CDC warns of mumps outbreak Maine institutions asked to ramp up vaccinations

With confirmed and suspected cases of mumps on the rise in Maine – including a suspected case in an employee at Eastern Maine Medical Center in Bangor – and a much more serious outbreak just across the border in Canada, Maine’s chief public health officer on Monday issued updated recommendations for vaccination against the potentially serious illness.

“Because this outbreak [in Maine] has spread, we are updating vaccination recommendations, especially among children, college and university students and hospital workers,” said Dr. Dora Anne Mills, head of the Maine Center for Disease Control and Prevention. Because of the environments where they live and work, such individuals are most likely to contract and spread the virus, Mills said.

Since September, seven cases of mumps have been confirmed in southern and central Maine, four of them in November alone. The state is awaiting the results of lab tests on as many as two dozen more suspected cases, according to the Maine CDC. The age of the sickened individuals ranges from the late teens to the late 50s.

While the number of cases in Maine may seem insignificant, more than 900 individuals in Nova Scotia and New Brunswick, mostly college students, have been sickened with mumps since last winter.

And on Monday, a housekeeper at EMMC was given a preliminary diagnosis of mumps, pending confirmation by laboratory testing. Donna Dunton, director of infection control at EMMC, confirmed Monday evening that the housekeeper has been asked to stay out of work until lab reports of her mumpslike symptoms are complete. The employee is not thought to have been in close enough contact with any patients to have spread the virus, Dunton stressed, and routine infection control measures such as hand washing are likely to have minimized the possibility of transmission.

Mumps is a viral infection of the salivary glands. Symptoms typically include fever, headache, muscle ache, and swelling and tenderness of the glands at the corner of the jaw. Symptoms may last seven to 10 days, and infected individuals are contagious for at least three days before becoming ill and as long as nine days after symptoms appear.

Infection occurs through direct contact with respiratory droplets from the nose or throat, through saliva, coughing, sneezing, sharing drinks, kissing or from contact with any surface that has been contaminated with the virus.

Rarely, mumps infection can lead to meningitis, inflammation of the testicles or ovaries, inflammation of the pancreas, and temporary or permanent hearing loss.

“Although mumps is a virus and is not treatable with antibiotics, the good news is that mumps can be prevented or its impact reduced with vaccine,” Mills said.

The MMR vaccine – which protects against mumps, measles and rubella, or “German measles” – is the most common vaccine used to protect against mumps.

The Maine CDC’s updated guidelines are as follows:

. For students in kindergarten through 12th grade, all vaccine records should be reviewed and updated. For any students who are not current with their MMR vaccines, a letter should be given to the parents notifying them of the mumps outbreak and informing them that if their child remains nonimmunized and the infection is detected in their school, their child will be excluded from school for at least 18 days.

. For college and university students, all vaccine records should be reviewed and updated. All students should have documentation of two doses of MMR, rather than the previously required one dose. Most students will have had two doses as part of their routine childhood vaccinations, but older “nontraditional” students may be lacking the second dose.

. Hospital health care workers with direct patient contact should have their vaccine records reviewed and updated. Adequate mumps vaccination for those born in 1957 or later now consists of two doses of MMR, rather than the previously required one dose. Adequate mumps vaccination for those born before 1957 now consists of one dose of MMR, rather than no doses, as previously required.

Besides the additional vaccinations, the Maine CDC also recommends that individuals who become infected should be isolated for nine days after the onset of illness. Those who are not immunized and who are exposed should be isolated for about 18 days after the last known exposure.

Mills acknowledged that compliance with these recommendations may be financially and logistically burdensome for some individuals, institutions and families. The average cost of a mumps vaccine is about $45, she said, but the state is trying to secure supplies of lower-cost vaccine. The Maine CDC can assist institutions with the process of reviewing records, setting up vaccine clinics and obtaining vaccine supplies, she said.

Mills added that the new recommendations are likely to be upgraded to requirements through departmental rule making in the near future.

“While there is no apparent direct connection between people in Maine with confirmed infection and the current outbreak in Canada, it is not surprising that a border state like Maine would see an outbreak,” Mills said.

A student health official at the University of Maine was unavailable Monday to comment on how the new recommendations might affect the Orono campus.

At EMMC, Dunton said employee charts have been under review for several months in response to changes in vaccine recommendations from the Maine CDC issued earlier this year. Monday’s announcement, she said, is likely to “step up the pace” of that review, and many employees are likely to be asked to roll up their sleeves.

For information on mumps, visit the Maine CDC’s Web site: www.mainepublichealth.gov.