Cases of Mumps in Acute Care Heralding Onset of an Outbreak in a Detention Facility

Background: The incidence of mumps has declined significantly due to widespread use of the mumps vaccine since 1967.  However, there have been several reports of sporadic mumps outbreaks, including a large outbreak in 2006 involving college dormitory residents.  Two inmates from a detention facility were admitted to acute care with a presumptive diagnosis of mumps.  Subsequently, a mumps outbreak was recognized in the detention facility.

Objective: Examine the clinical courses of the two patients for presenting symptoms, use of appropriate isolation precautions, establishment of diagnosis, and appropriate disposition back to detention facility for lessons learned about appropriate care recognition and isolation to reduce risk of secondary infection in the acute care setting.

Methods: Clinical features, history of mumps immunization, time to placement in isolation precautions, diagnostic labs, and disposition of the patients were reviewed.  Available data for other inmates at the detention facility that were not hospitalized was also reviewed.

Results: Both patients were transferred to the emergency department (ED) for evaluation on the same date.  Symptoms began 2 and 3 days prior to presentation and were similar for both males (ages 24 and 35 years).  Symptoms included fever, progressive jaw swelling, headache, myalgias, and low back pain.  Physical exam revealed tender, enlarged, bilateral parotid swelling in both men.  Each reported receiving the mumps vaccine as a child.  The same admitting physician evaluated both patients in the ED and ordered droplet isolation precautions prior to transfer from the ED to the acute care controlled access unit because of a concern for possible mumps.  No secondary cases of mumps occurred in acute care.   Serology was obtained for both patients and showed mumps IgG of 4.78 and 4.18 (positive > 0.5) and IgM 5.48 and 18.95 (positive > 1.21).  Saliva specimens were positive for mumps RNA by PCR in both patients but only one patient’s viral culture demonstrated growth of mumps.  Genotype was performed on this culture and demonstrated genotype G. Of 8 other male inmates suspected of having mumps in the detention facility within the same week, all 7 with parotitis had a positive mumps RNA PCR study.

Conclusions: Several sporadic mumps outbreaks have been described over the past several years.  To our knowledge, this is the first outbreak described in a detention facility.  Due to the necessary confinement of susceptible individuals in this congregate setting, it is particularly vulnerable to an outbreak scenario.  The recognition of a clinical presentation consistent with mumps infection on admission to the hospital led to rapid implementation of appropriate isolation precautions.  This preventive measure was largely responsible for prevention of any secondary transmission in acute care  as mumps immunization does not confer complete protection against infection.