Collaboration between the State Hygienic Laboratory and other agencies is essential in efforts to contain the mumps outbreak in Iowa.

Tricia Kitzmann, Deputy Director of Johnson County Public Health

Lucy DesJardin, director of the Office of Research Development, said the Hygienic Laboratory provides test results as one of three major components of public health's ongoing work during the outbreak, with the patient's clinical presentation and the epidemiological investigation comprising the other two elements.

"It's never just one public health entity," DesJardin said of the collaborative effort. "It takes all of this to come together."

Johnson County Public Health and the Iowa Department of Public Health have been working on the outbreak in conjunction with the State Hygienic Laboratory, as well as University of Iowa Student Health and the University of Iowa as a whole.

So far, the Hygienic Laboratory has tested 891 specimens related to the outbreak, with 330 positive results statewide.

Jeff Benfer, supervisor of the lab's Molecular Biology and Virology section, said having the specimens tested at the state laboratory was significant in recognizing the increase in number of mumps cases. Testing by individual private laboratories would have made it difficult to identify the upward trend. Benfer said the first positive results came in July, with a noticeable increase in September.

"That is why it's important that testing is done at the state public health laboratory," he said. "That is what separates us."

Tricia Kitzmann, Deputy Director of Johnson County Public Health, agreed with Benfer.

"It was easier to coordinate testing and to see trends in the outbreak," Kitzmann said. "It really streamlined things for us."

She noted that the Hygienic Laboratory's willingness to report negative results, as well as positive tests, also was important in the epidemiological work conducted by the health department.

Case numbers from Johnson County include 95 that were clinically diagnosed, in addition to 265 that were lab-confirmed. The combined numbers run higher than the laboratory's positive test numbers, as some of the patients diagnosed with mumps may have been tested before antibodies were present, producing negative test results.

"Not a lot of labs would want to track negative results and report them," Kitzmann said. “Doing so allowed health workers to link to laboratory-confirmed cases during the epidemiological investigation. This gave us a better idea of the magnitude of the outbreak."

Kitzmann noted that, because the majority of cases have been University of Iowa students, another significant benefit provided by the Hygienic Laboratory was the ability to offer testing in Johnson County at no charge, a cost covered in part by a grant through the Centers for Disease Control and Prevention.

Patients who could not make it to UI Student Health could go to other clinics in Johnson County, she said, knowing that the test would be offered at no charge, even if they were considered “out of network” under their health insurance.

"This removed a significant potential barrier to getting a complete picture of the outbreak," Kitzmann said.

Students also were offered a free measles, mumps and rubella booster during vaccination clinics through the University of Iowa, with nearly 5,000 students vaccinated.

“While many of the students diagnosed with mumps previously had received two doses of the vaccine, receiving a third dose could help with the population's herd immunity," Kitzmann said, adding that the CDC is interested in a possible study of the efficacy of that third dose based on the work in Johnson County.

Mumps is spread by transmission of the virus in mucus or droplets from the nose or throat of an infected person, usually when that person coughs or sneezes. The most common symptoms are fever, headache and swollen salivary glands under the jaw, but in rare cases mumps can also lead to hearing loss, meningitis and sterility in men.

Kitzmann said some of the patients were hospitalized, but so far all have recovered.

DesJardin and Benfer said experience from previous outbreaks, including the 2009 influenza pandemic, gave public health an edge in the collaborative work conducted during the mumps outbreak.

One vital component of that work occurred during the 2006 mumps outbreak, when the Hygienic Laboratory developed a molecular testing method that shortened the time in getting test results to the same day from the original two to three day period, DesJardin noted. The method has since been made available nationwide.

DesJardin, Benfer and Kitzmann all said it was unknown whether or not the outbreak has been contained.

Kitzmann added that mumps is sometimes seen as a seasonal disease.

"We typically see it in the spring, but we're hoping not," she said. "I feel like we've done everything we possibly could do to reach out. I feel like we have a really good handle on it."