The reasons for the Mumps Outbreak in Andhra Pradesh and how to do away with it

Introduction:

In recent times, a concerning outbreak of mumps has been reported across several states in the country, prompting heightened attention from public health officials. Mumps, a highly contagious viral infection primarily affecting the salivary glands, has resurfaced, leading to widespread discomfort and potential long-term complications. This note aims to provide a comprehensive overview of the current mumps outbreak, including its causes, clinical manifestations, diagnostic approaches, management strategies, and crucially, the importance of vaccination in preventing such outbreaks.

Outbreak Overview:

Mumps, caused by the Paramyxovirus, is characterized by swelling and pain in the salivary glands, with potential complications ranging from meningitis to deafness and reproductive organ inflammation. Despite the existence of a preventive vaccine, the recent outbreak has been linked to low vaccination rates, signalling a concerning trend in certain communities. This outbreak is notably the first during the post-COVID era, raising questions about the impact of the pandemic on routine vaccination schedules.

Burden of Disease:

A noteworthy aspect of mumps is the substantial underreporting, with over 90% of cases going unreported. The current outbreak highlights the need for improved surveillance and reporting mechanisms to better understand and control the spread of the virus.

Reasons for Outbreak:

Several factors contribute to the resurgence of mumps, making it essential to address these issues comprehensively:

Cyclical Trend: Mumps tends to follow a cyclical pattern, with outbreaks occurring every 3-4 years. Understanding this pattern is crucial for implementing timely preventive measures.

Vaccine Inclusion: The absence of the mumps vaccine in the National Immunization Schedule exacerbates the vulnerability of certain populations. Advocacy for the inclusion of the mumps vaccine in routine immunization programs becomes imperative.

Pandemic-Related Challenges: The disruption caused by the COVID-19 pandemic has led to loss of follow-up vaccinations, creating a gap in immunity. Addressing this fallout and reinstating routine vaccinations is crucial in preventing the resurgence of preventable diseases.

High Communicability: Mumps is highly contagious, emphasizing the need for swift and effective preventive measures to curb its transmission.

Concerns and Complications:

The consequences of mumps extend beyond the initial discomfort, with long-term sequelae being a cause for concern:

Sensorineural Hearing Loss: Persistent hearing loss is identified as a potential complication, emphasizing the need for early detection and intervention.

Sterility: Reproductive organ inflammation leading to sterility is another serious concern. This highlights the importance of prioritizing preventive measures to safeguard reproductive health.

Diabetic Ketoacidosis (DKA): Notably, cases of DKA have been observed in diabetic patients following mumps infection. This underscores the interconnectedness of different health conditions and the need for targeted monitoring and care.

Natural History and Clinical Features:

Understanding the natural history of mumps aids in early identification and intervention:

Caused by Paramyxovirus: The viral nature of mumps necessitates a targeted approach in both prevention and management. Incubation Period: With an incubation period of 10-14 days, prompt recognition of symptoms becomes crucial for timely intervention.

Commonly Affected Age Groups: The 2-12 age group is identified as the most susceptible, emphasizing the importance of paediatric vaccination efforts.

Clinical Features: Symptoms include fever, swelling of parotid glands, abdominal pain, vomiting (indicative of pancreatitis or oophoritis), and in severe cases, confusional states and irritability (signs of aseptic meningoencephalitis).

Diagnosis and Management:

Accurate diagnosis and appropriate management are key components in controlling the spread and impact of mumps:

Diagnosis: Clinical presentation is pivotal, with definitive diagnosis achieved through RT-PCR testing. Management: While mild cases can be managed on an outpatient basis with antipyretics, analgesics, and hydration, severe cases such as meningoencephalitis or pancreatitis require in-patient care. Quarantine measures are also implemented for mild cases to prevent further transmission.

Prevention Strategies:

Preventive measures play a central role in controlling mumps outbreaks:

Isolation: Swift isolation of infected individuals is crucial in limiting the spread of the virus within communities. Immunization: The cornerstone of prevention lies in vaccination. The MMR vaccine, with a single dose providing 60% immunity and two doses offering 90% immunity against mumps, stands as a powerful tool in preventing outbreaks.

Conclusion:

In conclusion, the recent mumps outbreak serves as a stark reminder of the ongoing challenges in maintaining population immunity against preventable diseases. Addressing the cyclical nature of mumps, advocating for vaccine inclusion in national schedules, and mitigating the impacts of pandemic-related disruptions are essential steps in preventing future outbreaks. The interconnectedness of mumps with severe complications like hearing loss, sterility, and even DKA emphasizes the need for a holistic approach to public health. Ultimately, this outbreak underscores the critical role of vaccination in protecting individuals and communities from the resurgence of potentially serious and preventable diseases.

 

By Dr. Vijay Kumar MD (Paediatrics) Fellowship in Neonatology, Diploma in Allergy & Asthma

Consultant Neonatologist & Paediatrician, Ankura Hospital for Women & Children, Vijayawada.