By Dr. Eli Rosen, MD
For the past 4 months we have been witnessing an outbreak of mumps of unprecedented proportion in the Crown Heights community. We are not alone in this: Boro Park, Williamsburg and other heimishe communities are also affected. This illness has spread to yeshivas out of town but at this time has not spread into those communities, thank G-d.
What is Mumps and how does it spread?
Mumps spreads by respiratory droplets through infected saliva that can be released when an infected person coughs or sneezes or just talks loudly close by. Symptoms include fever, body aches, headaches, and swelling of the salivary glands (the gland just below the ear). There is no effective treatment for mumps.
The incubation period is a long one, about 21 days, the reason this epidemic has been so drawn out. Individuals with mumps may be infectious even a day or two before becoming sick. Exposed individuals are most likely to be infectious 10-24 days after exposure.
Is this epidemic caused by a new strain of mumps?
No, the current epidemic is caused by mumps strain G which is one of the strains included in the vaccine that has been available for the last 50 years.
Is the mumps vaccine effective?
Yes, despite my earlier concerns that the vaccine may have been ineffective, it appears that the best possible way to be protected remains receiving 2 doses of vaccine. However, the vaccine does not always “take” and since there is a “wear-off” phenomenon, this allows for even vaccinated individuals to contract the mumps.
Children who have been given a dose of MMR at age 1 and again at age 4 seem to be protected in the vast majority of cases up until around age 12.
Beyond age 12 (including adults) immunity seems to wear off to levels that are not protective in a significant percentage of individuals.
Vaccinated individuals, primarily children, who contract the mumps are less prone to develop the complications of mumps (orchitis, meningitis, deafness).
Who is being most affected by the current epidemic?
Males are being much more frequently affected than females. Over the past few weeks, young adults (parents and teachers) seem to be contracting the illness at increasing rates. Unfortunately, adults are more prone to develop the complications of mumps than children.
Is Mumps Vaccine Available?
Vaccine is available in plentiful supply in a preparation combined with measles and rubella called MMR. There is no single component (“plain mumps vaccine”) available
Is MMR vaccine safe?
MMR is a safe vaccine although it cannot be used in pregnancy and in a few other medical conditions. Women who receive the vaccine should avoid getting pregnant for at least 28 days following vaccination. Individuals who manifest “full-blown emergency type” allergic symptoms to eggs should not take the vaccine.
Is there a reaction to the MMR vaccine?
MMR vaccine does cause some individuals, particularly adults, to have a brief flu-like illness usually one week following vaccination.
MMR and Autism?
In the past, there have been questions regarding autism and MMR. These questions were raised 14 years ago by Dr. Wakefield in England. Since then, he has been thoroughly discredited, his study withdrawn and numerous subsequent studies have shown no causative relationship between MMR and autism.
However, because of this bogus but very popular research, vaccination rates have dropped and there has been a resurgence of the illness.
Arecent outbreak of measles (an illness much more severe than mumps) in England has resulted in some serious consequences. The current “fashion” of not vaccinating children is clearly having an effect on the incidence of these diseases. In the presence of many infected individuals the virus can spread to those who are vaccinated, and as vaccination rates drop, the situation becomes more tenuous.
Why are vaccinated individuals contracting mumps?
There are 2 possible factors for this: waning of immunity with time and the large viral load present under epidemic conditions which seems to overwhelm the immune response.
Is a third dose of MMR effective?
It is my contention that a third dose of MMR is necessary to stem this epidemic in all older children and adults who have been previously vaccinated and have had recent close exposure.
Has a third dose been approved for use by the health authorities?
Unfortunately, not at this time. As such, it cannot be routinely given to those who have clear evidence of having received 2 doses of MMR.
Am I susceptible to Mumps?
Traditionally, we have used an IGG antibody blood test to determine immunity to mumps. Unfortunately, it would appear that this blood test (with the values used in the past) is not an accurate predictor of susceptibility to mumps. It is unclear at this time whether readjusting the normal range or refining the test will help us decide which individuals require another dose of MMR.
It is my contention that robust antibody levels (i.e. those higher than the normal cutoff) may be useful in determining who should receive a booster dose among those who have previously received 2 doses of vaccine.
What about being vaccinated after exposure?
Previously, it was stated that vaccination after exposure was not beneficial (too little, too late). However, with the current epidemic, the health authorities have approved the administration of vaccine for those who were recently exposed to a case of mumps and are unvaccinated or unsure of their vaccination status.
Individuals who have had mumps and those born before 1957 are considered immune.
Everyone under the age of 50 who has not received 2 doses of MMR or has no record of past immunization, should receive a booster dose of MMR as soon as possible, especially if they are parents or teachers.
Your personal physician has access to vaccine and there is currently no shortage. Vaccine has been made available by NY City for administration to people 10 years and older. Please refer to the sites listed at the end of this update.
What to Do For an Individual Infected with Mumps
1. Individuals with Mumps should be strictly quarantined.
2. Cover the mouth and nose with a tissue when coughing or sneezing.
3. Wash hands frequently with soap and water.
4.There is no effective treatment for Mumps. Rest, fluids, analgesia are helpful.
5. What to do if you are exposed to Mumps
Individuals with mumps are infectious 2-3 days prior to the onset of the illness. Check your immunization status and receive vaccination if you were not previously vaccinated.
Unfortunately, as stated earlier, 2 doses of vaccine in the distant past are absolutely no guarantee of protection. Blood tests for antibody levels can still be useful in determining the need for another dose of vaccine.
The practice of quarantine has been forgotten largely due to the success of the vaccination program. However, with a resurgence of illness, we urgently need to reinstitute the practice of quarantine.
Any individual who suspects he/she may have the mumps, should be considered infectious until the situation becomes clear.
For at least the first five days of the illness, those in the above group and those with mumps should stay home, not go to shul or yeshiva, remove themselves from a dormitory situation and be quarantined, either with other mumps cases or alone.
Children from homes where the parents do not vaccinate, must be considered infectious any time between 10-24 days after exposure and should be kept out of school for this time period. As long as those with the illness continue to mingle with the “herd”, the illness will persist.
Lastly, something has to be said at this juncture about the concept of herd immunity. Due to lay opposition to appropriate vaccination of our children and admission of these unvaccinated children into our school system, there has been a decline in herd immunity which may be one of the reasons why we are witnessing the current outbreak.
Even though vaccination of all children clearly has its costs and as we see not all vaccination confers life-time immunity, the healthcare authorities unequivocally recommend vaccination of all children. Hopefully, by vaccinating our children we will not allow for the epidemic spread of preventable diseases in our community.
Free or Low Cost Vaccine Available
Wednesday, February 17
2 pm – 10 pm
575 Bedford Avenue
(between Keap Street and Rodney Street)
Brooklyn, NY 11211
Thursday, February 18
2 pm – 10 pm
Anshe Sfard Hall
4502 14th Avenue
(between 45th Street and 46th Street)
Brooklyn, NY 11219
People over 10 can also receive free or at low-cost MMR vaccine at any of these health centers:
Quality Health Center
432 Bedford Avenue
Brooklyn, NY 11211
Call for times at 718-387-2408
ODA Health Center
14 Heyward Street,
Brooklyn, NY 11211
Call for times at 718-260-4600
Ezra Medical Center
1312 38th Street
Brooklyn, NY 11218
Call for times at 718-686-7600
Maimonides Medical Center Primary Care Site
1250 57th Street
Brooklyn, NY 11219
Call for times at 718-283-5700