1. 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

2. 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

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

4. 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

5. 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

6. Mumps in New York City: 2006-20153
1 = Outbreak in religious community in Brooklyn, ~1,800 cases
2 = College outbreak, 55 cases
3 = Current outbreak

7. 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

8. 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

9. Rockaway Beach

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

11. 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

12. Rockaway Beach Bars

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

14. 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

15. 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

17. Control Measures: Media
Media coverage by local NYC and Rockaways neighborhood news outlets
in August-September 2015
The Wave. September 18, p 43. Print.

18. 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

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

20. Control Measures: Facebook Ad

21. 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

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

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

24. 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

25. 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

27. Thank you
Questions?
Contact information:
Jane R. Zucker, MD, MSC Assistant Commissioner, BOI, NYC DOHMH phone: