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Information for Health ProfessionalsUpdate on Mumps Outbreak in the Maritimes National Summary, November 9, 2007Mumps cases related to the outbreak continue to occur. This year, 900 confirmed cases of mumps related to the outbreak have been reported from nine out of 13 Canadian provinces and territories (Nova Scotia, New Brunswick, Prince Edward Island, Newfoundland, Quebec, Ontario, Manitoba, Alberta, and British Columbia). The outbreak activity remains centred in Nova Scotia and New Brunswick localities with sporadic exportations to other provinces. All cases included in this report are either linked to cases in the Maritimes or are close contacts of these cases. To date, there has been no sustained transmission outside of the Maritimes related to the outbreak although other imported or sporadic cases of mumps may also occur. The viral strain in these outbreaks is identical to the strain (genotype G) detected from the 2005-06 Nova Scotia outbreaks, the United States' multi-state outbreak in 2006 and the United Kingdom epidemic between 2004 and 2006. In Nova Scotia and New Brunswick, the majority of cases were reported from only one or two public health authorities with limited activity seen elsewhere in these provinces. Likewise, the majority of cases have occurred in persons aged 17-37 years, many of whom are college or university students. All provinces and territories remain vigilant. Most of the cases where information has been reported to date have resulted in self-limited disease with few complications reported. Less than 2% of cases have resulted in hospital ER visits or overnight observation. None were reported recently but rather earlier in the outbreak. Mumps is an acute viral infection of the salivary glands. Symptoms include fever, headache, muscle ache and swelling and tenderness of the salivary glands at the angle of the jaw (parotid glands). Infection occurs through direct contact with respiratory droplets from the nose or throat, through saliva, coughing, sneezing, sharing drinks, kissing or from contact with any surface that has been contaminated with the mumps virus. Rarely, mumps infection can lead to meningitis, inflammation of the testicles or ovaries, inflammation of the pancreas and transient or permanent hearing loss.Case Counts As of November 9, 2007, 900 - confirmed cases of mumps related to the outbreak had been reported from the affected provinces, Table 1 (confirmed cases are either laboratory-confirmed OR clinically compatible and linked to a laboratory-confirmed case). Five new cases (Nova Scotia) were reported since the last update (2007-11-02) with onset dates over the previous five weeks. Table 1: Age and Sex Distribution of Confirmed* Mumps Cases Reported in Nine Canadian Provinces, November 9, 2007 (N=900)
Information on date of onset is known for 847 of the 900 confirmed mumps cases reported (Figure 1). The remaining 53 cases are pending or missing dates of onset. Figure 1: Confirmed* Mumps Cases Reported in Canada
The majority of cases are occurring among young adults (i.e., university-aged individuals). The reason for the particular susceptibility among this cohort is multifactorial. The very social and mobile lifestyles of this age group appears to be facilitating disease transmission and are posing barriers to the adherence of isolation requests. Additional cases in this demographic group and possibly other jurisdictions would not be unexpected. However, during previous outbreaks in Canada, this has not resulted in sustained transmission or large outbreaks. It is assumed that most people over the age of approximately 40 years have natural immunity to mumps. Most people between the ages of 12 and 17 years (depending on the province of residence) have had 2 doses of mumps vaccine due to the introduction of a second dose of measles, mumps and rubella (MMR) vaccine for measles control in 1996-97. This has left a susceptible cohort of people between the approximate ages of 12 or 17 (depending on the province or territory) and 40 years who were only eligible for one dose of MMR vaccine and who are not assumed to have natural immunity. It is important to note, that the age at which natural immunity to mumps can be assumed is not known with certainty and that some individuals born prior to 1970 may still be susceptible to mumps. The 2004 National Immunization Coverage Survey (NICS) found that 94% of Canadian children had received single dose of the MMR vaccine by their 2nd birthday. Coverage estimates for the second dose of MMR by 7 years of age was 79%. Overall, 93% of Canadians had received one or more doses of mumps vaccine by their 17th birthday.Access the Canadian National Report on Immunization for more information. Public Health Actions: Cases are asked to self-isolate for a period of 9 days following the onset of symptoms. The vaccine status of close contacts (i.e., household and intimate contacts/exchange of saliva) is assessed and updated so that they receive two doses of MMR. Guidelines have been put in place for health care workers who are cases or who are contacts of mumps cases. Public health and primary care providers are encouraged to refer to their local or provincial/territorial ministry of health for specific recommendations on action that may be required within that jurisdiction. All provinces and territories have been informed of the epidemiologic situation and the public health management strategies in the affected jurisdictions. Based on this, all jurisdictions are encouraged to continue monitoring mumps activity within their regions and report any changes and/or cases to the Public Health Agency of Canada, particularly in provinces and territories not currently affected by the on-going outbreak. Several provinces, territories and post-secondary institutions are encouraging students to ensure their immunization is up-to-date (see links to provincial websites). The Public Health Agency of Canada will continue to provide updates on the current outbreak of mumps. The Agency is working with the affected provinces in monitoring this outbreak, providing technical advice and assisting with laboratory testing of clinical specimens at the National Microbiology Laboratory. The Public Health Agency of Canada supports the provincial outbreak response strategies that include the recommended isolation of cases and targeted immunization of contacts and susceptible cohorts. The Public Health Agency of Canada recommends that jurisdictions experiencing outbreaks should consider offering an additional dose of MMR vaccine for immunization in outbreak settings. Some jurisdictions are encouraging and/or offering MMR vaccine to health-care workers and post-secondary students. In other jurisdictions, there are on-going discussions regarding an expanded immunization strategy to target the susceptible cohort. Readers should refer to their local or provincial/territorial ministry of health for specific recommendations. The Public Health Agency of Canada encourages parents, guardians and adults to maintain up-to-date immunizations for themselves and their children, and encourages susceptible individuals to be immunized in accordance with the National Advisory Committee on Immunization (NACI) guidelines. All guidelines can be accessed at: www.naci.gc.ca. NACI currently recommends a second dose of the measles, mumps and rubella vaccine (MMR) for certain adults born after 1970. This includes students at post secondary institutions and health care workers. 
ResourcesFor more information on mumps, please visit:
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Last Updated: 2007-11-14 |  |
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