1 Missouri Department of Health & Senior Services Healt h Health Update February 15, 2017 Update: FROM: RANDALL WILLIAMS, MD ACTING DIRECTOR Update 2: Mumps Outbreak SUBJECT: Update 2: Mumps Outbreak in Missouri in Missouri On November 18, 2016, the Missouri Department of Health and Senior Services (DHSS) released a Health Advisory entitled “Mumps Cases in Central Missouri.” The purpose of this Advisory was to alert health care providers of the outbreak of mumps among Missouri college students, to provide guidance on clinical and laboratory diagnosis, and to provide guidance on measures to control infection transmission. This notification is available at: February 15, 2017 http://health.mo.gov/emergencies/ert/alertsadvisories/pdf/advisory111816.pdf This document will be updated as new On December 8, 2016, DHSS released a Health Update entitled “Update 1: Mumps information becomes available. The Outbreak in Missouri.” The purpose of this Update was to provide current current version can always be viewed information on the status of the mumps outbreak at the University of Missouri in at http://www.health.mo.gov. Columbia. This notification is available at: The Missouri Department of Health & http://health.mo.gov/emergencies/ert/alertsadvisories/pdf/hu12816.pdf Senior Services (DHSS) is now using 4 types of documents to provide This Health Update provides new information on the status of the outbreak, as important information to medical and well as on additional cases reported in Missouri. The new information is in blue. public health professionals, and to other interested persons: The Columbia/Boone County Department of Public Health and Human Services Health Alerts convey information (CBCDPHHS), other local public health agencies (LPHAs) in Missouri, and DHSS of the highest level of importance continue to receive additional reports of mumps cases among persons associated with which warrants immediate action or the University of Missouri in Columbia (MU). A total of 361 laboratory-confirmed and attention from Missouri health providers, emergency responders, probable cases of mumps associated with the MU outbreak have been reported as of public health agencies or the public. February 7, 2017. Additionally, mumps activity was reported at 14 other colleges or Health Advisories provide universities during this same time period. important information for a specific incident or situation, including that A third dose of MMR vaccine has been used during prior mumps outbreaks in impacting neighboring states; may not university settings. While no national recommendation exists and the effectiveness of a require immediate action. third MMR dose has not been clearly established, the Centers for Disease Control and Health Guidances contain Prevention (CDC) has provided guidelines for considering its use during outbreaks. comprehensive information pertaining Factors that might trigger this recommendation include outbreaks among populations to a particular disease or condition, with 2-dose MMR vaccination (coverage of > 90%), intense exposure settings such as and include recommendations, guidelines, etc. endorsed by DHSS. universities, evidence of sustained transmission (>2 weeks), and high attack rates (>5 cases per 1,000 population). In December, after it had been determined that these Health Updates provide new or updated information on an incident or criteria had been met, MU in collaboration with CBCDPHHS and DHSS began situation; can also provide informa- recommending a third dose of MMR vaccine for MU students unless otherwise tion to update a previously sent contraindicated. As of February 7, 2017, more than 2,325 MU students were reported to Health Alert, Health Advisory, or have received a third dose of MMR vaccine. Health Guidance; unlikely to require immediate action. __________________________________ Mumps continues to have a presence on the MU campus despite the implementation of traditional control measures, the recommendation for a third dose of MMR vaccine, and Office of the Director a reduced student population on campus during the winter break. In response to 912 Wildwood P.O. Box 570 continued new case reports, MU has scheduled a mass vaccination clinic for MU Jefferson City, MO 65102 students to ensure the availability of a third dose of MMR vaccine. Telephone: (800) 392-0272 Fax: (573) 751-6041 There is evidence that mumps is also circulating outside higher education institutions. Website: http://www.health.mo.gov Twenty-two counties in Missouri, including Boone County, have had at least one 2 confirmed or probable mumps case reported since August 22, 2016. As of February 7, 2017, the statewide case count was 396 during this time period. Health care providers should maintain a high index of suspicion for mumps among persons with symptoms compatible with the disease, and mumps should not be ruled out because of history of appropriate vaccination in a person with suspected mumps. Additionally, health care providers should consider evaluating patients for MMR catch-up dose(s) as appropriate. DHSS and CDC recommend the following infection control measures for patients known or suspected of having mumps: • In a health care setting: use droplet precautions, in addition to standard precautions, for 5 days after onset of parotitis. • Isolation from the community: The patient should stay home, not go to school or work, and avoid prolonged, close contact with other people until at least 5 days after onset of parotitis. • Cover mouth and nose with a tissue or in the elbow when coughing or sneezing, not the hands. • Wash hands often with soap and water. • Avoiding sharing drinks or eating utensils. • Disinfecting frequently-touched surfaces, such as toys, doorknobs, tables, and counters. Persons who were contacts of a mumps case during the 2 days prior through 5 days after onset of parotitis in a diseased person should be identified, assessed for evidence of immunity (see http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm, Table 3), and offered vaccine as appropriate. In addition, all contacts should be educated on the symptoms of mumps, instructed to watch for symptoms from 12 to 25 days after the last exposure, and told to isolate themselves and contact their medical provider and their local health department if symptoms develop. The Missouri State Public Health Laboratory (MSPHL) provides laboratory support for the diagnosis of mumps infections occurring in Missouri. Laboratory testing should be performed if mumps is suspected. Specimen collection should include a buccal or oral swab specimen in viral transport; AND blood specimens. Note: before any specimen is sent to MSPHL, DHSS must first be consulted for approval of testing as resources are limited, and to ensure appropriate testing. Health care providers caring for a patient suspected of having mumps should contact their LPHA, or DHSS at 573/751-6113 or 800/392- 0272 (24/7), to report suspected cases of mumps and to discuss testing at MSPHL. For more information and guidance on mumps including, but not limited to, the challenges and availability of laboratory testing, laboratory results interpretation, controlling transmission, and links to additional resources, please visit the DHSS Health Advisory “Mumps Cases in Central Missouri” released on November 18, 2016, at: http://health.mo.gov/emergencies/ert/alertsadvisories/pdf/advisory111816.pdf Questions should be directed to DHSS’ Bureau of Communicable Disease Control and Prevention at 573/751-6113 or 800/392-0272 (24/7). 1 Missouri Department of Health & Senior Services Healt h Health Update December 29, 2017 Update: FROM: RANDALL W. WILLIAMS, MD, FACOG DIRECTOR UUppddaattee 88:: ZZiikkaa VViirruuss TTeessttiinngg TThhrroouugghh tthhee SUBJECT: Update 8: Zika Virus Testing Through the Missouri MMiissssoouurrii DDeeppaarrttmmeenntt Department of Health and Senior Services ooff HHeeaalltthh aanndd SSeenniioorr SSeerrvviicceess The Missouri Department of Health and Senior Services (DHSS) will no longer provide Zika testing services for the routine testing of asymptomatic pregnant women who have had possible recent, but not ongoing, Zika virus exposures. On July 24, 2017, the Centers for Disease Control and Prevention (CDC) published updated guidance, indicating the routine testing of these persons is no longer recommended. December 29, 2017 The updated testing guidance was due in part to the declining prevalence of Zika virus disease in the World Health Organization’s Region of the Americas, resulting in This document will be updated as new information becomes available. The an increased likelihood of a false-positive test result. The updated interim CDC current version can always be viewed guidance for health care providers is available at: at http://www.health.mo.gov. https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6629e1.pdf. The Missouri Department of Health & Senior Services (DHSS) is now using Zika virus testing is recommended, and remains available through the Missouri State four types of documents to provide Public Health Laboratory (MSPHL), for the following: important information to medical and public health professionals, and to other interested persons: • Anyone with recent possible Zika virus exposure and who has, or recently experienced, one or more symptoms of Zika virus disease. The symptoms of Health Alerts convey information Zika virus disease include acute onset of fever, maculopapular rash, arthralgia, of the highest level of importance which warrants immediate action or or conjunctivitis. attention from Missouri health providers, emergency responders, • Pregnant women who have recent possible Zika virus exposure and who have a public health agencies or the public. fetus with prenatal ultrasound findings consistent with congenital Zika virus Health Advisories provide syndrome. important information for a specific incident or situation, including that • Asymptomatic pregnant women with ongoing possible Zika virus exposure. impacting neighboring states; may not Persons with ongoing possible Zika virus exposure include those who reside in, require immediate action. or frequently travel (e.g., daily or weekly) to, an area with risk for Zika virus Health Guidances contain transmission. comprehensive information pertaining to a particular disease or condition, Zika virus testing is also recommended for infants with clinical findings consistent and include recommendations, with congenital Zika syndrome who were born to mothers with possible Zika virus guidelines, etc. endorsed by DHSS. exposure during pregnancy, regardless of maternal test results, and for infants without Health Updates provide new or clinical findings consistent with congenital Zika syndrome who were born to mothers updated information on an incident or situation; can also provide informa- with laboratory evidence of possible Zika virus infection. CDC published updated tion to update a previously sent guidance for the diagnosis, evaluation, and management of infants with possible Health Alert, Health Advisory, or congenital Zika virus infection on October 20, 2017. It is available at: Health Guidance; unlikely to require https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6641a1.pdf. immediate action. __________________________________ The definition of possible Zika virus exposure has not changed, and includes travel to, Office of the Director or residence in, an area with risk for mosquito-borne Zika virus transmission, or sex 912 Wildwood with a partner who has traveled to or resides in an area with risk for mosquito-borne P.O. Box 570 Jefferson City, MO 65102 Zika virus transmission. Areas with risk of Zika can be found on the CDC Zika Travel Telephone: 800-392-0272 Information webpage at: Fax: 573-751-6041 https://wwwnc.cdc.gov/travel/page/zika-information. Website: http://www.health.mo.gov 2 Despite the declining prevalence of Zika virus disease, all pregnant women in the United States should be asked about possible Zika virus exposure before and during the current pregnancy, at every prenatal care visit. In addition, pregnant women are recommended to not travel to any area with risk for Zika virus transmission. It is also recommended that pregnant women with a sex partner who has traveled to, or lives in, an area with risk for Zika virus transmission use condoms or abstain from sex for the duration of the pregnancy. Additional guidance for the prevention of sexual transmission of Zika is available at: https://www.cdc.gov/zika/hc-providers/clinical-guidance/sexualtransmission.html. Healthcare providers with questions regarding Zika testing, or who wish to request testing of a patient, should contact DHSS’ Bureau of Communicable Disease Control and Prevention, Monday through Friday, 8:00AM to 5:00PM, at 573-751-6113; after hours/weekends, 800-392-0272 (24/7). For all other questions about Zika, contact DHSS’ Office of Veterinary Public Health, Monday through Friday, 8:00AM to 5:00PM, at 573-526-4780; after hours/weekends, 800-392-0272 (24/7).