Nearly 30 mumps cases — including Yankton County residents — have arisen from a recent northeast Nebraska wedding, according to two states’ health departments.
"That’s a pretty large outbreak," Nebraska state epidemiologist Tom Safranek told the Press & Dakotan on Friday.
And the number could grow, depending on if and how quickly the disease would spread.
The Nebraska Department of Health and Human Services (DHHS) reported the disease’s emergence last week. The department didn’t specify the town in which the cases occurred. However, the DHHS said the disease originated in the northeast district consisting of Cedar, Thurston, Dixon and Wayne counties.
Safranek said his department has been tracking the cases.
"One individual was there (at the wedding) who we think was the source, and there were 28 cases we have been able to track down that were related to that exposure at the wedding, for a total of 29 (confirmed and probable) cases," he said.
The make-up of the wedding participants and guests created additional problems, Safranek said.
"In this case, they came to the wedding and then scattered, probably far away," he said. "As you move away from the epicenter (of where they gathered), the numbers (of mumps cases) may go down, but they’re widely scattered. I’m sure some of them were South Dakota residents."
He was right, based on reports received at the South Dakota Department of Health.
The mumps cases include the Yankton region, according to South Dakota state epidemiologist Josh Clayton. He confirmed the cases in an email to the Press & Dakotan.
"We currently have four cases, all of which are in Yankton and Union counties," he said. "All four cases were exposed to mumps at a wedding."
The large number of cases happened quickly and drew the state health department’s attention, Safranek said. "We didn’t become aware until the outbreak started happening," he said.
The mumps exposure occurred at a large gathering, Safranek said.
"There were over 150 people at the wedding," he said. "We don’t have any good explanation of why so many people got sick after that."
Mumps isn’t unusual for Nebraska, and the current outbreak already makes 2019 one of the highest numbers with four months remaining in the year.
Besides the northeast district’s cases, mumps were recently reported at a workplace in the Four Corners Health Department’s jurisdiction. The four corners jurisdiction includes Butler, Polk, York and Seward counties.
In recent years, Nebraska has recorded 19 cases in 2018, six cases in 2017, five cases in 2015, one case in 2014 and two cases in 2013.
"Usually, it’s single numbers (in terms of mumps cases) for us, but in 2016 we had 49 cases," he said, referring to the annual number of Nebraska cases. "I don’t think we’re there yet this year for Nebraska."
The mumps is transmitted through saliva and upper respiratory secretions, he said. The virus can be spread by spit, kissing or sharing cups and drinking glasses.
Safranek called the process "shedding," in which the virus comes from an individual who is infected in a way that other people can pick up and contract the disease.
The virus can be transmitted three days before the onset of symptoms, so carriers aren’t aware they are sick, he said.
"That’s one of the challenges," he said. "The (initial) case wasn’t symptomatic the day of the wedding. This person got sick the day after the wedding, so it was kind of a peak shedding period when they were at the wedding. Once you get the symptoms, you could be shedding for 5-9 days."
The most notable symptom is parotitis, or swollen glands under the jaw. Other symptoms can include fever, headache, tiredness and loss of appetite.
Because the virus remains contagious, a person with mumps needs to remain isolated from the public, according to DHHS epidemiologist Blake Hendrickson.
"You need a minimum five days of confinement from other people," he said. "If you have the parotitis swelling on your face, we ask that people stay home until it’s completely gone. It’s an indication you’re still infectious for some times up to 9 days."
The mumps has been confirmed in at least one northeast Nebraska school district. In a Sept. 3 notice to parents, the Pender Public School (PPS) provided the following information:
"We feel it is our duty to inform you that PPS now has a confirmed case of mumps in the building. This letter is to make you aware and to provide you with information that will help limit and hopefully prevent the spread of it.
"It is important to note that the individual in this confirmed case was immunized and left the building immediately upon becoming aware of symptoms. While that was an important step to take, the individual was unknowingly contagious for a few days prior to the onset of any symptoms.
"We are one P-12 building, so we recommend that everyone in attendance assumes they have been exposed to the virus. People who have been fully vaccinated are about nine times less likely to get mumps than unvaccinated people who have the same exposure to mumps virus, but they can still get and pass the virus. It is therefore vital for everyone to be vigilant and diligent moving forward."
The Pender school officials said they would take all precautions but that health care providers were the best source for more information on the disease or in confirming cases.
At least one other northeast Nebraska school district was alerting its patrons, according to an area weekly newspaper.
Hartington-Newcastle Superintendent A.J. Johnson notified parents in the school district that multiple local persons had been diagnosed with mumps, and parents should take extra precautions, the Cedar County News reported this week.
Johnson said, as of last week, the district had reported no cases of mumps in the local public schools. However, the district was taking a pro-active approach, he said.
"Precautions are being taken at school through classroom education and cleaning schedules, to help prevent this disease from occurring in our student body," the superintendent told the Cedar County News.
Johnson urged parents to help prevent the further spread of the disease.
"It is very important that (parents) help us in these precautions by not sending students to school if they exhibit the signs and symptoms of the mumps," he added.
The Press & Dakotan sought comment Friday from Johnson but did not receive an immediate response. The newspaper also sought but did not immediately receive comment from Chris Uttecht, the principal for Cedar Catholic Junior/Senior High School and Holy Trinity Elementary School, both in Hartington.
With a large percentage of the population vaccinated for mumps, the question becomes: How could this outbreak happen?
"The vaccine is pretty good, but it’s not perfect," Safranek said. "People who have received one dose of the vaccine have 78 percent immunity, and after two doses, it goes up to 88 percent. But that number falls off over time. As time has passed, the immunity level may diminish further."
In those cases, "it creates a vulnerability and susceptibility," he added.
Most people receive both of their mumps vaccinations as children, the first one at 15 months of age and the next one at 4 years old.
"You can still receive benefits if you receive the vaccine as an adult," Safranek said. "If you’re not vaccinated fully, I recommend everyone get the two doses of mumps vaccine."
As an adult, the two shots can be received 20 days apart, Hendrickson said.
However, the vaccines must be received ahead of any contact with the disease, Safranek said. "There isn’t any benefit after you’ve been exposed (to mumps)," he added.
While all age groups benefit from vaccinations, Safranek encouraged both the initial mumps shot and booster for children.
"We recommend that you make sure that all kids are fully vaccinated," he said. "The minute a kid develops symptoms, get the word out (to alert other parents)."
Safranek acknowledged the temptation for people who may have mumps to continue showing up for work or continue sending their children to school.
Both are bad ideas, he warned. "The minute you come down with symptoms, you need to isolate yourself from other people," he said.
People who believe they may have mumps would be well served to check it out with their health care provider, Safranek said.
"You can go home and self-isolate until you get over it, but we recommend you go to a clinic for evaluation," he said. "That way, we can also track it better and know what you’re dealing with."
Clayton offered the following information on mumps:
• Mumps is spread from person to person.
• A person infected with mumps can transmit the virus to another person during a period that extends from 2 days before their illness onset to 5 days after their illness onset.
• There is no treatment for mumps, so a person suspected of having mumps should be tested by their doctor and excluded from work, school, or daycare until 5 days after their illness onset to avoid spreading mumps.
• The SD-DOH investigates mumps cases and notifies individuals who may have been exposed to a mumps case.
• Getting vaccinated with the MMR (measles, mumps, rubella) vaccine is the best way to prevent illness from mumps.
• Individuals can also reduce the risk of illness by taking basic respiratory precautions:
— Cover your nose and mouth when you cough or sneeze
— Don’t share glasses, eating utensils, water bottles, or other things that have saliva on them
— Stay home when you are sick
— Wash hands frequently
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