It's not nice to get mumps. Mumps is caused by a paramyxovirus. Since the introduction of the measles-mumps-rubella vaccine most people have been spared the unpleasantness of the swollen, inflamed an painful salivary glands, or in older individuals, the systemic complications like orchitis (inflamed testicles) that can sometimes cause sterility in young males. It can also inflame the ovaries or breasts in females. It is contagious through the respiratory route and infected people shed virus three days before they get symptoms until up to nine days after symptoms start. So vaccination is the best prevention but isolating the sick is also an important measure. One thing you don't want is for mumps cases to go to school. The MMR vaccine is not 100% effective and not every child is up to date in their inoculations. Various states have different regulations for school and workplace excusions. In Illinios the exclusion is 9 days after onset, but next door in Iowa the school/worplace exclusion is 5 days. That area in the midwest suffered a large mumps outbreak in 2006 and CDC took a look at how well these exclusion rules were being followed in Illinois (day rule) by surveying a portion (68%) of the reported cases (see Borchardt SM, Rao P, Dworkin MS. Compliance with exclusion requirements to prevent mumps transmission [letter] Emerging Infectious Diseases).
94 of the respondents (54%) attended school and most of these (93%) stayed home at least some time after they developed swollen parotid glands, but 7% (six children) attended school the entire time of their obvious illness. 56% stayed at home the entire 9 days but 44% did not (median 5 days, range 1 - 8 days). For those who stayed away from work, the numbers were similar: 86% spent time at home, 57% the whole 9 days and 43% less than required. Reasons for failing to comply included not feeling sick enough to stay home or not receiving a diagnosis before they had already gone to school or work.
Most had been instructed in the exclusion requirements, however, but many still didn't comply fully. This raises the question whether school districts can count on voluntary isolation during or early in a pandemic or whether the only way to ensure that sick and health children don't mix is close the schools. Workplaces will be at similar risk. It is not likely that asking people who are sick to stay home will be a very successful tactic unless there are either strong incentives to stay home or strong disincentives to show up. Both tactics are problematic.
No one wants to get mumps or to have their child get mumps. Many people know it can have serious complications. Despite this, children still are going to school with mumps and workers are still showing up at work with mumps. Something to think about in pandemic planning.
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This is the same kind of problem that occurs in business when people are sick: some don't want to stay at home because of fears of getting behind, loss of the job, etc. Then there's the alpha group who can't stand to stay at home because they get so bored.
I imagine that some of the children who went to school while sick did so because their parents were working and couldn't take time off to care for them.
Liz is right - kids are kept in school because their parents are working. Or worse..... sometimes the feverish kids are brought to the parents' workplace and parked in a corner with a DVD and a computer game. It even happens with faculty in schools of public health.... Imagine that!
Liz: yes, this has been a persistent theme in the school closure debate. On the one hand, school closures produce a severe hardship for working parents. On the other hand, schools are a breeding ground and transmission nidus for communicable diseases. We put up with some of this under usual circumstances, but a flu pandemic would be a different kind of situation. For one thing, it is school age children most at risk from dying. Reliance on voluntary isolation probably won't work and many of us think the schools won't close until the parents and teachers close them by not showing up. It is something we need to anticipate and think through. If we had better sick leave (or any sick leave) policies it would make closing the schools easier. At the moment we don't.
Not having a diagnosis seems to me a reasonable reason to go to school or work sick, for many people. After all, mumps is fairly uncommon these days, so most people may not suspect what they have, or even suspect it's contagious.
Just as many workers in this country cannot financially afford to take time off, kids pay a price for missing school, as well. The idea of missing five to seven days of classes (nine days minus weekend(s)) in high school would have panicked me for the work I'd have trouble making up, such as labs in my science classes, but would have been held responsible for anyway. Would I have stayed out after I felt better, when I knew most of my peers were vaccinated?
It doesn't help that many schools have punitive absenteeism policies. In my high school, seventeen days of any missed class lost you credit for that class for the entire year. I was often getting close to that limit merely with sick days for bad coughs and ear infections. Yes, there were ways around that, but a mere doctor's note wouldn't do it; there were hoops to jump through. Would I have risked my college applications, and having to repeat a year of high school, to stay home all nine days?
Would you?
Ok, maybe you would have. But you have the benefit of a public health perspective most seventeen-year-olds don't.
So I'm torn. On the one hand, I wish there were better compliance with the rules designed to keep us all safer. On the other hand, I can't blame the non-compliant people; they're the ones who were caught between a rock and hard place. While they had mumps.
Well...Gee. I gotta tell you that my son was one of those Iowa mumps cases. He had been vaccinated, and was current on his shots. I sent him to school for a while because it was not how I'd ever heard mumps described-- he had a swelling on the outside of the jaw near the chin, and I thought (I guess wrongly) that mumps were further back, under the jaw. It wasn't painful, or excessive, and there was no rash or fever. He didn't seem or act sick. And he'd been vaccinated.
I might also add that it completely sucked that he had to be out of school for 5 days until the test came back. That one really need a quicker turnaround. "Oh, we need you to keep him home, and everone has to wear masks around him for five days until we even decide if he's sick. Then if he is sick, it'll be another week. Otherwise, we're sorry we've disrupted your life for no reason"
"Then if he is sick, it'll be another week. Otherwise, we're sorry we've disrupted your life for no reason"
Its not 'no reason' its public health. Sure its inconvienient but we need to realize that its convenience that destroying the planet.
It would be nice to have faster test. But we, as a society, need to public health higher on the priority list.
Maybe (?) bird flu in Mexico City???
45 patients have been given medical attention at the area's hospital after they reported symptoms including extreme headaches, stomachaches, vomiting, diarrhea and other weaknesses.
The cases have developed over the last two weeks, and "feel [like] death," according to Silvia Villalobos, one of the victims who spoke to El Universal correspondent Xochitl Alvarez in Spanish.
http://www.wnd.com/news/article.asp?ARTICLE_ID=57868
I ment to say in a mexican city, Guanajuato, not sure if that is anywhere near Mexico City. How reliable is El Universal for news?
rapid: Don't know about el Universal but WorldNet Daily is a Moonie source and extreme right wing, which might account for the highlighting that Mexico is the source of epidemic disease in the US (note the related links below; virulent anti-immigrant stuff). The political background contained in this article -- that the US will be under international regs -- is another clue this is a "news" piece with an agenda. There are also numerous scientific inconsistencies, e.g., that bird flu is like botulism, etc. Beyond that it is difficult to say, but so far no other sources are reporting any suspected bird flu outbreak, and Mexico is hardly a closed society. If the usual causes have been ruled out, this would presumably include influenza A. So I am not putting much credence in this report. As always, we have to wait and see but this one won't keep me up.
Revere-A quick question about H5N1. There was a news article on Monday? about H5N1 being able to infect a fetus thru the placenta wall and other organs. Dr. Capua asserted this back two years ago from the post on chickens as many of the organs were nearly liquified.
So my question is whether this applies to all flu, or just type A, or just H5N1? If you are pregnant and a high path H3 or something comes rolling around what should they do besides likely taking the flu shot before you get pregnant? .
Randy: Saw the report but have been so busy haven't had time to read the paper. My impression is that this only applies to H5N1, not seasonal flu. Since chickens don't have placentas the poultry data isn't comparable.
what has mumps to do with pandemic flu ?
shouldn't it be illegal to carelessly infect others ?
anon: the lesson of mumps is that even a "regulation" that says you have to stay out of school or work if you have mumps didn't work for a disease much easier to diagnose and more distinctive than influenza. So such a policy isn't likely to work for flu either.
however in a (H5N1)-pandemic we have the reverse
problem that people won't go to work, schools would
be closed anyway. So your "lesson" more applies to
seasonal flu rather than pandemic.
I think the main problem is, that it's generally
not considered as criminal or evil to infect
others.
"...people shed virus three days *before* they get symptoms..."
One consequence of better compliance with self-isolation is that a child is not isolated at home, and some of those parents are cops, firefighters, even medical and public health personnel.
When I first learned about bird flu and before finding this blog, I read some of the recommendations to "take muh gun n muh wumman n head for the hills". That seemed as dumb as inviting all with H5N1 into a general hospital.
It appears to me that what's needed are metro-wide plans to take the punch and come back: many will get sick (where will they be cared for?), too many will die (where will they be buried?), some may survive with intensive care (from whom? where?), many will need volunteer nursing (from whom? where?). And how will daily life go on in the absence of 20% or more of truck drivers, shelf stockers, garbage collectors, teachers...? Not everyone can telecommute (although schoolkids could).