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May 2006 Five people diagnosed with mumps who traveled on nine commercial flights on two airlines may be responsible for a multistate outbreak of the vaccine-preventable disease. As of April 24, Iowa has 1,070 reported, probable, confirmed and suspected cases of mumps, according to Patricia Quinlisk, MD, medical director and state epidemiologist in the Iowa Department of Health. Of the total, 630 are confirmed or probable and 345 are suspected, according to the department’s Web site. With more than 1,500 cases reported in the Midwest, this is the first major outbreak of mumps in more than 20 years. The CDC said the outbreak started in December 2005. It also affects the following states: Illinois (110 cases as of April 20), Kansas (205 confirmed and probable cases as of April 21), Minnesota (8 cases as of April, two possibly connected to the Iowa outbreak), Missouri (19 confirmed, probable and suspected cases as of April 17), Nebraska (20 suspected cases, 37 laboratory confirmed and 119 probable cases as of April 19) and Wisconsin (17 confirmed cases as of April 21). “We are definitely spreading it, unfortunately,” Quinlisk told Infectious Diseases in Children.
People aged 18 to 25 years, many of whom are vaccinated, account for most of the cases, according to the CDC, although Quinlisk added that age range of people infected is wide, from a 3-year-old to an 83-year-old. None of the cases resulted in fatalities. The five travelers, who were potentially infectious when they flew, traveled on nine commercial flights operated by Northwest and American airlines between March 26 and April 2, according to the CDC. The flights flew from or to Cedar Rapids and Waterloo, Iowa; Dallas; Detroit; Lafayette and Tucson, Ariz.; Minneapolis; St. Louis and Washington D.C. As of yet, no cases have been officially linked with airline travel. Quinlisk and Mary Mincer Hansen, director of the department, announced in an April 20 press conference that all people aged 18 to 22 in Iowa should receive both doses of the measles-mumps-rubella (MMR) vaccine. With a supply of 25,000 doses, the department planned mass vaccine campaigns for the last week of April and the beginning of this month. Hansen said vaccine providers would not turn away people without insurance. Health officials do not know the origin of infection, but they are not focusing on that, Quinlisk said. They are concentrating on slowing and stopping transmission. What they do know is that the circulating strain is genotype G, the same genotype to blame for an outbreak in the United Kingdom, according to the CDC. In the United Kingdom, more than 70,000 cases, mostly among unvaccinated young adults, have occurred since 2004. Samuel L. Katz, MD, chairman emeritus of pediatrics at Duke University and former chairman of the Advisory Committee on Immunization Practices, said that the United Kingdom’s problem is related to a paper published by Andrew Wakefield, MD, which suggested the MMR vaccine caused autism. “People stopped using MMR,” he told Infectious Diseases in Children. Katz said that in the United States, the CDC did not institute the second dose of MMR vaccine until 1990, and that might be a contributing factor to the United States outbreak. He said that immunity from one dose is about 80%, while two doses provide more than 90% protection. Despite the improved protection, however, there is always a risk. Katz said a lot of people older than 17 or 18 might not have the two-dose protection and therefore are susceptible to contracting mumps. The AAP recommends that children and teens age 4 and older who did not receive a second MMR vaccine should be revaccinated. “My take on the situation is, A, it’s regrettable that it happened,” Katz said. “B, it’s a wake-up call that nothing is perfect and C, that we live in a global community and we don’t have a number of these diseases here. They can be introduced and that’s a good reason for keeping up our immunization levels.” Mumps is a viral infection characterized by a nonspecific prodrome, including myalgia, anorexia, malaise, headache and fever, according to the CDC. Unilateral or bilateral infection, tender swelling of the parotid or other salivary glands follows. According to the Iowa Department of Health, sneezing, coughing and sharing utensils, cups or other objects that have been in contact with saliva spread the infection. After exposure it usually takes two to three weeks for symptoms to appear. Individuals diagnosed with mumps should not go back to school, day care or work for at least five days to prevent the spread of the disease. For more information: |
