1. Mumps Outbreaks Associated with Correctional Facilities Texas 2010-11
Rachel Wiseman, MPH
Emerging and Acute Infectious Disease Branch
March 28, 2011

2. Mumps Background Part of measles-mumps-rubella vaccine
Given at mos and 4-6 years
2 doses > 90% effective
Disease has a 40% asymptomatic rate
No treatment, no post-exposure prophylaxis
Incubation period of days
Recent US outbreaks in high-density, intense contact settings (e.g. college dorms)

3. Reported Cases of Mumps in Texas 1990-2010*
254 counties
~25 million total population
Public health structure
52 contracted LHDs
8 regional health departments
* Provisional as of March 23, 2011

4. Correctional Background
>150,000 people in state prisons
~100,000 in county jails
Many residents housed in dorms or pods (similar to barracks)
40-60 people housed in one large area together
Facility size ranges from <5 to >10,000

5. Outbreak 1: July 2010
Nine inmates at Facility A diagnosed with parotitis within 6 days
All incarcerated over 25 days
9/9 reported MMR x2
Found records for 4 in local immunization registry

6. Controlling Outbreak 1—Inmates
All suspects isolated for 5 days
All exposed dorms were quarantined for 25 days
Quarantine extended if new case diagnosed
Transferred exposed inmates were quarantined at new facility
Released exposed inmates were followed in the community
Vaccine offered to all quarantined inmates
Daily symptom checks

7. Controlling Outbreak 1—Staff
Healthcare staff offered vaccine
All staff educated on mumps
Staff assigned to quarantined areas offered vaccine
Staff cases were kept out of work for 5 days

8. Spread of Outbreak 1 1 spread case 3 of 4 had orchitis only
Exposed inmates transferred to other facilities before outbreak identified
State wide, multi-agency contact investigation
3 exposed inmates transferred to Facility B developed mumps
1 spread case
3 of 4 had orchitis only
Control measures implemented

9. End of Outbreak 1 30 cases total from July-October
4 officers at Facility A
22 inmates at Facility A
4 inmates at Facility B
No community cases related to this outbreak identified
Initially, 53 exposed inmates had been sent to 7 facilities around the state.

10. Outbreak 2—September 2010 6 had culture and serology
Nine inmates with parotitis onset in 4 days in Facility C
No connection to Facility A or B
Unclear vaccination history
1/7 IgM +
7/9 virus isolated
6 had culture and serology
4 virus isolated, IgM -

11. Controlling Outbreak 2 Facility C has 55 beds
Most inmates have community jobs
Exposed inmates allowed to continue working
Worksite notifications NOT done
Ill inmates isolated for 5 days
All staff and inmates offered vaccine
No secondary cases

12. Outbreak 3: December 2010
Six inmates with parotitis identified in 2 days at Facility D
Facility A and D in same county
Cases incarcerated at Facility D >25 days
1 inmate with mumps at Facility E
Not related to any other facilities
No secondary cases
Facility A identified a new case
Is entire correctional system infected?

13. Progression of Outbreak 3
Spread to Facility F in January
Many transfers between Facility D and F
Control measures from Facility A implemented at D and F
As of March 24:
Facility D: 18 inmates, 1 officer
Facility F: 11 inmates, 1 officer
Facility A: 3 new cases
Last onset March 5

14. Summary of Outbreaks
Since July 2010, 73 outbreak-related cases in correctional facilities
Genotype G identified at each facility
Common to other outbreaks in US
Previously found in TX community cases
Over 2000 doses of MMR distributed
No community spread identified

15. Laboratory Issues How useful is serology?
At Facilities D/F, NPV=43%
Lengthy turn around time of viral culture
Texas lab adding PCR capability
Difficult for facilities AND health departments to follow specimen collection/transport instructions

16. Correctional Issues We speak different languages
Tried to use their language as much as possible
Intense conference call schedule
Multiple site visits
Who is responsible for public health in correctional facilities?
Responsibilities outlined for disease investigation in corrections

17. Vaccine-Related Issues
No statewide life time registry
As of February 2011, we do!
High vaccine refusal rates
Scare tactics helped a little
Shipping vaccine and maintaining cold chain
Restricted vaccine delivery to health departments

18. Epidemiologic Issues Clinical case definition not broad enough
Changed to include non-parotitis presentations
How broad to define epi-link?
How to track spread with a 40% asymptomatic rate?
Good news: mumps transmission difficult in highly-vaccinated, non-incarcerated population

19. Questions? Rachel Wiseman, MPH Rachel.Wiseman@dshs.state.tx.us
(512) ext. 2632