CDC Reports on Mumps Outbreak in Midwest

The Centers for Disease Control and Prevention (CDC) is investigating an outbreak of mumps that began in Iowa in December 2005. As of April 10, 2006, more than 500 possible cases had been reported in Iowa, and other cases that were thought to be linked to the Iowa outbreak were being investigated in Illinois, Kansas, Minnesota, Missouri, Nebraska, and Wisconsin.

Two persons who were diagnosed with mumps and were potentially infectious traveled on Northwest Airlines and American Airlines flights between March 26 and April 2, 2006. The full CDC report contains a complete list of flights and is available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm55d411a1.htm?s_cid=mm55d411a1_e.

Mumps is characterized by a nonspecific prodrome, including myalgia, anorexia, malaise, headache, and fever, followed by acute onset of unilateral or bilateral tender swelling of parotid or other salivary glands. An estimated 60 to 70 percent of mumps infections produce typical acute parotitis. Approximately 20 percent of infections are asymptomatic, and nearly 50 percent are associated with nonspecific or primarily respiratory symptoms. Complications include orchitis, oophoritis, mastitis, meningitis, encephalitis, spontaneous abortion, and deafness. Transmission occurs by direct contact with respiratory droplets or saliva. The incubation period is 14 to 18 days, and the infectious period is from three days before symptom onset until nine days after symptom onset.

The risk for transmission of respiratory infectious diseases during air travel may depend on several factors, including immunity of passengers, infectiousness of the organism, degree of shedding of the pathogen by infectious passengers, hygienic practices of infectious passengers, proximity of others to infectious passengers, hygienic practices of the other passengers and flight crew, flight duration, and cabin environment of the aircraft. Although exposure and transmission of mumps during commercial air travel has not been described previously, transmission of other respiratory pathogens during air travel has been reported.

AAN Review of Carotid Endarterectomy

Carotid endarterectomy is the most common procedure used in the prevention of stroke. A subcommittee of the American Academy of Neurology (AAN) reviewed articles on carotid endarterectomy to assess the effectiveness of the procedure in preventing stroke in patients with internal carotid artery stenosis. The review was published in the September 27, 2005, issue of Neurology.

The AAN found good evidence to support carotid endarterectomy in patients with 70 to 99 percent internal carotid artery angiographic stenosis that has been symptomatic in the previous six months. Endarterectomy may be considered in patients with 50 to 69 percent symptomatic stenosis, but it is not indicated for patients with less than 50 percent symptomatic stenosis. Consideration of carotid endarterectomy is reasonable in selected patients with 60 to 99 percent asymptomatic stenosis.

Physicians should consider patient variables and radiologic factors when deciding whether carotid endarterectomy should be performed. For example, the procedure was of no clear benefit in women with 50 to 69 percent symptomatic stenosis; was of more benefit in patients with hemispheric transient ischemic attack (TIA) or stroke than in those with retinal ischemic events; was of no benefit in patients with asymptomatic stenosis and contralateral occlusion; and was of persistent benefit (although it increased risk) in patients with symptomatic stenosis and occlusion. The procedure is of greater benefit in patients whose last TIA or mild stroke occurs within two weeks of the operation.

Because the benefit of carotid endarterectomy is seen only after several years, the AAN recommends that patients undergoing the procedure have at least five years' life expectancy and that the perioperative stroke or death rate be less than 6 percent in patients with symptomatic stenosis. The AAN found good evidence that endarterectomy can reduce the future stroke rate if the perioperative stroke or death rate is kept below 3 percent.

Carotid endarterectomy should be performed without delay in patients with severe stenosis and a recent TIA or nondisabling stroke, preferably within two weeks after the last symptomatic event. The benefit of the procedure within four to six weeks after a moderate to severe stroke is unclear.

Low-dose aspirin (i.e., 81 to 325 mg) should be administered before and for at least three months after the procedure because this reduces the rates of stroke, myocardial infarction, and death. Aspirin should be continued indefinitely in the absence of contraindications.

Data regarding the value of emergent carotid endarterectomy in patients with a progressing neurologic deficit were insufficient for the AAN to make a recommendation.

NCHS Publishes Personal Health Assessment Survey Results

The National Center for Health Statistics (NCHS) published statistics on personal health assessment in the July 29, 2005, issue of Morbidity and Mortality Weekly Report. The NCHS found that American Indian/Alaskan Native and black adults were less likely than white or Asian adults to assess their health as excellent or very good. Seethe accompanying figure for results by race.

Percentage of Adults Who Assessed Their Health as Excellent or Very Good—United States, 1999 to 2003*

---

Figure.

Results of the National Center for Health Statistics' National Health Interview Survey (1999 to 2003), which asked participants to assess their own health as excellent, very good, good, fair, or poor.