10 questions about mumps with infectious disease and public health specialist Dr. William Schaffner

Schaffner, who recently returned from a CDC conference in which mumps was on the agenda, discusses the symptoms, transmission, and course of action of the disease

On Thursday, Feb. 16, the student body received an email from the Dean of Students that the mumps virus is present on campus.

“A small number of mumps cases have been confirmed on the Vanderbilt campus,” the email, signed by the Student Health Center, stated. While no students diagnosed with mumps remain contagious or on isolation, the possibility of more cases in the coming weeks does exist.”

The email also said that Vanderbilt students are required to have proof of their MMR (measles, mumps, rubella) vaccinations when registering to Vanderbilt. According to the Student Health Center’s website, a student can obtain a waiver from immunization requirements for personal, religious or medical exemptions, but this process is involved and can take up to 4 weeks.

So if the vast majority (if not the entirety) of Vanderbilt is vaccinated against mumps, how did this outbreak occur? The Hustler sat down with infectious disease and public health specialist Dr. William Schaffner of the VUMC to discuss the mumps virus and how this outbreak has played out.

  1. What is mumps? What kind of disease is it?

Mumps is basically a respiratory infection. It’s a viral infection, caused by a virus. It is spread person-to-person by the respiratory route, that is, the infected person has the mumps virus back in their throat, and when they breathe out, they breathe out with microscopic particles of the mumps virus. And if you are very close and usually close for a prolonged period of time, you can pick up the mumps virus, and then you may get sick.  

2. How did this outbreak happen even though everyone who gets into Vanderbilt has to be vaccinated for mumps?

In the days before we had a vaccine, many people almost universally acquired mumps. It isn’t spread as readily as measles, but it is spread person-to-person. Today and now for the last 40 years, every child in the U.S. receives vaccinations against mumps. It’s part of a triple vaccine that is abbreviated MMR, for measles, mumps, and rubella, which is the scientific name for German measles. So every child gets two doses, and at least 90 percent complete the routine two-dose series. Now, although the protection afforded by the measles and rubella component is very sturdy and likely lifelong, the protection afforded by mumps is excellent in the short-term, relatively, but after about 15 years, some of that protection wanes. It doesn’t go to zero, but you could get mumps. But, the complications almost never occur. In other words, you get a milder infection. And that is the circumstance that we see happening in the U.S. today.

So where does the mumps virus come from if we have essentially eliminated it from the U.S.? Well there are two possibilities. One is that someone in the U.S., a student, may have encountered the mumps and going to college, brought the mumps virus with them and that starts an outbreak. That’s possible. But what’s more likely is that the mumps virus is imported from parts of the world, such as Europe, where they don’t use the mumps vaccine as routinely as we do. Many of these outbreaks, or at least I should say some of them, have been investigated and traced back to an importation of a student who comes to the college in the U.S. from abroad. They are what we call incubating mumps. They get exposed to the mumps virus, and it can take two to two and a half weeks before mumps actually develops in that person. During that period, they are traveling, they get established in the college, and by the time they become transmitters of the mumps virus, they are surrounded by students here in the U.S., some of whom have had waning immunity. And you get some transmission to one student and another, and then you get a slow set of transmissions that kind of smolders through the student body for a period of time.

3. What are the symptoms of mumps?

You get fever, feeling poorly, and then you may lose your appetite, just not feel well. And then this mumps virus has a special predilection for going to glandular tissue. It particularly likes the salivary glands on the side of your face, by your cheeks. And it can get into those salivary glands and cause inflammation that causes them to swell up, and thus you get the name mumps. There are some complications. Some of them are fanciful, they are more mythological than real. For example, men can get this infection down in their testicles, and that’s called orchitis. And you can get inflammation, which is painful. Women can get it in their ovaries. So it can go to those reproductive structures. The myth part is that if you get inflammation of the testicles, that can lead to sterility. That is super rare and is largely mythical. There are some other things that can happen with mumps on occasion. The mumps virus can actually get into your central nervous system and cause inflammation of the coverings of the brain and that is called meningitis. That will get better on its own, but while you have it, it’s very discomforting. And on occasion, mumps can affect your hearing and actually can result in some residual partial deafness. So it’s not just a totally benign, short-term, discomforting illness. There are some complications which we would like to avoid.

4. What is the treatment like for mumps?

The treatment is almost completely symptomatic. We don’t have any antiviral drugs that attack the mumps virus, so we make you as comfortable as possible. It depends on the severity. Most people with mumps have a relatively mild infection and they don’t have to be hospitalized. On the other hand, if you do have one of the complications, you might actually get a short-term course of steroids, which are a powerful anti inflammatory drug, which reduces the inflammation. It can reduce the swelling and the pain, particular with involvement of the testes.

5. How do you feel about the University’s handling of mumps?

I think they have been transparent. They are working with the public health department. My understanding is that they are trying to quarantine, that is, remove from contact students who they know to be infected. I’m not close to the details about whether they are making another dose of vaccine available. The utility of that is debated by public health authorities. It won’t hurt, it’s just not sure how much help it is in curtailing an outbreak, but it is sometimes used. It won’t harm you.

6. Have there been any other situations similar to this one at other schools? Is this rare?

There have been a substantial number of outbreaks of mumps on college campuses. In 2016, the CDC has records of 19 outbreaks of mumps that occurred in universities and colleges in the U.S. That’s a large number–– that’s more than we usually have. So how do they usually happen? Here’s the postulate. The routine use of MMR has not completely, but almost completely eliminated the mumps virus from the U.S. So that’s concept number one. The second concept that we have to hold onto is that mumps will spread among a vaccinated group slowly, usually, but the people have to have prolonged face-to-face contact with each other for that to happen. In other words, mumps it is not spread readily. It requires usually prolonged face-to-face contact, but colleges are an ideal environment for prolonged face-to face-contact, because people live in dorms together, they go to classes together, they eat, they have extracurricular activities together, they have romantic relationships, they go to bars together. All of those things bring you into prolonged face-to-face contact .

I was at a CDC meeting yesterday where there was a specific presentation on mumps epidemiology in the U.S. today with a special attention to these outbreaks that are occurring on university campuses, because this is new, and so a special committee was set up to look into these more thoroughly. So we are having more of them than we have in years past. It’s not any longer so unusual, but it’s also not common. It’s somewhere in the middle.

7. How long would you anticipate it will take to completely rid the campus of the mumps?

Gee I wish you hadn’t asked. It’s a difficult thing to say. Unfortunately, one of the characteristics of these outbreaks is that they are somewhat tenacious. They don’t burst on the scene and cause a lot of illness, but they smolder over time, and that’s because everybody has some degree of immunity from their vaccinations. And you have to get people who carry the virus, who get up close to others, and you have to get up close to the right person who is a little bit more susceptible, and then they get sick. So they are difficult to curtail, and so they can smolder for quite a long while. We all hope that doesn’t happen here and we all hope that it’s a very break outbreak rather than one of those longer tenacious ones that are so vexing.

8. What are the best things students can do to stay healthy right now and avoid contracting the mumps?

It’s hard to make recommendations other than if you have a friend that you think has the mumps, make sure that they go see Student Health and keep your distance from them. If I were a close contact of someone who had mumps, and the [third] vaccine were offered [at Student Health], I would get it. It can’t hurt you. No vaccine is perfect, but it is a remarkably safe and effective vaccine.

  1.  A lot of students are experiencing, to some degree, a sense of panic and fear. How valid are those feelings about mumps?

I think an interest in mumps, wanting to know about it, being aware of it, of course, that is part of being a good citizen of the student body and knowing about it. But if what you characterize is real anxiety, fear, substantial concern, for that, I would say hold on, take a deep breath, just learn about it. It’s not worth all that. And once you become more familiar with it, I think your level of concern will recede. If [the third dose] is being made available and you have a concern, by all means take advantage of it and take the vaccine. I have absolutely no hesitation that you should get it if it is being provided voluntarily.

  1.  Why were events such as Dance Marathon and Greek date parties cancelled due to mumps?

I think that was all part of what’s often called the social interaction part of a public health response to a respiratory infection. These are events where there is close person-to-person contact that’s prolonged. And if you have the spread of this kind of virus, one of the things that you do is say “Okay, let’s not have too many of those events, because those might be circumstances when there is more transmission of the virus and what we are trying to do is keep ourselves apart a little bit now, let’s not get quite as close together as we used to be, just during this season temporarily to see if we can help get this mumps thing under control so it goes away more quickly.