Not Immune From Mumps
1 Dec 2009
by Sharon Udasin
Staff Writer
http://www.thejewishweek.com/viewArticle/c36_a17351/News/New_York.html
Stemming from an initial mumps outbreak that wreaked havoc at a Jewish camp this
summer, 247 New York City residents plus 131 other state residents have since
contracted the disease, which remains mostly contained among fervently Orthodox
adolescent boys in pockets of New York, New Jersey and Quebec, according to
official reports from the New York City and State Departments of Health.
The trigger case occurred back in June, when an 11-year-old boy returned to
his Sullivan County summer camp after traveling in the United Kingdom, where an
ongoing outbreak has now reached about 4,000 cases, the Centers for Disease
Control reported.
From there, the mumps spread to 24 other boys at the camp and continued to
plague their local communities when they returned
home, and the median age of patients remains around 14.
But perhaps the most frustrating news to some parents is that most of the
affected patients had received their proper two-dose vaccination as children —
83 percent, according to the CDC.
“This is a very confusing issue not only for ourselves but for providers and
parents,” said Cindy Schulte, vaccine-preventable disease surveillance officer
at the New York State Department of Health. “If you have a population that’s
fairly well but unevenly vaccinated, by logic, you’re going to end up having
some disease in the effective population.” The Measles, Mumps and Rubella (MMR)
vaccine has an 85 to 91 percent efficacy rate among those who take the proper
doses, she said.
The most common symptoms of this viral disease are fever, muscle aches and
parotitis, the signature inflammation of the salivary glands below the ear.
Though no deaths have occurred thus far and symptoms may often be subtle, there
have been several hospitalizations and one potential case of meningoencephalitis
(inflammation of the brain), according to Dr. Debra Blog, medical director at
the Bureau of Immunization Program in the New York State Department of Health.
Mumps can be particularly dangerous to pubescent boys, doctors say, because a
small number will develop orchitis, a swelling of the testicles that can
potentially (though rarely) lead to infertility. The same goes for girls, who
can develop swelling of the ovaries that can lead to sterility. While mumps
cases among women have certainly increased since the summer, New York City
infections remain around 79 percent male, Blog explained.
“These communities tend to have social contact with themselves and tend to be a
bit isolated from the outside community,” she said. “In New York City especially
it’s going through their schools.”
As of Oct. 30, the CDC had only reported a total of 179 cases in New York and
New Jersey and another 15 in Canada, but New York City health officials say that
the numbers have increased so dramatically in the past month simply because
doctors are taking more care to report their ill patients to the government.
“We’re still getting cases reported virtually every day,” said Dr. Chris
Zimmerman, medical director at the Bureau of Immunization in the New York City
Department of Health and Mental Hygiene. “There was a substantial increase just
from the week before the alert to when the alert came out.”
It is difficult to maintain an exact number of cases, Schulte added, because
disease spread is a “fluid number.”
A mumps outbreak of this size has not occurred since 2006, when the United
States experienced over 6,500 cases that were particularly hard-hitting among
college dormitory residents in Iowa. But the current wave largely remains within
pocketed chasidic communities, all linked back to that one summer camp flare-up.
“There have been less than a handful of cases outside the community,” Zimmerman said.
“The population is segregated — these kids are not going to public schools,
they’re going to yeshivas,” he continued. “They only have the opportunity to
interact with other boys in their community.”
And while statistics show that an overwhelming majority of the kids in these
neighborhoods are in fact properly vaccinated, the few outliers are probably the
ones perpetuating the disease spread, he added.
“Overall, immunization coverage is good, but this is a community that has had
resistance to MMR vaccines — their parents have claimed religious exemptions,”
Zimmerman said.
Yet despite outbreaks that have resurfaced from time to time, state medical
officials still maintain the mumps vaccine is a successful product, particularly
in what Blog calls “evenly vaccinated communities” — those who pretty much
unanimously undergo the immunization.
Regarding the disease spread, another crucial element worth considering among
the allegedly vaccinated patients is whether or not their dosages were properly
refrigerated speculated Dr. Michael Augenbraun, a professor of epidemiology at
Downstate Medical Center in Brooklyn.
“Breaks in the ‘cold chain’ are a serious problem for vaccine efficacy if, for
example, an office allowed for a vaccine to sit out on countertops overnight,”
Augenbraun said, noting that we have no way of knowing this after so many years,
however.
Thus far, despite the one hospitalization and some cases of orchitis,
complications from this outbreak have generally been minimal. Approximately 56
percent of the confirmed cases exhibited the parotitis, according to Schulte.
“We’re not seeing the same rate of complications that we saw in the pre-vaccine
era,” Zimmerman said, noting that before the vaccine, another dangerous side
effect of the mumps was permanent deafness.
But the subtle nature of so many of these current cases may be yet another
reason that the disease is spreading, because parents neglect to see a doctor
about their children’s illnesses.
So what can parents do to protect their families from catching the mumps?
They should make sure that their children have received the two dosages of the
vaccine on time, ideally before their first birthday, Schulte said. If an older
child has not yet received the vaccine but hasn’t yet been exposed to the
illness, this child too should be immunized.
And if a child or adult becomes sick, the best thing to do, as always, is to
stay home from school or work, wash hands frequently and see a doctor.
Blog added, “Isolation and vaccination are the two most effective things along
with common sense.”