“The mumps vaccine is not 100% effective,” says Chris Zimmerman, MD, MPH, medical director for the Bureau of Immunization with the New York City Health Department. “It’s maybe in the 76% to 95% range. That means even among those fully vaccinated, there is a certain percentage who are not protected.”
Barbara Montana, MD, MPH, FACP, medical director of the Communicable Disease Service at the New Jersey Department of Health and Senior Services, adds, “The antibodies one produces from the vaccine can wane with time.”
The first case of the current outbreak occurred at the end of June 2009, when an 11-year-old boy who had visited the United Kingdom, where mumps is endemic, came down with the disease at a Jewish camp in Sullivan County, N.Y., according to the CDC. Twenty-five children and camp staff became ill with mumps, about 6% of the 400 people on site.
Most of the campers lived in the Borough Park neighborhood of Brooklyn. As they returned home, transmission began, and 79 more people developed mumps by Oct. 30. By that date, 40 cases had occurred in Ocean County, N.J., having started at the camp and spreading to a private boys school serving the same Jewish community. Eight cases occurred in Orange County, N.J., 27 cases in Rockland County, N.Y., and 15 cases in Quebec, Canada, after members of the affected New York and New Jersey communities traveled to that country for a religious gathering. The CDC reported a total of 179 cases as of Oct. 30, but the outbreak is not over. Patients continue to present with mumps.
A paramyxovirus causes mumps, a disease characterized by a unilateral or bilateral swelling and tenderness of the parotid or other salivary glands. Swelling typically lasts at least two days.
“Most of the time, they have a low-grade fever, malaise, anorexia, bellyaches, and feelings of tiredness,” says Maria-Agnes Rosell, MSN, FNP, a nurse practitioner with the Metropolitan Jewish Health System in Brooklyn.
The disease is transmitted through direct contact with respiratory secretions or saliva or through fomites, according to the CDC.
“Good hand hygiene and covering one’s cough are the ways to protect oneself, on top of getting vaccinated,” Zimmerman said.
“Individuals with mumps may be infectious for up to three days before onset of symptoms until five days after the onset,” Montana says. “The incubation period is approximately 14 days.”
Donna Hallas, PhD, PNP-BC, CPNP, coordinator of the pediatric nurse practitioner program at New York University College of Nursing, recommends nurses annually review basic information about mumps and other diseases that they do not see frequently and refresh their knowledge so they can pick up signs and symptoms early.
Providers diagnose mumps primarily on symptoms but may check serum for mumps immunoglobulin M or IgG antibodies, says Viola Zaborski, RN, a nurse at the Maimonides Medical Center 57th Street Clinic in Brooklyn.
Nurses must report a suspected case to the local Department of Health within 24 hours. Zaborski says if a case presented, she also would notify other patients seen in the clinic that day.
Public health officials may collect buccal specimens with drainage from the parotid gland to isolate the virus and determine the viral strain. The CDC identified genotype G on multiple specimens received from the New York and New Jersey outbreak.
“We have no reason to believe at this time that [the vaccine] is not a good match, but we want to keep aware of what is happening,” Montana says.
Healthcare workers should be fully immunized. Metropolitan screens employees and requires they get vaccinated. Nurses should follow droplet precautions if examining a child with suspected mumps, Zimmerman says.
“Mumps is pretty benign and self-limiting, so we usually give supportive care,” Rosell says.
Hallas suggests Tylenol for the fever, bedrest, and soft foods to make chewing easier. Patients should be isolated for the first five days of symptoms, Rothman adds.
Although vaccinated youngsters may develop mumps, health experts still advise immunization. The measles, mumps, rubella vaccine is given at 12 to 15 months of age and a second dose at 4 to 6 years of age, although a young child could get the second does early if in a setting where mumps is circulating, as long as a month has passed since the first dose, says Amy Rothman, RN, MSN, CPNP, a nurse practitioner at Bellevue Hospital Center in New York. However, there is no evidence to support administering a third dose of the vaccine.
“Prevention is the biggest thing,” Hallas says. “You do not want to miss an opportunity. When [patients] come in, you review their immunization records, and if they only have had one dose, give the second dose.”
Hallas adds that the second dose helps the person develop immunogenicity. She also cautions nurses to always administer the live, attenuated vaccine within 30 minutes of drawing it up.
Another reason to immunize is that people who are vaccinated and contract the disease are less likely to develop mumps complications, Zimmerman says.
Complications include orchitis in post-pubertal boys, mastitis in older girls, deafness, and meningo-encephalitis. Orchitis occurs in about 40% of cases in boys in this age group. Patients should seek emergency care if symptoms develop, Rothman advises.
About 9% of the New York and New Jersey patients developed complications, including one with transient deafness and three children hospitalized for orchitis, according to the CDC report. No deaths have occurred.
Debra Anscombe Wood, RN, is a freelance writer. Send letters to the editor to editorNY@nursingspectrum.com or comment below.