Issue
Number 593
April 17, 2006
CONTENTS OF THIS ISSUE
- Important: Corrected CDC Health Advisory presents
information and guidance for the current mumps outbreak
- MMWR publishes report alerting healthcare providers
about recent U.S. air travel by persons infectious with mumps
- New: NIP website posts up-to-date resources regarding
the current mumps outbreak
- IAC posts another thimerosal resource to its website
homepage
- Updated: IAC revises "It's federal law!" and other
education pieces for health professionals and patients
- CDC updates its Influenza web section with current
information about avian influenza
- WHO issues guidelines for preparing for and mitigating
pandemic influenza in refugee and displaced populations
- CDC publishes recommendations for animal rabies
prevention and control
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ABBREVIATIONS: AAFP, American Academy of Family Physicians; AAP, American
Academy of Pediatrics; ACIP, Advisory Committee on Immunization Practices;
CDC, Centers for Disease Control and Prevention; FDA, Food and Drug
Administration; IAC, Immunization Action Coalition; MMWR, Morbidity and
Mortality Weekly Report; NIP, National Immunization Program; VIS, Vaccine
Information Statement; VPD, vaccine-preventable disease; WHO, World Health
Organization.
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April 17, 2006
IMPORTANT: CORRECTED CDC HEALTH ADVISORY PRESENTS INFORMATION AND GUIDANCE
FOR THE CURRENT MUMPS OUTBREAK
On April 14, CDC issued a Health Advisory with information about the current
mumps outbreak. On April 15, CDC issued a Health Update to correct an error
in the Health Advisory. The corrected document is reprinted below in its
entirety, with the exception of references.
*****************
This is an official CDC Health Update
Distributed via Health Alert Network
April 15, 2006, 12:39 EDT
CORRECTED: MULTI-STATE MUMPS OUTBREAK
This message is being sent to correct the flight arrival city in Arkansas
indicated for this outbreak. The arrival city was BENTONVILLE, AR not
Lafayette.
Original information from the CDC Advisory #00243, transmitted April 14,
2006:
The state of Iowa has been experiencing a large outbreak of mumps that began
in December 2005. As of April 12, 2006, 605 suspect, probable, and confirmed
cases have been reported to the Iowa Department of Public Health (IDPH) (IDPH,
unpublished data). The majority of cases are occurring among persons 18–25
years of age, many of whom are vaccinated. Additional cases of mumps,
possibly linked to the Iowa outbreak, are also under investigation in eight
neighboring states, including Illinois, Indiana, Kansas, Michigan,
Minnesota, Missouri, Nebraska, and Wisconsin (CDC unpublished data, April
14, 2006).
In addition, the Iowa Department of Public Health has identified two persons
diagnosed with mumps who were potentially infectious during travel on nine
different commercial flights involving two airlines between March 26, 2006
and April 2, 2006. The origin and arrival cities for these flights include
Cedar Rapids and Waterloo, IA; Dallas, TX; Detroit, MI; Lafayette, AR
[corrected to BENTONVILLE, AR, in the Health Update]; Minneapolis, MN; St.
Louis, MO; Tucson, AZ; and Washington, DC.
The source of the current US outbreak is unknown. However the mumps strain
has been identified as genotype G, the same genotype circulating in the
United Kingdom (UK). The outbreak in the UK has been ongoing from 2004 to
2006 and has involved [more than] 70,000 cases. Most UK cases have occurred
among unvaccinated young adults. The G genotype is not an unusual or rare
genotype and, like the rest of known genotypes of mumps, it has been
circulating globally for decades or longer.
MUMPS CLINICAL MANIFESTATIONS AND TRANSMISSION
Mumps is an acute viral infection characterized by a non-specific prodrome
including myalgia, anorexia, malaise, headache, and fever, followed by acute
onset of unilateral or bilateral tender swelling of parotid or other
salivary glands. In unvaccinated populations, an estimated 30–70% of mumps
infections are associated with typical acute parotitis. However, as many as
20% of infections are asymptomatic and nearly 50% are associated with
non-specific or primarily respiratory symptoms, with or without parotitis.
Complications of mumps infection can include deafness, orchitis, oophoritis,
or mastitis (inflammation of the testicles, ovaries, or breasts
respectively), pancreatitis, meningitis/encephalitis, and spontaneous
abortion. With the exception of deafness, these complications are more
common among adults than children.
Transmission of mumps virus occurs by direct contact with respiratory
droplets [or] saliva or contact with contaminated fomites. The incubation
period is generally 16–18 days (range 12–25 days) from exposure to onset of
symptoms. Mumps virus has been isolated from saliva from between two and
seven days before symptom onset until nine days after onset of symptoms.
MUMPS PREVENTION
The principal strategy to prevent mumps is to achieve and maintain high
immunization levels. The Advisory Committee on Immunization Practices (ACIP)
recommends that all preschool-aged children 12 months of age and older
receive one dose of measles-mumps-rubella vaccine (MMR) and all school-aged
children receive two doses of MMR, and to ensure that all adults have
evidence of immunity against mumps. As noted below, two doses of mumps
vaccine are more effective than a single dose. Consequently, during
outbreaks and for at-risk populations, ensuring high vaccination coverage
with two doses is encouraged. For example, healthcare workers may be at
increased risk of acquiring mumps and transmitting to patients and thus
should receive two doses of MMR vaccine or provide proof of immunity. Since
vaccination is the cornerstone of mumps prevention, public and private
health entities concerned about spread of mumps in a population can review
the vaccination status of populations of interest and work to address gaps
in vaccination.
MUMPS VACCINE EFFECTIVENESS
Data from outbreak investigations have shown that the effectiveness of MMR
against mumps is approximately 80% after one dose, and limited data suggest
effectiveness of approximately 90% after two doses. Available evidence
suggests that mumps vaccination should provide immunity against the genotype
G virus responsible for the current US outbreak. A study of a 2005 New York
outbreak that began with imported disease from the UK, demonstrated vaccine
effectiveness in the expected range for both one and two doses (New York,
unpublished data). However, since the vaccine is not 100% effective, some
cases can occur in vaccinated persons. When a highly vaccinated population
is exposed to disease, most cases of disease would be expected to be among
vaccinated persons. Mumps vaccine has not been shown to be effective in
postexposure prophylaxis, and an interval of 2–4 weeks after vaccination may
be required for the vaccine's full immunogenicity to be achieved. For these
reasons, and because of the mumps' incubation period of 12–25 days, during
an outbreak, newly vaccinated persons may develop mumps disease as long as a
month after vaccination.
CONTROL OF MUMPS OUTBREAKS
The main strategies for controlling a mumps outbreak are to define the
at-risk population and transmission setting, identify and isolate suspected
cases, and rapidly identify and vaccinate susceptible persons or, if a
contraindication to MMR vaccine exists, to exclude susceptible persons from
the setting to prevent exposure and transmission. Specific strategies are
listed below.
1. Offer MMR vaccine to persons without evidence of immunity. Evidence of
immunity includes physician diagnosis or laboratory evidence of mumps
infection, birth before 1957, or one dose of MMR vaccine. For pre-school
aged children, the first MMR dose should be administered as close to age 12
months as possible. Although birth before 1957 is usually considered proof
of immunity, during an outbreak, vaccination can be considered for this age
group if the epidemiology of the outbreak suggests that they are at
increased risk of disease. Since two doses of MMR vaccine [are] more
effective than one dose for preventing mumps, a second dose of MMR vaccine
is recommended for the following groups: healthcare workers, school-aged
children, students at post-high school educational institutions, and other
age groups considered at high risk of exposure.
2. Surveillance for mumps should be enhanced in all affected areas for
persons with parotitis or other salivary gland inflammation. Enhanced
surveillance should continue for 50 days (two times the maximum incubation
period) after the date of illness onset in the last identified case. CSTE
[Council of State and Territorial Epidemiologists] approved case definitions
and case classifications for mumps are available.
3. Persons with suspected mumps should be tested and reported immediately to
local public health officials. Information on collection and testing of
clinical specimens for mumps will be available by Monday April 17, 2006, at
http://www.cdc.gov/nip/diseases/mumps/mumps-lab.htm Testing is essential
as not all cases of parotitis are mumps, although mumps is the only known
cause of epidemic parotitis.
4. Persons suspected of having mumps should be isolated for nine days after
symptom onset. In healthcare settings, the use of respiratory precautions is
recommended.
5. Exclusion of persons without evidence of immunity to mumps from
institutions such as schools and colleges affected by a mumps outbreak (and
other, unaffected institutions judged by local public health authorities to
be at risk for transmission of disease) should be considered. Once
vaccinated, students can be readmitted to school. The period of exclusion
for those that remain unvaccinated should be for at least 25 days after the
onset of parotitis in the last person with mumps in the affected
institution.
Additional information on mumps and the prevention and control of mumps
outbreaks, including vaccination, can be found at the following website:
http://www.cdc.gov/nip/diseases/mumps/mumps-outbreak.htm
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To access the corrected Health Update from the Health Alert Network, go to:
http://www.phppo.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00244
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April 17, 2006
MMWR PUBLISHES REPORT ALERTING HEALTHCARE PROVIDERS ABOUT RECENT U.S. AIR
TRAVEL BY PERSONS INFECTIOUS WITH MUMPS
CDC published "Exposure to Mumps During Air Travel—United States, April
2006" in the April 14 issue of MMWR. Previously, the article was available
only in electronic format as an MMWR Dispatch.
To access a web-text (HTML) version of the MMWR article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5514a6.htm
To access a ready-to-print (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5514.pdf
To receive a FREE electronic subscription to MMWR (which includes new ACIP
statements), go to:
http://www.cdc.gov/mmwr/mmwrsubscribe.html
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April 17, 2006
NEW: NIP WEBSITE POSTS UP-TO-DATE RESOURCES REGARDING THE CURRENT MUMPS
OUTBREAK
On April 16, NIP updated its website with links to resources regarding the
current mumps outbreak. Resources include information for the public and
healthcare professionals.
To access these resources, go to:
http://www.cdc.gov/nip/diseases/mumps
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April 17, 2006
IAC POSTS ANOTHER THIMEROSAL RESOURCE TO ITS WEBSITE HOMEPAGE
IAC recently added "CDC's key messages: Thimerosal, vaccines, and autism,"
to the homepage of its website at
http://www.immunize.org This resource will be useful to providers in
discussing thimerosal with their patients. You'll find the link in the upper
right corner of the homepage, along with other links.
To access this resource directly, go to:
http://www.immunize.org/cdc_thimerosal.pdf
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April 17, 2006
UPDATED: IAC REVISES "IT'S FEDERAL LAW!" AND OTHER EDUCATION PIECES FOR
HEALTH PROFESSIONALS AND PATIENTS
IAC recently added updated information to several of its print pieces,
including the professional-education piece "It's federal law! You must give
your patients current Vaccine Information Statements (VISs)." The updated
pieces include the following:
FOR HEALTH PROFESSIONALS
1. "It's federal law! You must give your patients current Vaccine
Information Statements (VISs)": The information about VIS dates was made
current.
To access a ready-to-print (PDF) version, go to:
http://www.immunize.org/catg.d/2027law.pdf
To access a web-text (HTML) version, go to:
http://www.immunize.org/catg.d/2027law.htm
2. "Quiz #1: Immunization": Information about Tdap vaccine was added.
To access a ready-to-print (PDF) version, go to:
http://www.immunize.org/catg.d/p7001qz.pdf
To access a web-text (HTML) version, go to:
http://www.immunize.org/catg.d/p7001qz.htm
3. "Emergency response worksheet: What to do in case of a power failure or
another event that results in vaccine storage outside of the recommended
temperature range": Vaccine manufacturers' telephone numbers were updated.
To access a ready-to-print (PDF) version, go to:
http://www.immunize.org/catg.d/p3051.pdf
4. "Vaccine handling tips: Outdated or improperly stored vaccines won't
protect patients!" Information about rotavirus vaccine was added.
To access a ready-to-print (PDF) version, go to:
http://www.immunize.org/catg.d/p3048.pdf
5. "Maintaining the cold chain during transport": Information about
rotavirus vaccine was added.
To access a ready-to-print (PDF) version, go to:
http://www.immunize.org/catg.d/p3049.pdf
6. "Notification of vaccination letter": Information about rotavirus vaccine
was added.
To access a ready-to-print (PDF) version, go to:
http://www.immunize.org/catg.d/p3060not.pdf
FOR PATIENTS
7. "What if you don't immunize your child?" The statistic on annual
worldwide measles mortality was updated.
To access a ready-to-print (PDF) version, go to:
http://www.immunize.org/catg.d/p4017.pdf
To access a web-text (HTML) version, go to:
http://www.immunize.org/catg.d/p4017.htm
8. "If you, your parents, or your children were born in any of these places
. . . give this brochure to your healthcare provider and ask to find out
your hepatitis B status": The most recent version (dated 9/05) has been
translated into Russian. IAC gratefully acknowledges the California
Department of Health Services for the translation.
To access a ready-to-print (PDF) version in Russian, go to:
http://www.immunize.org/catg.d/p4170ru.pdf
To access a ready-to-print (PDF) version in English, go to:
http://www.immunize.org/catg.d/p4170ref.pdf
To access a web-text (HTML) version in English, go to:
http://www.immunize.org/catg.d/p4170.htm
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April 17, 2006
CDC UPDATES ITS INFLUENZA WEB SECTION WITH CURRENT INFORMATION ABOUT AVIAN
INFLUENZA
CDC recently updated two pages of its Influenza web section:
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Questions & answers about avian influenza (bird flu) & avian influenza
virus (posted 4/12/06)
-
Embargo of birds from specified countries [Burkina Faso and Pakistan]
(posted 4/10/06)
To access these materials, go to:
http://www.cdc.gov/flu/whatsnew.htm#updated and click on the pertinent
links.
To access a broad range of continually updated information on seasonal
influenza, avian influenza, and pandemic influenza, go to:
http://www.cdc.gov/flu
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April 17, 2006
WHO ISSUES GUIDELINES FOR PREPARING FOR AND MITIGATING PANDEMIC INFLUENZA
IN REFUGEE AND DISPLACED POPULATIONS
WHO recently issued "Pandemic influenza preparedness and mitigation in
refugee and displaced populations: WHO guidelines for humanitarian
agencies." It focuses on a potential pandemic situation and human health,
describing the expected response in settings with populations of refugees
and internally displaced persons.
To access the guidelines, go to:
http://www.who.int/csr/disease/avian_influenza/guidelines/avian2006-04-9.pdf
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April 17, 2006
CDC PUBLISHES RECOMMENDATIONS FOR ANIMAL RABIES PREVENTION AND CONTROL
CDC published "Compendium of Animal Rabies Prevention and Control, 2006:
National Association of State Public Health Veterinarians, Inc. (NASPHV)"
in the April 14 issue of MMWR Recommendations and Reports. The
introductory paragraph is reprinted below in its entirety, excluding
references.
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Rabies is a fatal viral zoonosis and a serious public health problem. The
recommendations in this compendium serve as the basis for animal rabies
prevention and control programs throughout the United States and
facilitate standardization of procedures among jurisdictions, thereby
contributing to an effective national rabies-control program. This
document is reviewed annually and revised as necessary. These
recommendations do not supersede state and local laws or requirements.
Principles of rabies prevention and control are detailed in Part I; Part
II contains recommendations for parenteral vaccination procedures; all
animal rabies vaccines licensed by the United States Department of
Agriculture (USDA) and marketed in the United States are listed in Part
III.
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To obtain a web-text (HTML) version of the recommendations online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5505a1.htm
To obtain a ready-to-copy (PDF) version, go to:
http://www.cdc.gov/mmwr/PDF/rr/rr5505.pdf |
