Raise your hand if you thought mumps — the infectious disease that can make your neck swell — had gone the way of Saturday classes, cheap tuition and residence hall curfews.
Separate outbreaks in the past month at both High Point University and Elon University show that mumps still lurks. The two schools confirmed a combined 17 mumps cases — five more than were reported across all of North Carolina in 2018.
In fact, several recent outbreaks at colleges and universities led to national surges in reported mumps cases over the past several years.
So why do college campuses seem to be a nexus for mumps cases? And why mumps of all things? Pull out a pen and paper or your laptop because this all might be on the test.
What is mumps?
Mumps is a contagious viral disease that can cause puffy cheeks and a swollen jaw.
Mumps starts out like a bad cold or the flu — with fever, headache, muscle aches, fatigue and loss of appetite. Next comes massive swelling of the salivary glands for about one long, miserable week.
Some people who get the mumps show very mild symptoms or no symptoms at all. In unusual cases, mumps can cause inflammation of the testicles or ovaries. In rare cases it causes hearing loss.
Symptoms don’t usually appear until on average 16 to 18 days after a person is infected. An infected person is contagious for two days before their face begins to swell and five days after swelling appears.
How does mumps spread?
The mumps virus is found in saliva and in respiratory droplets in the throat, nose and mouth.
The virus spreads in lots of ways: by sneezing, coughing, talking or kissing; by sharing cups, bottles and eating utensils; by taking part in sports, dancing or other close-contact activities; and by touching things with unwashed hands that contagious people with unwashed hands have touched before you.
How common is mumps?
Back in the day, mumps was a common childhood disease. During World War I, according to the U.S. Centers for Disease Control and Prevention, the only illnesses that sent more soldiers to the hospital were influenza and gonorrhea. Some 212,000 mumps cases were reported in 1964, according to the CDC — nearly the combined enrollment of North Carolina’s 16 public universities today.
Mumps declined after a vaccine (more on that in a minute) was introduced in the United States in the late 1960s. After a two-dose mumps vaccine became commonplace by the late 1980s, reported mumps cases declined by 99%.
Since 2005, North Carolina has generally seen between three and 15 mumps cases per year, according to the N.C. Department of Health and Human Services. The cases at HPU were the first in Guilford County since 2014. Alamance County, Elon’s home, hadn’t seen a mumps case since 2006.
Even three recent statewide spikes — 60 cases in 2006, 49 in 2016 and 50 in 2017 — are relatively minor compared to the pre-vaccine days.
Nationally since 2000, the CDC said the number of mumps cases have fluctuated between 229 in 2012 and 6,584 in 2006, when mumps swept through several college campuses in the Midwest. Most years, the U.S. sees fewer than 1,000 mumps cases.
Is there a cure?
Nope. But there is a vaccine. Most Americans have been vaccinated against mumps. Many have received two rounds of the MMR (measles, mumps and rubella) vaccine — at 12 to 15 months and at 4 to 6 years.
North Carolina law requires most college students to get at least two mumps vaccine shots before they can enroll, though students can apply for medical or religious exemptions. Elon and High Point universities say they comply with the state’s vaccination laws and that nearly all of their students have had at least two MMR shots.
The MMR vaccine isn’t foolproof, however. Health experts say two MMR shots are 88% effective at warding off mumps. Dr. Christopher Ohl, an infectious diseases expert with Wake Forest Baptist Health in Winston-Salem, said that the immunity to mumps provided by the vaccine can wane a bit for some people. This most often happens in late adolescence or early adulthood — about the time folks are going to college.
Why does mumps hit colleges so hard?
A college campus seems to be the perfect place for mumps. Mumps is highly contagious. College campuses are full of young adults whose protection against mumps might be starting to fade. And many colleges are what Ohl called a “congregate setting” — lots of people living, learning, eating and playing in the same spaces.
“What better setting to have person-to-person transmission than a university,” Ohl said.
High Point and Elon certainly fit the definition of a “congregate setting.” Nearly all of High Point’s undergraduates live on campus. At Elon, about two-thirds of students reside in university housing, while most of the rest can walk to campus in 10 minutes or less.
Since late September, health officials have confirmed 11 cases of mumps at High Point and six at Elon. (All of the infected persons were students.) Kelly Haight Connor, a state DHHS spokeswoman, said no other N.C. university has seen a mumps case this fall.
It could have been a lot worse. In a year-long outbreak from 2015 to 2016, the University of Iowa and the University of Illinois each reported more than 300 mumps cases.
As to why mumps hit Elon and HPU, no one knows exactly how it got to campus.
“It’s like flu — it’s always out there,” Connor said.
How did the schools respond?
Elon and High Point worked closely with county and state officials and rolled out what health officials described as a standard response.
“Everyone’s doing what they’re supposed to be doing,” Connor said.
Once mumps cases popped up on their campuses, the two schools notified other students and employees who might have come in contact with infected persons. They communicated with the campus about risk factors and preventative measures. And they offered MMR vaccines to students, faculty and staff. Elon has given out nearly 800 MMR shots at a pair of recent on-campus events. HPU is holding campuswide shot clinics this week.
Jana Lynn Patterson, Elon’s associate vice president for student life and dean of students, said Elon and other schools must be careful to share vital information without causing a panic. Elon, like many other schools in similar situations, developed and is following its plan for dealing with a campuswide illness.
“We’re not in a panic state,” Patterson said. “We’re managing things and managing individual students who are sick.”
But mumps was a little different, she said, and it prompted some anxiety on campus.
“Mumps isn’t something you hear about in a young adult population any more,” she said. “There are a lot of unknowns about it. It’s just not something we deal with every day.”
How worried should you be?
Not very worried at all, Ohl said, especially if you’re not a college student living on campus.
“Even if you are a college student,” he added. “I’d worry more about the final exams next week than getting the mumps. But wash your hands.”