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Hello. I'm Doctor Raymond Strikas, medical officer in CDC's National Center for
Immunization and Respiratory Diseases. We are pleased to present this video in which Pam
Pontones, State Epidemiologist and Director of the Epidemiology Resource Center at the Indiana
State Department of Health, shares her insight regarding a series of mumps outbreaks at
college campuses in Indiana thoughout 2016.
In 2016, Indiana actually experienced several different mumps outbreaks on various
college campuses, starting with 2 cases that were identified at a small private university in
February of 2016. That outbreak was investigated in collaboration with university
officials, the university health center, the local health department of jurisdiction, and
the State Department of Health. But our outbreaks did not stop there. As the year progressed
we identified cases which were eventually epidemiologically linked among several different
students at different, larger public universities that eventually met the outbreak
threshold. All of which required further contact tracing investigation and vaccine
clinics with measles, mumps, rubella vaccine. By May of 2016, there were more than 20
confirmed cases and additional probable cases identified on that same campus. As the year
progressed, other outbreaks were identified in other large state universities, and by year's end,
the number of confirmed cases was more than 280 throughout the state. During the outbreak
the epidemiologists at the Indiana State Department of Health leveraged the use
of our office of public affairs to really help get the word out, not only to the university
population, but also to the communities at large. The Indiana State Department of
Health issued press releases, did postings and tweets on social media, worked with
university officials to create signage and email push messaging that could reach the faculty,
staff, and students very quickly. The use of that messaging, along with the
community, the college campus population, and our health care providers, rapidly and
effectively helped to keep everyone informed, and really helped to allay concern and
ensure that contact tracing, laboratory specimen submission, and reporting were done promptly
and effectively. The use of immunization registries is of particular importance here. In
Indiana, we have the Children and Hoosiers Immunization Registry Program, which was so
helpful to be able to quickly assess students and even faculty and staff that may have had
records entered into the registry. So making sure that providers enter any immunization
records into their respective immunization registries is so important in the event of an
outbreak as it makes that assessment all the easier. In addition to being able to verify
the records that university officials maintain, it's also important for students and
faculty and staff to have access to their immunization records quickly and effectively if those
records are not available in an immunization registry. Epidemiologists at the Indiana
State Department of Health were asked about what the source of these outbreaks may have been.
And while we may never know the source of the outbreaks, particularly because about 30%
of individuals who develop mumps will not develop any symptoms, the real focus was to identify
individuals who were potentially exposed and especially those who were under or un-immunized and
required at least 1 or 2 doses of vaccine. That being the goal, there was a lot of effort and
time spent to identify individuals through that contact tracing process. Sometimes that
was challenging, due to the fact that on some of these college campuses there were a lot of
activities happening and final exams were also scheduled over the time that some of this
outbreak investigation was occurring. Even those challenges can be overcome or at least
minimized with solid messaging and using your partnerships with university officials and local
health departments to quickly identify students. That again underscores the importance of
one of the lessons that we learned was in having university officials ensure that they can
keep accurate immunization records, and being able to incorporate those records into
immunization information sytems that state health departments have available. If those records
can be quickly accessed and the data collected in a standardized way, much time can be saved
assessing and identifying individuals who would require additional vaccination to be
protected. There were people involved in these investigations at every level. Local health
care providers, local health departments, the State Department of Health, and we
consulted with CDC experts as well. So we really used the entire public health system to
investigate these outbreaks and to enact the proper control measures. On the local level,
health care providers who were diagnosing and reporting cases in a timely manner were key.
We did issue 5 health, Indiana Health Alert Network messages to providers statewide so that we
could quickly disseminate the information that we were gathering in as close to real
time as possible. Informing providers of what symptoms to watch for, how to inform their
patients, how to report. We also distributed a specimen collection and testing algorithm
so that they could collect the proper specimens in a timely way; they could transport and
ship them properly, and then be able to understand what the test results meant. That was key to
making sure that we could confirm cases promptly and accurately. Our local health
departments played such a critical role in all of these outbreaks, to ensure that the
university officials were properly informed, to make sure that the reporting was being
done correctly, to report cases promptly to the State Department of Health. And they were
certainly phenomenal in enacting the control measures that were needed, such as
isolation, exclusion, and helping to plan and prepare and offer vaccination clinics. At
the State Department of Health, our epidemiologists were involved early and often, as
well as our laboratory, in helping to identify cases and contacts of cases. With all of
these outbreaks occurring sometimes simultaneously, or at least partially one leading into
another, having that surge capacity where we could quickly reassign and provide help where
it was needed quickly and efffectively was key as well. Being able to coordinate that
effort, having our vaccine-preventable disease epidemiologist serve as the
coordinator of all of these different responses, and then having folks actually in the
field with our field epidemiologist being able to assist local health departments,
assist universities, on the ground, was instrumental in being able to provide a timely
and robust response.
This Indiana example illustrates that the investigation and control of mumps outbreaks can
be challenging. It is important to collect data from these investigations to provide useful
information about the epidemiology of this disease as well as the effectiveness of
various interventions.