Stemming from an initial mumps outbreak that wreaked havoc at a Jewish camp this summer, 247 New York City residents plus 131 other state residents have since contracted the disease, which remains mostly contained among fervently Orthodox adolescent boys in pockets of New York, New Jersey and Quebec, according to official reports from the New York City and State Departments of Health.
The trigger case occurred back in June, when an 11-year-old boy returned to his Sullivan County summer camp after traveling in the United Kingdom, where an ongoing outbreak has now reached about 4,000 cases, the Centers for Disease Control reported.
From there, the mumps spread to 24 other boys at the camp and continued to plague their local communities when they returned home, and the median age of patients remains around 14.
But perhaps the most frustrating news to some parents is that most of the affected patients had received their proper two-dose vaccination as children — 83 percent, according to the CDC.
“This is a very confusing issue not only for ourselves but for providers and parents,” said Cindy Schulte, vaccine-preventable disease surveillance officer at the New York State Department of Health. “If you have a population that’s fairly well but unevenly vaccinated, by logic, you’re going to end up having some disease in the effective population.” The Measles, Mumps and Rubella (MMR) vaccine has an 85 to 91 percent efficacy rate among those who take the proper doses, she said.
The most common symptoms of this viral disease are fever, muscle aches and parotitis, the signature inflammation of the salivary glands below the ear. Though no deaths have occurred thus far and symptoms may often be subtle, there have been several hospitalizations and one potential case of meningoencephalitis (inflammation of the brain), according to Dr. Debra Blog, medical director at the Bureau of Immunization Program in the New York State Department of Health.
Mumps can be particularly dangerous to pubescent boys, doctors say, because a small number will develop orchitis, a swelling of the testicles that can potentially (though rarely) lead to infertility. The same goes for girls, who can develop swelling of the ovaries that can lead to sterility. While mumps cases among women have certainly increased since the summer, New York City infections remain around 79 percent male, Blog explained.
“These communities tend to have social contact with themselves and tend to be a bit isolated from the outside community,” she said. “In New York City especially it’s going through their schools.”
As of Oct. 30, the CDC had only reported a total of 179 cases in New York and New Jersey and another 15 in Canada, but New York City health officials say that the numbers have increased so dramatically in the past month simply because doctors are taking more care to report their ill patients to the government.
“We’re still getting cases reported virtually every day,” said Dr. Chris Zimmerman, medical director at the Bureau of Immunization in the New York City Department of Health and Mental Hygiene. “There was a substantial increase just from the week before the alert to when the alert came out.”
It is difficult to maintain an exact number of cases, Schulte added, because disease spread is a “fluid number.”
A mumps outbreak of this size has not occurred since 2006, when the United States experienced over 6,500 cases that were particularly hard-hitting among college dormitory residents in Iowa. But the current wave largely remains within pocketed chasidic communities, all linked back to that one summer camp flare-up.
“There have been less than a handful of cases outside the community,” Zimmerman said.
“The population is segregated — these kids are not going to public schools, they’re going to yeshivas,” he continued. “They only have the opportunity to interact with other boys in their community.”
And while statistics show that an overwhelming majority of the kids in these neighborhoods are in fact properly vaccinated, the few outliers are probably the ones perpetuating the disease spread, he added.
“Overall, immunization coverage is good, but this is a community that has had resistance to MMR vaccines — their parents have claimed religious exemptions,” Zimmerman said.
Yet despite outbreaks that have resurfaced from time to time, state medical officials still maintain the mumps vaccine is a successful product, particularly in what Blog calls “evenly vaccinated communities” — those who pretty much unanimously undergo the immunization.
Regarding the disease spread, another crucial element worth considering among the allegedly vaccinated patients is whether or not their dosages were properly refrigerated speculated Dr. Michael Augenbraun, a professor of epidemiology at Downstate Medical Center in Brooklyn.
“Breaks in the ‘cold chain’ are a serious problem for vaccine efficacy if, for example, an office allowed for a vaccine to sit out on countertops overnight,” Augenbraun said, noting that we have no way of knowing this after so many years, however.
Thus far, despite the one hospitalization and some cases of orchitis, complications from this outbreak have generally been minimal. Approximately 56 percent of the confirmed cases exhibited the parotitis, according to Schulte.
“We’re not seeing the same rate of complications that we saw in the pre-vaccine era,” Zimmerman said, noting that before the vaccine, another dangerous side effect of the mumps was permanent deafness.
But the subtle nature of so many of these current cases may be yet another reason that the disease is spreading, because parents neglect to see a doctor about their children’s illnesses.
So what can parents do to protect their families from catching the mumps?
They should make sure that their children have received the two dosages of the vaccine on time, ideally before their first birthday, Schulte said. If an older child has not yet received the vaccine but hasn’t yet been exposed to the illness, this child too should be immunized.
And if a child or adult becomes sick, the best thing to do, as always, is to stay home from school or work, wash hands frequently and see a doctor.
Blog added, “Isolation and vaccination are the two most effective things along with common sense.”