Exposure to Mumps During Air Travel --- United States, April 2006

CAL/AAEM News Service calaaem_news at yahoo.com
Fri Apr 14 23:18:33 PDT 2006

Exposure to Mumps During Air Travel  ---  United States, April 2006 

Source: MMWR (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm55d411a1.htm) 
Date : April 2006

The state of Iowa has been experiencing a large mumps outbreak that began in December
2005 (1). As of April 10, 2006, a total of 515 possible mumps cases have been reported to
the Iowa Department of Public Health (IDPH) during 2006 (2). This outbreak has spread
across Iowa, and mumps activity, possibly linked to the Iowa outbreak, is under
investigation in six neighboring states, including Illinois (n = four), Kansas (n = 33),
Minnesota (n = one), Missouri (n = four), Nebraska (n = 43), and Wisconsin (n = four)
(CDC, unpublished data, April 10, 2006). The reasons for this outbreak are under

Mumps is an acute viral infection characterized by a nonspecific prodrome, including
myalgia, anorexia, malaise, headache, and fever, followed by acute onset of unilateral or
bilateral tender swelling of parotid or other salivary glands (2). An estimated 60%--70%
of mumps infections produce typical acute parotitis (3). Approximately 20% of infections
are asymptomatic, and nearly 50% are associated with nonspecific or primarily respiratory
symptoms. Complications include orchitis, oophoritis, or mastitis (inflammation of the
testicles, ovaries, or breasts, respectively), meningitis/encephalitis, spontaneous
abortion, and deafness. Transmission occurs by direct contact with respiratory droplets
or saliva. The incubation period is 14--18 days (range: 14--25 days) from exposure to
onset of symptoms. The infectious period is from 3 days before symptom onset until 9 days
after onset of symptoms. 

IDPH has identified two persons who had mumps diagnosed and were potentially infectious
during travel on nine different commercial flights involving two airlines during March
26--April 2, 2006. The commercial airline flights identified with a potentially
infectious traveler are listed below by date, carrier, and flight number: 

Northwest Airline (NWA) flights: 

March 26 NWA (Mesaba) #3025 from Waterloo, Iowa to Minneapolis, Minnesota 
March 26 NWA #760 from Minneapolis, Minnesota, to Detroit, Michigan 
March 27 NWA #0260 from Detroit, Michigan, to Washington, DC--Reagan National 
March 29 NWA #1705 from Washington, DC--Reagan National to Minneapolis, Minnesota 
March 29 NWA (Mesaba) #3026 from Minneapolis, Minnesota, to Waterloo, Iowa 

American Airline (AA) flights: 

April 2 AA #1216 from Tucson, Arizona, to Dallas, Texas (DFW) 
April 2 AA #3617 from DFW to Lafayette, Arkansas (Northwest Arkansas Regional [NAR]) 
April 2 AA #5399 from NAR to St. Louis, Missouri 
April 2 AA #5498 from St. Louis, Missouri, to Cedar Rapids, Iowa 

Persons on these flights who have symptoms consistent with mumps within 21 days of travel
should be evaluated for mumps by a health-care provider. Health-care providers should
remain vigilant for mumps among persons with parotitis or other salivary gland
inflammation. Cases of suspected mumps should be reported immediately to public health

A multistate investigation has been initiated by CDC and the state health departments in
affected states to notify potentially exposed passengers (i.e., those seated in close
proximity to the index cases). This investigation is using a new software application,
eManifest, developed by the CDC Division of Global Migration and Quarantine (DGMQ) to
securely import, sort, and assign passenger-locating information to jurisdictions to
facilitate timely identification of exposed persons. These data are securely transmitted
to state and territorial health departments via the Epidemic Information Exchange (Epi-X)
Forum (available at http://www.cdc.gov/mmwr/epix/epix.html) for notification of
potentially exposed passengers. 

Incidence of mumps in the United States began to decrease after vaccine introduction in
1967 and recommendations for routine vaccination of children in 1977. Since the 1990s, a
further decrease in the reported incidence of mumps has occurred, which is thought to be
attributable to the implementation of the second dose of measles, mumps, and rubella
vaccine (3). The risk for transmission of respiratory infectious diseases during air
travel might depend on several factors, including 1) immunity of passengers; 2)
infectiousness of the organism; 3) degree of shedding of the pathogen by infected
passengers; 4) hygienic practices of infectious passengers; 5) proximity of others to
infectious passengers; 6) hygienic practices of the other passengers/crew; 7) flight
duration; and 8) cabin environment of the aircraft (4). Transmission of other respiratory
pathogens during air travel has been reported (5--9). Exposure and transmission of mumps
during commercial air travel has not been described previously. 

Reported by: P Quinlisk, MD, Iowa Dept of Public Health. S Redd, G Dayan, MD, National
Center for Immunization and Respiratory Diseases; N Gallagher, Geographic Medicine and
Health Promotion Br, P Lutz, K Marienau, MD, F Averhoff, MD, Quarantine and Border Health
Svcs Br, Div of Global Migration and Quarantine, National Center for Infectious Diseases,

Cyrus Shahpar & Brian Potts 
Managing Editors, CAL/AAEM News Service
University of California, Irvine

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