Tag: mumps

Mumps at the National Cheerleaders Association All-Star National Championship

The boys and girls at the 2018 National Cheerleaders Association All-Star National Championship in Dallas were hoping to go home with a trophy.

Some got a little more – exposure to mumps.

Mumps at the National Cheerleaders Association All-Star National Championship

If you don’t have a kid in competitive cheer, you should know that the NCA All-Star Nationals is a big deal.

Over 1,300 teams with more than 23,000 cheerleaders were competing. They came from 9 countries and 38 states for a 3 day competition at the Kay Bailey Hutchison Convention Center in downtown Dallas.

The Texas Department of State Health Services has issued a warning that a person with mumps was present at the NCA All-Star Nationals.
The Texas Department of State Health Services has issued a warning that a person with mumps was present at the NCA All-Star Nationals.

They worked hard, but they had fun.

And some of them may have been exposed to mumps.

What to Do If You Were Exposed to Mumps at the NCA All-Star Nationals

So what do you do if you were exposed to mumps in Dallas?

While mumps is a vaccine-preventable disease, even kids who have gotten two MMR shots can still get mumps. That’s because waning immunity causes the vaccine to become less effective over time.

Still, mumps is not nearly as contagious as other vaccine-preventable diseases, such as measles. You generally have to have close contact with someone with mumps to catch it.

“The mumps virus replicates in the upper respiratory tract and spreads through direct contact with respiratory secretions or saliva or through fomites. The risk of spreading the virus increases the longer and the closer the contact a person has with someone who has mumps.”

CDC on Mumps for Healthcare Providers

Unless you were on the same team as the person with mumps (if it was a cheerleader), your risk of getting sick probably isn’t that high. Of course, the risk goes up the more contact you had.

Mumps is not just for kids anymoreUnfortunately, neither a post-exposure dose of MMR nor immune globulin work to prevent mumps after you are already exposed.

At this point, whether or not your child is vaccinated, all you can do is wait and watch to see if they develop signs or symptoms of mumps.

With an incubation period of 12 to 25 days, that means that those who were exposed could get sick between March 7 and March 22.

While there is no treatment for mumps, you do want to watch for complications and make sure you don’t expose anyone else.

And if your child is unvaccinated, this exposure is a good reminder that outbreaks still happen, vaccines are necessary, and this is a good time to get caught up.

Mumps and Cheer

Not surprisingly, this isn’t the first time we are hearing about mumps at a cheer competition.

In 2016, mumps exposures at several cheer competitions in North Texas led to at least 11 cases of mumps.

Why cheer? It’s not cheer, but the nature of cheer competitions. You just have a lot of older kids together at these competitions from a lot of different places and the MMR vaccine is known to have an issue with waning immunity.

Fortunately, most of these kids are vaccinated, which helps keep these outbreaks from really getting out of control, like they did in the pre-vaccine era.

What to Know About Mumps at the NCA All-Star Nationals

Tens of thousands of kids could have been exposed to mumps at a cheerleader competition in Dallas.

More on Mumps at the NCA All-Star Nationals

 

 

 

What to Do If Your Child Is Exposed to Mumps

Although things are much better than they were in the pre-vaccine era, we still have mumps outbreaks in the United States.

How does that work?

Waning immunity and folks who are unvaccinated.

How Contagious is Mumps?

Mumps is contagious, but not nearly as contagious as other vaccine-preventable diseases, such as measles.

“Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected.”

CDC on Transmission of Measles

Unlike measles, which is so contagious that you can get it if you are simply in the same room with someone that is sick, mumps typically requires prolonged, close contact.

“When you have mumps, you should avoid prolonged, close contact with other people until at least five days after your salivary glands begin to swell because you are contagious during this time. You should not go to work or school. You should stay home when you are sick with mumps and limit contact with the people you live with; for example, sleep in a separate room by yourself if you can.”

CDC on Mumps Outbreak-Related Questions and Answers for Patients

How do you get mumps?

Since the virus spreads through saliva and mucus, you can get sick if you are in close contact with someone with mumps and they:

  • cough or sneeze
  • use a cup or eating utensil that you then use
  • touch an object or surface that you then touch (fomites)

And like many other vaccine-preventable diseases, people with mumps are usually contagious just before they begin to show symptoms.

“The mumps virus replicates in the upper respiratory tract and spreads through direct contact with respiratory secretions or saliva or through fomites. The risk of spreading the virus increases the longer and the closer the contact a person has with someone who has mumps.”

CDC on Mumps for Healthcare Providers

The need for prolonged, close contact is likely why most outbreaks these days are on college campuses.

Is Your Child Protected Against the Mumps?

Tips to prevent getting sick with the mumps.
You can prevent the mumps.

The MMR vaccine protects us against mumps – and measles and rubella.

One dose of MMR is 78% effective at preventing mumps, while a second dose increases that to 88%. Unfortunately, that protection can decrease over time.

Kids get their first dose of MMR when they are 12 to 15 months old. While the second dose of MMR isn’t typically given until just before kids start kindergarten, when they are 4 to 6 years old, it can be given earlier. In fact, it can be given anytime after your child’s first birthday, as long as 28 days have passed since their first dose.

“Evidence of adequate vaccination for school-aged children, college students, and students in other postsecondary educational institutions who are at risk for exposure and infection during measles and mumps outbreaks consists of 2 doses of measles- or mumps-containing vaccine separated by at least 28 days, respectively. If the outbreak affects preschool-aged children or adults with community-wide transmission, a second dose should be considered for children aged 1 through 4 years or adults who have received 1 dose. In addition, during measles outbreaks involving infants aged <12 months with ongoing risk for exposure, infants aged ≥6 months can be vaccinated.”

CDC on Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices

And although it won’t count as their first dose, in special situations, kids can get an early MMR once they are six months old.

What to Do If Your Unvaccinated Child Is Exposed to Mumps

To be considered fully vaccinated and protected against mumps, kids need two doses of MMR – one at 12 to 15 months and another when they are 4 to 6 years.

“Although mumps-containing vaccination has not been shown to be effective in preventing mumps in persons already infected, it will prevent infection in those persons who are not yet exposed or infected. If persons without evidence of immunity can be vaccinated early in the course of an outbreak, they can be protected prior to exposure.”

Surveillance Manual

If your unvaccinated child is exposed to mumps, you should talk to your pediatrician or local health department, but unlike measles and chicken pox, there are no recommendations to start post-exposure prophylaxis.

Mumps quarantine sign

Unfortunately, neither a post-exposure dose of MMR nor immune globulin work to prevent mumps after you are already exposed. They should still get an MMR though, as it will provide immunity against measles and rubella, and mumps if they don’t get a natural infection.

“Persons who continue to be exempted from or who refuse mumps vaccination should be excluded from the school, child care, or other institutions until 21 days after rash onset in the last case of measles.”

Manual for the Surveillance of Vaccine-Preventable Diseases

Be sure to alert your pediatrician if you think your child might have measles or another vaccine-preventable disease.
Be sure to alert your pediatrician if you think your child might have measles or another vaccine-preventable disease.

Unvaccinated kids who are exposed to mumps will likely need to be quarantined, as you watch for signs and symptoms of measles developing over the next 12 to 25 days.

If your exposed child develops mumps, be sure to call your health care provider before going in for a visit, so that they can be prepared to see you and so you don’t expose other people to mumps. Your child with suspected mumps should be wearing a mask before going out in public and if possible, will be put in a negative pressure room in the emergency room or doctor’s office.

It is very important to understand that simply wearing a mask doesn’t eliminate the risk that your child with mumps could expose others, it just reduces the risk. You still want to avoid other people!

What to Do If Your Vaccinated Child Is Exposed to Mumps

If your fully vaccinated child is exposed to mumps, does that mean you are in the clear?

Again, it depends on what you mean by fully vaccinated.

It also depends on what you mean by exposed. Is it someone in the same school that your child has had no real contact with or a sibling that he is around all of the time?

And is your child fully vaccinated for his age or has he had two doses of MMR?

Since kids get their first dose of MMR at 12 to 15 months and the second when they are 4 to 6 years old, it is easy to see that many infants, toddlers and preschoolers who are following the immunization schedule are not going to be fully vaccinated against mumps, even if they are not skipping or delaying any vaccines.

“In the case of a local outbreak, you also might consider vaccinating children age 12 months and older at the minimum age (12 months, instead of 12 through 15 months) and giving the second dose 4 weeks later (at the minimum interval) instead of waiting until age 4 through 6 years.”

Ask the Experts about MMR

In most cases, documentation of age-appropriate vaccination with at least one dose of MMR is good enough protection. That’s because the focus in controlling an outbreak is often on those folks who don’t have any evidence of immunity – the unvaccinated.

And one dose of MMR is about 78% effective at preventing mumps infections. A second dose does increase the vaccine’s effectiveness against mumps to over 88%.

An early second dose is a good idea though if your child might be exposed to mumps in an ongoing outbreak, has only had one dose of MMR, and is age-eligible for the second dose (over age 12 months and at least 28 days since the first dose). Your child would eventually get this second dose anyway. Unlike the early dose before 12 months, this early dose will count as the second dose of MMR on the immunization schedule.

“Persons previously vaccinated with 2 doses of a mumps virus–containing vaccine who are identified by public health authorities as being part of a group or population at increased risk for acquiring mumps because of an outbreak should receive a third dose of a mumps virus–containing vaccine to improve protection against mumps disease and related complications.”

Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak

And in some cases, folks should now get a third of dose of MMR.

This third dose of MMR is not for post-exposure prophylaxis though, which again, doesn’t work for mumps. It is to prevent mumps from ongoing exposures.

You should still watch for signs and symptoms of mumps over the next 12 to 25 days though, as no vaccine is 100% effective. Your vaccinated child won’t need to be quarantined though.

Most importantly, in addition to understanding that vaccines are safe and necessary, know that the ultimate guidance and rules for what happens when a child is exposed to mumps will depend on your local or state health department.

What to Know About Getting Exposed to Mumps

Talk to your pediatrician if your child gets exposed to mumps, even if you think he is up-to-date on his vaccines, as some kids need a third dose of the MMR vaccine during on-going mumps outbreaks.

More on Getting Exposed to Mumps

Do Your Kids Need a Mumps Booster Shot?

Traditionally, kids get vaccines to protect them against mumps when they are 12 to 15 months old (1st dose of MMR) and again before starting kindergarten (2nd dose of MMR).

Do Your Kids Need a Mumps Booster Shot?

Routine use of the mumps vaccine, which was first licensed in 1967, has helped to greatly reduce the incidence of mumps cases from pre-vaccine era levels.

Outbreaks of mumps the last few years have led to calls for a third dose of MMR in some situations though.

mumps-booster
During an outbreak, universities make sure students are up-to-date with their MMR vaccines.

Does that mean that your kids will need a third dose of the MMR vaccine?

Probably not.

“Persons previously vaccinated with 2 doses of a mumps virus–containing vaccine who are identified by public health authorities as being part of a group or population at increased risk for acquiring mumps because of an outbreak should receive a third dose of a mumps virus–containing vaccine to improve protection against mumps disease and related complications.”

Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak

Is there a mumps outbreak in your area?

While that is the main reason to get a third dose of MMR, simply being near an outbreak still doesn’t mean an extra vaccine is necessary.

“In the setting of an identified mumps outbreak, public health authorities should define target groups at increased risk for mumps during the outbreak, determine whether vaccination of at-risk persons is indicated, and provide recommendations for vaccination to health care providers.”

Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak

Your local or state health department will decide which folks need a third dose of MMR in an outbreak situation.

“Persons at increased risk for acquiring mumps are those who are more likely to have prolonged or intense exposure to droplets or saliva from a person infected with mumps, such as through close contact or sharing of drinks or utensils.”

Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak

Why not just give everyone a third dose of MMR?

The issue with the mumps vaccine is waning immunity, so it isn’t known how long an extra dose would last, and that’s why at this time, the only recommendation is to give an extra dose during outbreaks.

If you are still unsure about needing a third dose of MMR, ask your pediatrician, school health clinic, or local health department, especially if you have heard about local mumps cases.

What to Know About the Mumps Booster Shot

A third dose of MMR is recommended for some people at high risk to get mumps in an outbreak situation.

More on the Mumps Booster Shot

Mumps Outbreaks

Pre-Vaccine Era Mumps Outbreaks

In the pre-vaccine era, mumps was a common childhood disease that could cause orchitis, meningitis, pancreatitis, deafness, and even death.

There were about 212,000 cases a year in the early 1960s, before the first mumps vaccine was licensed in 1968.

Post-Vaccine Era Mumps Outbreaks

Tips to prevent getting sick with the mumps.
A large Ohio mumps outbreak prompted an education campaign to help protect everyone from getting sick.

As with other vaccine-preventable diseases, there was a big drop in cases of mumps once the mumps vaccine was introduced.

In 1968, there were just over 152,000 cases and 25 deaths  and just ten years later, in 1978, that was down to 16,817 cases and 3 deaths.

Once the recommendation for the second dose of MMR came in 1990, it looked like mumps was on it’s way out.

We went from 5,292 cases and one death that year, to just 906 cases and no deaths in 1995. When measles hit its low point of 37 cases in 2004, there were just 258 cases of mumps.

That wasn’t the end for mumps though, as we had some up and down years, including big outbreaks in:

  • 2006 – 6,584 cases among Midwest college students and one death
  • 2008 – only 454 cases, but one death
  • 2009 – 1,991 cases and two deaths
  • 2010 – 2,612 cases mostly among Orthodox Jewish communities and two deaths
  • 2011 – 370 cases
  • 2012 – 229 cases
  • 2013 – 584 cases
  • 2014 – 1,223 cases involving a large outbreak in Ohio and in the NHL
  • 2015 – 1,057 cases mostly among university students in Iowa and Illinois
  • 2016 – 6,369 cases in 46 states (no cases in Delaware, Louisiana, Vermont, or Wyoming), with the most cases in Arkansas, Iowa, Indiana, Illinois, Maine, New York, Oklahoma, and Texas.
  • 2017 – at least 6,109 cases of mumps, with cases in all states except Wyoming, South Carolina, and South Dakota. With outbreaks at Syracuse University, in Anchorage, Alaska (many unvaccinated cases), and Hawaii.
  • 2018 – about 2,251 cases

Could this all be because of waning immunity?

The herd immunity threshold may need to be higher than the previously suggested 88%–92% to prevent community transmission and outbreaks of mumps.

Quinlisk on Mumps Control Today

Many of these outbreaks occur despite many of the cases having had two doses of the MMR vaccine. A third dose is sometimes recommended during these outbreaks.

That doesn’t mean that the MMR vaccine doesn’t work. After all, just compare today’s rates of mumps, even if they are a little higher than we would like, to pre-vaccine levels…

Unfortunately, this Syracuse University poster doesn't mention getting vaccinated...
Unfortunately, this Syracuse University poster doesn’t mention getting vaccinated…

And in the biggest outbreak, in Arkansas, only 71% of people were up-to-date on their vaccines!

Of course, getting two doses of the MMR vaccine is still the best way to avoid mumps.

There is no general recommendations to get an extra shot, although a third dose of MMR during an outbreak was recently recommended by the ACIP. The recommendation has not yet been formally approved though.

A recent study that was published in the New England Journal of Medicine, Effectiveness of a Third Dose of MMR Vaccine for Mumps Outbreak Control, found a lower risk of mumps in those who got a third dose of MMR.

Not surprisingly, the study also found a much higher risk of mumps, with the highest attack rates, in those who were unvaccinated or who had just one dose!

Keep in mind that the MMR vaccine isn’t just for kids. Adults who didn’t have mumps when they were kids (or who were born before 1957, when most kids got mumps), should make sure they are vaccinated (at least one dose) and protected too.

Vaccines work. They just aren’t perfect…

And these outbreaks show that they are definitely still necessary. In the latest outbreak in Hawaii, where “has been confirmed in children and adults, both vaccinated and unvaccinated,” there have been at least “16 reports of complications due to mumps infection,” including orchitis and hearing loss.

What to Know About Mumps Outbreaks

Although mumps outbreaks are occurring among those who are vaccinated, you still have a much higher chance of getting mumps if you are unvaccinated and unprotected.

For More Information on Mumps Outbreaks:

Updated on January 9, 2019