December 24, 2009: Increased Mumps Activity in Ontario

To: City of Ottawa Physicians, Emergency Departments, Community Health Centres, Walk-in Clinics, and Infection Control Departments

From: Dr. Isra Levy, Medical Officer of Health, Dr. Nadine Sicard, Associate Medical Officer of Health, Dr. Vera Etches, Associate Medical Officer of Health

Dear Colleagues,

We are writing to advise you of a recent notification from the Ministry of Health and Long-Term Care regarding an increase in mumps activity in the province of Ontario. The index case is a young adult male from Simcoe Muskoka health unit who experienced onset of parotitis on September 11, 2009. Cases of mumps have now been detected in seven Ontario health units. To date there have been no cases identified in the Ottawa area. Nonetheless, we thank you for remaining watchful for potential cases of mumps to facilitate early detection and infection control.

Mumps is an acute viral illness that is transmitted from person-to-person through direct contact with respiratory droplets from the nose or mouth of an infected person. A person with mumps can spread the infection from 7 days before to 9 days after symptoms develop. The average length of incubation period is 16-18 days, however it can range from 14-25 days.

Mumps should be suspected in any person with fever, swelling and tenderness of one or more salivary glands usually the parotid, and sometimes sublingual and submaxillary glands lasting 2 or more days, where there is no other apparent cause. Laboratory testing is required for any suspect case of mumps, and should include both virus isolation and serologic testing:

1. Virus isolation for RT PCR testing may be collected up to 9 days after the onset of parotitis:
1. Buccal swab: A buccal swab is the preferred specimen. Obtain a buccal swab after massaging the parotid gland area (the space between the cheek and the teeth) just below the ear for 30 seconds. Use the same viral kits used for Herpes and Chlamydia cultures, if obtained from the Public Health Laboratory these swabs contain a pink medium and a blue top. Place the swab in viral transport medium.
2. Throat swab: a throat swab can be taken in addition to serology and a buccal swab. Take the throat swab and place it in viral transport medium. Use the same viral kits used for Herpes and Chlamydia cultures, if obtained from the Public Health laboratory these swabs contain a pink medium and blue top.
3. Urine specimen: collect a clean catch urine specimen (50 ml) using a sterile screw top container.
2. Serological testing include:
1. Acute serum: A blood specimen, to test for mumps antibodies, IgM and IgG, within 5 days of onset of symptoms.
2. Convalescent serum: A second blood test for mumps antibodies, IgM and IgG, is recommended if the mumps IgM is indeterminate and should be done approximately 2 weeks after the onset of symptoms, to check for seroconversion or a significant rise in mumps IgG antibodies.
3. Ensure that all requisitions indicate: the symptoms, onset of symptoms, exposure history and mumps vaccination history, as well as the type of specimen collected. All specimens should be stored in the fridge until sent to the laboratory.

Please note: All suspect cases of mumps must be excluded from school or work for 9 days from onset of parotitis and must be reported immediately to Ottawa Public Health at 613-580-6744 ext. 24224 during business hours and 613-580-2400 or 311 after hours and on weekends or holidays. ottawa.