Mumps: Difference between revisions

Mumps
Mumps
Specialty	Infectious diseases, pediatrics

Mumps virus
	File:PHIL 1874.jpg
	TEM micrograph of the mumps virus.
Virus classification
Group:	Group V ((−)ssRNA)
Order:	Mononegavirales
Family:	Paramyxoviridae
Genus:	Rubulavirus
Type species
	Mumps virus;

Browse history interactively

← Previous edit Next edit →

Content deleted Content added

VisualWikitext

Inline

Revision as of 12:44, 22 April 2008

Mumps or epidemic parotitis is a viral disease of humans. The word "mumps" originally meant "to mumble", and came to be applied to the disease because of the side effects it causes. Prior to the development of vaccination and the introduction of a vaccine, it was a common childhood disease worldwide, and is still a significant threat to health in the third world.^[1]

Painful swelling of the salivary glands (classically the parotid gland) is the most typical presentation.^[2] Painful testicular swelling and rash may also occur. While symptoms are generally not severe in children, the symptoms in teenagers and adults can be more severe and complications such as infertility or subfertility are relatively common, although still rare in absolute terms.^[3]^,^[4]^,^[5] The disease is generally self-limited, running its course before waning, with no specific treatment apart from controlling the symptoms with painkillers.

Symptoms

The more common symptoms of mumps are:

Swelling of the parotid glands (or parotitis) in 60–70% of infections and 95% of patients with symptoms.^[2] It can occur on one side (unilateral) or both sides (bilateral), and pain behind the lower jaw when chewing.
Fever
Headache
Sore throat
Orchitis, referring to painful inflammation of the testicle.^[6] Males past puberty who develop mumps have a 30 percent risk of orchitis.^[7]

Other symptoms of mumps can include sore face and/or ears and occasionally in more serious cases, loss of voice.

Prodrome

Fever and headache can occur already as prodromal symptoms of mumps, together with malaise and anorexia.

Signs and tests

A physical examination confirms the presence of the swollen glands. Usually the disease is diagnosed on clinical grounds and no confirmatory laboratory testing is needed. If there is uncertainty about the diagnosis, a test of saliva, urine, or blood may be carried out; a newer diagnostic confirmation, using real-time nested polymerase chain reaction (PCR) technology, has also been developed ^[8]. An estimated 20%-30% of cases are asymptomatic. ^[9]

Treatment

There is no specific treatment for mumps. Symptoms may be relieved by the application of intermittent ice or heat to the affected neck area and by Acetaminophen/Paracetamol (Tylenol) for pain relief. Aspirin use is discouraged in young children because of studies showing an increased risk of Reye's syndrome.^[10] Warm salt water gargles, soft foods, and extra fluids may also help relieve symptoms.

Patients are advised to avoid fruit juice or any acidic foods, since these stimulate the salivary glands, which can be painful.

Research treatments

A research group published a 1996 report on a chemical extracted from Spirulina platensis, a species of blue-green algae, which inhibited Mumps virus in a viral plaque assay.^[11]

A University of Tokyo group reported in 1992 that research compound TJ13025 ((6'R)-6'-C-methylneplanocin A) had an antiviral effect on four Mumps virus strains cultured in Vero cells.(see 16526604, tables 1 and 2) Additional research improved the synthesis of a particular isomer, RMNPA, of TJ13025 from the racemic product.^[12]^[13]

A 2005 publication in a Russian journal reports that Myramistin has antiviral activity against Mumps virus in Vero cells culture.^[14]

Prognosis

Death is very unusual. The disease is self-limiting, and general outcome is good, even if other organs are involved. Mumps viral infections in adult males carries a 25% risk that the testes may become infected leading to sterility. After the illness, life-long immunity to mumps generally occurs.

Complications

Known complications of mumps include:

Infection of other organ systems
Sterility in men (this is quite rare, and mostly occurs in older men)
Mild forms of meningitis (rare, 40% of cases occur without parotid swelling)
Encephalitis (very rare, rarely fatal)
Profound (91 dB or more) but rare sensorineural hearing loss, uni- or bilateral
Pancreatitis manifesting as pain abdomen and vomiting
Oophoritis (inflammation of ovaries) but fertility is rarely affected.

Prevention

The most common preventative measure against mumps is immunization with a mumps vaccine. The vaccine may be given separately or as part of the MMR immunization vaccine which also protects against measles and rubella. In the US, MMR is now being supplanted by MMRV, which adds protection against Chickenpox. The WHO (World Health Organization) recommends the use of mumps vaccines in all countries with well-functioning childhood vaccination programmes. In the United Kingdom it is routinely given to children at age 15 months. The American Academy of Pediatrics recommends the routine administration of MMR vaccine at ages 12-15 months and at 4-6 years.^[15] In some locations, the vaccine is given again between 4 to 6 years of age, or between 11 and 12 years of age if not previously given. Efficacy of the vaccine depends on the strain of the vaccine, but is usually around 80%.^[16]^,^[17] The Jeryl Lynn strain is most commonly used in developed countries, but has been shown to have reduced efficacy in epidemic situations. The Leningrad-Zagreb strain is commonly used in developing countries, but appears to have superior efficacy in epidemic situations.^[18]

Some anti-vaccine activists protest against the administration of a vaccine against mumps, claiming that the attenuated vaccine strain is harmful, and/or that the wild disease is beneficial. Disagreeing, the WHO, the American Academy of Pediatrics, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, the American Academy of Family Physicians, the British Medical Association and the Royal Pharmaceutical Society of Great Britain currently recommend routine vaccination of children against mumps. The British Medical Association and Royal Pharmaceutical Society of Great Britain had previously recommended against general mumps vaccination, changing that recommendation in 1987. In 1988 it became United Kingdom government policy to introduce mass child mumps vaccination programmes with the MMR vaccine, and MMR vaccine is now routinely administered in the UK.

Before the introduction of the mumps vaccine, the mumps virus was the leading cause of viral meningoencephalitis in the United States. However, encephalitis occurs rarely (less than 2 per 100,000).^[19] In one of the largest studies in the literature, the most common symptoms of mumps meningoencephalitis were found to be fever (97%), vomiting (94%) and headache (88.8%).^[20] The mumps vaccine was introduced into the United States in December 1967: since its introduction there has been a steady decrease in the incidence of mumps and mumps virus infection. There were 151,209 cases of mumps reported in 1968; in 1998 there were only 666 cases reported.

References

^ Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, Isselbacher KJ, Eds. (2004). Harrison's Principles of Internal Medicine (16th ed.). McGraw-Hill Professional. ISBN 0-07-140235-7.{{cite book}}: CS1 maint: multiple names: authors list (link)
^ ^a ^b Hviid A, Rubin S, Mühlemann K (2008). "Mumps". Lancet. 371 (9616): 932–44. doi:10.1016/S0140-6736(08)60419-5. PMID 18342688.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Preveden T, Jovanovic J, Ristic D (1996). "[Fertility in men after mumps infection without manifestations of orchitis]". Med Pregl. 49 (3–4): 99–102. PMID 8692089.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Shakhov EV, Krupin VN (1990). "[The clinico-statistical characteristics of the testicular generative function in male subfertility following mumps]". Urol Nefrol (Mosk) (2): 46–50. PMID 2368216.
^ Tsvetkov D (1990). "[Spermatological disorders in patients with postmumps orchitis]". Akush Ginekol (Sofiia). 29 (6): 46–9. PMID 2100952.
^ Manson AL (1990). "Mumps orchitis". Urology. 36 (4): 355–8. PMID 2219620.
^ [1]^{[dead link]}
^ Real-time PCR for mumps diagnosis on clinical spec...[J Clin Virol. 2006] - PubMed Result
^ http://jama.ama-assn.org/cgi/reprint/295/20/2348.pdf#search=%22orchitis%20iowa%20health%2030%2020%22
^ The significance of these studies has been questioned.
^ Hayashi T, Hayashi K, Maeda M, Kojima I (1996). "Calcium spirulan, an inhibitor of enveloped virus replication, from a blue-green alga Spirulina platensis". J Nat Prod. 59 (1): 83–7. PMID 8984158.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Shuto S, Obara T, Yaginuma S, Matsuda A (1997). "New neplanocin analogues. IX. A practical preparation of (6'R)-6'-C-methylneplanocin A (RMNPA), a potent antiviral eileen, and the determination of its 6'-configuration. Diastereoselective deamination by adenosine deaminase". Chem Pharm Bull (Tokyo). 45: 138–42. PMID 9023976. {{cite journal}}: Text "issue1" ignored (help)CS1 maint: multiple names: authors list (link)
^ Shuto S, Minakawa N, Niizuma S, Kim HS, Wataya Y, Matsuda A (2002). "New neplanocin analogues. 12. Alternative synthesis and antimalarial effect of (6'R)-6'-C-methylneplanocin A, a potent AdoHcy hydrolase inhibitor". J Med Chem. 45 (3): 748–51. PMID 11806727.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Agafonov AP, Ignat'ev GM, Svistov VV, Smirnov IV, Krivoshein IuS (2005). "[In vitro study of antiviral activity of Myramistin against measles and mumps viruses]". Antibiot Khimioter. 50 (5–6): 17–9. PMID 16526604.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Template:PDFlink
^ Schlegel M, Osterwalder JJ, Galeazzi RL, Vernazza PL (1999). "Comparative efficacy of three mumps vaccines during disease outbreak in Eastern Switzerland: cohort study". BMJ. 319 (7206): 352. PMID 10435956.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ "Summary". WHO: Mumps vaccine. Retrieved 2006-04-18.
^ Peltola H, Kulkarni PS, Kapre SV, Paunio M, Jadhav SS, Dhere RM (2007). "Mumps outbreaks in Canada and the United States: Time for new thinking on mumps vaccines". Clin Infect Dis. 45: 459–66.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Atkinson W, Humiston S, Wolfe C, Nelson R (Editors). (2006). Epidemiology and Prevention of Vaccine-Preventable Diseases (9th ed.). Centers for Disease Control and prevention. Fulltext. {{cite book}}: |author= has generic name (help)CS1 maint: multiple names: authors list (link)
^ Kanra G, Isik P, Kara A, Cengiz AB, Secmeer G, Ceyhan M (2004). "Complementary findings in clinical and epidemiologic features of mumps and mumps meningoencephalitis in children without mumps vaccination". Pediatr Int. 46 (6): 663–8. PMID 15660864.{{cite journal}}: CS1 maint: multiple names: authors list (link)

External links

Original version based on the National Library of Medicine's Medline Plus website. Update Date: 08/15/01. Update date included for cross-reference against newer versions.
Schlegel M, Osterwalder JJ, Galeazzi RL, Vernazza PL (1999). "Comparative efficacy of three mumps vaccines during disease outbreak in Eastern Switzerland: cohort study". BMJ. 319 (7206): 352. PMID 10435956 fulltext @ BMJJournals.com.{{cite journal}}: CS1 maint: multiple names: authors list (link)
NHS.uk - Encyclopedia - 'NHS Direct Online Health Encyclopaedia: Mumps', National Health Service (UK)
WHO.int - "Immunization, Vaccines and Biologicals: Mumps vaccine", World Health Organisation
MicrobiologyBytes: Paramyxoviruses"
nih.gov - "NIH database entry: complete genome of Miyahara strain of Mumps"
cdc.gov - Collection of information from the CDC concerning mumps
[2] - Information on Wheaton College cases

[Harrison-1] Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, Isselbacher KJ, Eds. (2004). Harrison's Principles of Internal Medicine (16th ed.). McGraw-Hill Professional. ISBN 0-07-140235-7.{{cite book}}: CS1 maint: multiple names: authors list (link)

[Hviid-2] Hviid A, Rubin S, Mühlemann K (2008). "Mumps". Lancet. 371 (9616): 932–44. doi:10.1016/S0140-6736(08)60419-5. PMID 18342688.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[3] Preveden T, Jovanovic J, Ristic D (1996). "[Fertility in men after mumps infection without manifestations of orchitis]". Med Pregl. 49 (3–4): 99–102. PMID 8692089.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[4] Shakhov EV, Krupin VN (1990). "[The clinico-statistical characteristics of the testicular generative function in male subfertility following mumps]". Urol Nefrol (Mosk) (2): 46–50. PMID 2368216.

[5] Tsvetkov D (1990). "[Spermatological disorders in patients with postmumps orchitis]". Akush Ginekol (Sofiia). 29 (6): 46–9. PMID 2100952.

[6] Manson AL (1990). "Mumps orchitis". Urology. 36 (4): 355–8. PMID 2219620.

[7] [1]^{[dead link]}

[8] Real-time PCR for mumps diagnosis on clinical spec...[J Clin Virol. 2006] - PubMed Result

[9] ttp://jama.ama-assn.org/cgi/reprint/295/20/2348.pdf#search=%22orchitis%20iowa%20health%2030%2020%22

[10] The significance of these studies has been questioned.

[11] Hayashi T, Hayashi K, Maeda M, Kojima I (1996). "Calcium spirulan, an inhibitor of enveloped virus replication, from a blue-green alga Spirulina platensis". J Nat Prod. 59 (1): 83–7. PMID 8984158.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[Shuto_1997-12] Shuto S, Obara T, Yaginuma S, Matsuda A (1997). "New neplanocin analogues. IX. A practical preparation of (6'R)-6'-C-methylneplanocin A (RMNPA), a potent antiviral eileen, and the determination of its 6'-configuration. Diastereoselective deamination by adenosine deaminase". Chem Pharm Bull (Tokyo). 45: 138–42. PMID 9023976. {{cite journal}}: Text "issue1" ignored (help)CS1 maint: multiple names: authors list (link)

[Shuto_2002-13] Shuto S, Minakawa N, Niizuma S, Kim HS, Wataya Y, Matsuda A (2002). "New neplanocin analogues. 12. Alternative synthesis and antimalarial effect of (6'R)-6'-C-methylneplanocin A, a potent AdoHcy hydrolase inhibitor". J Med Chem. 45 (3): 748–51. PMID 11806727.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[14] Agafonov AP, Ignat'ev GM, Svistov VV, Smirnov IV, Krivoshein IuS (2005). "[In vitro study of antiviral activity of Myramistin against measles and mumps viruses]". Antibiot Khimioter. 50 (5–6): 17–9. PMID 16526604.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[15] Template:PDFlink

[16] Schlegel M, Osterwalder JJ, Galeazzi RL, Vernazza PL (1999). "Comparative efficacy of three mumps vaccines during disease outbreak in Eastern Switzerland: cohort study". BMJ. 319 (7206): 352. PMID 10435956.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[17] "Summary". WHO: Mumps vaccine. Retrieved 2006-04-18.

[18] Peltola H, Kulkarni PS, Kapre SV, Paunio M, Jadhav SS, Dhere RM (2007). "Mumps outbreaks in Canada and the United States: Time for new thinking on mumps vaccines". Clin Infect Dis. 45: 459–66.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[PinkBook_2006-19] Atkinson W, Humiston S, Wolfe C, Nelson R (Editors). (2006). Epidemiology and Prevention of Vaccine-Preventable Diseases (9th ed.). Centers for Disease Control and prevention. Fulltext. {{cite book}}: |author= has generic name (help)CS1 maint: multiple names: authors list (link)

[20] Kanra G, Isik P, Kara A, Cengiz AB, Secmeer G, Ceyhan M (2004). "Complementary findings in clinical and epidemiologic features of mumps and mumps meningoencephalitis in children without mumps vaccination". Pediatr Int. 46 (6): 663–8. PMID 15660864.{{cite journal}}: CS1 maint: multiple names: authors list (link)

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

[13]

[14]

[15]

[16]

[17]

[18]

[19]

[20]

@@ Line 94: / Line 94: @@
 Before the introduction of the mumps vaccine, the mumps virus was the leading cause of viral meningoencephalitis in the United States.  However, encephalitis occurs rarely (less than 2 per 100,000).<ref name=PinkBook_2006>{{cite book | author = Atkinson W, Humiston S, Wolfe C, Nelson R (Editors). | title = Epidemiology and Prevention of Vaccine-Preventable Diseases | edition = 9th | publisher = Centers for Disease Control and prevention | year = 2006 | id =  [http://www.cdc.gov/nip/publications/pink/def_pink_full.htm Fulltext] }}</ref> In one of the largest studies in the literature, the most common symptoms of mumps meningoencephalitis were found to be fever (97%), vomiting (94%) and headache (88.8%).<ref>{{cite journal | author=Kanra G, Isik P, Kara A, Cengiz AB, Secmeer G, Ceyhan M | title=Complementary findings in clinical and epidemiologic features of mumps and mumps meningoencephalitis in children without mumps vaccination | journal=Pediatr Int | year=2004 | pages=663-8 | volume=46 | issue=6 | id={{PMID|15660864}} }}</ref> The mumps vaccine was introduced into the United States in December 1967: since its introduction there has been a steady decrease in the incidence of mumps and mumps virus infection. There were 151,209 cases of mumps reported in 1968; in 1998 there were only 666 cases reported.
-==Current outbreaks==
+==See also==
+* [[List of modern mumps outbreaks]]
-{{recentism|date=January 2008}}
-===Canada (April 2007)===
-[[Dalhousie University]], [[Halifax Regional Municipality|Halifax]], [[Nova Scotia]]. Dalhousie University was struck with an outbreak of the mumps confirmed in many students with suspected cases in dozens of others. The main causes of the large outbreak include students being unaware of being infected, and other students who knowingly ignored quarantine restrictions. The outbreak began after [[St. Patrick's Day]], and has spread beyond the university community, with confirmed cases reaching 350 cases of mumps since February, including about 24 new cases that have surfaced during the week ending [[June 9]], [[2007]].  The end of the university year in May meant that many students travelled to their homes across the country carrying the infection, leading to a large scale spread, the extent of which is still not clear, although the prevalence of the disease lay in people aged 17 to 24.  Roughly 50 personnel of the Halifax-based navy ship HMCS ''Glace Bay'' were sent home as a precaution.  Reported outbreaks have begun in [[New Brunswick]] (Approximately 100 cases), [[Prince Edward Island]] (2 cases), [[Ontario]] (3 cases confirmed, 5 suspected), West Coast of Newfoundland (2 cases)<ref name="vocm.com_news">{{cite web|url=http://www.vocm.com/news-info.asp?id=21158|title="West Coast Woman Diagnosed With Mumps"|date="[[06 June]] [[2007]]"|publisher="vocm.com"}}</ref>, and [[Toronto]] (3 cases). On October 3rd 2007, a new case was reported at [[Nipissing University]]/[[Canadore College]], in [[North Bay, Ontario]].  On October 26th, four additional cases were reported in Alberta at the [[University of Lethbridge]] and [[Lethbridge College]]<ref name="uleth.ca_news">{{cite web|url=http://www.uleth.ca/notice/display.html?b=301&s=8722|title="Chinook Health identifies mumps cases in Lethbridge"|date="26 Oct 2007"|publisher="uleth.ca"}}</ref>; By October 30th, this had expanded to 5 confirmed.<ref name="chr.ab.ca_news">{{cite web|url=http://www.chr.ab.ca/bins/content_page.asp?cid=5075-5106-5079-10893-13506|title="Chinook Health Launches Mumps immunization campaign"|date="30 Oct 2007"}}</ref>. As of Nov. 16 there have been a total of 54 cases in Alberta<ref>{{cite web|url=http://www.chr.ab.ca/bins/content_page.asp?cid=5075-5106-5079-10893-13708|title="Chinook Health Expands Mumps Immunizations"|date="16 Nov 2007"}}</ref>. As of Nov. 29 there have been 57 confirmed cases in Calgary Alberta, six at the [[University of Calgary]] as well as outbreaks at [[SAIT Polytechnic]] and [[Mount Royal College]]. A vaccination program is currently being undertaken to re-immunize all students in post-secondary by the Calgary Health Region. Vaccinations are also occurring at universities in Edmonton.<ref>{{cite web|url=http://www.ucalgary.ca/emergencyplan/mumpsclinic|title="University of Calgary Mumps vaccination campaign"|date="26 Nov 2007"}}</ref> As of December 11, 2007 the Alberta government has suspended its inoculation program after several people suffered severe allergic reactions.<ref>{{cite web|url=http://www.cbc.ca/canada/new-brunswick/story/2007/12/11/mumps-suspend.html|title="Alberta mumps clinics halted after allergic reactions"|date="11 Dec 2007"}}</ref>
-===United Kingdom (2004&ndash;2007)===
-In the United Kingdom, between the years of 2004-2006, a mumps outbreak<ref>[http://bmj.bmjjournals.com/cgi/content/extract/330/7500/1132 BMJ] Mumps epidemic in UK 2005</ref> has involved more than 70,000 patients.[http://www.voanews.com/english/2006-04-19-voa74.cfm]<ref>{{cite journal |author= CDC |title=Mumps epidemic--United kingdom, 2004-2005 |journal=MMWR Morb Mortal Wkly Rep |year=2006 |pages=173-5 |volume=55 |issue=7 |id={{PMID|16498380}} }}</ref> The cause of the outbreak is low immunity in those too old to have received MMR, but young enough to have not developed natural immunity through exposure. A catch-up programme of immunisation of under twenty five year olds, particularly in university towns such as [[Exeter]] was implemented.
-* [[12 November]] [[2004]]:  The [[University of Bath]] ''Internal News'' reports that twenty three students have presented to the University of Bath Medical Centre with Mumps.  A "Mumps Vaccination programme" is announced, to commence [[15 November]] [[2004]].<ref name="University_Bath_Internal_News_26_Nov_2004">{{cite web|url=http://www.bath.ac.uk/internal/news/mumps04.htm|title="University of Bath Internal News"|date="[[26 November]] [[2004]]"|publisher="University of Bath Public Relations"}}</ref>
-===United States (2005-2006)===
-Although there may not be a direct link with the mumps outbreak in Ireland, United States [[Centers for Disease Control and Prevention|CDC]] Director Dr. Julie Gerberding has been quoted stating that the genotype from the U.S. outbreak, "in the early cases of this outbreak, was the same genotype of virus that was associated with the United Kingdom outbreak." [http://www.voanews.com/english/2006-04-19-voa74.cfm]  Entrez Gene contains a placeholder database record for a new Mumps gene; the record is dated [[23 Feb]] [[2006]].[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=gene&cmd=Retrieve&dopt=full_report&list_uids=2828643]
-*[[31 January]]  [[2007]]:  6404 cases of mumps in [[2006]] compared to 314 in [[2005]]. As of today, YTD 15 deaths in the United States were reported.[http://wonder.cdc.gov/mmwr/mmwr_reps.asp?mmwr_year=2007&mmwr_week=03&mmwr_table=1]
-====Iowa (2005-2006)====
-In early 2006, for reasons still not fully understood, the state of [[Iowa]] experienced a large surge in the number of reported mumps infections.<ref name=MMWR_2006a>{{cite journal |author= CDC |title=Exposure to mumps during air travel--United States, April 2006 |journal=MMWR Morb Mortal Wkly Rep |year=2006 |pages=401-2 |volume=55 |issue=14 |id={{PMID|16617290}} }}</ref> [http://www.cdc.gov/MMWR/preview/mmwrhtml/mm5513a3.htm]According to the [[New York Times]], college students accounted for about a quarter of the 245 cases [http://www.nytimes.com/2006/04/01/us/01mumps.html?ex=1301544000&en=1c014c388ceee9ae&ei=5088&partner=rssnyt&emc=rss], while about half of the cases are people aged seventeen to twenty five.
-Doctors are attributing the rise in mumps case frequency to low vaccination rates in Iowa's youth, coupled with the close quarters in dormitories, classrooms and cafeterias.
-{{cquote|When you expect five and you get 245, this is pretty serious... We're trying to get ahead of it and get it stopped... It could be that on some of these college campuses, they were not as well vaccinated as we'd like them to be, [but] our law does not allow us to identify entities associated with outbreaks.|Patricia Quinlisk|state epidemiologist at the Iowa department of public health}}
-According to Canadian media reports [http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20060419/mumps_outbreak_060419/20060419?hub=TopStories], there may be something novel about this mumps strain which indicates a standard MMR-series vaccination is not 95% effective, as was thought.
-*[[14 April]] [[2006]]: [[Iowa]] has experienced more than 600 suspected cases since December.  Other states reporting cases are [[California]], [[Illinois]], [[Kansas]], [[Minnesota]], [[Missouri]], [[Nebraska]], [[South Dakota]], and [[Wisconsin]]. The Centers for Disease Control and Prevention agency has not yet released the name of the ninth Midwestern state, however there have been confirmed cases in [[Michigan]] [http://wnem.com/Global/story.asp?S=4796924]. The mumps outbreak is the nation's largest in twenty years.
-*[[18 April]] [[2006]]: 815 cases have been reported [http://www.chron.com/disp/story.mpl/ap/health/3802314.html] in Iowa alone, representing a  caseload reporting increase of 200 in the last week.
-*[[25 April]] [[2006]]: There are over 1,120 confirmed[http://www.chron.com/disp/story.mpl/ap/health/3818947.html], probable and suspected cases of mumps. Over 1000 of the cases are confirmed.
-*[[2 May]] [[2006]]: Iowa reports 1,487 cases.[http://www.infozine.com/news/stories/op/storiesView/sid/14740/]
-*[[11 May]] [[2006]]:  Iowa reports 1,184 confirmed, 253 probable, and 237 suspect cases, or 1674 total. {{PDFlink|[http://www.idph.state.ia.us/adper/common/pdf/mumps/mumps_update_051106.pdf]|84.2&nbsp;[[Kibibyte|KiB]]<!-- application/pdf, 86285 bytes -->}}
-====Georgia (2006)====
-* [[28 April]] [[2006]]: A confirmed case of mumps is reported in a college student at the [[Georgia Institute of Technology]] campus in downtown [[Atlanta, Georgia|Atlanta]].[http://www.health.gatech.edu/main/3_news/1_Mumps.php]
-====Illinois (2006)====
-There have been three confirmed cases of the mumps at [[Southern Illinois University-Carbondale]], Two cases at Loyola University Chicago, and has spread to three other neighboring counties in the [[Southern Illinois]] area. There has also been one confirmed case at Knox College, in Galesburg (Western Illinois). [[Wheaton College (Illinois)|Wheaton College]] has also been affected by 93 cases since early September (as of Jan 9).[http://www.wheaton.edu/news/news/stories/stories_06_07/ns_091506_Mumpshomepage.html]
-* [[9 May]] [[2006]]: Illinois reports 279 total cases.[http://www.idph.state.il.us/mumps/mumpscases.htm]
-* [[September 28]], [[2006]]: The Illinois Department of Public Health has reported 636 cases of mumps in Illinois between [[January 1]], [[2006]] and [[September 28]], [[2006]]. [http://www.idph.state.il.us/mumps/mumpscases.htm]
-====Indiana (2006)====
-* [[21 April]] [[2006]]: A case is reported in a college student at [[Indiana University (Bloomington)|Indiana University]].[http://www.wthr.com/Global/story.asp?S=4801928&nav=9Tai]
-====Kansas (2006)====
-* [[2 May]] [[2006]]: With 340 mumps      cases now reported in Kansas, state health officials have asked the U.S. Centers for Disease Control and Prevention to help.[http://www.kansascity.com/mld/kansascity/news/14476787.htm]
-* [[10 May]] [[2006]]: Kansas reports 546 cases.{{PDFlink|[http://www.kdheks.gov/epi/download/Mumps_Epi_Report.pdf]|79.4&nbsp;[[Kibibyte|KiB]]<!-- application/pdf, 81362 bytes -->}}
-====Kentucky (2006)====
-* [[4 May]] [[2006]]: Two cases diagnosed by Doctor Roach in Paducah,KY, a border town to Southern Illinois.<ref>[http://www.wkyxwngo.com/local-news-details.asp?NewsID=3152 First Confirmed Case Of Mumps In Western Kentucky], WKYX-FM/WNGO-AM, May 18, 2006</ref>
-====Michigan (2006)====
-* [[20 April]] [[2006]]: A woman in [[Saginaw County, Michigan|Saginaw County]] was diagnosed with mumps, with another pending results [http://wnem.com/Global/story.asp?S=4796924].  Cases in [[Oakland County, Michigan|Oakland County]] and [[Delta County, Michigan|Delta County]] were previously confirmed, and results in neighboring [[Bay County, Michigan|Bay County]] came back negative.
-* [[04 May]] [[2006]]: A case of the mumps is reported in Plymouth-Canton High School, [[Canton, Michigan|Canton]].  The three high schools in Canton are requiring students to provide documentation of vaccination.[http://www.wxyz.com/wxyz/nw_local_news/article/0,2132,WXYZ_15924_4673185,00.html]
-====Minnesota (2006)====
-*May 2006: The Minnesota Department of Health has confirmed eleven mumps cases in Minnesota in 2006. Four of the eleven cases may be linked to Iowa. Please continue to check back for updates. [http://www.health.state.mn.us/divs/idepc/diseases/mumps/index.html]
-====Missouri (2006)====
-*[[10 May]] [[2006]]:  Missouri reports twenty one confirmed, eighty eight probable, for a total of 109 cases <ref>[http://www.dhss.mo.gov/mumps/Update5-11.html Reported Cases of Mumps, Confirmed and Probable, by Region and Jurisdiction, Missouri, Year-to-Date 2006*], Missouri Dept of Health and Senior Services</ref>
-====Nebraska (2006)====
-*[[10 May]] [[2006]]: Nebraska reports sixty four confirmed, 193 probable, twenty two suspect, for a total of 279 cases in forty three counties. [http://www.hhs.state.ne.us/epi/mumps/]Officials say many people with mumps in  Nebraska had connections to Iowa.
-====North Carolina (2006)====
-* [[4 May]] [[2006]]: An 8-year-old in [[Mecklenburg County, North Carolina|Mecklenburg County]] is diagnosed with the mumps, the first case in the county since 2002.<ref>[http://www.charmeck.org/Departments/Health+Department/Top+News/News+Archive/2006/Mumps+-+05-04-2006.htm HEALTH DEPARTMENT: FIRST CASE OF MUMPS IS DIAGNOSED IN SCHOOL AGED CHILD], Mecklenburg County Health Department, May 4, 2006</ref>
-====Ohio (2008)====
-*[[14 February]] [[2008]]: The University of Toledo was hit by a sudden outbreak of the mumps on February 14th, 2008.  Most of the pregnant students were moved into quarantined buildings, and all the students in the Ottawa House buildings were required to provide medical record of previous mumps vaccinations.
-====Oregon (2006)====
-*[[18 May]] [[2006]]: three cases in [[Lane County, Oregon|Lane County]] are confirmed, including a potential of four more at the [[University of Oregon]] alone. <ref>Goodwin, Susan. [http://media.www.dailyemerald.com/media/storage/paper859/news/2006/05/18/News/Student.Contracts.The.Mumps-2012017.shtml?sourcedomain=www.dailyemerald.com&MIIHost=media.collegepublisher.com Student contracts the mumps], ''The Oregon Daily Emerald'', May 18, 2006</ref>
-*[[6 June]] [[2006]]: twenty four confirmed and four presumptive cases in [[Lane County, Oregon|Lane County]], two cases in [[Multnomah County, Oregon|Multnomah County]], one each in [[Douglas County, Oregon|Douglas]], [[Hood River County, Oregon|Hood River]], and [[Linn County, Oregon|Linn]] [[County|Counties]].<ref>[http://www.oregon.gov/DHS/ph/acd/diseases/mumps/mumps.shtml Mumps], Oregon Acute and Communicable Disease Prevention</ref>
-====South Dakota (2006)====
-* [[12 May]] [[2006]]: SD Department of Health reports thirty three confirmed cases, fifty three probable cases, and six suspect cases for a total of ninety two cases.<ref>[http://www.state.sd.us/doh/mumps/ South Dakota Department of Health]</ref>
-====Virginia (2008)====
-*[[Fall]] [[2006]]:In the fall of 2006, University of Virginia had an outbreak of mumps with 55 cases.<ref>[http://www.virginia.edu/uvatoday/newsRelease.php?id=4499]"Mumps Cases Suspected at the University of Virginia," UVA Today</ref>
-*[[13 March]] [[2008]]: University of Virginia reports two suspected cases.<ref>[http://www.virginia.edu/uvatoday/newsRelease.php?id=4499]"Mumps Cases Suspected at the University of Virginia," UVA Today</ref>
-====Wisconsin (2006)====
-*[[10 May]] [[2006]]: 185 confirmed cases, at least one case in one out of three counties. <ref>[http://dhfs.wisconsin.gov/immunization/mumps_confirmed.htm] Wisconsin Immunization Program - Laboratory Confirmed Mumps Cases</ref>
-===Republic of Moldova (2007-2008)===
-*[[24 January]] [[2008]]: more than 2000 confirmed cases. Most affected are the regions of Chişinău, Orhei, Străşeni, Nisporeni, Ialoveni, Cahul, Comrat, Ungheni, Teleneşti, Hânceşti, Anenii Noi, Rezina, Floreşti. <ref>[http://www.info-prim.md/?x=22&y=12694] Info-Prim-Neo News Agency</ref>
-===The Netherlands (2008) ===
-*[[19 April]] [[2008]], the areas of [[Zeeland]] and [[Veluwe]], inhabited by a large number of conservative [[Protestantism|Protestants]] who oppose vaccination, has confirmed 60 cases by blood test.<ref>{{cite news | title = Mumps epidemic hits Dutch Bible belt | publisher = DutchNews.nl | url = http://www.dutchnews.nl/news/archives/2008/04/mumps_epidemic_hits_dutch_bibl.php | date = 2008-04-21 | accessdate = 2008-04-22 }}</ref>
 ==References==