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Influenza - Continued

FIGURE 5. Cases of influenza-like illness* reported from physicians, by geographic area United States, 1983-1984 season

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*Reported to CDC by approximately 125 physician-members of the American Academy of Family Physicians research panel. A case was defined as a patient with fever 37.8C (100F) or greater and at least cough or sore throat.

Epidemiologic Notes and Reports

Mumps Outbreak - New Jersey

From October 19, through December 14, 1983, 63 cases of mumps were reported from six schools in a school district in Atlantic County, New Jersey. These 63 cases are a 40% increase over the previous year's total of mumps among schoolchildren in the state. Before 1978, mumps vaccination was not required for school entry in New Jersey; however, beginning in 1978, mumps vaccination was required for school entry for children 7 years of age or younger. By the fall of 1983, students in kindergarten (K) through grade 5 would have been covered by the law. An investigation was undertaken to determine the possible reasons for the outbreak and to control its spread. In particular, this marked increase in reported mumps presented an opportunity to: (1) determine the compliance with the 1978 school immunization law; (2) investigate the effect of the law on the pattern of the outbreak; (3) estimate the efficacy of mumps vaccine; and (4) quantitate the economic impact of the outbreak on the community.

A case of mumps was defined as unilateral or bilateral swelling of the parotid or other salivary gland for 2 or more days as reported by a physician, nurse, or parent. Acute mumps infection was serologically confirmed (i.e., a fourfold rise in complement fixation antibodies between acute- and convalescent-phase sera) in four cases. No viral cultures were attempted.

The index patient was a 12-year-old, unvaccinated, sixth-grade boy attending Elementary

Mumps - Continued School A. The source of his infection was not identified. All cases in the five other elementary, middle, and high schools involved could be epidemiologically linked to cases in this elementary school. When cases were plotted by date of onset, two distinct peaks of disease were identified that occurred 14-18 days apart (Figure 1). Of the 63 students who met the case definition, 37 (59%) were girls. Ill students ranged in age from 6 years to 17 years (mean 11 years). Thirty-six (57%) cases occurred among children in grade 6 or higher. None of the patients developed complications, and none were hospitalized.

Forty-eight (76%) cases occurred in Elementary School A, for an overall attack rate of 5% (48/933). Twenty-five (52%) of these 48 cases occurred among the sixth grade students (Table 1). The attack rate in grade 6 (15%) was five times that in grades K-5 (3%) (p < 0.001) (Table 1).

School vaccination records were reviewed for evidence of previous mumps vaccination or mumps disease to determine student susceptibility. A student with (1) a history of physiciandiagnosed mumps; (2) serologic evidence of mumps immunity; or (3) a dated parental, school, or physician record of vaccination with live mumps vaccine on or after 12 months of age was considered immune to mumps (1). Vaccine coverage rates were greater than 95% in grades K-5 but fell to 68% in the sixth grade. Overall, records showed grade-specific susceptibility rates (Table 2) parallelled grade-specific attack rates (Table 1). Sixth graders were (Continued on page 427)

TABLE 1. Summary-cases specified notifiable diseases, United States

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"Eight of the 64 reported cases for this week were imported from a foreign country or can be directly traceable to a known internationally imnorted case within two generations.

TABLE III. Cases of specified notifiable diseases, United States, weeks ending

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TABLE III. (Cont'd.) Cases of specified notifiable diseases, United States, weeks ending
July 21, 1984 and July 23, 1983 (29th Week)

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small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small]

TABLE III. (Cont'd.) Cases of specified notifiable diseases, United States, weeks ending
July 21, 1984 and July 23, 1983 (29th Week)

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