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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_June_2006-Page2 Indiana Mumps Update

Indiana Epidemiology Newsletter
June 2006

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.

Updated Recommendations of the Advisory Committee (ACIP) for the Control and Elimination of Mumps

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:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm55e601a1.htm.

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
1998 ACIP RECOMMENDATIONS ON MUMPS
MAY 17, 2006

Acceptable Presumptive Evidence of Immunity

  • Documentation of adequate vaccination is now two doses of mumps virus vaccine instead of one dose for:
    • School-aged children (i.e., grades K-12).
    • Adults at high risk (i.e., persons who work in health care facilities, students at post-high school educational institutions, and international travelers).

Routine Vaccination for Health Care Workers

  • Persons born during or after 1957 without other evidence of immunity: two doses of a live mumps virus vaccine.
  • Persons born before 1957 without other evidence of immunity: consider recommending one dose of live virus mumps vaccine.

For Outbreak Settings

  • Children aged 1-4 years and adults at low risk: if affected by the outbreak, consider a second dose* of live mumps virus vaccine.
  • Health care workers born before 1957 without other evidence of immunity: strongly consider recommending two doses of live mumps virus vaccine.

*Minimum interval between doses = 28 days