Wyoming recorded its first case of mumps in eight years last month after St. John’s Medical Center staff diagnosed the communicable disease in a visiting Colorado woman.
“We never want to overreact but we never want to under-react either,” Wyoming Department of Health spokeswoman Kim Deti said. “This is an unusual thing, but there’s really no cause for concern for the community.”
There was no community exposure risk at the time of the diagnosis, officials from the Wyoming Department of Health, Teton County Health Department and the hospital determined. The two-week incubation period has passed.
There are only a few hundred cases of mumps, a contagious viral disease, nationally every year. So far in 2019, 426 cases have been recorded.
Symptoms typically start with fever, headache, muscle aches, tiredness and a loss of appetite before the salivary glands swell, leading to telltale puffy cheeks and a tender, swollen jaw.
Although the vaccine has “drastically” reduced mumps cases — a 99 percent reduction from about 186,000 reported cases a year before 1989 — outbreaks still occur, the Centers for Disease Control and Prevention reports. Such surges tend to happen among groups of people who have prolonged close contact through things like sharing water bottles, kissing, practicing sports or living in close quarters with someone who has mumps.
Seventy-nine percent of Teton County teens aged 13 to 17 years old received the measles, mumps and rubella vaccine in 2018, compared to the state’s 74%, according to Wyoming’s Immunization Registry.
That age group is tracked to feed into the CDC’s national immunization survey, but vaccinations are usually given much younger. The CDC recommends two doses, first between 12 and 15 months and a booster between ages 4 and 6.
But local vaccination rates are only one piece of the puzzle for a town that’s a travel destination.
“We have people coming here from all over the world where these illnesses are still in high prevalence,” Dr. Jim Little Jr. said. “So we’re at a higher risk than a lot of places in the world just because we’re a tourist destination.”
Since measles isn’t eradicated in other parts of the world, transmission is often someone who isn’t vaccinated traveling to where it’s more common. The disease spreads when others who lack a vaccination are exposed.
Hospital verifies staff immunity
The hospital took a cautious approach, and as a result had some staff who stayed home from work. About 50 people were identified as having a potential exposure.
“We used an abundance of caution,” St. John’s chief communications officer Karen Connelly said.
Though St. John’s requires proof of two doses of the measles, mumps and rubella vaccine, better known as the MMR vaccine, or “titers” to validate immunity for employment, the policy is relatively new.
At the time of the exposure, four St. John’s staff members hadn’t received the vaccine or hadn’t been exposed to the disease to have built up immunity. Another dozen had blood drawn for a titer, a test that measures antibodies as a measure of immunity, because vaccination records were unavailable.
Those staffers weren’t on the medical campus while tests were being run, but they were paid for the time they would have worked.
“I feel fortunate that it turned out the way it did,” Connelly said. Swift internal communication, she said, ensured “we didn’t expose patients to someone who might come down with the mumps in a week.”
Docs recommend vaccination
Unlike mumps, measles hasn’t shown up in Wyoming, at least not since 2010. But recent outbreaks in Washington and New York have spurred doctors and other medical professionals to talk about vaccination early and often.
“Vaccines are clearly the No. 1 thing that we push during these types of cases,” said Rachael Wheeler, public health response coordinator for the Teton County Health Department. “It is important for overall herd immunity.”
The MMR vaccination is available from the health department and private providers. Some who are vaccinated may still contract the diseases it protects against, but symptoms are generally milder.
And despite not having reared its head yet, measles is a bigger threat than mumps in the view of Wyoming health officials.
“Measles is far more contagious,” Deti said. “We don’t want to see it in Wyoming, but it is cropping up more across the country.”
In the experience of Dr. Travis Riddell, the county’s health officer, people are generally not resistant to getting the MMR vaccine.
“The vast majority of our families understand the importance of vaccines and are open to conversations with us,” said Riddell, a pediatrician. “It’s not a difficult conversation most of the time. We’re usually on the same page.”