24 year old OR nurse diagnosed  with mumps. Initially presented with about 3 days of unilateral parotid pain and swelling.   

Documented history of two doses of vaccine; her IgG antibody titer at time of hire about 5 years ago was 39.2 AU/mL (Positive >10.9 by that lab).

 

At the onset of symptoms she got a curbside from one of the surgeons who she was working with that day, and referred to one of our urgent care centers;  mumps confirmed by PCR.  Boyfriend had similar illness the week before;  was diagnosed as having salivary duct stone (!).

 

Once the diagnosis was made, we sent her home for 5 days.   Uneventful recovery.

 

We conferred with the state health department;  they felt that the intensity and duration of the exposure was similar to contact in a public place;  they did not feel that we had to check on immune status of all the people she had come in contact with, and a booster dose of vaccine was not indicated.  Of note is that we have a college campus outbreak of mumps that’s been going on for a several months.

 

I’m trying to reconcile the 5 year old IgG titer and having mumps disease.  Several factors.  Can humeral immunity wane over that relatively short period of time?  Or does she have impaired cellular immunity that is not measured.  Or was it a lab error and she was always susceptible, and her luck ran out.

 

Or it’s just not helpful getting the IgG titer at time of hire, like in this case, because we don’t know what a positive titre actualy represents.

 

Ed Galaid

   

 

 

Edward I. Galaid, MD, MPH, FACOEM

ABIM, ABPM (OM)

Medical Director, Roper St. Francis Physician Partners Occupational Medicine

Charleston, SC

Member, ACOEM Task Group,  Guidance for the Medical Evaluation of Law Enforcement Officers

Special Expert, NFPA Fire Service Occupational Safety & Health (FIX-AAA) Committee

(O) 843-402-5053