Mumps Prevention and Control in Healthcare Settings
Mumps transmission in healthcare settings, while not common, has occurred in past outbreaks involving hospitals and long-term care facilities housing adolescents and adults. Mumps is transmitted by contact with virus-containing respiratory secretions, including saliva; the portals of entry are the nose and mouth. The incubation period varies from 12 to 25 days and is usually 16 to 18 days.
In unvaccinated persons, unilateral or bilateral parotitis occurs in approximately half of patients infected with mumps; 15-20% are asymptomatically infected and the remainder have nonspecific, flu-like symptoms without parotitis. Although the virus has been isolated from saliva from 7 days before parotitis and may persist for as long as 8 days after onset of disease, the highest isolation rates (~90%) occur closest to parotitis onset and decline rapidly thereafter. Most mumps transmission likely occurs before parotitis onset and within the subsequent 5 days. Transmission may also occur from persons who are not isolated including during the prodromal phase and from subclinical infections. While transmission of mumps in healthcare settings has not been commonly reported, during community outbreaks, unprotected exposure of healthcare personnel to mumps is common, both in outpatient settings and in the community. These exposures can have a significant impact on healthcare resources, in that exclusion of non-immune exposed healthcare workers can be for as long as 26 days.
Preventing transmission of mumps in healthcare settings consists of five major components:
- Assessment of evidence of immunity of healthcare personnel, including: documented administration of 2 doses of live mumps virus vaccine*, laboratory evidence of immunity or laboratory-confirmation of disease, or born before 1957† ‡ §
- Vaccination of those without evidence of immunity,
- Exclusion of healthcare workers with active mumps illness as well as non-immune healthcare workers who are exposed to persons with mumps
- Isolation of patients in whom mumps is suspected
- Use of droplet precautions for patients with suspected or confirmed mumps
*The first dose should be administered on or after the first birthday; the second dose of mumps-containing vaccine should be administered no earlier than one month (i.e., a minimum of 28 days) after the first dose. Combined MMR vaccine generally should be used whenever any of its component vaccines is indicated.
†May vary depending on current state or local requirements.
‡For unvaccinated personnel born before 1957 who lack laboratory evidence of mumps immunity or laboratory confirmation of disease, healthcare facilities should consider vaccinating personnel with two doses of MMR vaccine at the appropriate interval.
§For unvaccinated personnel born before 1957 who lack laboratory evidence of mumps immunity or laboratory confirmation of disease, healthcare facilities should recommend two doses of MMR vaccine during an outbreak of mumps.
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