Mumps Case Definition and Investigation

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Mumps Case Definition and Investigation

• L. Alice Allie Clay, R.N.
• IDEP Surveillance Nurse
• IDEP Training February 2008

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Objectives

• To describe what information is necessary
• for case ascertainment
• To have a better understanding of case
• investigation and ascertainment of
• Mumps

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Mumps, Oh NOOOOOOOOO!!!
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Reportable by law

• Healthcare Providers/Facilities responsibilities
• Report suspected cases of mumps to your
  local health department
• immediately
• Laboratory responsibilities
• 1. Report positive lab reports immediately
  to
• healthcare provider the infection
  control
• practitioner
• 2. Report positive lab reports immediately
  to the local
• health department
• Local Health Departments
• Notify your regional epidemiologist IDEP
  immediately
• when you have a suspected case of mumps

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Mumps Clinical Case Definition

• Illness with
• Acute onset of unilateral or bilateral
• tender, self-limited swelling of the
• parotid and/or salivary gland(s)
• Lasting _at_ least 2 days, and without
• other apparent cause

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Clinically Compatible Illness

• Infection with mumps virus may present
• as aseptic meningitis, encephalitis,
• hearing loss, orchitis, oophoritis, parotitis
• or other salivary gland swelling, mastitis
• or pancreatitis

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Laboratory Criteria for Diagnosis

• Isolation of mumps virus from a clinical
• specimen, (culture) or
• Detection of mumps nucleic acid (e.g.,
• standard or real time RT-PCR assays), or
• Detection of mumps IgM antibody, or
• 
  contd

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Laboratory Criteria contd

• Demonstration of specific mumps anti-
• body response in absence of recent
• vaccination, either a four-fold increase
• in IgG titer as measured by quantitative
• assays, or a seroconversion from
• negative to positive using a standard
• serologic assay of paired acute and
• convalescent serum specimens

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Case Classification

• Suspected
• Case with clinically compatible illness OR
• Meets the clinical case definition without lab
  testing OR
• A case with lab tests suggestive of mumps without
  clinical information
• Probable
• A case that meets the clinical case definition
  without lab
• confirmation AND
• 2. Is epi-linked to a clinically compatible
  case
• 
  
• 
  
• 
  
• 
  

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Case classification contd

• Confirmed A case that
• 1. meets the clinical case definition or
• has clinically compatible illness,
• AND
• 2. is laboratory confirmed or is
• epi-linked to a confirmed case

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Mumps Outbreak Recognition

• An outbreak may be defined as two or
• more cases in a county
• OR
• one or more cases in a congregate setting
• (e.g., school or workplace).

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Outbreak Notification

• Notify your regional epidemiologist IDEP
• immediately
• Immediately identify all suspect or confirmed
  cases
• Initiate control measures to prevent spread of
  disease
• Isolate (droplet precautions) all symptomatic
  suspect cases for 5 days after onset of parotitis

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Interpretation of Laboratory Results

• Isolation of mumps virus from a clinical
• specimen, or
• Detection of mumps DNA by PCR, or
• Detection of mumps IgM antibody, or
• A four-fold rise in IgG antibody

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What would you do if you receive a lab report on
mumps?

• Laboratory Corporation of
  America
• Patient Name/Address
  PAT. ID 234563
• Mary Smith
  Spec. 12345
• PO Box 334
  Spec. Date 01/02/08
• Great Scott, WI 26543
  Report Date 02/04/08
• DOB 04/04/2002 Submitter
  Great Scott General Hospital
• Age 5 yrs
  1222 Holley Court
• Sex Female
  Great Scott, WI 26543
• Specimen Blood
• Test Name Mumps antibodies IgM
  Results 1.21
• 
  (Negative lt0.80)
• 
  (Borderline 0.80-1.20)
• 
  (Positive gt1.20)

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Does it meet the lab criteria?
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Does it meet the lab criteria?

• - Check lab criteria for diagnosis

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What is the next step before initiating a
case investigation?
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What is the next step before initiating a case
investigation?

• Refer to Mumps Protocol
• Begin ascertainment of the case

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How do you ascertain a case?

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How do you ascertain a case?

• Three pieces of information needed to determine
  if you have a Mumps case
• Clinical information
• Lab report
• Epi-link

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What information would you obtain from
the provider?
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What information would you obtain from a provider?
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What information to obtain from a provider contd
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Lab Information needed
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Lab Information needed contd
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What information would you obtain from
the patient/parent?
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What information would you obtain from the
patient/parent?
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What would you obtain from the patient/parent
contd
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What Epi-Link information do you need to obtain?
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Epi-Link information contd
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When investigation is completed

• Document public health action
• Check case classification
• Print the report for your files or per your
• LHD policy procedure
• Mail or fax lab report(s) to IDEP
• Submit completed WVEDSS report electronically
• to your regional epidemiologist

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Remember!!!

• Clinical information, Laboratory report(s),
• and Epi-link information is the three
• main pieces of information needed to
• determine if you have a Mumps case
• AND
• Follow your Mumps Protocol

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Resources

• IDEP Mumps site
• http//www.wvdhhr.org/idep/a-z/a-z-mumps.asp
  
• CSTE site on mumps http//www.cste.org/PS/2007ps/
  2007psfinal/ID/07-ID-02.pdf

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Thank You

• L. Alice Allie Clay, R.N.
• lillieclay_at_wvdhhr.org

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