11/19/2018

1

MUMPS SYRACUSE UNIVERSITY 2017-2018

Background

VIRAL ILLNESS CAUSED BY A PARAMYXOVIRUS

HUMANS ONLY RESERVOIR AVERAGE INCUBATION FROM

EXPOSURE TO SYMPTOMS STARTING IS 16-18 DAYS

WIDESPREAD VACCINATION IN US STARTED IN 1967

PRIOR TO VACCINATION, AVERAGE 200K CASES/YEAR. NOW 99% LESS PEOPLE AFFECTED BUT OUTBREAKS SINCE 2006

11/19/2018

2

CDC Website

Cdc website

11/19/2018

3

MUMPS OUTBREAKS

ANYTIME OF YEAR STILL OCCURING IN HIGHLY VACCINATED COMMUNITIES RISKS

CROWDED ENVIORMENTS-CLASSROOMS, DORMS, TEAMS EXCHANGING SALIVA-SHARING CUPS/UTENSILS/WATER

BOTTLES/SPORTS EQUIPMENT/LIP BALM/CIGARETTES, KISSING

2006-MULTISTATE, PRIMARILY MIDWEST ON COLLEGE CAMPUSES > 6500 CASES

2009/2010- 2 LARGE OUTBREAKS, 1 > 3,000 MOSTLY HIGH SCHOOLAGE IN TIGHT KNIT RELIGIOUS COMMUNITY IN NY STATE

MORE MUMPS OUTBREAKS

2011-2013 MULTIPLE ON COLLEGE CAMPUSES, BUT LIMITED SPREAD 2014-2016 SEVERAL AT UNIVERSITIES IN MULTIPLE STATES – LARGEST IN

IOWA AND ILLINOIS HAD WIDESPREAD VACCINE CAMPAIGNS COMMUNITY OUTBREAKS–LARGEST IN ARKANSAS ALMOST 3,000

2016-2017 HARVARD, MISSOURI, SUNY NEW PALTZ ,UNIVERSITY OF WASHINGTON, INDIANA, U OF SANDIEGO, SYRACUSE UNIVERSITY

11/19/2018

4

MUMPS PRESENTATION

NONSPECIFIC SYMPTOMS MAY OCCUR SEVERAL DAYS PRIOR (CALLED A PRODROME) AND INCLUDE :

FEVER-LOW GRADE, LASTING 3-4 DAYSMYALGIA, LOSS OF APPETITE, MALAISE, HEADACHE

PAROTITIS-SWELLING, PAIN AND TENDERNESS OF THE PAROTID GLANDLASTS 2-3 DAYS GENERALLY BUT UP TO 10 DAYSMAY INVOLVE ONE (25%)OR BOTH SIMULTANEOUSLY OR SEPARATELY SWELLING

ANY OF THE SALIVARY GLANDS CAN BE INVOLVED ONLY SUBMANDIBULAR OR SUBLINGUAL GLAND 10% OF CASES ASYMPTOMATIC CASES MAY BE UP TO 20%

11/19/2018

5

COMPLICATIONS

ASEPTIC MENINGITIS

ENCEPHALITIS

ORCHITIS

OOPHORITIS

HEARING LOSS

PANCREATITS

MYOCARDITIS

ARTHRITIS

ORCHITIS OCCURS IN 3-10% OF POST VACCINE ERA MUMPS CASES IN MALES

OOPHORITIS RATE 1% IN POST PUBERTAL FEMALES IN POST VACINE ERA

MUCH MORE COMMON PRIOR TO VACCINE ERA

TRANSMISSION OF MUMPS

MUMPS VIRUS MULTIPLIES IN UPPER RESIRATORY TRACT SPREAD BY RESPIRATORY DROPLETS AND SALIVA OR BY DIRECT

CONTACT WITH INFECTED SURFACE ( desk, doorknob, water bottle) VIRUS SHED FOR 2 DAYS PRIOR AND UP TO 5 DAYS AFTER ONSET OF

PAROTITIS INFECTION CAN OCCUR BY DROPLETS UP TO A DISTANCE OF 3 FEET

11/19/2018

6

TESTING FOR MUMPS

POSITIVE DIAGNOSIS IS MADE BY: ISOLATION OF VIRUS IN CULTURE FROM BUCCAL/ORAL SWAB

POSITIVE MUMPS PCR FROM BUCCAL/ORAL SWAB

POSITIVE IGM ON SERUM TEST

4X INCREASE IN IGG OR NEW IGM OR IGG NOT PREVIOUSLY PRESENT ON A CONVALESCENT SAMPLE 14-21 DAYS AFTER ORIGINAL BLOODWORK.

BEST TO SWAB WITHIN 3 DAYS OF ONSET OF PAROTITIS

CASE CLASSIFICATION/DEFINITIONS

CONFIRMED- POSITIVE PCR FROM BUCCAL/ORAL SWAB OR CULTURE WITH ACUTE ILLNESS

PROBABLE- ACUTE PAROTITS FOR > 2 DAYS WITH A POSITIVE IGM OR LINK TO A CONFIRMED CASE IN AN OUTBREAK

OUTBREAK- 3 OR MORE CASES OF THE DISEASE IN A COMMON SETTING WITHIN AN INCUBATION PERIOD

11/19/2018

7

SYRACUSE UNIVERSITY OUTBREAK

1ST CASE – PRESENTED AUGUST 30TH , 2017 STUDENT CONTRACTED WHILE TRAVELING IN ASIA PLAYED A CLUB SPORT

2ND WAVE- 5 CASES ( 3 CONFIRMED, 2 PROBABLE) SEPTEMBER 16th-22nd

3RD WAVE- 18 CASES BETWEEN OCTOBER 3RD AND 6TH

( 13 CONFIRMED AND 5 PROBABLE ) ONONDAGA COUNTY DECLARED AN OUTBREAK SEPTEMBER 22ND

TOTAL SYRACUSE UNIVERSITY OUTBREAK CONFIRMED 54PROBABLE 91 TOTAL 145

ALL STUDENTS EXCEPT 2 PROBABLE WERE EMPLOYEES

ATHLETICS

OUTBREAK STARTED IN STUDENTS ASSOCIATED WITH ATHLETICS

MULTIPLE MENS AND WOMENS TEAMS INVOLVED INCLUDINGMENS AND WOMENS LACROSSE (LARGEST GROUP),MENS SOCCER, ROWING, MENS BASKETBALL, FOOTBALL

23/54 CONFIRMED AND 18/91 PROBABLE WERE ATHLETES

9/10 FIRST CONFIRMED CASES ATHLETES

2 EMPLOYEE CASES WORKED IN ATHLETICS

SUSPECTED ROUTES OF SPREAD-SHARING WATER BOTTLES, SHARING SPORTS EQUIPMENT, TRAINING ROOM-SURFACE AND DIRECT CONTACT, LEARNING CENTER- SURFACE AND DIRECTCONTACT, SOCIAL CONTACT AT PARTIES, ROOMMATES

11/19/2018

8

GREEK COMMUNITY CASE 24 IN SORORITY , CASE 35

SORORITY

14 CONFIRMED CASES 18 PROBABLE

12 OF LAST 25 CASES ASSOCIATED WITH FRATERNITY/SORORITY

ROUTES OF SPREAD-ROOMMATE, INTIMATE CONTACT, SOCIAL CONTACT AT PARTIES, SHARING DRINKS

SU MUMPS DEMOGRAPHICS

AVERAGE AGE 20.5 YEARS 18% FRESHMAN, 23% SOPHMORE, 25% JUNIOR, 22% SENIOR, 11%

GRAD 62% LIVED OFF CAMPUS, 38% LIVED ON CAMPUS SEX 55% FEMALE 45% MALE RACE 83% CAUCASIAN , 5% AFRICAN AMERICAN, 3% ASIAN 2%

LATINO AND 2% NATIVE AMERICAN OTHER ROUTES OF SPREAD- CLASSROOM, BUS FROM SOUTH CAMPUS, WORK

IN DORMITORY FRONT DESK

11/19/2018

9

MANAGEMENT OF OUTBREAK WHEN 2ND CASE REPORTED, SYRACUSE UNIVERSITY LACKED

IMMUNIZATION STATUS OF 2,000 STUDENTS WITHIN A FEW DAYS-1,000 STUDENTS AND SEPTEMBER 20TH

ONONDAGA COUNTY HEALTH DEPARTMENT GAVE US 5 DAYS TO TRACK DOWN THE REST

USED TEXT MESSAGING, EMAILS, ROBOCALLS, PHONE BANK TO REACH STUDENTS FOR IMMUNIZATION RECORDS OR MMR SHOT

DEPARTMENT OF PUBLIC SAFETY HELPED TO TRACK DOWN LAST FEW AND DELIVER LETTERS EXCLUDING 6 STUDENTS FROM CAMPUS

1 MEDICAL WAIVER, 5 RELIGIOUS WAIVERS BY NOVEMBER- 1 MEDICAL AND 1 RELIGIOUS (BECAME CASE 144)

CONTROL MEASURES

2ND MMR FOR STUDENTS WITH ONLY 1 MMR SEPARATE CLINIC FOR POTENTIAL MUMPS CASES ONLINE SCHEDULING AND SELF CHECK IN DISABLED POTENIAL CASES ISOLATED OFF CAMPUS FOR 5 DAYS ATHLETIC TEAMS- PRACTICE/FALL SEASON CANCELLED

WATER BOTTLES BANNED PROCEDURES FOR CLEANING EQUIPMENT

ALL GREEK LIFE IN HOUSE ACTIVITIES CANCELLED WIDESPREAD CLEANING EFFORTS

11/19/2018

10

COMMUNICATIONS

EMAILS TO ALL CLASS CONTACTS MULTIPLE CAMPUS WIDE EDUCATIONAL EMAILS WRITTEN NOTIFICATION AND EDUCATIONAL POWERPOINT FOR

URGENT CARES AND EMERGENCY ROOMS LETTERS TO PARENTS BUMP THE MUMPS COORDINATED WITH ATHLETICS AND GREEK LIFE ADMINISTRATION

3RD MMR 1 DOSE 78% EFFECTIVE, 2 DOSES 88% EFFECTIVE NUMEROUS STUDIES SUGGESTED 3RD OR BOOSTER IS PROTECTIVE CDC GUIDELINES FOR PUBLIC HEALTH AGENCIES FOR 3RD MMR -2012

2 DOSE VACCINE COVERAGE IS >90%EVIDENCE OF SUSTAINED TRANSMISSION FOR > 2WEEKSINTENSE EXPOSURE SUCH AS COLLEGE CAMPUSHIGH ATTACK RATES > 5/1,000

ACIP MEETING –OCTOBER 2017 FORMAL RECOMMENDATION FOR 3RD MMR IN THE SETTING OF AN OUTBREAK

11/19/2018

11

PODS COORDINATED WITH ONONDAGA

COUNTY AND THE NEW YORK HEALTH DEPARTMENT FROM THE BEGINNING

MULTIDISCIPLANARY TEAM

1ST POD THE DAY CDC RECOMMENDED 3RD DOSE –October 24th

4760 DOSES GIVEN IN 9 PODS

SYRACUSE UNIVERSITY CASES

Dylan Johns - NYSDOH

11/19/2018

12

THE END! OUTBREAK DECLARED OVER WHEN 2 FULL INCUBATION PERIODS ( 52

DAYS) WITHOUT A CASE. ONONDAGA COUNTY HEALTH DEPARTMENT DECLARED OUTBREAK

OVER FEBRUARY 14TH 2018. SYRACUSE UNIVERSITY MAKE CHANGES FOR IMMUNIZATION

REPORTING FALL 2018.