Mumps cases continue to increase in San Diego County

[COLOR=var(--primaryTextColor)]This file photo shows a measles, mumps and rubella vaccine on a countertop at a pediatrics clinic in Greenbrae.
(Eric Risberg / AP)

]By PAUL SISSON
JULY 24, 2019 6 AM

San Diego County has tallied 23 mumps cases so far this year, already matching the tally for 2016, which was the highest number seen in the last 25 years.


In a recent advisory to all local doctors, county health officials state that seven of the 2019 cases have come from detainees at the Otay Mesa Detention Center. That facility, along with other similar facilities in other regions, has seen an increase in several forms of communicable illness, especially the flu, since the federal government has halted thousands of Central American asylum seekers at the border.


This year, three additional residents have come down with the mumps after visiting foreign countries where the disease is more prevalent than it is in the United States.

Subtracting those 10 cases from the overall total, 13 cases of unknown origin remain, suggesting that mumps is being transmitted from person to person in the community.


Dr. Eric McDonald, medical director of the county epidemiology and immunization services branch, said two of those 13 patients not associated with travel or detention center stays were roommates. But public health investigators have turned up no other obvious connections.


“What’s not typical is having these individual cases kind of pop up in people who haven’t recently traveled and who aren’t in a congregate living setting,” McDonald said.

“That’s telling us that there has to be at least a low level of mumps circulating in the community.”


The director said that none of the three travel cases who came home with mumps had received a second booster shot as is recommended before foreign travel. That was also the case, he added, for the seven detention center cases.


“We don’t really have good records on the migrants who were in ICE custody, but Mexico and many other Central American countries where these individuals come from actually do have very good childhood vaccination programs, especially with MMR,” McDonald said, referring to the measles, mumps and rubella vaccine that confers mumps immunity.


However, he said, many countries still only recommend a single MMR shot though a second dose was added to the routine childhood vaccination schedule in the United States in 1989.



Vaccination status among the cases with no known cause, McDonald said, was in keeping with whatever was in place when they were kids. To date, the age range for 2019 mumps cases in San Diego County has been as young as 2 and as old as 62. So far, none has gotten sick enough to require hospitalization.

The 2 year old and 62 year old, then, would each have had only one MMR dose as a second dose is not recommended until age 5 or 6 and anyone in their 60s would have been far away from childhood before the second dose was recommended in the late 1980s.


That second dose was added due to a growing understanding that the immunity conferred by the vaccine wanes somewhere between 10 and 15 years after that second dose, much more quickly than it does for measles and rubella. Typically, mumps outbreaks occur on college campuses where large populations of young people whose immunity is running out often live close together.


While a 20 year old who did have both doses is among the 23 cases reported so far this year, there has been no college connection as there was in 2016 when the University of San Diego and San Diego State University each had a mumps outbreak, setting off mass vaccination campaigns on both campuses.


McDonald said the county has limited involvement with the cases at the Otay detention center, which is staffed with federal health service employees, not county workers. But best-practice recommendations for quarantine and segregation of populations potentially exposed to mumps, he said, do appear to be in effect.

“They’ve given us the type of detailed responses and vaccination numbers that indicate they’re closely following their own policies in terms of how to deal with a mumps outbreak in an ICE facility,” McDonald said.


Mumps has been a growing concern in detention facilities in other states, where media reports have indicated that hundreds of cases have appeared as larger and larger numbers of detainees are held in overcrowded conditions.


According to the U.S. Centers for Disease Control and Prevention, mumps cases have been detected in 45 states so far this year, tallying a total of 1,799 cases nationwide. That’s already nearly as many as the 2,251 cases reported in all of 2018 though still significantly fewer than popped up in 2016 and 2017, which each saw more than 6,000 cases nationwide.

Mumps symptoms include discomfort and swelling of the salivary glands in the front of the neck or the parotid glands in front of the ears. Other symptoms include difficulty chewing, pain and tenderness of the testicles, fever, headache, muscle aches and tiredness.


McDonald said three of the 23 people who have become infected this year have suffered side effects. One had hearing loss and two had testicular complications. He said anyone who is traveling should definitely make sure they’ve had both MMR shots and anyone with swollen parotid or salivary glands should seek medical attention, especially if they are around anyone with a compromised immune system or who may be only partially immunized.


In most cases, infection causes only salivary gland swelling and other minor symptoms and is resolved without treatment within a week to 10 days. But in rare cases, complications such as meningitis, decreased fertility and permanent hearing loss have been reported.

In very rare cases, mumps infection can cause loss of pregnancy in the third trimester.

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