Mumps DISEASE REPORTABLE WITHIN 24 HOURS OF DIAGNOSIS

Transcription

1 Mumps DISEASE REPORTABLE WITHIN 24 HOURS OF DIAGNOSIS Per NJAC 8:57, healthcare providers and administrators shall report by mail or by electronic reporting within 24 hours of diagnosis, confirmed cases of mumps to the health officer of the jurisdiction where the ill or infected person lives, or if unknown, wherein the diagnosis is made. A directory of local health departments in New Jersey is available at If the health officer is unavailable, the healthcare provider or administrator shall make the report to the Department by telephone to , between 8:00 A.M. and 5:00 P.M. on non-holiday weekdays or to during all other days and hours. April 2010

2 Mumps 1 THE DISEASE AND ITS EPIDEMIOLOGY A. Etiologic Agent Mumps is caused by a ribonucleic acid (RNA) virus, a member of the Paramyxoviridae family and genus Parmyxovirus. It is also antigenically related to the parainfluenza virus. B. Clinical Description Mumps is a systemic disease characterized by swelling of the salivary glands (parotitis).which usually lasts several days. However, about one third of infections do not cause clinically apparent salivary gland swelling. Meningeal signs are common. Encephalitis occurs rarely, and permanent sequelae or death is uncommon. Infection in adulthood is likely to produce more severe disease, including mastitis, which occurs in up to 31% of females aged 15 years and older, and orchitis, which occurs in 20% to 30% of postpubertal males. Other rare complications include arthritis, renal involvement, myocarditis, cerebellar ataxia, pancreatitis, and hearing impairment. Mumps infection during the first trimester of pregnancy can increase the risk of spontaneous abortion, although no evidence exists that mumps infection in pregnancy causes congenital malformations. While death due to mumps is rare, more than half the fatalities occur in those 19 years of age or older. NOTE: Swelling of the salivary glands can also be caused by parainfluenza virus types 1 and 3, influenza A, coxsackieviruses and other enteroviruses, lymphocytic choriomeningitis virus, human immunodeficiency virus (HIV), staphylococcus aureus, nontuberculosis mycobacterium, and, less often, other grampositive and gram-negative bacteria, salivary duct calculi, starch 2 Mumps

3 New Jersey Department of Health and Senior Services ingestion, drug reactions (e.g., phenylbutazone, thiouracil, iodides), and metabolic disorders such as diabetes mellitus, cirrhosis, and malnutrition. C. Reservoirs Humans are the only host. Asymptomatic patients can transmit the virus, although no carrier state has been reported or known to exist. D. Modes of Transmission Mumps is transmitted person-to-person by droplet or direct contact with nasopharyngeal or salivary secretions of an infected person, and by the airborne route. The latter is rare and should not be a parameter for determining exposure especially in a school setting. E. Incubation Period The incubation period is usually 16 to 18 days, with a range of 12 to 25 days. F. Period of Communicability or Infectious Period The infectious period is from seven days before until five days after onset of parotitis. Maximum infectiousness occurs from one to two days before onset of parotid swelling to five days after onset of parotid swelling. The virus has been isolated from saliva from seven days before through five days after onset of swelling. The initial day of swelling should be counted as day zero. Mumps is similar to influenza and rubella in the degree of infectiousness, but is not as contagious as measles or chickenpox. G. Epidemiology Mumps occurs worldwide. In the United States, it is endemic year-round, peaking in winter and spring. Most adults born in the United States before 1957 have been infected and are probably immune to mumps. Mumps may be seen in unimmunized children or adolescents. Mumps may also occur in individuals from other countries where mumps vaccine is not given routinely. About one third of infections do not cause apparent parotitis but can still transmit disease; most infections in children younger than two years of age are subclinical. It is important to note that in immunized children most cases of parotitis are not caused by mumps infection. These cases will be non-mumps parotitis, bacterial parotitis, or most likely, lymphadenitis. The incidence of mumps in the United States has declined since the vaccine came into usage in In 1986 and 1987 there was a relative resurgence of mumps, apparently due to the absence of comprehensive state immunization requirements as well as, in some instances, vaccine failure. Up until 2006, fewer than 300 cases of mumps were reported annually in the United States. However, outbreaks in highly vaccinated populations still occur, probably due to vaccine failure. From January 1, 2006, through October 2006 an outbreak occurred in the United States, with case reports from 45 states. As of October 2006, Last Updated April

4 Communicable Disease Service Manual 3,113 confirmed cases had been reported to the Centers for Disease Control and Prevention (CDC). The incidence rate was highest among persons 18 to 24 years of age, many of whom were college students. The majority of cases reported from all states were in two-dose measles, mumps, and rubella (MMR) recipients. Most cases now in the United States are among individuals older than 14 years. 2 CASE DEFINITION A. New Jersey Department of Health and Senior Services (NJDHSS) Case Definition Case definition for mumps as approved by the Council of State and Territorial Epidemiologists and published in 2008 at B. Clinical Case Description/Definition An illness with acute onset of unilateral or bilateral tender, self-limited swelling of the parotid or other salivary gland, lasting two days or longer, and without other apparent cause. C. Clinically Compatible Illness Infection with mumps virus may present as aseptic meningitis, encephalitis, hearing loss, orchitis, oophoritis, parotitis, or other salivary gland swelling, mastitis, or pancreatitis. D. Laboratory Criteria for Diagnosis Isolation of mumps virus from clinical specimen OR Detection of mumps nucleic acid (e.g., standard or real-time reverse transcription polymerase chain reaction [RT-PCR] assays) OR Detection of mumps immunoglobulin M (IgM) antibody OR Demonstration of specific mumps antibody response in the absence of recent vaccination, either a four-fold increase in immunoglobulin G (IgG) titer as measured by quantitative assays or a seroconversion from negative to positive using a standard serologic assay of paired acute and convalescent serum specimens. E. Case Classification CONFIRMED A case that meets the clinical case definition or has clinically compatible illness AND Is either laboratory confirmed or is epidemiologically linked to a confirmed case. 4 Mumps

5 New Jersey Department of Health and Senior Services PROBABLE A case that meets the clinical case definition, without laboratory confirmation, and is epidemiologically linked to a clinically compatible case. SUSPECTED A case with clinically compatible illness or that meets the clinical case definition without laboratory testing OR A case with laboratory tests suggestive of mumps without clinical information. 1. Case Classification for Import Status Internationally imported case: An internationally imported case is defined as a case in which mumps results from exposure to mumps virus outside the United States as evidenced by at least some of the exposure period (12 to 25 days before onset of parotitis or other mumps-associated complications) occurring outside the United States and the onset of parotitis or other mumps-associated complication within 25 days of entering the United States and no known exposure to mumps in the United States during that time. All other cases are considered U.S.-acquired cases. U.S.-acquired case: A U.S.-acquired case is defined as a case in which the patient had not been outside the United States during the 25 days before onset of parotitis or other mumpsassociated complications or was known to have been exposed to mumps within the United States. U.S.-acquired cases are subclassified into four mutually exclusive groups: Import-linked case: Any case in a chain of transmission that is epidemiologically linked to an internationally imported case. Imported-virus case: A case for which an epidemiologic link to an internationally imported case was not identified but for which viral genetic evidence indicates an imported mumps genotype, that is, a genotype that is not occurring within the United States in a pattern indicative of endemic transmission. An endemic genotype is the genotype of any mumps virus that occurs in an endemic chain of transmission (i.e., lasting 12 months or more). Any genotype that is found repeatedly in U.S.-acquired cases should be thoroughly investigated as a potential endemic genotype, especially if the cases are closely related in time or location. Endemic case: A case for which epidemiological or virological evidence indicates an endemic chain of transmission. Endemic transmission is defined as a chain of mumps virus transmission continuous for 12 months or more within the United States. Unknown source case: A case for which an epidemiological or virological link to importation or to endemic transmission within the United States cannot be established after a thorough investigation. These cases must be carefully assessed epidemiologically to ensure that they do not represent a sustained U.S.-acquired chain of transmission or an endemic chain of transmission within the United States. Last Updated April

6 Communicable Disease Service Manual Local health departments (LHDs) should be alert to and notify NJDHSS if they are aware of A suspect or confirmed case of mumps, as diagnosed by a healthcare professional OR Isolation of mumps virus from clinical specimen OR Significant rise between acute- and convalescent-phase titers in serum mumps IgG antibody level by any standard serologic assay OR Positive serologic test for mumps IgM antibody. 3 LABORATORY TESTING SERVICES AVAILABLE NOTE: Prior to drawing or sending any specimens to the Public Health and Environmental Laboratories (PHEL) for diagnostic/confirmation testing, call NJDHSS Vaccine Preventable Disease Program (VPDP) at for consultation and guidance. Acute mumps infection can be confirmed by the presence of serum mumps IgM, a significant rise in IgG antibody titer in acute and convalescent serum specimens, positive mumps virus culture, or detection of virus by RT-PCR. A. Serological Testing Sera should be collected as soon as possible after onset of parotitis for IgM and IgG testing or as the acute specimen for examining seroconversion. The convalescent specimen for IgG detection should be drawn about two weeks later. IgM antibodies are detectable within the first few days of illness, reach a maximum level about a week after onset of symptoms, and remain elevated for several weeks to months. Immunity to mumps may be documented by the presence of serum IgG mumps-specific antibodies by enzyme immunoassay (EIA). B. Viral Cultures Mumps virus can be isolated from throat swabs, urine, and cerebrospinal fluid (CSF). Efforts should be made to obtain the specimen as soon as possible after parotitis or meningitis onset. Virus may be isolated from the buccal mucosa from seven days before until five days after salivary enlargement, and from urine during the period from six days before to 15 days after the onset of parotitis. Because few laboratories perform mumps virus culture, it is rarely used for clinical diagnosis in uncomplicated cases. Successful isolation should always be confirmed by immunofluorescence with a mumps-specific monoclonal antibody or by molecular techniques. Molecular typing of virus isolates provides epidemiologically important information and is now recommended. 6 Mumps

7 New Jersey Department of Health and Senior Services C. Molecular Typing Molecular typing such as RT-PCR can be used to detect mumps RNA in appropriately collected throat swabs, urine samples, and CSF. Molecular epidemiological surveillance makes it possible to build a sequence database that will help track transmission pathways of mumps strains circulating in the United States. In addition, typing methods are available to distinguish wild-type mumps virus from vaccine virus. Specimens for molecular typing should be obtained from the buccal mucosa with nasopharyngeal swabs and from urine as soon as possible after the onset of parotitis, from the day of onset to three days later. Virus isolation and molecular typing can be performed by CDC. Prior to drawing or sending any specimens to PHEL for diagnostic/confirmation testing, call NJDHSS VPDP at for consultation and guidance. 4 PURPOSE OF SURVEILLANCE AND REPORTING AND REPORTING REQUIREMENTS A. Purpose of Surveillance and Reporting To promptly identify cases and susceptible exposed people rapidly and to prevent further spread of disease To promptly identify clusters or outbreaks and initiate appropriate prevention and control measures To follow disease trends in the population To confirm mumps infection as the cause of parotitis To distinguish between failure to vaccinate and vaccine failure and address the problem To assess progress towards disease reduction goals To characterize populations requiring disease control measures B. Laboratory Reporting Requirements The New Jersey Administrative Code (NJAC 8:57-1) stipulates that laboratories report within 24 hours, by telephone, any positive culture, test, or assay result specific to mumps to the LHD where the patient resides. If the laboratory director or his/her designee is unable to reach the LHD where the patient resides, he/she should report the result to NJDHSS VPDP at (nonholiday weekdays between 8 A.M. and 5 P.M.) or (nights/weekends/holidays). Telephone reports shall be followed by a report via confidential fax, over the Internet using the Communicable Disease Reporting and Surveillance System (CDRSS), or in writing to the health officer having jurisdiction over the locality in which the patient lives or, if unknown, to the health officer in whose jurisdiction the healthcare provider requesting the laboratory examination is located. Please refer to the lists of reportable diseases ( for information. Last Updated April

8 Communicable Disease Service Manual C. Healthcare Provider Reporting Requirements As specified at NJAC 8:57-1, any healthcare provider shall report by telephone confirmed or suspect cases of mumps within 24 hours to the LHD where the patient resides. It shall be followed by a detailed investigation report (in writing, via confidential fax, or using CDRSS) to the health officer of the jurisdiction in which the patient lives or, if unknown, wherein the diagnosis is made. If the health officer is unavailable, the report shall be made to NJDHSS VPDP at (nonholiday weekdays between 8 A.M. and 5 P.M.) or (nights/weekends/holidays). D. Health Officer Reporting and Follow-up Responsibilities As specified at NJAC 8:57-1 each local health officer notified of mumps must report the occurrence of any case or outbreak of mumps to NJDHSS VPDP within 24 hours of receiving the report. The health officer shall within 24 hours of receipt of a report initiate or update the information on CDRSS. If the initial report is incomplete, a health officer shall seek complete information and provide all available information to NJDHSS VPDP within five days of receiving the initial report. Refer to the health officer s Reporting Timeline ( for information on prioritization and timeliness requirements of reporting and case investigation. E. Entry into CDRSS The mandatory fields in CDRSS include disease, last name, county, municipality, gender, race, ethnicity, case status, and report status. The following table can be used as a quick reference guide to determine which CDRSS fields need to be completed for accurate and complete reporting of mumps cases. The CDRSS Screen column includes the tabs that appear along the top of the CDRSS screen. The Required Information column provides detailed explanations of what data should be entered. CDRSS Screen Patient Info Addresses Required Information Enter the disease name ( MUMPS ), patient demographic information, illness onset date, and the date the case was reported to the LHD. There are no subgroups for mumps. Enter any alternate address (e.g., a daycare address). Use the Comments section in this screen to record any pertinent information about the alternate address (e.g., the times per week the case-patient attends daycare). Entering an alternate address will allow other disease investigators access to the case if the alternate address falls within their jurisdiction. 8 Mumps

9 New Jersey Department of Health and Senior Services CDRSS Screen Clinical Status Signs/Symptoms Risk Factors Laboratory Eval Contact Tracing Required Information Enter any treatment that the patient received and record the names of the medical facilities and physician(s) involved in the patient s care. If the patient received care from two or more hospitals, be sure that all are entered so the case can be accessed by all infection control professionals (ICPs) covering these facilities. Indicate pregnancy status under Clinical Status section. If immunization status is known, it should also be entered under the Immunizations section. If the patient died, date of death should be recorded under the Mortality section. Check appropriate boxes for signs and symptoms and indicate their onset date. Make every effort to get complete information by interviewing the physician, family members, ICP, or others who might have knowledge of the patient s illness. Also, information regarding the resolution of signs and symptoms should be entered. Enter complete information about risk factors to facilitate study of mumps disease in New Jersey. If the patient has not received immunizations due to a medical or religious exemption, please check risk factor in Risk factor(s) section. Please document travel history of patient or any visitors to the patient (e.g., domestic/international within past 25 days) in the Comments section. Indicate appropriate test, specimen collection date, and serology (IgM and IgG) test result with values. Following initial diagnosis of mumps, convalescent serology (repeated IgM and IgG) laboratory results should also be entered in this section. Detection of mumps antigen by PCR ( MUMPS VIRUS RNA ) from a clinical specimen should also be recorded. Information regarding contacts is required for this disease including information on any household and other close contacts. Identify susceptible high-risk contacts (e.g., pregnant women, immunocompromised or unvaccinated persons, infants <12 months of age). Document any vaccine or travel history of contacts in Comments section. Last Updated April

10 Communicable Disease Service Manual CDRSS Screen Case Comments Epidemiology Case Classification Report Status Required Information Enter general comments (i.e., information that is not discretely captured by a specific topic screen or drop-down menu) in the Comments section. NOTE: Select pieces of information entered in the Comments section CANNOT be automatically exported when generating reports. Therefore, whenever possible, record information about the case in the fields that have been designated to capture this information; information included in these fields CAN be automatically exported when generating reports. Indicate method of import in the Epidemiology section. Under the Other Control Measures section, indicate if the patient falls into any of the categories listed under Patient Role(s)/Function(s) (e.g., SCHOOL ENVIRONMENT, DAYCARE PROVIDER ). Record name and contact information for case investigators from other agencies (e.g., CDC, out-of-state health departments). Document communication between investigators in the Comments section. Case status options are REPORT UNDER INVESTIGATION (RUI), CONFIRMED, PROBABLE, POSSIBLE, and NOT A CASE. All cases entered by laboratories (including LabCorp electronic submissions) should be assigned a case status of REPORT UNDER INVESTIGATION (RUI). Cases still under investigation by the LHD should be assigned a case status of REPORT UNDER INVESTIGATION (RUI). Upon completion of the investigation, the LHD should assign a case status on the basis of the case definition. CONFIRMED, PROBABLE, and NOT A CASE are the only appropriate options for classifying a case of mumps (see Section 2A). Report status options are PENDING, LHD OPEN, LHD REVIEW, LHD CLOSED, DELETE, REOPENED, DHSS OPEN, DHSS REVIEW, and DHSS APPROVED. Cases reported by laboratories (including LabCorp electronic submissions) should be assigned a report status of PENDING. Once the LHD begins investigating a case, the report status should be changed to LHD OPEN. The LHD REVIEW option can be used if the LHD has a 10 Mumps

11 New Jersey Department of Health and Senior Services CDRSS Screen Required Information person who reviews the case before it is closed (e.g., health officer or director of nursing). Once the LHD investigation is complete and all the data are entered into CDRSS, the LHD should change the report status to LHD CLOSED. LHD CLOSED cases will be reviewed by DHSS and be assigned one of the DHSS-specific report status categories. If additional information is needed on a particular case, the report status will be changed to REOPENED and the LHD will be notified by . Cases that are DHSS APPROVED cannot be edited by LHD staff. If a case is inappropriately entered (e.g., a case of measles was erroneously entered as a case of mumps) the case should be assigned a report status of DELETE. A report status of DELETE should NOT be used if a reported case of mumps simply does not meet case definition. Rather, it should be assigned the appropriate case status, as described above. 5 CASE INVESTIGATION It is the health officer s responsibility to investigate the case by interviewing the patient and others who may be able to provide pertinent information. Following notification, the local health officer shall complete a Mumps Surveillance Record (IMM-21) on all suspected or confirmed cases (Attachment A) and initiate or update the case on CDRSS. Document information about o Symptoms and date of onset of symptoms o Mumps immunization history o Recent history of dental work o Recent history of travel (to where and dates) o Recent out-of-town visitors (from where and dates) o Recent contact with anyone with similar symptoms o Country of birth, age, sex, county, length of time in the United States o Possible transmission setting (e.g., children, school, healthcare setting) o Risk factors for disease After completing the IMM-21, send to NJDHSS VPDP, PO Box 369, Trenton, NJ , or fax to Last Updated April

12 Communicable Disease Service Manual Institution of disease control is an integral part of case investigation. It is the local health officer s responsibility to understand and, if necessary and approved by NJDHSS, institute control guidelines listed below in Section 6. 6 CONTROLLING FURTHER SPREAD A. Isolation and Quarantine Requirements (NJAC-8:57-1) NJDHSS VPDP should be notified for consultation and approval before any institutional, exclusion, or community-wide outbreak control measures are planned or implemented. Generally, outbreak control measures are not necessary in response to a sporadic case. 1. Minimum Period of Isolation of Patient Through five days after onset of gland swelling. 2. Minimum Period of Quarantine of Contacts Healthcare workers or pupils born after 1956 who are not appropriately immunized or do not have serologic evidence of immunity should be excluded from work or classes from the 12th through the 26th day after their last exposure. When multiple cases occur, susceptibles need to be excluded through 26 days after the onset of the last case at the school or workplace. B. Protection of Contacts of a Case 1. Inquire about contact with a known or suspected case or travel during the mumps exposure period (16 to 25 days prior to onset). 2. Identify all those exposed. To identify exposed, think in terms of the zones of exposure and consider members of the following groups, if they were in contact with the case during his/her infectious period: Household members School/daycare (students and staff) Staff and patients at medical facility where patient was seen Individuals at workplace of case (especially daycare centers, schools, and medical settings) Religious/social groups Sports teams and other extracurricular groups Bus/carpool mates Close friends Persons potentially exposed at social events, travel sites, etc. 12 Mumps

13 New Jersey Department of Health and Senior Services 3. Identify high-risk susceptibles who had contact with the case during the infectious period: Pregnant women should be referred to their obstetrician for screening and management. In daycare or school settings, remember to determine whether any teachers, student teachers, staff, or students are pregnant. Immunosuppressed individuals should be referred to their healthcare provider. Infants younger than 12 months of age should be referred to their pediatrician. 4. Identify all other susceptibles. These are individuals without proof of immunity, including those with medical or religious exemptions to immunization. Proof of immunity is defined in the box below. Key Changes to 1998 Advisory Committee on Immunization Practices Recommendation on Mumps May 17, 2006 Acceptable Presumptive Evidence of Immunity Documentation of adequate vaccination is now two doses of a live 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 healthcare facilities, international travelers, and students at post high school educational institutions). Routine Vaccination for Healthcare 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 a live mumps virus vaccine. For Outbreak Settings Children ages one to four years and adults at low risk: if affected by the outbreak, consider a second dose of live mumps virus vaccine. Healthcare 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 5. Immunize all susceptibles 12 months of age or older for whom MMR is not contraindicated. Keep in mind the following: The combination MMR vaccine is the preferred formulation for all those 12 months of age or older. (MMR vaccine should never be given to infants.) Last Updated April

14 Communicable Disease Service Manual Vaccinating an exposed individual who may be incubating mumps virus is not harmful; however, mumps-containing vaccine, unlike measles vaccine, will not prevent acquisition of disease after infection. Exposed individuals should be vaccinated to protect against subsequent exposures. Immune globulin (IG) is of no value as postexposure prophylaxis and is not recommended. 6. After consideration, consultation, and approval of the NJDHSS VPDP, exclude as follows: Confirmed case: Exclude through five days after onset of parotitis (counting the day of swelling onset as day zero). The suspect case may return to normal activities on the sixth day. Contacts: o Only after consultation and approval of the NJDHSS VPDP, exclude susceptibles (including those with medical or religious exemptions) on days 12 to 26 after their last exposure or, if there are multiple cases, for 26 days after onset of parotitis in the last reported case in the outbreak setting. They may return on the 27th day. o Excluded susceptibles may be readmitted immediately after vaccination. However, due to the relatively long incubation period of mumps, cases can be expected to occur for approximately three weeks following vaccination. 7. Conduct active surveillance for mumps for two incubation periods (50 days) after onset of the last case. In general, outbreak control interventions are rarely initiated for mumps disease and only for confirmed cases. C. Managing Special Situations 1. Mumps in Healthcare Settings 1. Proof of immunity: Although birth before 1957 is generally considered acceptable evidence of immunity to mumps, the Advisory Committee on Immunization Practices (ACIP) has changed this recommendation for healthcare workers (see box above). An effective routine MMR vaccination program for healthcare workers (in addition to standard precautions) is the best approach to prevent nosocomial transmission. 2. Isolation of patients: Patients should be placed on droplet precautions through five days after onset of parotid swelling (counting the day of onset as day zero). They may be taken off precautions on the sixth day. Exposed susceptible patients should be placed on droplet precautions from the 12th day after the earliest exposure through the 26th day after the last exposure. They may be taken off precautions on the 27th day. 14 Mumps

15 3. Recommended exclusion of healthcare facility staff: New Jersey Department of Health and Senior Services Personnel who become sick should be excluded from work through fifth days after parotid swelling onset. They may return on the sixth day. Exposed susceptible personnel (including those with medical or religious exemptions) should be excluded from the 12th day after their first exposure through the 26th day after their last exposure. They may return on the 27th day. 4. Surveillance: Conduct active surveillance for mumps for two incubation periods (50 days) after onset of the last case. 7 OUTBREAK SITUATIONS Depending on the epidemiology of the outbreak, a second dose of mumps vaccine should be considered for children aged one to four years and adults who have received one dose. In healthcare settings during an outbreak, two doses of a live mumps virus vaccine are recommended to unvaccinated workers born before 1957 who do not have evidence of mumps immunity. Reviewing the immune status of healthcare workers routinely and providing appropriate vaccinations, including a second dose of mumps vaccine in conjunction with other routine annual disease prevention measures (e.g., influenza vaccination), is recommended. 8 PREVENTIVE MEASURES 1. Personal Preventive Measures/Education Vaccination, including routine childhood vaccination, catch-up vaccination of adolescents, and targeted vaccination of high-risk adult groups, is the best preventive measure against mumps. Good personal hygiene (which consists of proper hand-washing, disposal of used tissues, drinking from same cups, bottles, not sharing eating utensils, etc.) is also important. Please refer to the most current versions of the ACIP statement on measles, rubella, and mumps (listed under References, below). Additional Information Additional information on mumps can be obtained at the NJDHSS Web site at Click on the Health Topics A to Z link and scroll down to Mumps. Last Updated April

16 Communicable Disease Service Manual References American Academy of Pediatrics Red Book: Report of the Committee on Infectious Diseases. 27th ed. Chicago, IL: Academy of Pediatrics; Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance. MMWR Morb Mortal Wkly Rep. 1997;46:RR-10. Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine- Preventable Diseases. 11th ed. Washington, DC: Public Health Foundation; May Available at: Centers for Disease Control and Prevention. Immunization of health care workers. Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR Morb Mortal Wkly Rep. 1997;46: RR-18. Centers for Disease Control and Prevention. Manual for the Surveillance of Vaccine-Preventable Diseases. Atlanta, GA: CDC; Available at: Centers for Disease Control and Prevention. Measles, mumps, and rubella vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 1998;47:RR-8. Centers for Disease Control and Prevention. Update: Multistate outbreak of mumps United States, January 1 May 2, MMWR Morb Mortal Wkly Rep. 2006;55 (Dispatch);1-5 Centers for Disease Control and Prevention. Brief Report: Update: Mumps Activity United States, January 1 October 7, MMWR Morb Mortal Wkly Rep. 2006;55 (42); Centers for Disease Control and Prevention. Notice to readers: updated recommendations of the Advisory Committee on Immunization Practices (ACIP) for the Control and Elimination of Mumps. MMWR Morb Mortal Wkly Rep. 2006;55(22): Chin J, ed. Control of Communicable Diseases Manual. 17th ed. Washington, DC: American Public Health Association; Council of State and Territorial Epidemiologists (CSTE) Position Statements. CSTE National Meeting, Madison, WI. Position Statement ID Attachment A: Mumps Surveillance Record (IMM-21) Also available at 16 Mumps

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