So spring breakers on South Padre Island in Texas are coming down with the mumps. Since the MMR (measles, mumps, rubella) vaccine was introduced in 1967, we’ve stopped expecting these outbreaks.
But recent increases in those who choose to have their children forego vaccines has led to a loss of herd immunity and an increase in these outbreaks.
To further complicate the issue, it seems that immunity wanes with time, which is why many college students (hello spring break!) find themselves falling ill eight to ten years after their last booster at age 12 to 15.
*Amy’s Disclaimer – I love South Padre – I grew up going there and have a lifetime of memories from spending family vacations there. However, I would never go there during spring break, mumps or not. That goes for most beaches during spring break, lol!
Kendall: [00:00:00] Amy this year has given me yet another reason to avoid South Padre.
Amy: [00:00:04] You mean South Padre this spring break vacation spot Deluxe for Texas college students the same you needed another reason. Tens of thousands of screaming scantily clad inebriated college kids wasn’t enough.
[00:00:15] But wait there’s more. The mumps if you don’t want the mumps,stay away from South Padre at spring break.
[00:00:22] That’s true. Texas is experiencing a 20 year high in mumps cases in many of the cases have been traced to exposure during spring break at South Padre. So let’s talk about mumps why we’re seeing a sudden uptick in cases. And what we as patients and doctors can do about it.
[00:00:39] Hello and welcome 2 Docs Talk, the podcast about health care, the science of medicine, and everything in between.
[00:00:46] OK so you have to admit of the three, measles mumps and rubella, it’s measles that gets all the press probably because of the widely trumpeted myth that it is linked to autism.
[00:00:56] We talked about that in a previous podcast – the egos and fear that created the myth in the science that refuted it. But we digress.
[00:01:04] So moving on mumps not measles mumps is a viral illness characterized by fever malaise headache and parotitis. So the prodded gland is his salivary gland at the angle of the job both sides and it can become inflamed and enlarged to an alarming size. That’s what we mean when we say parotitis. So for a good time look at the Google Images for mumps.
[00:01:29] It’s not a good time. And here’s a funny story. I told my son who’s 18 that we were going to be doing a podcast about mumps and he goes, “what’s mumps?” because we don’t have mumps anymore thank goodness. And here we go. Anyway there’s one poor slob whose picture keeps popping up over and over on Google. How would you like to be that guy. The Google Mumps guy.
[00:01:53] Yeah well hopefully he didn’t have the most dreaded complication of mumps. Orchitis which is inflammation of the testes in the scrotum. The scrotum can become just hugely swollen. Painful, red, really hot – people can get admitted to hospital just for pain control
[00:02:11] And some can even have problems with fertility later in life. But I think that’s pretty rare.
[00:02:16] It seems men have a much harder time than women with this disease. Besides orchitis they’re also more likely to get meningitis or encephalitis which are inflammation of the brain and its lining.
[00:02:26] But luckily most patients fully recover without any residual problems.
[00:02:31] Sure. But still not a fun disease, especially for men.
[00:02:34] No. So we usually see outbreaks among college kids because it’s very contagious and they’re often living in close quarters. So your roommate sneezes across the room and you inhale the viral particles and the next thing you know, you look like a chipmunk.
[00:02:48] I think you need to be three feet away or closer to transmit the disease. Well you should have seen my freshman dorm room. It was about three feet wide.
[00:02:58] I think the incubation time is longer like 18 to 25 days. Quite a long time.
[00:03:04] That’s long. And you can also get it from fomites. Fomites are inanimate objects. We’re viral particles can just hang out until a poor unsuspecting host comes along and grabs the doorknob for example.
[00:03:16] Yeah or accidentally uses somebody else’s toothbrush.
[00:03:19] Yes. But the real problem is that people are contagious up to three days before they even have symptoms which makes infection control very challenging.
[00:03:27] But luckily we have a vaccine.
[00:03:30] Yeah. Then answer me this if we have a vaccine why are we having outbreaks of the mumps and why has it peaked this past year. According to the CDC there were fifty-eight hundred thirty three cases in 2016 the most since 1994. And I think there were over 2500 cases from January to April 22nd of this year.
[00:03:49] Yeah. So there has been a peak but let’s put this in perspective a little bit. The mumps vaccine was introduced in 1967. Before then we averaged about 186 thousand cases a year. And that’s an underestimate because of underreporting. I mean most moms probably just made a diagnosis themselves as soon as they saw the swollen face. And and let it play its course or tried some home remedy or something but, they didn’t take them to the doctor.
[00:04:17] Yeah. Same as you know they used to chicken pox and all kinds of stuff right. So what you’re saying is these outbreaks come nowhere near what it was like before the vaccine.
[00:04:26] Right. And also the severity of the disease that you see in these outbreaks is much less. We’re just not seeing any cases of orchitis or encephalitis or meningitis whereas before the vaccine the rate of orchitis was around 30 percent.
[00:04:38] So the cases now are milder.
[00:04:40] Exactly. And most people think that this is because most of the cases are occurring in folks that have been immunized.
[00:04:46] OK. Well that doesn’t help – what it sounds like you’re saying is that the vaccine didn’t work.
[00:04:51] No no I don’t mean that at all. OK well kind of. As we mentioned before the MMR vaccine has been around since 1967. And first they gave just one dose at around 12 to 15 months old but they noticed after about 10 years immunity would wane – some people who had been vaccinated as a baby would get the disease as a young adult.
[00:05:08] Meaning they lost their immunity.
[00:05:10] Well not completely. It’s just not as good as when they first got the vaccine. So anyway the CDC decided to recommend a booster shot and now the MMR vaccine schedule has two doses the first dose is given when the child’s around 12 to 15 months old and the second dose is at age four to six years old.
[00:05:29] And according to the CDC this confers about 88 percent immunity. So what’s happening in South Padre besides debauchery and things we as mothers would rather not know about.
[00:05:37] Well the CDC is looking into it but they think that two things are happening. First even after the second booster shot immunity to mumps continues to wane. So public health folks are considering a third booster shot.
[00:05:50] This is kind of like the tetanus shot right? You need to get it every 10 years or so because of waning immunity.
[00:05:55] Right. I mean we’re going to have to start doing that with the mumps vaccine. But that’s not for sure. But the second problem is due to the anti-vaxxers. Yes. Because of them there is a kind of reservoir of disease that persists within the population and this increases the exposure risk.
[00:06:13] Right. And people who have not been vaccinated are ten times more likely to contract the disease after exposure than people who have been vaccinated.
[00:06:22] So this is an issue that’s been coming up a lot on physicians’ websites and journals and just regular conversation. What should a physician do about patients that have not been vaccinated?
[00:06:32] Yeah that’s a good question. So let’s say you have an unvaccinated patient with a fever who comes to see you and turns out they have mumps? By coming to see you they expose everyone in the waiting room and your staff to what is a largely preventable disease.
[00:06:45] Which is the reason some doctors are asking maybe we should fire patients that refuse vaccines for non-medical reasons.
[00:06:51] Well there are a couple of counterarguments to this. First the risk of infectivity from any disease while sitting in a waiting room is pretty low.
[00:07:00] Yeah but it is not so much that. The fewer people who are vaccinated the less herd immunity that develops in a population. And herd immunity is what helps protect people who can’t get the vaccine because they’re either too young or immunosuppressed or pregnant or whatever.
[00:07:14] That’s a good point. But secondly some pediatricians – and by the way most of this conversation is occurring between pediatricians – some pediatricians say that by firing families that don’t vaccinate, physicians can no longer have a conversation with them about the benefits of vaccinating.
[00:07:30] Yes. So now the only information they get is what they read on the Internet or hear from their anti-vaxxer girlfriends or from celebrities.
[00:07:38] Yeah there’s a lot of that. So they don’t get a professional counterargument to those opinions. And apparently the number of anti-vaxxers out there is growing. There was a poll of pediatricians in 2013 that showed 87 percent of them had patients whose parents refused vaccines as opposed to only seventy four point five percent of them in 2006.
[00:07:59] So what is that?
[00:08:02] A 12 and a half percent increase.
[00:08:06] Yeah. Well yeah. So cutting off communication with this group of folks is not going to make them change their minds.
[00:08:12] Probably not. I mean don’t you think. I actually think people who refuse the flu vaccine though for whatever reason they pose a bigger public health threat than people who haven’t had the MMR vaccine.
[00:08:23] True, and lack of compliance with flu vaccines is usually due to lack of motivation not ideology and that just drives me crazy.
[00:08:31] OK so what about schools? Should we keep kids that do not have vaccinations out of schools. I think each state has their own requirements about that.
[00:08:40] Well all states have vaccination requirements for public school. Which vaccines are required can vary a little, like some states require Hep A, some don’t, that kind of thing. But the big issue is whether to provide exemptions.
[00:08:51] You mean non-medical exemptions for personal or religious reasons.
[00:08:55] Right. States can decide whether to allow these exemptions. There’s only three states that don’t allow non-medical exemptions. California which most recently passed that legislation in 2015. But then surprisingly Mississippi and West Virginia. Laws against non medical exemptions have been on the books in West Virginia and Mississippi for decades.
[00:09:19] So if you live in these three states and aren’t vaccinated you just don’t get to go to public school.
[00:09:24] Right. And at least in California you can’t go to state licensed day care facilities either unless you have a medical reason for not getting vaccinated.
[00:09:31] Now as you would expect Mississippi has the lowest rate of unvaccinated kids at 0.3 percent as opposed to Colorado which is around 18 percent for MMR and 19 percent for the DTAP. That’s détour diptheria tetanus pertussis.
[00:09:47] And consequently Mississippi and West Virginia have no measles mumps or other vaccinatable disease outbreaks. They haven’t had any for decades.
[00:09:55] And by the way they don’t have a higher rate of autism in these states either. I think New Jersey has the highest at one in 47 kids, in Alabama is the lowest at one in 175 kids.
[00:10:05] In Colorado with the highest rate of unvaccinated kids is at one in one hundred and one kids.
[00:10:12] So rates of autism do not correlate at all with the rates of vaccination. From a public health perspective it is a no brainer – don’t provide non-medical exemptions.
[00:10:21] Yeah. Well we couldn’t help it. We got on a tangent and now found ourselves somewhere very far away from the mumps.
[00:10:27] Personally I want to stay very far away from the mumps.
[00:10:30] OK so here’s a question for you. Do you think kids going off to college should get a third dose of the mumps vaccine, or at least have titres drawn to see if their immunity has waned?
[00:10:38] Well this the CDC doesn’t recommend that at least currently unless kids have been exposed to a confirmed case of the mumps. So is there a take home message from all of this.
[00:10:47] Yes. Get vaccinated of course. And don’t go to South Padre for spring break stay home and learn to knit and spend some time with your mother or better yet volunteer at your local health department giving vaccines to kids.
[00:10:57] Well that’s our show for today. If you like what you what you heard. Leave us a review on iTunes.
[00:11:02] And until next time do the right thing stay up to date on your vaccines.
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