The worst mumps outbreak in 20 years is prompting school administrators to use the generally mild disease as an opportunity to strengthen their ties with local health officials and test emergency plans that would be used in the breakout of a more serious illness.
Mumps, a viral infection, leads to sore throat, fever, chills, and its trademark symptom, swelling of the salivary glands. The latest outbreak first appeared in Iowa in December and has since increased to about 1,700 cases in that state, compared with about 265 cases nationwide in a normal year. More than 1,300 cases of mumps have since been recorded in other Midwestern states. Most cases have been seen among 18- to 22-year-olds.
The virus is spread much like the common cold, through contact with body fluids such as saliva. A vaccine for mumps, once considered a common disease of childhood, has been around since the 1960s. However, the three-in-one vaccine against measles, mumps, and rubella was recommended as the preferred vaccine in 1977. It is about 90 percent effective when given in two doses: one at about age 1, and the second between ages 4 and 6.
But many of the current mumps cases are being seen in people who had been vaccinated, which will warrant further investigation, said officials of the federal Centers for Disease Control and Prevention in Atlanta.
Testing Policies
In Iowa, where most of the cases have appeared, school districts have reacted by staying in close contact with local health workers and educating parents, administrators say.
Mumps is a viral infection transmitted, like colds, through exposure to saliva or mucus from an infected person. Surfaces can also transmit the disease if infected people touch an object, and non-infected people touch the same surface and then rub their eyes or nose.
Symptoms: Symptoms typically appear 16-18 days after infection. The most common symptoms are fever, headache, muscle aches, tiredness, and loss of appetite, followed by swollen and tender salivary glands under the ears on one or both sides. It has generally not been a fatal disease.
Treatment: There is no specific treatment or cure for the mumps. An infected person is given supportive treatment as the illness runs its course. The mumps vaccine, given when a child is about age 1 and once more between ages 4 to 6, is considered to be about 90 percent effective in preventing the disease.
Cases: Since 2001, an average of 265 mumps cases have been reported each year in the United States. This latest outbreak began last December in Iowa, which reported 1,487 confirmed cases as of May 1. Other cases have been reported in Illinois, Indiana, Kansas, Michigan, Minnesota, Missouri, Nebraska, Oklahoma, Pennsylvania, South Dakota, and Wisconsin.
SOURCE: U.S. Centers for Disease Control and Prevention
“We do work closely with our Linn County public-health department,” said Rhoda Shepherd, the director of student services for the 17,800-student Cedar Rapids district, which has so far seen nine cases of mumps in its schools, among 75 cases in the county. “We do have board policies on communicable diseases. This gives us an opportunity to test out those policies.”
For example, she said, school nurses have reviewed student records in order to keep track of students who have not been vaccinated against mumps and are therefore more susceptible to the disease.
While the district is tracking unvaccinated students, “as long as people don’t have symptoms of illness, they can continue coming to school,” Ms. Shepherd said.
Susie Poulton, the director of health services for the 11,000-student Iowa City district, said the school system has seen just seven cases so far, despite the fact that the virus has been most active among young adults and the University of Iowa is nearby.
“We feel very fortunate about that,” she said.
“With this and pertussis”—a bacterial infection also known as whooping cough that spreads among children—“it’s reinforced the need for us, and local health officials, and state health officials to all work together,” Ms. Poulton said.
Iowa City schools have sent letters to the parents of classmates of infected elementary pupils. At the secondary school level, the letters have gone home to parents of the few students who have not been vaccinated, Ms. Poulton said. Relatively few parents have said they’re seriously worried, she said.
‘A Small World’
Kathi Slaughter, the communications director for the Iowa education department, said the mumps outbreak is not a crisis situation for schools. It does, however, give the department a chance to remind school leaders that in health matters, their local health department is their first resource. Some district officials naturally turn to the state education department for information, “but I always want to turn them back” to local health officials, Ms. Slaughter said.
“We are pretty lucky that we can practice our communications in this environment,” Ms. Slaughter said, instead of in a more serious public-health situation.
But not every state is reacting in the same way. In Ottawa, Kan., 15-year-old David Brockway was told in late April that he had to stay home from Ottawa High School after another student contracted mumps, because Mr. Brockway has not been vaccinated. The school board of the 2,500-student Ottawa district reversed itself after his parents signed a release, but the sophomore’s stepmother, Kris Brockway, said the local health department was still reviewing the case.
“We’re kind of scratching our heads,” said Ms. Brockway. “What sense does it make to pull a healthy child out of school?”
The district said it was following state health department guidelines in making its original recommendations. Sharon Watson, the spokeswoman for the Kansas Department of Health and Environment, said the department has the authority to remove a student from school if there is a mumps outbreak, which is three cases or more in one school. Ottawa High School has not seen that many cases, and David Brockway appears to have had no close contact with the one ill student, she said.
Susan Will, the president of the National Association of School Nurses in Castle Rock, Colo., said that schools are an essential part of the management of disease outbreaks like mumps.
“It’s very important to have trained school health professionals at the table,” she said. “Schools are an essential piece of the management picture.
‘Fire Drill’
Dr. William Schaffner, the chairman of the department of preventive medicine at the Vanderbilt University School of Medicine in Nashville, Tenn., said schools should be using the mumps outbreak as a learning experience.
“This is a bit of a fire drill,” Dr. Schaffner said. “You can use this as training to see how we all work together.”
Another lesson, he said, is that “we do live in a small world, and we have to keep our guard up. All that quite assiduous and, let’s be fair, tedious work of reviewing vaccination records is important.”
