Use of Facebook During a Mumps Outbreak, New York City, June-November 2015 New York City Department of Health and Mental Hygiene Bureau of Immunization AIM Bull’s Eye Award February 2016

Mumps Viral illness Parotitis or inflammation of other salivary glands Complications: orchitis, oophoritis, aseptic meningitis, encephalitis, hearing loss, mastitis, pancreatitis 20%-30% of cases may be asymptomatic Photo: NBC sports http://www.hngn.com/articles/52714/20141212/nhl-rumors-did-penguins-sidney-crosby-attend-practice-with-the-mumps.htm

Mumps Transmission Spread by respiratory droplets Infectious period: 2 days before parotitis onset through 5 days after Incubation period: 12-25 days after exposure No post-exposure prophylaxis

Diagnostic Testing PCR (Polymerase Chain Reaction) Specimen from buccal swab Collected through 5 days after parotitis onset Serology IgM False negative results in vaccinated individuals common

Classification of Mumps Clinical case definition: parotitis for ≥2 days Confirmed Meets clinical definition Positive PCR Probable IgM positive OR epidemiologic link to confirmed case or outbreak location

Mumps in New York City: 2006-2015 3 1 = Outbreak in religious community in Brooklyn, ~1,800 cases 2 = College outbreak, 55 cases 3 = Current outbreak

Mumps Cases in the Rockaways by Week of Parotitis Onset, June to November 2015 52 Confirmed/Probable: 29 Confirmed 23 Probable First case reported to DOHMH

Confirmed/Probable Mumps Cases in the Rockaways, Queens by Zip Code 2 associated with outbreak live outside of NYC (New Rochelle), were not considered among 52 in NYC outbreak 5 reside elsewhere in NYC (4 manhattan, 1 brooklyn) 47 reside in Rockaways neighborhood 5 reside elsewhere in NYC

Rockaway Beach

Age Distribution of Confirmed/Probable Mumps Cases Median age: 31 years Age range: 4 – 69 years

Characteristics of Confirmed/Probable Mumps Cases Evidence of prior immunity (2 doses MMR, IgG+, or birth before 1957): Immunity: 25 (48%) Unknown: 27 (52%) No complications or hospitalizations Common social settings 22 mentioned attending local Rockaways bars/restaurants in common

Rockaway Beach Bars

Laboratory Results for Confirmed/Probable Mumps Cases Positive by any test: 32/50 (64%) IgM positive: 7/47 (15%) PCR positive: 29/44 (66%)

Provider Focused Control Measures Enhanced surveillance: contacted providers in the Rockaways area to ask about recent and retrospective cases of parotitis Sent letter to Rockaways providers with information about mumps and mumps reporting Provided 50 doses of MMR vaccine to 2 local Federally Qualified Health Centers, available at no cost

Community Control Measures Communicated with local elected officials Assessed immunization coverage at local schools, auditing all schools with <90% of students completely immunized Distributed posters/flyers throughout the Rockaways Made sure to visit bars/restaurants mentioned by cases Returned to ensure that posters distributed were posted

Control Measures: Media Media coverage by local NYC and Rockaways neighborhood news outlets in August-September 2015 The Wave. September 18, 2015. p 43. Print. https://www.dnainfo.com/new-york/20150915/breezy-point/20-mumps-cases-reported-rockaway-health-officials-say

Despite Control Measures As of October, DOHMH continued to receive mumps reports from the Rockaways, outbreak was not slowing Concern that control measures had not reached affected population Looked for better way to reach target population

Control Measures: Facebook Ran Facebook ad from 10/30 through 11/17 Targeted persons aged 20-59 years Targeted 7 Rockaways-associated zip codes determined by: Home address in Facebook IP address used to access internet Location of mobile device

Control Measures: Facebook Ad

Control Measures: Facebook Ad Results Shown to: 86,118 people (unique users) Liked, commented, or shared: 2,094 Clicks: 4,085 Engagement rate: 5% Inexpensive: cost was $3,200

Control Measures: Facebook Ad Results Commenters were able to ask questions, DOHMH provided responses

Control Measures: Facebook Ad Results Many comments indicated no prior knowledge of the outbreak

Conclusions Recognition of the outbreak was delayed Importance of PCR in addition to serologic testing to diagnose mumps Negative laboratory results or evidence of immunity do not exclude mumps Report to the health department when mumps suspected Facebook was a valuable tool for successfully and rapidly reaching the target demographic Able to target specific population Promoted engagement with DOHMH

Acknowledgements Surveillance Unit, Bureau of Immunizations, NYC DOHMH Bureau of Communication, NYC DOHMH Office of External Affairs, NYC DOHMH Public Health Laboratory, NYC DOHMH Measles, Mumps, Rubella, and Herpesvirus Laboratory, CDC

Thank you Questions? Contact information: Jane R. Zucker, MD, MSC Assistant Commissioner, BOI, NYC DOHMH e-mail: jzucker@health.nyc.gov phone: 917-807-5686