Multifaceted Faces of A Local Mumps Outbreak

We report an outbreak of mumps among religiously observant and other susceptible communities in Rockland County as part of a multi-jurisdictional outbreak in New York, New Jersey, Israel and Quebec, Canada.

In September of 2009, there were 2 reported cases of mumps in school aged campers were reported to the Rockland County Health Department (RCDOH). These cases were due to an exposure a month earlier to an imported case of mumps, however the illness spread from the unvaccinated campers to local religiously observant communities. The RCDOH developed and distributed several provider and education based notifications. By December, there were over 200 confirmed cases identified.

Initial case findings indicated lower vaccination coverage in the case population. The majority of the cases were in adolescent males, which matched the distribution in the other jurisdictions affected nationally and internationally. The RCDOH initiated school exclusion orders and conducted school based audits of vaccination records with the assistance of the New York State Department of Health and Centers for Disease Control. While the results of school audits indicated better vaccination coverage than initially identified, the case numbers increased to over 370 cases by February 2010, with newer epi-linked cases identified in a susceptible immigrant population

This presentation highlights the multi faceted approaches to investigating and controlling a sustained outbreak of mumps from the perspective of a local health department. Of additional importance is the role that epidemiology, clinical diagnosis, educational, community networks, perception and communication play in the success or failure to maintain controls that curb outbreak conditions.