By Stephanie Gunn, Ashley Larsen, Danielle McDermott, and Taryn Velazquez
As young students of Nursing & Science, one of the first things we learned in our Microbiology class was that microorganisms are Ubiquitous i.e., found everywhere. This explains how easily it is for a particular disease to spread in a susceptible population. As mentioned in a Bulletin last year our Microbiology professor, Dr. Michael Dickman, informs his classes daily of any New Infectious Disease “Outbreaks” before our lectures. His updates deal with Infectious Disease “Outbreaks” that are currently occurring throughout the United States and all over the world. He explained that this was done to demonstrate that Microbiology & Infectious Diseases are constantly evolving. Our group recently brought up a recent Mumps outbreak that occurred close to home in Philadelphia, before even our Professor realized its full importance.
Currently, there is a Mini-Epidemic of Mumps taking place in the city of Philadelphia and surrounding counties. The most notable and well publicized outbreak occurred on the Campus of Temple University. Our group discovered these Index Cases of Mumps before its rapid spread and mentioned it to Dr. Dickman. Suddenly clusters of Mumps cases were reported at Drexel University, West Chester University, and at Pennsbury High School in Bucks County.
Mumps is an airborne Virus (Paramyxovirus) that spreads rapidly from the Respiratory Tract to the Parotid glands causing both cheeks to swell visibly. If the disease progresses further the Mumps Virus can subsequently enter the cerebrospinal fluid (CSF) and spread to the brain, pancreas, and gonads (testis or ovaries). According to the Communicable Disease Center (CDC) in order to prevent Mumps (plus Measles & Rubella) all children aged 12-15 months should receive an initial Prophylactic MMR vaccine followed by a second dose at 4-6 years of age. If everyone follows this preventative routine, we can achieve what is termed “Herd Immunity” in the population where no one will contract Mumps or serves as a “carrier” of the virus. As Nurses we will be responsible for ensuring that all of our patients are vaccinated in a timely manner.
Currently, at Temple University a Mumps Outbreak has sickened 134 people over the last two months. This figure includes 18 “confirmed” Mumps cases and 116 “probable” cases. The Philadelphia Public Health Department reports that 123 of those cases are in the city and 11 are occurred in surrounding counties. In a response to this unexpected outbreak Temple held two free Vaccine Clinics and delivered 4,819 doses of MMR to students, staff, and the entire Temple community. A West Chester University student who had visited a friend on the Temple University campus developed symptoms of Mumps and has been treated and confined. The student has been kept off of the Campus as directed from the University Public Health personnel. As a result of this rapid response, no additional Mumps cases have been reported at West Chester.
As of March 22, 2019, one Drexel University graduate student is believed to have developed the disease. In Montgomery County, there are currently 20 “suspected” cases, but none have yet been confirmed. In addition to these 2 “probable” University cases, one case has been reported in an Elementary School student from North Wales and another in an Abington Senior High School. According to the Pennsbury School District the most recent confirmed case involves a student from Pennwood Middle School. The Pennsbury School District immediately sent a letter home with each student identifying the signs and symptoms of the disease to look out for. If any of these occur the student should be kept home and an appointment made to see a Doctor.
This sudden “Epidemic” that we are witnessing may possibly be due to “Waning Immunity” which occurs over time in the younger adult population. “Waning Immunity” occurs when an individual loses the protective immunity that exists following a childhood vaccination with the MMR preparation. Since children received their last dose of MMR at age 4-6, this makes many of them again susceptible to the Mumps Virus when they enter school. Some students for one reason or another are never vaccinated during the pediatric period e.g., those with a religious opposition to vaccination. Therefore, adults in 18-20-year age group should be re-vaccinated with a third dose of MMR to prevent the occurrence of Mumps. Colleges should start implicating a mandatory MMR re-vaccination requirement for newly enrolled students to help prevent the spread of this disease on campus.
Additional evidence of “Waning Immunity” to the MMR vaccine is suggested by a concomitant increase in reported cases of Measles in this country. Measles has reached a new yearly high for 2019, and there are dozens of new infections which count to 465 “confirmed” cases this year. Representing an in an increase in the number of yearly cases reported per year since 2000. In Brooklyn, there has been a large outbreak in an Orthodox religious Community because there has been considerable resistance to vaccinations. This Outbreak which prompted the Mayor of New York City to declare a State of Emergency on April 10th. This Order banned children and teenagers who were not vaccinated against Measles from public places for a stipulated time period or until they were vaccinated. This New York City Order ordered fines for unvaccinated children. The best way to protect yourself from Mumps and Measles is to receive the MMR vaccine in a timely fashion. Both diseases can be easily spread through coughing and sneezing. Therefore, consistently washing your hands and using the correct “Cough Edicate” (coughing into your sleeve) are additional ways to protect yourself from developing Mumps.
It is tempting to speculate whether these unvaccinated children or those with Waning Immunity might also be susceptible to German Measles (Rubella), also included in the MMR vaccine. Rubella can pose a very serious complication in children born to non-immune mothers.
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