the mailing container (ISDH type 9A). Store and ship specimens cold (4C) (using ice packs). Serum specimens may be shipped without refrigeration in a suitable mailing container (e.g., ISDH type 9A). Serum is the preferred specimen, but 5-10 ml of whole blood is acceptable.

The Virology/Immunology Request Form, State Form 35212 (R3/5-03), available at http://www.IN.gov/isdh/healthinfo/westnile/35212.pdf, should be completed and sent with serologic specimens. If specimens will be delivered via U.S. Postal Service, route to:

Indiana State Department of Health
Virology/Immunology
P.O. Box 7203
Indianapolis, Indiana 46207-7203

If specimens will be delivered via courier/drop off, route to:

Indiana State Department of Health
Virology/Immunology
635 North Barnhill Drive, Room MS2023
Indianapolis, Indiana 46202

ISDH type 9A mailing containers and Virology/Immunology Request Forms can be obtained from the ISDH Laboratories by telephone at 317.233.8105 or by e-mail at
containers@isdh.IN.gov. For questions, please contact the ISDH Laboratories at 317.233.8000.