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Indiana Epidemiology Newsletter
Wayne Staggs, MS
Vaccine Preventable Epidemiologist
As of June 16, the Indiana State Department of Health (ISDH) is reporting seven cases of mumps for 2006. Two of the cases are classified as confirmed, and five are classified as probable cases*. Both confirmed cases had parotid gland swelling onset in April.
|*A confirmed case is 1) laboratory confirmed; or 2) meets the clinical case definition and is epidemiologically linked to a confirmed or probable case. A probable case meets the clinical case definition, has no laboratory confirmation, and is not epidemiologically linked to a confirmed or probable case. The clinical case definition for mumps is an illness with acute onset of unilateral or bilateral tender, self-limiting swelling of the parotid or other salivary gland lasting >2 days and without other apparent cause. For additional information on the typical physical findings and complications of mumps, visit the CDC Web site at http://www.cdc.gov/nip/diseases/mumps/faqs-phys-complic.htm.|
Numerous reports of suspected cases of mumps have been investigated by the ISDH Immunization staff this year. Since April 24, oral fluid and/or urine specimens have been collected and submitted for mumps analysis on 85 persons living in Indiana. Two (2%) of those 85 persons were confirmed as having mumps by RT-PCR analysis at the Centers for Disease Control and Prevention. The remaining 83 persons had negative PCR results. No outbreaks or clustering of confirmed, probable, or suspected cases have been identified in Indiana. In addition, none of the cases investigated by ISDH staff has a known direct link to a case from the multi-state outbreak, which began in Iowa and was recently featured in an MMWR Dispatch on May 18, 2006. The Dispatch can be found at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm55d518a1.htm.
Based on the small number of laboratory-confirmed cases and lack of epidemiologically linked cases, it is felt that Indiana is not experiencing widespread mumps virus circulation or an outbreak environment.
Please note that serologic testing is not being used as laboratory evidence to confirm or rule out mumps cases in Indiana. For laboratory confirmation of the diagnosis of mumps, the ISDH recommends health care providers collect buccal swabs and/or urine specimens for viral culture and PCR testing. For additional information on laboratory collection of specimens for mumps analysis, please visit the ISDH Web site at http://www.IN.gov/isdh/ or call the ISDH Laboratory at 317.233.8000.
In a special meeting held May 17, 2006, the ACIP updated criteria for mumps immunity and recommendations for mumps vaccination. You may review the updated recommendations in the Notice to Readers published by the MMWR on June 1, 2006, at:
To avoid outbreaks such as the one which has occurred in Iowa, the ISDH will be incorporating these changes into immunization program policy in the next few months. In the meantime, all immunization providers, schools (K-12), post-high school education institutions, and health care facilities are strongly encouraged to implement these recommendations immediately. Although these recommendations will not become school or college entry requirements for the 2006-2007 year, the ISDH is requesting that schools and colleges identify students with only one dose of mumps vaccine, contact them or their parents, and encourage a second dose of mumps vaccine. We have provided a summary of the ACIP changes in the box below
SUMMARY OF CHANGES TO
Acceptable Presumptive Evidence of Immunity
Routine Vaccination for Health Care Workers
For Outbreak Settings
*Minimum interval between doses = 28 days