ARCHIVED - Guidelines for the Prevention and Control of Mumps Outbreaks in Canada

 

Appendix 2: Key Recommendations for the Prevention and Control of Mumps Outbreaks


Section(s) Key Recommendations
4.2

Outbreak Definition

Confirmed cases in excess of what is expected in the jurisdiction over a given period of time.

4.3

 

Case Definitions

In the absence of recent immunization (i.e. in the previous 28 days):

Confirmed Case (any one of the following):

  1. mumps virus detection or isolation from an appropriate specimen (buccal swab is preferred);
  2. positive serologic test for mumps IgM antibody in a person who has mumps-compatible clinical illness (see Clinical Case below);
  3. significant rise (four-fold or greater) or seroconversion in mumps IgG titre;
  4. mumps-compatible clinical illness (see Clinical Case below) in a person with an epidemiologic link to a laboratory-confirmed case.

Clinical Case / Probable Case

  1. acute onset of unilateral or bilateral parotitis lasting longer than 2 days without other apparent cause

Refer to Section 5.0 and Appendix 4 for details on preferred clinical specimens and interpretation of laboratory results.

4.3

Contact Definition

Any of the following during the infectious period (i.e. approximately 7 days before to 5 days after symptom onset):

  1. household contacts of a case;
  2. persons who share sleeping arrangements with the case, including shared rooms (e.g. dormitories);
  3. direct contact with the oral/nasal secretions of a case (e.g. face-to-face contact, sharing cigarettes/drinking glasses/food/cosmetics like lip gloss, kissing on the mouth)
  4. children and staff in child care and school facilities.

Refer to Section 6.3.3 if the contact is a health care worker.

6.1

Case Management

Clinical cases should be managed as confirmed cases until laboratory evidence suggests otherwise.

  1. Mumps is a reportable disease in all Canadian jurisdictions, and public health authorities should be notified through the usual channels.
  2. In the absence of an epidemiologic link to a confirmed case, an oral swab (buccal specimen is preferred) should be obtained for laboratory confirmation (refer to Section 5.0 and Appendix 4).
  3. Assess risk factors: obtain immunization and/or disease history, assess epidemiologic links to cases or settings, including travel.
  4. There is no specific treatment for mumps, only supportive care.
  5. Advise the case to:
    • stay home (self-isolate) for 5 days from symptom onset
    • perform hand hygiene (wash with soap and water or use an alcohol-based hand rub) frequently
    • avoid sharing drinking glasses, eating utensils or any object used on the nose or mouth
    • cover coughs and sneezes with a tissue or forearm.
  6. Cases admitted to a health care facility should be managed with droplet precautions until 5 days after the onset of symptoms.

6.2
7.3.2

Contact Management (community contacts; health care workers who are contacts are addressed separately in section 6.4.3)

At the start of the outbreak, individual contacts can be managed either directly/individually or indirectly using the case to disseminate information to their contacts. Depending on the epidemiology of the outbreak, alternative follow-up mechanisms (e.g. letter, Internet, public service announcement, press release, toll-free telephone number) should be considered to reach contacts and other at-risk groups.

Regardless of the mechanism, the dissemination of information to contacts should include

  1. information on mumps disease, its symptoms and prevention
  2. advice to visit a health care provider should any symptoms develop but to call before going (if possible).

Offer immunization to susceptible groups as defined by the epidemiology of the outbreak; recognize that immunization may not prevent disease if the individual is already infected, and previous outbreak experiences have found uptake to be low

6.3.1

Gatherings

During an outbreak, events need not be cancelled. However, because of the slight but real risk of exposure, public exposure settings should be communicated to the public and gathering organizers should advise participants of the following:

  • the potential for exposure and how to prevent spread of the disease (e.g. check with health care provider to ensure that immunization is up to date, use good hand hygiene, avoid sharing food/drink/utensils, cover coughs and sneezes with a tissue or forearm, stay home when ill);
  • of mumps disease, its symptoms and prevention;
  • the need to visit a health care provider should any symptoms develop but to call before going (if possible).

6.3.2

Schools/Educational Institutions

Encourage schools/educational institutions to practise general good hygiene to prevent disease spread (e.g. use good hand hygiene, avoid sharing food/drink/utensils, cover coughs and sneezes with a tissue or forearm, and stay home when ill).

If a case is identified, notify staff, students and families.

Refer to Section 4.3 for defining contacts of cases.

6.3.3
7.2

Health Care Settings (include acute care, long-term care and home care)

7.3.3

Some health care settings may not have occupational health and infection prevention and control departments. When occupational health and infection prevention and control are referred to, they mean the individual(s) responsible for occupational health and infection prevention and control for that health care setting.

Definitions:

A health care worker (HCW) is an individual who may have the potential to acquire or transmit an infectious agent during the course of his or her work in the health care workplace (e.g. nurses, physicians, students, volunteers, home care workers, emergency responders and support staff).

Pre-placement of HCWs

  • Occupational Health should document HCW immune status at the pre-placement examination. A HCW is considered immune if there is
    1. documentation of two doses of a mumps-containing vaccine;
    2. documentation of laboratory-confirmed mumps; or
    3. positive mumps IgG (refer to Section 5.0 and Appendix 4 for interpretation of IgG results).

Existing HCWs

Occupational Health should provide MMR to all HCWs unless the individual has

  1. documentation of two doses of a mumps-containing vaccine;
  2. documentation of laboratory-confirmed mumps;
  3. positive measles, mumps, and rubella IgG; or
  4. a valid contraindication to measles, mumps and rubella (MMR) vaccine.

HCWs who are cases

  • Clinical cases are managed as confirmed cases until laboratory evidence suggests otherwise.
  • Advise cases to immediately notify Occupational Health and/or Infection Control for the facility in which they work.
  • Advise case to stay home for 5 days from symptom onset and until symptoms have resolved.
  • Cases are to report to Occupational Health and/or Infection Control for their facility to determine fitness to return to work.

HCWs who are contacts


Contact in the community, see Section 4.3.
Contact in the facility if unprotected face-to-face interaction within 1 metre of an infectious mumps case:

  • Advise HCW to immediately notify Occupational Health and/or Infection Control for the facility in which they work.
  • Provide information on mumps disease and its symptoms.
  • Assess immunity to mumps if not assessed at pre-placement:
    1. documented two doses of mumps-containing vaccine, can return to work immediately
    2. documented laboratory-confirmed mumps infection, can return to work immediately
    3. documented one dose of mumps-containing vaccine, provide a dose of MMR vaccine, can return to work immediately
    4. undocumented immunization history:
      • draw blood for MMR IgG serology
      • provide a dose of MMR vaccine (after specimen taken)
      • while waiting for serology results, exclude HCW from work for the period of communicability, which starts on day 10 after exposure where exposure is day 1
      • refer to Section 5.0 and Appendix 4 for interpretation of IgG results:
        1. if IgG positive, then consider immune and can return to work, but consider a second dose of MMR vaccine for adequate measles protection
        2. if IgG negative, then consider susceptible, provide a second dose of MMR vaccine 28 days after the first and exclude from work on day 10 after first exposure until day 26 after last exposure
6.4

Travellers

Travellers should ensure that their routine immunizations are up to date. As mumps is transmitted through infected oral/nasal secretions, travellers should protect themselves and others by practicing good hand hygiene and coughing or sneezing into a tissue or forearm. They should avoid sharing food, drinks or utensils.

In Canada, individuals can be refused permission to board an aircraft or cruise ship if they appear to have an infectious disease. Travellers with symptoms of mumps, including fever, should postpone travelling until they are better.

When provincial/territorial borders are crossed, the province or territory where the case was diagnosed should alert other provinces/territories and the Public Health Agency of Canada (Centre for Immunization and Respiratory Infectious Diseases). When cases or contacts are from a different country, the identifying provincial/territorial health authority should notify PHAC, which will contact the appropriate authority of the affected country. When mumps cases or contacts are identified in international travellers by the Quarantine Service or Duty Officers at an international port of entry, PHAC will notify the appropriate provincial/territorial or international public health authority.

Airplanes: Individual follow-up is not recommended, although notification of implicated public health authorities is suggested as other jurisdictions may have different protocols.

Cruise Ships: The cruise ship's health services would have the responsibility for the traveller's health during the cruise and would follow up with contacts according to the conveyance operator's policy.

7.0

Immunization (summarized from previous sections)

7.3.2

Community contacts of cases

6.2

  • Offer immunization to susceptible groups as defined by the epidemiology of the outbreak; recognize that immunization may not prevent disease if the individual is already infected. Previous outbreaks have indicated that immunization uptake is low.

7.3.3

HCWs who are contacts of cases

6.3.3

  • If documented one dose of mumps-containing vaccine, provide a dose of MMR vaccine.
  • If undocumented immunization history, provide a dose of MMR vaccine after serology is taken; if IgG negative, then consider susceptible and provide a second dose of MMR vaccine; if IgG positive, then consider immune and can return to work.
8.0

Strategic Risk Communications

In outbreaks, strategic communications play a key role in successfully managing the risk. It is important that risk managers and communicators collaborate to identify the desired behavioural changes that will reduce the risk among stakeholders and to identify the barriers that may discourage change, in order to develop efficient strategies for risk mitigation.

8.1

The goal of strategic risk communications is to establish trust with the affected stakeholders in order to encourage them to make behavioural changes to reduce their risk. The best way to do this is to involve stakeholders early on and to be transparent with all information.

8.2

Communications activities include identifying spokespersons to speak to the media about the issue and developing media lines, backgrounders, and question and answer content.

Sharing key messages, communication materials and best practices across all jurisdictions involved is essential for managing an outbreak.

 


Report a problem or mistake on this page
Please select all that apply:

Thank you for your help!

You will not receive a reply. For enquiries, contact us.

Date modified: