Jewish Community Health Initiative

Dec 2, 2010 - Physicians: The board of health needs prompt filing of case reporting forms of reportable diseases. For your convenience, the confidential reportable disease form as well as the list of Ohio Reportable DIseases is available for download here.

Dec 1, 2010 - There have been at least 2 probable cases of mumps at the Hebrew Academy Boys Elementary division. Rabbi Dessler has been vigilant in following the guidance of the Cuyahoga County Board of Health. Since early September there has been a trickle of cases every couple of weeks. It could stop any time, but it might continue for a while. There are a few important points to be made:

1. Perspective. Serious complications in mumps are uncommon. It is uncomfortable, and the 5 days of isolation are a nuisance even if the symptoms are mild. Adults miss work if they get mumps, and may also miss work if a child gets mumps. Since serious complications are so uncommon, this is more of a public health issue than a medical issue. We wish to minimize spread of the virus.

2. We know that 1st and 5th grade boys at HAC were likely exposed to the virus. A person infected with mumps is contagious from about 2 days prior to appearance of symptoms. They do not know they are contagious for 2 days, during which time others are exposed. If a child became infected at the time of exposure, they will not become symptomatic for 12-25 days, with most cases being 2-3 weeks. Based on the dates of exposure, friday Dec 3 is about the earliest that a person infected from these exposures could become contagious (2 days before symptoms), and Dec 21 would be about the last day for symptoms to appear. However, there may be other cases now or in the interim, so there could be future exposures to the virus. Of course, there had to be people exposed outside of school. Therefore, our community should suspect mumps when there is swelling along the jawline or in front of the ears and consult a doctor. Since mumps has been confirmed in local cases tested during convalescence, anyone who fits the clinical picture for mumps is called a "probable" case as it can be linked epidemiologically to a confirmed case.

3.  Mumps is the only known cause of epidemic parotitis (swelling along jaw or in front of ear), so if there is the characteristic swelling, the assumption is that it is mumps - even if they test negative, which is common. People who do have mumps are still more likely to test negative when tested early. JCHi arranged for convalescent testing of 6 local cases at the CDC, and all 6 were positive - including at least one who had previously tested negative.

4. Family member with mumps? Take precautions! At least 5 parents of local cases became infected after their child was sent home for isolation. Check the mumps page for more information on what to do if someone in your home has mumps.

5. The vaccine works, but it isn't perfect. It greatly reduces the number and severity of cases. Mumps is extremely contagious.  Without vaccination we would be having a huge number of cases.

6. Wash your hands!! With soap! It is remarkable how effective frequent handwashing with soap is for fighting infections. Tell your kids!

7. Someone who has been exposed should stay away from people with suppressed immune systems, such as cancer and transplant patients.

8. Stay informed. Sign up for Health Alerts and get e-mails when there is an urgent health matter.

Nov 4 2010 - Samples from 6 local cases were sent to the CDC labs for testing. All 6 tested positive. This merely confirms what was already presumed to be true - this is mumps. There continue to be a trickle of cases. For some this has been a painful experience. There have been cases of adults in the community (not just teens), so anyone experiencing a swollen or painful jawline, should consult with their physician and take precautions not to spread this virus. If we prevent exposure to large numbers of people, the outbreak is likely to peeter out.

Update on mumps, Oct 21 2010

So far there are 14 probable cases of mumps - 10 high school age boys (all but 1 from Telshe) and 4 adults with high level contact with 1 or more Telshe cases. It is impossible to say how long this will last, or whether this will become anything more than a trickle. At this point there really is nothing special for anyone to be doing. I continue to work with health departments, local doctors and the CDC on this matter, and will endeavor to keep relevant parties and the public informed as needed.

UPDATE (Oct 4 2010):

The father of one of the cases came down with what appears to be mumps. This was 2 to 2-1/2 weeks following exposure to his son, a normal incubation period for mumps. I am not aware of other cases of Telshe HS boys becoming symptomatic over bein hazmanim, but with the boys not at the yeshiva it is much harder to keep track of. I am trying to coordinate information, so I can keep our local physicians up to date and inform the community as needed. Anyone with information to share is encouraged to contact me ( mailto:jchi@case.edu ).

Please remember that bochurim who were exposed prior to or on Yom Kippur may still become symptomatic, so parents are urged to consult a physician if possible symptoms appear. Also, anyone exposed since Yom Kippur is entering the period of time when they may become symptomatic.

Click Here for Memo on Mumps for Public Posting (e.g. shuls), Sept 22 2010

(Sept 21, 2010 10:45pm)

There are at least 7 possible cases of mumps exhibiting signs of parotitis (swollen salivary glands under ears causing swollen jawline). Mumps is the only known cause of epidemic parotitis, and so the working assumption is that this is mumps. Lab confirmation is very tricky - it often requires retesting a few weeks later to confirm, and even then it doesn't always show up. In addition to being in touch with the local boards of health, I spoke at length with the CDC's team leader for mumps, measles, rubella and polio. We had been in contact in March when I was alerting them to Pesach travel patterns and the risk of spread. She was able to share with me her experiences in dealing with the 2009-2010 epidemic in NY/NJ.

Practically speaking, what does this mean for everyone? What should we be doing?

First, we need to keep everything in perspective. Mumps is usually very mild, especially for people who have had their shots. This is certainly a good time to get caught up on shots. People who have resisted vaccinations might want to reconsider. Adults born after 1956 who are unsure of their vaccination status or know they only had 1 shot, and don't think they ever had mumps, may wish to consider getting a dose of MMR vaccine. Babies under 12 months are considered to be at very low risk. Women in their 1st trimester who get mumps might be at somewhat additional risk of fetal death, but the evidence for this is weak. There really aren't any high risk groups - except adolescents and young adults who have never been vaccinated.

With all that in mind, it is still annoying to get sick, even if it isn't "serious". Symptoms can last up to several weeks, so we do want to take simple precautions to try and limit spread of the virus.

For those wondering why people who are vaccinated are still getting mumps, see the Mumps page. Basically, the vaccine isn't perfect, but even when it doesn't "prevent" mumps, it reduces symptoms.

Practical Steps.

Mumps is transmitted by saliva. Coughing, sneezing, talking, handling objects that are then touched by others. Knowing that over the chag there will be crowded sukkahs, simchas beis hashoevas, simchas torah and sometimes sleeping quarters, there are a few things to keep in mind.

1. Minimize crowding. OK, easier said than done. But for people who know they were exposed, you need to make some effort. Telshe bochurim who have not yet had symptoms are not "in the clear" until at least after the chag. They can still become symptomatic, and by then they have already been contagious for 2 days. Anybody who has been exposed to someone who was contagious, should be cautious starting 10 days following exposure (earliest one may become contagious). Avoid crowded situations when possible, and if starting to feel any of the symptoms, even just headaches or muscle aches or fever, play it safe and avoid gatherings.

2. If you have known exposure and begin to feel symptoms, don't wait for your jaw to make you look disfigured, consult your doc. Early diagnosis means early isolation (sorry) but reduced spread.

3. Avoid sharing bottled drinks, cups, utensils, toothbrushes, etc....People who know they have been exposed (Telshe guys, my son included, listen up!) should try to clean up after themselves! Seriously, this avoids the situation where others may end up sharing your cups,etc...

4. Wash often, with soap! It is really remarkable, but washing frequently with soap is the greatest defense against infection. In a study at an army camp, the commanding officer ordered everyone to wash their hands thoroughly with soap at least 5 times a day. Infections were cut nearly in half.

It is too soon to tell if this is going to quickly pass. We do know that the chag will quickly pass, so be sure to enjoy and pack in the simcha to get us til Chanukah.

Gut Yom Tov!

mendel

Suspected Mumps Outbreak in Cleveland....... (updated Sept 17 2010 12:40pm)

There is a possible mumps outbreak at Telshe Yeshiva in Cleveland. The Yeshiva is actively taking all appropriate measures, and wishes the community to be aware of this development.

Mumps is usually very mild, especially in those who have had 2 doses of the vaccine. However, mumps can occasionally cause complications, and some of them can be serious.

Please note that it usually takes approximately 2-1/2 weeks after exposure before symptoms appear. For example, anyone exposed on Yom Kippur may not experience symptoms until after Sukkos. Mumps is contagious from 1-3 days before symptons until about 5 days following symptoms. Anyone experiencing a swollen jawline (under ears or jaw of one or both sides of the face) should contact their doctor. Other symptoms include fever, headaches,muscle aches, tiredness, loss of appetite. People with children over 12 months who have not had their 2nd shot should consult with their pediatrician about whether to give the 2nd MMR shot ahead of schedule. Adults born after 1956 who had less than 2 doses of vaccine, and never had mumps, should consult their physician. Adults born prior to 1957 who know they did not have mumps, and had less than 2 doses of vaccine should consult their physician. People in homes with boys who learn at Telshe should exercise additional caution.

The Jewish Community Health Initiative is working with the local health departments, local doctors and the Yeshiva.

Doctors who would like to receive updates, or share their own information with other doctors, are encouraged to contact:

Mendel Singer at 216-368-1951 or mendel@case.edu

 

For more information, check our Mumps Page.

JCHi has developed an acronym for preventing the spread of mumps: 

SVARAS Can Stop Mumps!

Space	Minimize Crowding
VAccinate	MMR Vaacine is the best protection we have
Rapid Assessment	Symptoms? Quicker diagnosis, quicker isolation
Soap	Wash often, with soap