Con-Crud Followup: Mumps Exposure at Large Non-Cosplay Event

As a follow up to our recent post about #ConCrud at comic, anime & furry #conventions, potentially 230,000 people may have been exposed to #mumps at a Texas cheerleading competition in February of this year. Of those, more than 25,000 of the attendees were athletes and coaches, according to the National Cheerleading Association (NCA).

Mumps is an extremely contagious viral infection of the salivary glands that most commonly affects children. While most people born after 1957 have been vaccinated against mumps, measles and rubella (MMR), a few hundred cases of mumps usually occur each year. Large outbreaks of mumps occurred in the United States in 2006 and 2009–10 with more than 6,000 and 3,000 cases (respectively) reported in those years. A mumps outbreak at Penn State University infected 86 people.

While no specific cases of illness were reported as of the time that the CNN article was written on March 9, 2018 regarding the NCA cheerleading competition last month, the incubation period for mumps can range anywhere from 12 to 25 days. Typically, symptoms appear between 16 and 18 days of exposure and infection according to the CDC.

Mumps Symptoms

The most common symptoms for mumps include:

  • Fever
  • Headache
  • Muscle aches
  • Tiredness
  • Loss of appetite
  • Swollen and tender salivary glands under the ears on one or both sides (parotitis)

Parotitis occurs only in 31% to 65% of individuals infected with mumps. From 15% to 27% of people with mumps will have no signs or symptoms of illness; others may have respiratory symptoms or only nonspecific symptoms such as headache, loss of appetite, and low-grade fever. Thus, not everyone may know that they are sick or that the sickness that they have is mumps.

How Mumps Spreads

Mumps spreads from person to person via droplets of saliva or mucus from the mouth, nose, or throat of an infected person, usually when the person coughs, sneezes, or talks. The virus may also be spread indirectly when someone with mumps touches items or surfaces without washing their hands and then someone else touches the same surface and rubs their mouth or nose. Mumps is less contagious than measles or chickenpox.

Mumps Complications for Adults

While mumps is usually a mild disease for children, adults may have more serious disease and potentially more complications.

Post-puberty males could experience orchitis (testicular inflammation) as a complication of mumps. This may involve pain, swelling, nausea, vomiting, and fever, with tenderness of the area possibly lasting for weeks. Approximately half of patients with orchitis have some degree of testicular atrophy, but sterility is rare.

In females who are post-puberty, inflammation of the ovaries (oophoritis) and/or breasts (mastitis) can occur. An increase in spontaneous abortion (miscarriage) has been found among women who developed mumps during the first trimester of pregnancy in some studies but not in others. There is no evidence that mumps causes birth defects.

Deafness, in one or both ears, can occur in approximately one per 20,000 reported cases of mumps.

People who Need Secondary MMR Vaccinations

Adults who are at a higher risk of exposure to measles, mumps, and/or rubella and may need a second dose of MMR vaccine unless they have other evidence of immunity; this includes adults who are:

  • Students in postsecondary educational institutions (for measles and mumps)
  • Healthcare personnel (for measles and mumps).
  • Living in a community experiencing an outbreak or recently exposed to the disease (for measles and mumps).
  • People planning to travel internationally (for measles and mumps)
  • People who received inactivated (killed) measles vaccine or measles vaccine of unknown type during 1963-1967 should be revaccinated with two doses of MMR vaccine.
  • People vaccinated before 1979 with either killed mumps vaccine or mumps vaccine of unknown type who are at high risk for mumps infection (e.g., people who are working in a healthcare facility) should be considered for revaccination with 2 doses of MMR vaccine.

Mumps Cases in the U.S. by Year

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Mumps Cases by State as of May 1, 2017

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References

 

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Tis’ the Season of Con-Crud

As this is essentially the start of the comic, anime & furry convention season around the country, it’s also the beginning of the spread of #ConCrud, a.k.a., #ConPlague, the #Blorch, etc.

What Is Con-Crud?

Con-crud (or any of the related terms) is a colloquialism used to describe any of a number of infectious diseases (typically respiratory or gastrointestinal) that an unlucky attendee has contracted while attending a convention.

Infectious diseases are disorders caused by pathogens (or foreign organisms, i.e., bacteria, viruses, fungi or parasites) that have invaded a person’s body. When an infection occurs, a pathogen has successfully entered a person’s body where it begins to grow and multiply. This is referred to as colonization and the person has then become the unwitting host for the pathogen.

The appearance and severity of an infectious disease depends on the ability of the pathogen to damage the host, as well as the host’s ability to resist the pathogen. The host’s resistance depends upon his/her immune system, which (while attempting to control an infection) can also damage the host’s body. It is at this point during the disease process that the host will begin to experience one or more signs & symptoms.

Signs & Symptoms

After being infected with a disease-causing pathogen, a person may not begin to experience signs or symptoms associated with the disease for as many as 1 to 4 days. Thus, many attendees that were infected at a convention don’t begin to experience signs or symptoms until after they have returned to their homes.

The types of signs & symptoms that someone may experience varies depending upon the type and virulence of the infectious disease(s) that the he/she has contracted. And, yes: there is the possibility that more than one infectious disease has been contracted.

Signs & symptoms that are common to a number of infectious diseases include the following:

  • Fever
  • Diarrhea
  • Fatique
  • Muscle aches
  • Coughing
  • Sore throat
  • Congestion

Contagiousness

Infectious diseases that are easily transmitted via contact with an ill person or their secretions are often referred to as contagious diseases. As a subset of infectious diseases, a contagious disease is either especially infective or easily transmitted. While infectious diseases can be spread via a wide variety of ways, the methods of transmission most associated with contagious respiratory or gastrointestinal diseases usually involve one of the following methods:

  • Person-to-person contact.
  • Droplet spread.
  • Airborne transmission.
  • Contaminated objects.
  • Contaminated food or beverages.

Risk Factors

While anyone can catch an infectious disease, some people may have risk factors that can increase the possibility of becoming sick when exposed to a pathogen. This is especially true if a person’s immune system isn’t working properly. Several risk factors are listed below.

  • Taking steroids or other medications that suppress the immune system, such as anti-rejection drugs for a transplanted organ.
  • Anyone who has HIV or AIDS.
  • Certain types of cancer or other disorders that adversely affect the immune system.
  • Having an implanted medical device.
  • Malnutrition.
  • Extremes of age.
  • Smoking.

Why Can Disease Spread So Easily at Conventions?

Comic, anime & furry conventions can attract thousands (or even tens of thousands) of attendees. With limited space and crowded walkways for attendees to move & congregate in, attendees can often find themselves surrounded by large numbers of people. Cosplayers in particular also attract people wanting photos. This often includes posing with the cosplayers and possibly being in physical contact with the cosplayers while photos are taken.

Thus, person-to-person contact between a large number of people occurs at a much higher rate at a convention than it typically would at home, work or school. This gives pathogens that prefer to be spread by direct contact a much higher rate of success.

Given the large number of attendees crammed into small spaces, if any attendee sneezes or coughs (and they don’t cover their mouth & nose when it happens), any airborne pathogens that were released may be unknowingly breathed in by others or land on their skin where they may also be able to infect or wait to do so.

Then there’s all of the vendors at conventions with tables of items for sale. Multiple people may pick up a variety of items for sale without buying them, then put them back for others to pick up and handle. Any pathogens that may have been left behind on the items by someone who’s sick or is simply a carrier can quickly be spread to others who pick up those same items.

After being in close, person-to-person contact with other attendees, having taken photos with others or having handled various objects at the convention, should the hands of that attendee have pathogens on the skin surface and he/she then rubs their face, nose or ears: voila! Those waiting pathogens have just been provided direct access to entering into that person’s body and they become infected themselves.

And here’s something else to bear in mind: not everyone who uses public restrooms takes the time to wash their hands afterwards. There’s also the possibility that due to the large crowds at conventions, it’s entirely possible that the available public restrooms may run out of soap. Hence, there very likely will be people walking around the convention with unwashed hands handling objects and coming into direct contact with others. This increases the likelihood for fecal matter to be present in the convention hall & to potentially end up on items being handled by multiple people.

Attendees also have to eat, but did they wash their hands before doing so? Attendees can also be seen carrying open containers of food & beverages as they walk through a crowded convention. If someone nearby happens to cough or sneeze, there’s the possibility of droplets ejected by that person landing on or in that open food or beverage container.

And, let’s be perfectly honest here. Not everyone who suspects or knows that they’re sick or starting to become sick will do the right thing by not going to the convention. People can get very excited about attending a convention, especially if they put a lot of effort & money into buying passes, preparing cosplays or are expectantly looking forward to meeting a beloved celebrity. If they’re sick, starting to get sick or even getting over a very recent sickness, then they’re very likely contagious. And, by going to a crowded convention anyway, they are knowingly exposing a lot of other people to their germs.

Prevention

What can you do to protect yourself from becoming infected at a crowded convention?

  1. Assume that there are going to be sick & contagious attendees at the convention.
  2. Frequently wash or sanitize your hands. This is probably the most effective means of prevention.
  3. Avoid touching your eyes, nose & mouth. Each of these is an open door for pathogens.
  4. If you haven’t done so, get a flu shot at least 2 weeks prior to the first convention that you attend.
  5. Get plenty of rest. This will help your immune system. Sleep-deprivation does the opposite.
  6. Don’t drink excessive (or any) amounts of alcohol. Alcohol can affect the quality of your rest.
  7. Eat nutritionally, especially protein. Lack of protein can deplete the immune system.
  8. Take Vitamin C, but not more than 400 mg a day; anything above that will just be excreted in urine. While it may not prevent a cold, it may reduce the duration by one day.

If you do get sick, DON’T GO into the convention.

What Contagious Diseases Might Be Present at a Convention?

Finally, let’s jot down what the actual contagious diseases might include (but are not limited to) at any given crowded convention:

  • Common Cold.
  • Influenza (the flu, especially during flu season)
  • Strep Throat (possibly more than 1 type)
  • Gastroenteritis
  • Giardia

References