HEALTH ADVISORY: Mumps
April 12, 2017

The Texas Department of State Health Services is investigating multiple outbreaks of mumps throughout the state of Texas. The recent resurgence of the mumps virus has resulted in Texas experiencing the highest incidence of mumps in 22 years. State, regional, and local health departments are currently investigating multiple outbreaks throughout the state, including one that includes possible exposures on South Padre Island. Mumps cases potentially linked to South Padre Island first came to light this week when another state health department contacted DSHS about a patient with mumps who had traveled to the area for spring break. DSHS alerted other states and, as of April 11, has been notified of 13 mumps cases in people who traveled to South Padre Island between March 8 and March 22 from six states, including two cases from Texas.

Due to the highly communicable nature of this disease, please consider mumps as a diagnosis for any patients presenting with the following symptoms, particularly those who have traveled out of the state or have come into contact with known mumps cases:

• Unilateral or bilateral swelling of the parotid or salivary glands preceded by a low-grade fever, myalgia, malaise, or headache

Complications or other presentations are rare and usually mild but include deafness, pancreatitis, oophoritis, meningitis, and encephalitis. Additionally, up to 20 percent of those infected may be asymptomatic.

Vaccination: Check the vaccination status of all patients and offer vaccine to anyone that is not up-to-date. CDC guidance for mumps vaccination may be found here: https://www.cdc.gov/mumps/vaccination.html.

Disease Reporting: Several Texas laws (Health & Safety Code, Chapters 81, 84, and 87) require specific information regarding notifiable conditions be provided to DSHS. Health care providers, hospitals, laboratories, schools, childcare facilities and others are required to report patients who are suspected of having mumps (Chapter 97, Title 25, Texas Administrative Code).

In Texas, diagnosis or suspicion of mumps is required to be reported within one work day. Do not wait for laboratory confirmation to report suspect mumps cases. Mumps reports should be made to your local health department or by calling 800-705-8868.

Laboratory Confirmation Testing: Both of the following specimens should be collected for all patients suspected to have mumps at the time of the initial medical visit:

• Buccal swab (preferred) for viral isolation and PCR testing.
  • Ideally, specimen collection should happen within three days of onset of parotitis, but specimens may be collected up to 10 days after parotitis onset.
  • PCR positive buccal swabs may be forwarded to the CDC for genotyping.
• Blood drawn and submitted for serological testing to detect IgM antibody.
  • NOTE: individuals previously vaccinated may not develop detectable IgM antibodies therefore a buccal swab is highly recommended.
  • Specimen collection should take place between three and seven days after parotitis onset.

Infection Control: Mumps is transmitted from person to person by respiratory droplets or saliva. The incubation period is 16-18 days (range of 12-25 days) from exposure to onset of parotitis. Persons are contagious from 3 days before to 5 days after onset of parotitis. Patients admitted to a healthcare facility should be placed on droplet precautions and a minimum of a plain surgical mask should be used when caring for patients with suspected or confirmed mumps.

All healthcare facilities should ensure that they have updated documentation of mumps immunity status for all staff—not just healthcare providers. Documentation of immunity includes written record of receipt of two MMRs, positive serological titers, or birth prior to 1957. Healthcare facilities should consider vaccinating unvaccinated personnel born before 1957 who do not have laboratory evidence of mumps immunity.

People suspected of having mumps should be told to stay home from work, school, daycare, and any public outings (e.g., church, grocery store) until five days have passed since symptom onset. Household and close contacts of suspected mumps cases should be advised to watch for signs and symptoms of mumps for up to 25 days after last exposure. Only contacts who develop signs or symptoms consistent with mumps should be advised to be excluded from work, school, or group settings. Individuals who develop signs or symptoms of mumps should contact their healthcare provider prior going to a clinic setting for care and testing to ensure proper prevention and control measures are taken to prevent the further spread of disease.