11/19/2018 MUMPS SYRACUSE UNIVERSITY Background

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1 MUMPS SYRACUSE UNIVERSITY Background VIRAL ILLNESS CAUSED BY A PARAMYXOVIRUS HUMANS ONLY RESERVOIR AVERAGE INCUBATION FROM EXPOSURE TO SYMPTOMS STARTING IS DAYS WIDESPREAD VACCINATION IN US STARTED IN 1967 PRIOR TO VACCINATION, AVERAGE 200K CASES/YEAR. NOW 99% LESS PEOPLE AFFECTED BUT OUTBREAKS SINCE

2 CDC Website Cdc website 2

3 MUMPS OUTBREAKS ANYTIME OF YEAR STILL OCCURING IN HIGHLY VACCINATED COMMUNITIES RISKS CROWDED ENVIORMENTS-CLASSROOMS, DORMS, TEAMS EXCHANGING SALIVA-SHARING CUPS/UTENSILS/WATER BOTTLES/SPORTS EQUIPMENT/LIP BALM/CIGARETTES, KISSING 2006-MULTISTATE, PRIMARILY MIDWEST ON COLLEGE CAMPUSES > 6500 CASES 2009/ LARGE OUTBREAKS, 1 > 3,000 MOSTLY HIGH SCHOOL AGE IN TIGHT KNIT RELIGIOUS COMMUNITY IN NY STATE MORE MUMPS OUTBREAKS MULTIPLE ON COLLEGE CAMPUSES, BUT LIMITED SPREAD SEVERAL AT UNIVERSITIES IN MULTIPLE STATES LARGEST IN IOWA AND ILLINOIS HAD WIDESPREAD VACCINE CAMPAIGNS COMMUNITY OUTBREAKS LARGEST IN ARKANSAS ALMOST 3, HARVARD, MISSOURI, SUNY NEW PALTZ,UNIVERSITY OF WASHINGTON, INDIANA, U OF SANDIEGO, SYRACUSE UNIVERSITY 3

4 MUMPS PRESENTATION NONSPECIFIC SYMPTOMS MAY OCCUR SEVERAL DAYS PRIOR (CALLED A PRODROME) AND INCLUDE : FEVER-LOW GRADE, LASTING 3-4 DAYS MYALGIA, LOSS OF APPETITE, MALAISE, HEADACHE PAROTITIS-SWELLING, PAIN AND TENDERNESS OF THE PAROTID GLAND LASTS 2-3 DAYS GENERALLY BUT UP TO 10 DAYS MAY INVOLVE ONE (25%)OR BOTH SIMULTANEOUSLY OR SEPARATELY SWELLING ANY OF THE SALIVARY GLANDS CAN BE INVOLVED ONLY SUBMANDIBULAR OR SUBLINGUAL GLAND 10% OF CASES ASYMPTOMATIC CASES MAY BE UP TO 20% 4

5 COMPLICATIONS ASEPTIC MENINGITIS ENCEPHALITIS ORCHITIS OOPHORITIS HEARING LOSS PANCREATITS MYOCARDITIS ORCHITIS OCCURS IN 3-10% OF POST VACCINE ERA MUMPS CASES IN MALES OOPHORITIS RATE 1% IN POST PUBERTAL FEMALES IN POST VACINE ERA MUCH MORE COMMON PRIOR TO VACCINE ERA ARTHRITIS TRANSMISSION OF MUMPS MUMPS VIRUS MULTIPLIES IN UPPER RESIRATORY TRACT SPREAD BY RESPIRATORY DROPLETS AND SALIVA OR BY DIRECT CONTACT WITH INFECTED SURFACE ( desk, doorknob, water bottle) VIRUS SHED FOR 2 DAYS PRIOR AND UP TO 5 DAYS AFTER ONSET OF PAROTITIS INFECTION CAN OCCUR BY DROPLETS UP TO A DISTANCE OF 3 FEET 5

6 TESTING FOR MUMPS POSITIVE DIAGNOSIS IS MADE BY: ISOLATION OF VIRUS IN CULTURE FROM BUCCAL/ORAL SWAB POSITIVE MUMPS PCR FROM BUCCAL/ORAL SWAB POSITIVE IGM ON SERUM TEST 4X INCREASE IN IGG OR NEW IGM OR IGG NOT PREVIOUSLY PRESENT ON A CONVALESCENT SAMPLE DAYS AFTER ORIGINAL BLOODWORK. BEST TO SWAB WITHIN 3 DAYS OF ONSET OF PAROTITIS CASE CLASSIFICATION/DEFINITIONS CONFIRMED- POSITIVE PCR FROM BUCCAL/ORAL SWAB OR CULTURE WITH ACUTE ILLNESS PROBABLE- ACUTE PAROTITS FOR > 2 DAYS WITH A POSITIVE IGM OR LINK TO A CONFIRMED CASE IN AN OUTBREAK OUTBREAK- 3 OR MORE CASES OF THE DISEASE IN A COMMON SETTING WITHIN AN INCUBATION PERIOD 6

7 SYRACUSE UNIVERSITY OUTBREAK 1 ST CASE PRESENTED AUGUST 30 TH, 2017 STUDENT CONTRACTED WHILE TRAVELING IN ASIA PLAYED A CLUB SPORT 2 ND WAVE- 5 CASES ( 3 CONFIRMED, 2 PROBABLE) SEPTEMBER 16 th - 22nd 3 RD WAVE- 18 CASES BETWEEN OCTOBER 3 RD AND 6 TH ( 13 CONFIRMED AND 5 PROBABLE ) ONONDAGA COUNTY DECLARED AN OUTBREAK SEPTEMBER 22ND TOTAL SYRACUSE UNIVERSITY OUTBREAK CONFIRMED 54 PROBABLE 91 TOTAL 145 ALL STUDENTS EXCEPT 2 PROBABLE WERE EMPLOYEES ATHLETICS OUTBREAK STARTED IN STUDENTS ASSOCIATED WITH ATHLETICS MULTIPLE MENS AND WOMENS TEAMS INVOLVED INCLUDING MENS AND WOMENS LACROSSE (LARGEST GROUP),MENS SOCCER, ROWING, MENS BASKETBALL, FOOTBALL 23/54 CONFIRMED AND 18/91 PROBABLE WERE ATHLETES 9/10 FIRST CONFIRMED CASES ATHLETES 2 EMPLOYEE CASES WORKED IN ATHLETICS SUSPECTED ROUTES OF SPREAD-SHARING WATER BOTTLES, SHARING SPORTS EQUIPMENT, TRAINING ROOM-SURFACE AND DIRECT CONTACT, LEARNING CENTER- SURFACE AND DIRECT CONTACT, SOCIAL CONTACT AT PARTIES, ROOMMATES 7

8 GREEK COMMUNITY CASE 24 IN SORORITY, CASE 35 SORORITY 14 CONFIRMED CASES 18 PROBABLE 12 OF LAST 25 CASES ASSOCIATED WITH FRATERNITY/SORORITY ROUTES OF SPREAD-ROOMMATE, INTIMATE CONTACT, SOCIAL CONTACT AT PARTIES, SHARING DRINKS SU MUMPS DEMOGRAPHICS AVERAGE AGE 20.5 YEARS 18% FRESHMAN, 23% SOPHMORE, 25% JUNIOR, 22% SENIOR, 11% GRAD 62% LIVED OFF CAMPUS, 38% LIVED ON CAMPUS SEX 55% FEMALE 45% MALE RACE 83% CAUCASIAN, 5% AFRICAN AMERICAN, 3% ASIAN 2% LATINO AND 2% NATIVE AMERICAN OTHER ROUTES OF SPREAD- CLASSROOM, BUS FROM SOUTH CAMPUS, WORK IN DORMITORY FRONT DESK 8

9 MANAGEMENT OF OUTBREAK WHEN 2 ND CASE REPORTED, SYRACUSE UNIVERSITY LACKED IMMUNIZATION STATUS OF 2,000 STUDENTS WITHIN A FEW DAYS-1,000 STUDENTS AND SEPTEMBER 20 TH ONONDAGA COUNTY HEALTH DEPARTMENT GAVE US 5 DAYS TO TRACK DOWN THE REST USED TEXT MESSAGING, S, ROBOCALLS, PHONE BANK TO REACH STUDENTS FOR IMMUNIZATION RECORDS OR MMR SHOT DEPARTMENT OF PUBLIC SAFETY HELPED TO TRACK DOWN LAST FEW AND DELIVER LETTERS EXCLUDING 6 STUDENTS FROM CAMPUS 1 MEDICAL WAIVER, 5 RELIGIOUS WAIVERS BY NOVEMBER- 1 MEDICAL AND 1 RELIGIOUS (BECAME CASE 144) CONTROL MEASURES 2 ND MMR FOR STUDENTS WITH ONLY 1 MMR SEPARATE CLINIC FOR POTENTIAL MUMPS CASES ONLINE SCHEDULING AND SELF CHECK IN DISABLED POTENIAL CASES ISOLATED OFF CAMPUS FOR 5 DAYS ATHLETIC TEAMS- PRACTICE/FALL SEASON CANCELLED WATER BOTTLES BANNED PROCEDURES FOR CLEANING EQUIPMENT ALL GREEK LIFE IN HOUSE ACTIVITIES CANCELLED WIDESPREAD CLEANING EFFORTS 9

10 COMMUNICATIONS S TO ALL CLASS CONTACTS MULTIPLE CAMPUS WIDE EDUCATIONAL S WRITTEN NOTIFICATION AND EDUCATIONAL POWERPOINT FOR URGENT CARES AND EMERGENCY ROOMS LETTERS TO PARENTS BUMP THE MUMPS COORDINATED WITH ATHLETICS AND GREEK LIFE ADMINISTRATION 3 RD MMR 1 DOSE 78% EFFECTIVE, 2 DOSES 88% EFFECTIVE NUMEROUS STUDIES SUGGESTED 3 RD OR BOOSTER IS PROTECTIVE CDC GUIDELINES FOR PUBLIC HEALTH AGENCIES FOR 3 RD MMR DOSE VACCINE COVERAGE IS >90% EVIDENCE OF SUSTAINED TRANSMISSION FOR > 2WEEKS INTENSE EXPOSURE SUCH AS COLLEGE CAMPUS HIGH ATTACK RATES > 5/1,000 ACIP MEETING OCTOBER 2017 FORMAL RECOMMENDATION FOR 3 RD MMR IN THE SETTING OF AN OUTBREAK 10

11 PODS COORDINATED WITH ONONDAGA COUNTY AND THE NEW YORK HEALTH DEPARTMENT FROM THE BEGINNING MULTIDISCIPLANARY TEAM 1 ST POD THE DAY CDC RECOMMENDED 3 RD DOSE October 24th 4760 DOSES GIVEN IN 9 PODS SYRACUSE UNIVERSITY CASES Dylan Johns - NYSDOH 11

12 THE END! OUTBREAK DECLARED OVER WHEN 2 FULL INCUBATION PERIODS ( 52 DAYS) WITHOUT A CASE. ONONDAGA COUNTY HEALTH DEPARTMENT DECLARED OUTBREAK OVER FEBRUARY 14 TH SYRACUSE UNIVERSITY MAKE CHANGES FOR IMMUNIZATION REPORTING FALL