Appendix A: Disease-Specific Chapters

1 Infectious Diseases Protocol Appendix A: Disease-Specific Chapters chapter : Mumps Revised January 2014. Mumps Communicable Virulent Health Protection and Promotion Act: Ontario Regulation 558/91 Specification of Communicable Diseases Health Protection and Promotion Act: Ontario Regulation 559/91 Specification of Reportable Diseases Aetiologic Agent Mumps is caused by a RNA (ribonucleic) virus of the genus Rubulavirus in the Paramyxoviridae , 2. Case Definition Surveillance Case Definition See Appendix B. Outbreak Case Definition Public health units should notify Public Health Ontario (PHO), as specified by the Ministry of Health and Long-Term Care (the Ministry), when a case is identified.

2 If secondary transmission occurs, an outbreak case definition may be developed in consultation with PHO. based on a review of the epidemiology of identified cases. The outbreak case definition may evolve over time to reflect the changing dynamics of the outbreak. The outbreak case definition varies with the outbreak under investigation. Consideration should be given to the provincial surveillance case definition and the following criteria when establishing an outbreak case definition: 1. Clinical, laboratory and/or epidemiological criteria;. 2. Time frame of occurrence;. 3. Geographic location(s) or place(s) where cases live or became ill/exposed;. 4. Special attributes of cases ( age, underlying conditions); and, 5.

3 Further strain typing as appropriate, which may be used to support linkage. Identification Clinical Presentation Fever, swelling and tenderness of one or more salivary glands are characteristic of Parotitis (inflammation of the parotid gland) will develop in about 40% of those infected, 25% of which is In approximately 20% to 30% of mumps cases, infections are subclinical, but remain ,4 Nonspecific or primarily respiratory symptoms that occur in about 50% of those who acquire infection can add to the difficulty in diagnosing , 4 Orchitis (testicular inflammation) is a relatively common complication among 2. post-pubertal males (20-30%), whereas other complications are rare and include oophoritis (ovarian inflammation) and sensorineural hearing , 3 In general, permanent sequelae are rare, although mumps infection in adults is more likely to be severe and result in , 3.

4 Mumps was a major cause of viral meningitis prior to widespread use of mumps vaccine. Mumps infection during the first trimester of pregnancy may increase the rate of spontaneous abortion, but mumps infection during pregnancy has not been associated with congenital Diagnosis See Appendix B for diagnostic criteria relevant to the Case Definitions. For further information about human diagnostic testing, contact the Public Health Ontario Laboratories or refer to the Public Health Ontario Laboratory Services webpage: px Epidemiology Occurrence Between 2007 and 2011, an average of 136 cases occurred per year in Ontario. The incidence of mumps in Ontario has increased significantly since 2007 with the increase mainly driven by outbreaks.

5 Mumps cases in the susceptible cohort who were born between 1980 and 1992. accounted for 41% of mumps cases reported in 2011. For more information on infectious diseases activity in Ontario, refer to the current versions of the Ontario Annual Infectious Diseases Epidemiology Reports and the Monthly Infectious Diseases Surveillance , 6. Reservoir Modes of Transmission Transmission is generally by droplet spread during face-to-face contact and direct contact with saliva or respiratory droplets from the nose or throat of an infected person. Mumps is spread through coughing, sneezing, sharing drinks, kissing, or from contact with any surface that has been contaminated with droplets containing the mumps , 4.

6 Incubation Period The incubation period ranges from 12 and 25 days, commonly between 16 and 18 Period of Communicability Mumps can be communicable from seven days before and up to five days after the onset of Recent evidence suggests that while mumps virus can be isolated from saliva and respiratory secretions for up to nine days after the onset of parotitis, there is a significant 3. reduction in viral secretion by five days after symptom onset, thereby reducing the risk of , 7. Host Susceptibility and Resistance After natural infection, immunity is generally Effectiveness of mumps vaccination after one dose is estimated to be between 62% and 91% and between 76% and 95% after two There is also evidence to suggest waning immunity after both one and two doses of In Ontario, susceptibility of young adults to mumps infection identified in the cohort born between approximately 1980 and 1992 can be attributed to the receipt of a single dose of mumps-containing vaccine, as well as the circulation of wild Reporting Requirements To local Board of Health Individuals who have or may have mumps shall be reported to the Medical Officer of Health (MOH)

7 By persons required to do so under the Health Protection and Promotion Act, 1990 (HPPA).9. Note: Laboratory confirmed cases are to be reported by phone to the local MOH as soon as identified. To the Ministry of Health and Long-Term Care (the ministry) or Public Health Ontario (PHO), as specified by the ministry Report only case classifications specified in the case definition. Cases shall be reported using the integrated Public Health Information System (iPHIS), or any other method specified by the ministry, within one business day of receipt of initial notification as per iPHIS Bulletin #17: Timely Entry of The minimum data elements to be reported for each case are specified in the following: Ontario Regulation 569 (Reports) under the HPPA;11.

8 The iPHIS User Guide published by PHO; and Bulletins and directives issued by PHO. Prevention and Control Measures Personal Prevention Measures Immunize as per the current Publicly Funded Immunization Schedules for According to the Immunization of School Pupils Act,13 all students without valid exemptions must have documented receipt of one dose of mumps-containing vaccine on or after the first birthday usually given as measles-mumps-rubella (MMR) or measles-mumps-rubella- varicella (MMRV) depending upon age. A two-dose mumps vaccine schedule is now recommended. 4. Six to 23 days after MMR immunization, approximately 5% of immunized children experience malaise and fever (with or without rash) lasting up to 3 days.

9 Parotitis, rash, lymphadenophy, and joint symptoms also occur occasionally after MMR Parotitis should be reported as an adverse event following immunization (AEFI) rather than a case of mumps if it meets the reporting criteria for parotitis specified in the AEFI disease - specific chapter in Appendix B ( , 5 to 30 days). Infection Prevention and Control Strategies For hospitalized cases, droplet precautions, in addition to routine practice, are recommended until five days after onset of Refer to Public Health Ontario's website at to search for the most up-to-date Provincial Infectious Diseases Advisory Committee (PIDAC) best practices on Infection Prevention and Control (IPAC). PIDAC best practice documents can be found at: Management of Cases All clinical cases should be managed as confirmed cases until laboratory evidence suggests Cases should be advised to stay home from school or post-secondary educational institutions, child care facilities, workplaces, and other group settings for five days from symptom onset.

10 Self-isolation will prevent exposure of susceptible individuals to the Cases should be investigated to determine the source of infection, including inquiring about travel history or exposure to persons who have recently travelled and documenting location of travel. Refer to Section 5: Reporting Requirements above for relevant data to be collected during case investigation. The following disease specific information should also be obtained during case management:4. Clinical: symptoms, date of symptom onset, hospitalization and complications;. Laboratory: specimen type, specimen source, further strain characterization;. Immunization status, specifically dates of vaccination with mumps-containing vaccines.