Case Study 2.

Mumps Epidemic in Iowa: Lessons Learned from the Front Line of Testing

Mumps Epidemic in Iowa: Lessons Learned from the Front Line of Testing
M.A. Pentella SYNOPSIS
This case study describes experiences during spring 2006 at a state public health laboratory. The State Hygienic Laboratory (SHL) at the University of Iowa is Iowas public health laboratory. SHL scientists perform diagnostic tests on human, animal, or environmental specimens to assist in maintaining public health in Iowa. SHL received samples from approximately 5,500 individuals for mumps testing between January 1 and June 1, 2006. Typically, only 2-3 patient specimens would have been tested during that time period. During the first six months of 2006, as per usual procedure, if a patient in the state of Iowa presented at a physicians office with symptoms of mumps, a blood sample and an oral swab were gathered. These samples were sent to SHL for analysis. The blood specimens were tested for mumps-specific IgM antibodies. The oral swabs were tested to determine if live virus would grow from them in viral culture or detected by the Polymerase Chain Reaction (PCR) test. Mumps virus is most commonly transmitted in the saliva of infected individuals, either by droplets or by other contact with infected saliva. While fortunately, there were no fatalities associated with the epidemic, there was great concern in the community, in part because of the ease with which mumps is transmitted and the possibility of side effects or death. This was truly an epidemic, as there were a total of 1,514 patients who had at least one positive test result indicating infection with mumps virus. The public health response required that cases be detected and prevention measures be taken to stop the spread of the virus. Therefore, the laboratory response was critical to the control of the epidemic. However, laboratory testing is expensive, and funding to support these kinds of public health prevention activities is a challenge regardless of economic conditions.

Introduction to Epidemiology HTSC440 Page 1 of 2

Case Study 2. Mumps Epidemic in Iowa: Lessons Learned from the Front Line of Testing

LEARNING OBJECTIVES
At the completion of the case study, students should be able to: Examine the challenges posed by an epidemic. Recognize the importance of prior decisions in preparation for the response. Debate various perspectives in the decision process.

KEY QUESTIONS
1. What role does laboratory testing play in the prevention of communicable diseases? 2. What considerations must laboratory professionals take into account in determining whether to maintain or eliminate particular tests? 3. What information can laboratory leadership call upon to determine when to implement an emergency response plan? 4. While this is Iowas experience, how applicable would it be to other states or other diseases? 5. Will technological advances in the laboratory further change how public health experts approach emergency response? 6. How would the outcome have changed if the testing had been outsourced to another laboratory before the start of the mumps epidemic?

Introduction to Epidemiology HTSC440 Page 2 of 2