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DES MOINES, Iowa, April 12 - Iowa state health officials reported today that mumps has spread to 53 of the state's 99 counties, with a tally of 515 cases since the outbreak began, up by 150 cases since last Thursday.
Epidemiologist Meghan Harris, M.P.H., of the Iowa Department of Public Health said there is still no indication that the outbreak has peaked, but she said that the recent jump in cases may be due to increased awareness of mumps.
"We have increased awareness and we now have doctors actively looking for cases," she said. When surveillance increases, "the number of reported cases also goes up." Harris declined to estimate when the outbreak would peak, but she said that in the days when mumps was endemic in Iowa, outbreaks were seasonal and tended to fade by late spring or early summer.
Asked whether there have been any reported cases in elementary schools, high schools, or daycare centers, Harris said the health department is "still assessing that information and we may have better information later this week." Harris will update her data tomorrow.
So far the outbreak, which began in early February but began to build momentum in early March, has been concentrated among young adults, with 50% of cases occurring in 19-year-olds. As of Tuesday, 17% of the 515 cases occurred in college students and 68% of cases were reported in people who had received the recommended two doses of mumps-measles-rubella (MMR) vaccine.
Four-hundred-sixty of the 515 cases with completed blood tests were IgM positive, which confirms "that we are still finding mumps virus, so this outbreak is still very active," Harris said.
The Iowa cases share a common pedigree with a recent outbreak in England, both caused by the same strain of mumps.
The Public Health data include confirmed, suspect and probable cases of mumps. Probable cases are those that meet the clinical case definition but have no confirmed serologic or virologic testing. Suspect cases are those with positive IgM serology and confirmed cases are cases that meet clinical definition that are also laboratory-confirmed or epidemiologically linked.
Blaise Congeni, M.D., director of pediatric infectious diseases at Akron Children's Hospital in Akron, Ohio, said the Iowa outbreak is typical of many mumps outbreaks in that it will be difficult to identify an index case because the immunization rate in the state is so high.
The primary symptom of mumps -- parotitis -- is often not fully evaluated by clinicians, he said. "If the patient's record indicates that he or she has been received two MMR doses, the assumption would be that this is caused by another virus," Dr. Congeni said. If the symptoms abate, the episode would be little more than a notation in a medical record.
Dr. Congeni said, however, that a mumps outbreak does not carry the potential for public health disaster that would be associated with a measles or rubella outbreak.
"There is a small risk that some kids will develop viral meningitis and orchitis is a concern, but we know that orchitis doesn't cause sterility," Dr. Congeni said.
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