Rules of mumps exclusion infected, exposed HCWs

All workers should look for signs after exposure

The Centers for Disease Control and Prevention's division of healthcare quality promotion recently posted updated guidance on mumps and infection control on its web site. Key points regarding health care worker exclusion from work include the following:

Exclude health care workers with active mumps illness and those who are nonimmune and have had unprotected exposures to mumps.

Unprotected exposures are defined as being within 3 feet of a patient with a diagnosis of mumps without the use of proper personal protective equipment (surgical mask). Irrespective of their immune status, all exposed health care workers should report any signs or symptoms of illness during the incubation period, from 12 until 25 days after exposure.

Management of health care workers with illness due to mumps:

A diagnosis of mumps should be considered in exposed health care workers who develop nonspecific respiratory infection symptoms during the incubation period after unprotected exposures to mumps, even in the absence of parotitis.

Health care workers with mumps illness should be excluded until nine days after the onset of parotitis.

Management of health care personnel who are exposed to persons with mumps:

Health care workers with any of the following are considered immune to mumps: history of physician diagnosed mumps, past receipt of at least one dose of mumps vaccine or positive mumps IgG.

For health care personnel who are nonimmune:

Nonimmune personnel should be excluded from the 12th day after the first unprotected exposure to mumps through the 26th day after the last exposure. The mumps vaccine cannot be used to prevent the development of mumps after exposure. Hence, previously unvaccinated health care personnel who receive a first dose of vaccine after an exposure are considered nonimmune and must be excluded from the 12th day after the first exposure to mumps through the 26th day after the last exposure.

For health care personnel who are immune

Those personnel who had been previously vaccinated for mumps, but received only one dose of mumps vaccine may continue working following an unprotected exposure to mumps. Such workers should receive a second dose as soon as possible, but no sooner than 28 days after the first.

Health care personnel who are immune do not need to be excluded from work following an unprotected exposure. However, because one dose of MMR vaccine is about 80% effective in preventing mumps and two doses is about 90% effective, some vaccinated personnel remain at risk for infection. Therefore, health care workers should be educated about symptoms of mumps, including nonspecific presentations, and should notify employee health if they develop these symptoms.

(Editor's note: For more information, go to www.cdc.gov/nip/diseases/mumps/control-hcw.htm.)