Mumps outbreak reported in suburban Illinois high school

Officials from the Lake County Health Department and Community Health Center in northern Illinois have confirmed three cases of mumps at Barrington High School.

Additionally, health officials have reported one unrelated confirmed case in Barrington, one unrelated probable case in Lake Zurich, with a total of seven probable cases and 20 suspect cases in two local high schools, two local middle schools and throughout the surrounding area.

Among the 3,000 students enrolled in Barrington High School, approximately 20 have received only one of the two required doses of the measles-mumps-rubella (MMR) vaccines, whereas 10 students cited religious or medical exemptions.

Symptoms of the mumps can include fever, headache, muscle aches, fatigue and swollen glands near the ears or on either (or both) sides of the face, many of resemble influenza symptoms. However, James Jupa, MD, medical advisor of the Lake County Health Department, said that although transmission and symptoms may be similar, inflammation of the parotid gland — a noticeable symptom of mumps — is not a common presentation of the flu. “Most of the cases that we have confirmed have shown positive IgM or rising antibodies to mumps,” he said. “I am confident that most of these cases, if not all of them, are actual mumps.”

The first cases of mumps began to present in mid- to late February, and the last cases were documented in early April, Victor Plotkin, an epidemiologist at Lake County Health Department, told Infectious Diseases in Children. Because the CDC and the state of Illinois require two incubation periods for an outbreak to be declared over, he estimates that the current outbreak will most likely end in early April.

“We know that many cases are mild for mumps, but about 30% cases are asymptomatic,” Plotkin said. “It makes the recognition of early cases and exclusion challenging. We are, unfortunately, far from [the end of this outbreak], but we feel that we are lucky because school officials, staff, parents and [the Department of Health] are working together to control it.”

Nadia Qureshi

In an interview with Infectious Diseases in Children, Nadia Qureshi, MD, FAAP, infectious disease specialist at Loyola University Health System, recommended that those with fevers, malaise, headache or swelling in front of the ear should remain in their homes because individuals with mumps can spread the disease for 5 days after the initial onset of symptoms.

“That is the time when they are most likely to easily transmit the virus to others,” Qureshi told Infectious Diseases in Children. “The ones [who] are sick need to be quarantined, stay at home and limit their contact with others and those in the community.”

Illinois has had experience with mumps outbreaks in the past, most notably at the University of Illinois, where the CDC confirmed 317 cases of mumps on campus between April 2015 and May 2016. Although many people receive one MMR vaccine in infancy and a second between the ages of 4 and 6, a third booster was recommended during a mumps outbreak.

To curtail this outbreak, the Department of Health in Lake County has offered vaccination clinics at the school, which provides free vaccines to faculty, staff and students with one MMR vaccine, and educational materials to promote personal hygiene and identifying suspicious signs and symptoms early.

This outbreak, like others in the past, raises questions for doctors about the efficacy of their vaccine education and patients about why others are not vaccinating. Parents who do not vaccinate their children, according to Qureshi, have rationales ranging from possible adverse side effects to simply not wanting to upset their children. She urges health care professionals to educate vaccine-hesitant parents regarding debunked misinformation, including the association of the MMR vaccine with autism.

“When I ask a parent’s reason for not vaccinating, they are usually misinformed, yet think they have done their research. It is important to recognize who those patients are and what exactly their concerns are,” Qureshi said. “We know that the study supporting [MMR’s link to autism] has been debunked and how much data [were] fabricated in that study.”

Additionally, Plotkin urges people not to become complacent when it comes to vaccination and vaccine-preventable diseases, because people who receive the MMR vaccine tend to have more mild symptoms and fewer complications.

“Unfortunately, outbreaks of mumps, though infrequent, do occur, usually in schools, colleges and similar institutions,” he said. “We have referred to a very safe and effective vaccine and we need to take advantage of it. There is no need to play Russian roulette and avoid vaccination.”

Ultimately, Qureshi said that it comes down to the risks and benefits of vaccination.

“We should try to understand the exact concerns of vaccine-hesitant parents and address them to help avoid situations like this — where in the United States, despite such great and available vaccines, we continue to see these outbreaks.” – by Katherine Bortz