Mumps in Central Indiana and Beyond: 2016 Update

Transcription

1 Mumps in Central Indiana and Beyond: 2016 Update Mid-America College Health Association Conference October 28, 2016 Pam Pontones, MA State Epidemiologist 1

2 Source: CDC Mumps Incidence

3 Mumps Epidemiology Reservoir Transmission Temporal Pattern Symptoms Infectious Period Incubation Period Humans only Respiratory droplets Peak in late winter-early spring Parotid swelling (uni- or bilateral) and jaw pain (9-94%) Low grade fever, cough, upper respiratory s/s, malaise, body aches, fatigue, ear pain, headaches Up to 30% are asymptomatic Two days before until five days after the date of parotitis onset Average: days after exposure Range: days after exposure

4 What Is an Outbreak? Occurrence of more cases of a disease than expected in a population during a certain time One case of anthrax, plague, botulism, or measles anywhere in the US is an outbreak requiring immediate response Epidemic and outbreak are the same Epidemic is often applied to an outbreak of special concern 4

5 Mumps Outbreak Timeline 5

6 Mumps Outbreak Timeline 6

7 Mumps Outbreak Epidemiology Setting Confirmed Outbreak Outbreak Case Count Start Date End Date Butler University 24 2/12/16 5/9/16 Indiana University Bloomington 74 2/17/16 9/10/16 IUPUI 8 3/11/16 8/13/16 Purdue University 59 4/2/16 8/20/16 Community 77 n/a n/a Total 242 2/12/16 9/10/16 Vaccination Status Doses University Cases Community Cases 1 MMR 4.8% 15.6% 2 MMR 70.3% 50.6% 2 MMR (self report) 7.9% 14.2% 3+ MMR 6.7% 0.0% unvaccinated 2.4% 3.9% unknown 7.9% 15.6% SYMPTOMS n (%) Fever 100 (41.3%) Headache 64 (26.4%) Parotitis 235 (97.1%) Earache 51 (21.1%) Malaise/Body Aches/Fatigue 6 (2.5%) Jaw pain 15 (6.2%) Sore throat 10 (4.1%) Orchitis 4 (1.6%) Meningitis 1 (0.4%) Ages of university cases ranged from 18 to 38 years (mean: 21.6 years; median: 21 years) Ages of community cases ranged from 4 to 55 years old (mean: 29.1 years; median 26 years). Seven vaccination clinics were held at three; ~5100 MMR doses administered 7

8 Mumps Epidemic Curve Figure 1. Mumps cases by week of parotid swelling onset. MMWR Week 3 corresponds with the week ending January 23, MMWR Week 38 corresponds with the week ending September 24,

9 Points of Interest Successes Partnerships and Communication Vaccination Clinic Logistics and Administration Laboratory Testing Challenges Disseminating Testing Protocol Vaccination Record-Keeping Personnel Capacity 9

10 Lessons Learned Need for more standardized record keeping of vaccination records Implementing a strong control measure protocol and high mass vaccination coverage seems to be helpful in containing outbreaks early Need for better understanding of why these types of outbreaks are occurring (e.g. risk factors) Plans must be in place for how to allocated resources and personnel capacity for not just large, but also long-lasting outbreaks 10

11 Other Mumps Outbreaks Iowa: Over 600 lab-confirmed cases since July, 2015 Ongoing transmission as of October 2016 noted at University of Iowa, University of Northern Iowa, and many communities Third-dose recommended in August 2015, multiple vaccination clinics at University of Iowa Illinois: 317 confirmed/probable cases from April 2015-May 2016 No current transmission at University of Illinois 89% of cases had two documented MMR doses Third dose recommended, ~8,200 MMR doses given over 5 clinics between August 6-27, /50 cases who had received a third dose developed parotitis > 4 weeks from 3 rd dose vaccination 1% of cases experienced complications of mumps (orchitis, meningitis) Sources:

12 Other Mumps Outbreaks Massachusetts: ~60 confirmed cases since February 2016 Vaccination clinics held at Harvard University Restrictions on attending graduation implemented for cases and close contacts without documentation of vaccination Oklahoma: Over 40 confirmed cases since July 2016 Ongoing community transmission; no university involved No hospitalizations or other complications currently reported 74% of cases had documentation of age-appropriate doses of MMR Sources:

13 Other Mumps Outbreaks Arkansas: 391 cases under investigation by October 4, 2016 Ongoing community transmission; likely source from U of Iowa, but no university involved Impacts 13 workplaces and two school districts Vaccine coverage 89.3% of school-age children have documentation of two doses 33.9% of adults have had documentation of two doses Additional outbreaks reported in 2016 University of Kentucky Eastern Illinois University University of Dayton (Ohio) University of San Diego Sacred Heart University (Connecticut) Long Beach, NY (mainly community-wide outbreak) University of Wisconsin St. Anselm College (New Hampshire) Sources:

14 Questions? Pam Pontones State Epidemiologist Indiana State Department of Health

15 Butler Epidemiology CASE COUNTS Confirmed 24 Probable 1 Community* 3 * Cases reporting a direct association or connection in comments. SYMPTOMS n (%) fever 13 (52%) headache 11 (44%) parotitis 23 (92%) earache 9 (36%) malaise 0 (0%) Jaw pain 2 (8%) sore throat 2 (8%) orchitis 0 (0%) Most frequently reported keyword: Sigma Chi (28% of cases) 23/25 had 2+ doses of MMR; 8/25 cases had 3+ doses of MMR. 7 of the 8 had received a dose at a Butler clinic, but only one person MAYBE would have been exposed after vaccination. 23/25 seen at Butler Health Services 9/25 students were Indiana residents Average age of cases was (median = 20) ~70 students were tested at ISDH Lab between February and May

16 Maximum Incubation Period Butler Epi Curves

17 IU Bloomington Epidemiology CASE COUNTS Confirmed 74 Probable 9 Community 21* * Confirmed and probable, with or without direct link to IU students/staff. Vaccination Status Doses Count 2 MMR 73 2 MMR (self report) 1 3 MMR 3 unknown 1 unvaccinated 1 Of those with 3 MMRs, one vaxed 1-2 months before symptoms, two had a third dose within the last 3-4 years Keyword # of mentions bars 9 Kilroys 25 Sports 9 Little fraternity 5 sorority 2 Brothers 9 Average age of cases was (median = 22) ~70 students were tested at ISDH Lab between February and September 5 cases who were PCR+ also had IgMs reported. 2/5 were SYMPTOMS n (%) fever 19 (22.8%) headache 13 (15.7%) parotitis 81 (97.6%) earache 7 (8.4%) Malaise/Body Aches 4 (4.8%) Jaw pain 6 (7.2%) sore throat 4 (4.8%) orchitis 2 (2.5%) Facility Total IU Health Center 44 Bloomington Hospital ED 10 Urgent Care 8 MedExpress Bloomington 6 Lab from IU Path Lab 4 PCP 4 Medcheck Carmel 2 Community Hospital North 1 Deaconess Hospital 1 Decatur County Memorial Hospital 1 Hancock Regional 1 IUPUI Campus Health 1 Margaret Mary Community Hospital 1 Noblesville Family Medicine 1

18 IUB Epi Curve

19 IUPUI Epidemiology CASE COUNTS Confirmed 8 Probable 1 Facility Never any strong evidence of oncampus transmission 3/9 cases reported frequenting or working at downtown Indy locations Average age of cases was 22 (median = 22) ~10 students were tested at ISDH Lab between March and August One case who was PCR+ also had IgMs reported, and was IgM- Total IUPUI Student Health Center 4 PCP 2 Medcheck Speedway 1 Johnson Memorial Hospital 1 Good Samaritan Hospital 1 Vaccination Status Doses Count 1 MMR 3 2 MMR 4 2 MMR (self report) 1 unvaccinated 1 IUPUI did not require formal documentation of vaccinations for entry, but began requiring this starting fall SYMPTOMS n (%) fever 3 (33.3%) headache 4 (44.4%) parotitis 9 (100%) earache 7 (77.8%) Malaise/Body Aches 0 (0%) Jaw pain 0 (0%) sore throat 0 (0%) orchitis 0 (0%)

20 IUPUI Epi Curve

21 Purdue Epidemiology CASE COUNTS Confirmed 59 Probable 12 Community 9 Facility Average age of cases was 21.9 (median = 22) ~60 students were tested at ISDH Lab between April and August One case who was PCR+ also had IgMs reported, and was IgM+ Total Vaccination Status Doses Count 1 MMR 4 2 MMR 49 2 MMR (self report) 11 unvaccinated 3 3+ MMR 2 unknown 11 SYMPTOMS n (%) fever % headache % parotitis % earache 7 9.9% Malaise/Body Aches 1 1.4% Jaw pain 3 4.2% sore throat 1 1.4% orchitis 1 1.4%