I saw an almost 2-year-old child this morning who’d been given all his vaccinations. He’d had fever since last night, and this morning his mother noticed that the right side of his face and the area under his lower jaw were swollen. My examination wasn’t conclusive – I wasn’t entirely certain that the infection was in the parotid salivary gland; it might also be a bacterial infection of the surrounding lymph nodes (acute lymphadenitis). But as I’d heard that mumps is now circulating in Borough Park among the ultra-Orthodox Jews – the very same location and demographic which had a measles epidemic a few short months ago, and whose relatives are among the population I serve, it was definitely worth checking to see if mumps had arrived in our area as well.
A few short phone calls (to our local infectious disease consult, the Health Ministry’s epidemiology dept. and the virology lab in Tel Hashomer hospital near Tel Aviv) confirmed that there have indeed been cases of mumps in our area, and that we should regard this little boy as a suspected case, quarantine him, and check if he has an acute antibody reaction (IgM antibodies) to the mumps virus. I’m also giving him antibiotics on the chance that it’s bacterial lymphadenitis and not a viral infection, however.
Of the 3 viral infections the MMR vaccinates against, the mumps vaccine is the least effective – the vaccine strain most often used in the west used to vaccinate against mumps (Jeryl Lynn) is about 75-90% effective in a highly vaccinated population, possibly lower in an epidemic situation. Hence it’s not surprising that most of the people who contacted mumps in the New York outbreak were themselves vaccinated (for further explanation of why this happens, see here). That’s far from saying it’s worthless: While complications are rare in young children, it was a leading cause of deafness (uni- and bilateral) in children before vaccination programs began; in fact, Japanese researchers – in Japan, mumps is endemic,as the vaccine is optional – suspect that it’s more common than previously thought. Mumps is also a cause of sterility in young men acquiring it, and rarely may also cause pancreatitis and encephalitis – severe and often fatal diseases.
Let’s keep our fingers crossed that this little boy doesn’t have it.
Filed under: Medical Practice, Vaccines |
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Another example of how herd immunity protects us all.
My aunt is deaf in one ear, courtesy of a childhood bout with mumps.
I hope your young patient has a full and uneventful recovery.
This gave me chills because it’s what I fear–my son getting a vaccine-preventable disease even though he’s gotten all his shots.
How do you manage posting patient info/ pix on your blog? When I discuss any patient stuff, I’m pretty paranoid re: HIPPA and confidentiality. How do you bring it up with the parents? Do you document?
I mention this because I was thinking of posting something and then decided not to because of the above issues.
That’s a generic photo of a child with mumps, Miriam. I would never post a photo of a patient without express permission from the parents! I’ll make it clear, though.
Also, I’m pretty sure I’m adhering to medical ethics in this post (not sure what HIPPA regulations say, but then, as Alexis pointed out, I’m not bound by them). I haven’t disclosed anything about the patient other than gender, approximate age, vaccination status and presumptive diagnosis, which aren’t unique enough to ID the patient – and I’ve seen CME cases and case reports in the medical literature which disclose far, far more, and I’m sure in many cases the patients were not asked. In fact, in one case worth mentioning, I found the physician’s report of a certain case in a medical journal article after the patient’s parents had gone public with the story, and as it was obvious that there was no love lost between parents and physician – I doubt very much permission was given to publish it. In that particular event, the mother was identified by her initials, and enough unique features of the case were provided by the patients’ parents and by the medical case report to realize that they were clearly one and the same.
I have refrained from using interesting cases in the past with unique features, which really might ID the patient to those who know him/her – even though the chance of anyone they know seeing my post is remote.
I assumed that wasn’t a photo of her specific patient but a generic boy-with-mumps photo.
That said, since Esther isn’t in the States, she isn’t bound by HIPAA… just general medical ethics.
how interesting… my friend’s daughter just got chicken pox (she’s vaccinated)… speaking of immunizations not being perfect. While trying to find how likely it is my 5 mo might get it (we were there the day before she broke out) and whether breastfeeding might be any protection, I came across a blog where the mom was HAPPY her unvaccinated kid had gotten chicken pox and was going to hold a pox party.
Probably someone like that got my friend’s kid sick (or it might have been a little old lady with shingles…)
An elderly friend of mine has five adopted children. The last three were mostly young (teenage) refugees she wanted to get out of their home countries, but the first two were because her husband was sterile from mumps.
I didn’t know it caused deafness. I thought the sterility was scary enough.