Infection Prevention and Control: General Recommendations
The mumps vaccine is available in two combination vaccines: the MMR and the pediatric measles-mumps-rubella-varicella (MMRV) vaccine. The mumps vaccine is very effective: 88% with two doses (range 66-95%) and 78% with one dose (range 49-92%).3 Vaccination with two doses has been recommended by the ACIP since 1989.2 Ensuring a high rate of childhood vaccination is the most effective strategy to prevent disease in the population.
The ACIP recommends that all adults without proof of immunity to mumps be vaccinated unless they have a medical contraindication like pregnancy or severe immunodeficiency.14
- A single dose of MMR is recommended for most adults.
- Two vaccine doses are recommended for the following individuals:
- HIV infected (CD4+ T-lymphocyte count ≥200 cells/µl for at least 6 months)
- Health care personnel
- Students in postsecondary educational institutions
- Those who plan to travel internationally
- Those who received inactivated (killed) measles vaccine or measles vaccine of unknown type during years 1963–1967
- Those who were vaccinated before 1979 with either inactivated mumps vaccine or mumps vaccine of unknown type who are at high risk for mumps infection, e.g., health care workers.
In adults, proof of immunity includes birth before 1957, documentation of MMR receipt, or laboratory evidence of immunity or disease.14 Proof of immunity among health care workers differs slightly from the general population5 and includes any one of the following:
- Written documentation of vaccination with two doses of live mumps or MMR vaccine administered after 12 months of age and at least 28 days apart
- Laboratory evidence of immunity: equivocal results should be considered negative
- Laboratory confirmation of disease
- Birth before 1957 which presumes natural immunity. A caveat here is if there is laboratory evidence of lack of immunity or disease in a person born before 1957, vaccination with two doses is required in an outbreak setting and is encouraged in a routine setting.
Infection control and reporting
Suspect mumps patients should remain home and away from public spaces such as school and work for five days after parotitis onset or, in its absence, until the resolution of constitutional symptoms.3
In the health care setting, droplet precautions (mask with eye protection) in addition to standard precautions (hand hygiene and appropriate environmental cleaning) are recommended until five days after onset of parotid swelling.5,15,16 Health care workers without evidence of immunity should be excluded from the 12th day after the first unprotected exposure to mumps through the 25th day after the last unprotected exposure.5 Those with partial vaccination may continue working following an unprotected exposure but should immediately receive a second dose of vaccine. Workers with immunity do not need to be removed from work.
Suspected mumps cases should be promptly reported to the local health department without waiting for laboratory confirmation (Box 3). In LA County, once reported, DPH will assist in the management of all suspect cases and their contacts.