Public Health/Preventive Medicine Residency Program, Division of Epidemiology, New York City Department of Health and Mental Hygiene, Queens, NY, USA.
Bureau of Immunization, New York City Department of Health and Mental Hygiene, Queens, New York, USA.
Clin Infect Dis. 2017 Feb 15;64(4):408-412. doi: 10.1093/cid/ciw762.
On 14 January 2014, a vaccinated student presented with parotitis. Mumps immunoglobulin M (IgM) testing was negative and reverse-transcription polymerase chain reaction (RT-PCR) testing was not performed, resulting in a missed diagnosis and the start of an outbreak at a New York City (NYC) university.
Mumps case investigations included patient interviews, medical records review, and laboratory testing including mumps serology and RT-PCR. Case patients were considered linked to the outbreak if they attended or had epidemiologic linkage to the university. Epidemiologic, clinical, and laboratory data for outbreak cases residing in NYC were analyzed.
Fifty-six NYC residents with mumps were identified with onset between 12 January and 30 April 2014. Fifty-three cases (95%) were university students, 1 (2%) was a staff member, and 2 (4%) had epidemiologic links to the university. The median age was 20 years (range 18-37 years). All cases had parotitis. Three cases were hospitalized, including 1 of 2 cases with orchitis. Fifty-four (96%) cases had received ≥1 mumps-containing vaccine, 1 (2%) was unvaccinated due to religious exemption, and 1 (2%) had unknown vaccination status. Two of the 44 (5%) cases tested by serology were mumps IgM positive, and 27 of the 40 (68%) tested by RT-PCR were positive.
Mumps outbreaks can occur in highly vaccinated populations. Mumps should be considered in patients with parotitis regardless of vaccination status. RT-PCR is the preferred testing method; providers should not rely on IgM testing alone. High vaccination coverage and control measures likely limited the extent of the outbreak.
2014 年 1 月 14 日，一名接种过疫苗的学生出现腮腺炎。由于未进行反转录聚合酶链反应（RT-PCR）检测，仅进行了流行性腮腺炎免疫球蛋白 M（IgM）检测且结果为阴性，导致误诊，并在纽约市（NYC）一所大学引发了疫情。
对流行性腮腺炎病例进行调查，包括患者访谈、病历审查和实验室检测，包括流行性腮腺炎血清学和 RT-PCR。如果病例患者曾就读或与该大学有流行病学关联，则认为其与疫情相关。对居住在 NYC 的暴发疫情病例的流行病学、临床和实验室数据进行分析。
2014 年 1 月 12 日至 4 月 30 日，共发现 56 名 NYC 居民患有流行性腮腺炎，发病时间为 12 月 1 日至 4 月 30 日。53 例（95%）为大学生，1 例（2%）为工作人员，2 例（4%）与该大学有流行病学关联。中位年龄为 20 岁（范围 18-37 岁）。所有病例均有腮腺炎。3 例住院，其中 2 例伴有睾丸炎。54 例（96%）病例至少接种过 1 剂含腮腺炎成分的疫苗，1 例（2%）因宗教豁免而未接种疫苗，1 例（2%）疫苗接种状态未知。通过血清学检测的 44 例病例中的 2 例（5%）流行性腮腺炎 IgM 阳性，通过 RT-PCR 检测的 40 例中的 27 例（68%）阳性。
在高接种率人群中可能发生流行性腮腺炎暴发。无论接种状况如何，出现腮腺炎的患者均应考虑流行性腮腺炎。RT-PCR 是首选的检测方法；临床医生不应仅依赖 IgM 检测。高疫苗接种率和控制措施可能限制了疫情的范围。
