|LETTER TO EDITOR
|Year : 2014 | Volume
| Issue : 3 | Page : 216-217
Mumps outbreak in dental care providers in a North Indian dental college
Clarence J Samuel1, Abi M Thomas2, Deepak Bhatia3
1 Department of Community Medicine, Christian Medical College, Ludhiana, India
2 Department of Pedodontics and Preventive Dentistry, Christian Dental College and Hospital, CMC Ludhiana, India
3 Department of Health and Family Welfare, Integrated Disease Surveillance Programme (Punjab), Chandigarh, India
|Date of Web Publication||17-Aug-2014|
Clarence J Samuel
Department of Community Medicine, Christian Medical College, Ludhiana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Samuel CJ, Thomas AM, Bhatia D. Mumps outbreak in dental care providers in a North Indian dental college. CHRISMED J Health Res 2014;1:216-7
|How to cite this URL:|
Samuel CJ, Thomas AM, Bhatia D. Mumps outbreak in dental care providers in a North Indian dental college. CHRISMED J Health Res [serial online] 2014 [cited 2020 Jun 5];1:216-7. Available from: http://www.cjhr.org/text.asp?2014/1/3/216/138916
Mumps is an acute viral infection affecting primarily the parotid gland but can also involve other major salivary glands. It is caused by a Paramyxovirus and is spread via droplets or by direct contact with salivary and respiratory secretions of infectious persons. Transmission of the virus is very common in high density close contact environments such as schools, hostels, etc.  Patients often mistake parotid swellings for tooth related problems. Resulting transmission can cause an outbreaks in the dental care setting including dental care personnel.
In February 2012, we received the information that two dentistry students had developed bilateral swelling of the parotid glands; the possible source was an infectious patient. An epidemiological investigation was required in this situation to determine the existence of epidemic of mumps, if any, to identify the source, and to recommend and adopt control measures. A line-list was prepared, active case search was made and the active cases were then admitted in the isolation ward. For all cases, information on personal details, time of onset, and immunisation history was obtained. Sera from five cases were collected for immunoglobulin M (IgM) antibodies for Mumps virus by enzyme-linked immunosorbent assay (ELISA), buccal swabs in Viral Transport Medium (VTM) were sent to the State Reference Laboratory (SRL) for virus isolation by the District Surveillance unit (DSU) of the Integrated Disease Surveillance Programme (IDSP) Punjab with the SRL confirming a Mumps outbreak.
There are 200 dental students in the college among which were found seven cases of mumps-three females and four males, the average age was 22.57 years (22-24 years). All seven cases had bilateral parotiditis, while two of them presented with the additional involvement of the submandibular glands. All cases received measles, mumps, and rubella (MMR) vaccination in childhood. All the cases were treated symptomatically with paracetamol for pain relief, warm saline gargles, soft diet, and rest. Convalescence was uneventful and no serious complications were reported in this outbreak.
To prevent the transmission of infectious agents in healthcare settings the Center for Disease Control (CDC) Atlanta, formulated the Universal Precautions in 1987-88. This further developed into two tiers of precautions namely, Standard Precautions (e.g. Respiratory Hygiene/Cough Etiquette, Safe Injection Practices etc) and Transmission-Based Precautions (e.g. Contact Precautions, Droplet Precautions, Airborne Precautions). Standard Precautions is the primary strategy for the prevention of health care associated transmission of infectious agents, applicable to the care of all patients in all health care settings, regardless of the suspected or confirmed presence of an infectious agent.Transmission-Based Precautions are for patients who are known or are suspected to be infected with certain pathogens, which require additional control measures to effectively prevent transmission. When Contact, Droplet, or Airborne Precautions are specified, Standard Precautions also apply. 
Hands are the most common mode of transmission of nosocomial pathogens among health care workers.  To prevent or reduce the risk of exposure to the virus, the standard precautions mandates that all dental care practitioners (DCPs) use Personal Protective Equipment (PPE) like gloves, mask, and head cap during dental procedures. However, gloves do not provide complete protection against infection, studies have shown that nearly one third of health care workers (HCW) who wore gloves during patient contact were positive for patients bacterial flora.  The pathogens presumably contaminated the hands during glove removal. Therefore wearing gloves does not eliminate the need for appropriate hand hygiene practices.
Mumps outbreaks among vaccinated populations are reported world-wide and are not rare. There are lower clinical attack rates among vaccinated populations, but epidemics occur much later in the second and third decade often with severe complications.  There is a growing body of evidence demonstrating waning immunity overtime (greater than 15 years) leading to secondary vaccine failure. 
Current mumps outbreak measures generally concentrate on gathering good surveillance data and advising individuals in the affected area who are not fully vaccinated to complete their MMR vaccination. The potential for more extensive disease transmission, behoves that efforts be made to improve the surveillance for mumps by timely reporting to the DSU/IDSP by medical and dental practitioners and clinics. Awareness programs regarding vaccination with MMR for children and adults cannot be understated.
There are very few contraindications to mumps vaccination except for those with immune deficiency or immunosuppression. All persons who work in dental-care facilities should have presumptive evidence of immunity to mumps and those who require a second dose of MMR should be advised one.
To prevent transmission among susceptible persons, a check-list or a visual gallery can be used to identify mumps cases and other infectious conditions. When a person suspected of having mumps visits a dental-care facility, only personnel with adequate presumptive evidence of immunity should be exposed to the person, and in addition to standard precautions, droplet precautions should be followed. , The DCP should coordinate with the infectious disease unit or internal medicine department promptly regarding care, isolation and notification of the patient. MMR prophylaxis after exposure to suspected mumps does not provide an adequate antibody response soon enough, hence the best method of protection is adequate immunisation prior to exposure. 
Dentists and dental care providers are 18% more at risk of acquiring mumps from patients as compared to paediatricians 37%, physicians 15% which are higher compared to non HCW like school teachers 9%.  Therefore DCPs should have adequate knowledge regarding identification of mumps infections, preventive and protective measures, apart from the timely notification to the IDSP, thereby helping to contain the spread of mumps and reduce the impact of mumps outbreaks.
| References|| |
|1.||IAP. Immunization Guide Book-New.p65-IAP Immunization Guide Book_2009_2010.pdf [Internet]. Available from: http://www.iapindia.org/files/IAP%20Immunization%20Guide%20Book_2009_2010.pdf [Last cited on 2014 Apr 18]. |
|2.||CDC. Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention. Immunization of health-care personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2011;60(RR-7):14-6. |
|3.||Pittet D, Allegranzi B, Sax H, Dharan S, Pessoa-Silva CL, Donaldson L, et al. Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infect Dis 2006;6:641-52. |
|4.||Olsen RJ, Lynch P, Coyle MB, Cummings J, Bokete T, Stamm WE. Examination gloves as barriers to hand contamination in clinical practice. JAMA 1993;270:350-3. |
|5.||Wharton M, Cochi SL, Hutcheson RH, Bistowish JM, Schaffner W. A large outbreak of mumps in the postvaccine era. J Infect Dis 1988;158:1253-60. |