By Dr. Grace Chen O'NeilJanuary 31, 2018
HONOLULU (January 31, 2018) - With more than 800 confirmed cases of mumps in Hawaii since March 2017, providers at Tripler Army Medical Center are encouraged to screen immunization records for newly suggested doses of the "Mumps Outbreak Vaccination," and offer the vaccine to those meeting specific criteria.
The TAMC Chief of Preventive Medicine, Col. Christine Lang explains, "During these types of sustained outbreaks, an additional outbreak dose of the MMR (Measles, Mumps, Rubella vaccine) is recommended for all persons between the ages of 10-59 who are not pregnant and who have not received a total of three-lifetime doses."
More than half of the mumps cases in Hawaii have been in people over 18 years old, and several local service members and family members have become sick with the mumps even though they were fully vaccinated in the past or had blood drawn to show immunity (titers).
Fortunately, a high vaccination rate does limit the size, length of time, and spread of mumps during an outbreak.
"MMR is only 88 percent effective against mumps in persons who have had two doses and immunity has been shown to wane over time, which is why the outbreak dose is helpful," said Lang.
Aside from routine pediatric MMR dosing for children at ages 12-15 months and again four to six years later, TAMC clinic leaders and providers recommend the outbreak dose to those who lack any documentation or have had only one MMR dose, and then to those with documentation of only two MMR doses. Persons born before 1957 or anyone who has had three or more documented lifetime doses are exempt.
Mumps outbreaks can occur during any season, and a significant risk factor is being in close contact with those who have mumps in a crowded environment. (Such as attending the same school or being on the same sports team as someone with mumps.) Mumps is also transmitted when saliva is exchanged. (Such as when kissing, or sharing utensils, cups, chapstick, or cigarettes.)
Symptoms of mumps include pain and swelling of both salivary glands in the cheek and jaw area. The swelling usually lasts about two weeks but peaks around days one to three. In some patients, only one side swells. Other salivary glands under the floor of the mouth also may swell though less frequently. People may have fevers for three to four days with body aches, loss of appetite, and headache. People are most infectious for several days before or after the swelling of the salivary glands.
To prevent transmission, Hawaii state law requires persons with mumps to self-isolate (e.g., no work, school, travel or public places) for nine days after the onset of gland swelling.
Complications of mumps include deafness, inflammation of the brain, sterility and rarely death. Orchitis, or inflammation of the testis happens in three to 10 percent of adolescent or adult males. In most cases, only one testis is affected. Orchitis rarely causes sterility. Other rare complications include inflammation of the pancreas and a brain infection.
While an outbreak MMR vaccination is not mandatory, it is highly recommended to prevent you from becoming sick with mumps or developing complications associated with the illness.
For questions or to obtain the vaccination, please contact your assigned primary care provider online through Relay Health or by calling the Tripler Appointment Line at 808-433-2778.
For more information about mumps and the ongoing investigation in Hawaii visit the Hawaii Department of Health Mumps Webpage at http://health.hawaii.gov/docd/department-of-health-investigating-mumps-cases/.
(Contributions made by Leanne Thomas, Tripler Army Medical Center Public Affairs.)