Highlights From MMWR: Iowa Mumps Outbreak Spreads to 10 States and More

Yael Waknine

May 26, 2006

May 26, 2006 — The US Centers for Disease Control and Prevention (CDC) reported in the May 26 issue of the Morbidity and Mortality Weekly Report on an outbreak of mumps that has spread from Iowa to at least 10 additional states; the prevalence of tobacco use among students aged 13 to 15 years worldwide; and increased rates of antihypertensive medication use among blacks and whites.

CDC Update: Iowa Mumps Outbreak Spreads to 10 States

The CDC has reported on interim data from an ongoing investigation into an outbreak of mumps that began in Iowa in December 2005 and has since spread to at least 10 additional states.

Between January 1 and May 2, a total of 11 states reported 2597 mumps cases; 8 states reported outbreaks with ongoing local transmission or case clusters, and 3 states reported cases that were linked to travel from an outbreak state.

According to the CDC, this is the largest number of mumps cases reported in a single year since 1991. Although the outbreak initially involved young adults on a college campus in Iowa, it has since spread to all age groups.

Factors that may have contributed to the spreading of infection include the close nature of the college campus environment; lack of college entrance requirements for full measles-mumps-rubella (MMR) vaccination; delayed recognition of mumps cases; and the less than 100% prophylactic efficacy of the vaccine.

For the 80% of cases for which data was available, the median age of patients with mumps is 21 years (range, <1 - 96 years). The prevalence of mumps was highest among young adults aged 18 to 24 years (17.1 per 100,000 population), followed by children aged 5 to 17 years (5.2 per 100,000 population), and adults aged 25 to 39 years (4.8 per 100,000 population).

Parotitis was reported in the majority (66%) of 1327 patients for whom such data were available. Although the data are incomplete, the CDC has received reports of orchitis (27 cases), meningitis (11), encephalitis (4), deafness (4), oophoritis (1), mastitis (1), pancreatitis (1), and unspecified complications (1). No deaths were reported.

According to preliminary vaccination data from Iowa, 51% of cases had received 2 doses of the MMR vaccine and 6% were unvaccinated (status unknown, 31%). Colleges reporting lower vaccination rates had a higher proportion of students affected by mumps.

The Advisory Committee on Immunization Practices (ACIP) recommends that all children receive a 2-dose MMR vaccination series, with the first dose given between the ages of 12 to 15 months and the second at 4 to 6 years of age.

Two doses of MMR vaccine are recommended for school and college entry unless the student has other evidence of immunity, and administration of 1 dose should be considered for unvaccinated healthcare workers born before 1957 who do not have other evidence of mumps immunity.

To decrease transmission in outbreak settings, a second dose of vaccine should be considered for adults and for children aged 1 to 4 years who have received 1 dose; a minimum of 28 days is required between doses. ACIP notes that healthcare facilities should strongly consider recommending 2 doses of MMR vaccine to unvaccinated workers born before 1957 who do not have other evidence of mumps immunity.

In addition, individuals without evidence of immunity to mumps should be excluded from institutions such as schools and universities that are affected by the outbreak. Students and staff may be immediately readmitted upon vaccination, even if they have been exposed to the disease.

For those who remain unvaccinated, the period of exclusion is 26 days after onset of parotitis in the last case of mumps at the institution; students who contract mumps should be excluded for 9 days after onset of parotitis.

Unvaccinated healthcare workers without evidence of immunity should be vaccinated upon exposure to mumps and excluded from duty from the 12th day after the first exposure through the 26th day after the last exposure. Those who become ill should be excluded from work until 9 days after parotitis onset.

In response to continuing reports of mumps transmission, the Iowa Department of Public Health launched a statewide vaccination campaign in April that targeted young adults aged 18 to 22 years in high-density college areas. A second phase began in May to cover individuals aged 18 to 25 years in the remainder of the state; a recently initiated third phase is targeting those aged 18 to 46 years. Similar activities are being planned in neighboring states.

Prevalence of Tobacco Use in Teens Worldwide Reaches 20%

Nearly 20% of students worldwide aged 13 to 15 years currently use a tobacco product, according to an analysis of 1999 to 2005 data from the Global Youth Tobacco Survey (GYTS). The survey covered 132 countries and the Gaza Strip/West Bank.

Overall, the prevalence of any tobacco use was highest in the American and European regions (22.2% and 19.8%, respectively) and lowest in the South-East Asian (12.9%) and Western Pacific regions (11.4%).

Although the prevalence of smoking was similar to that for other tobacco use (8.9% vs 11.2%), teenagers in European and American regions were more likely to smoke cigarettes (17.9% and 17.5%, respectively), while those in the South-East Asian and Eastern Mediterranean areas (13.3% and 12.9%, respectively) were more likely to use other products such as bidis, smokeless tobacco, and shisha. No significant differences in tobacco use were noted between boys and girls.

According to the CDC, these findings underscore the need for countries worldwide to develop, implement, and evaluate their tobacco-control programs that address use of all types of tobacco products, especially among girls

Prevalence of AntiHypertensive Use Increases Among Blacks and Whites

Adults with hypertension are more likely than before to receive treatment, according to a report from the CDC.

The study found that the prevalence of antihypertensive medication use increased from 57% in 1988-1994 to nearly 63% in 1999-2002. Substantial increases in medication use were observed among whites and blacks, but the rate remained the same (40%) among Mexican Americans.

MMWR. 2006;55:553-584

Reviewed by Gary D. Vogin, MD


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