A dozen or more cases of mumps have been reported among Loyola University Maryland students over the past month, prompting officials to alert the campus community to signs of the rare virus that has spread rapidly across college campuses in recent outbreaks.
That's as many cases as have occurred in a typical year statewide since 2005, when the state health department started tracking outbreaks.
Confirmed and suspected infections were found in undergraduate students in multiple class years and living both on and off Loyola's North Baltimore campus. City and state health officials are investigating possible links among the students.
New cases have continued to crop up as university officials moved to warn the wider campus population of the risk, urging them to seek medical attention if they exhibit symptoms, which often include swollen salivary glands and fever.
Isolation is key to stopping the spread of the virus, which can't be treated with antibiotics. Patients are usually told to rest, drink plenty of fluids and take over-the-counter pain relievers or use warm or cold packs for swelling.
Mumps largely disappeared in the United States after a vaccine became available in 1967, but significant outbreaks have occurred, often among college students living in close quarters. One involved more than 6,500 people, predominantly college students, in the Midwest in 2006. The vaccine is considered about 90 percent effective, though its strength can wane with time.
While cases are rarely severe or deadly, one doctor old enough to have experienced the disease called it "not all that pleasant." And though the case count is relatively low out of Loyola's student population of 3,900 undergraduates, it could grow rapidly. About 3,200 students live on the campus.
"It obviously bears watching," said Dr. Charles Haile, chief of infectious disease medicine at Greater Baltimore Medical Center. "Sometimes with an outbreak like this, it has a geometric spread."
University officials said they notified students and their parents of the first few mumps cases before spring break began March 4. After more were reported over spring break, they cautioned the wider campus population of the growing number of cases in a letter sent Monday.
Since that letter was sent, "a few more" suspected cases have been reported on top of 12 previous confirmed and suspected cases, university spokeswoman Courtney Jolley said.
The letter warns the campus to be on guard for symptoms including salivary gland swelling, low-grade fever, muscle aches and testicular or ovarian inflammation and tenderness. It adds that those who contract the virus can be contagious for up to two days before any symptoms are present, urging frequent hand washing, avoidance of sharing drinks or utensils, and thorough cleaning of bathroom and kitchen surfaces, computer keyboards and phones.
The virus typically has a 16-to-18-day incubation period before any symptoms show. It spreads through the air by coughing or through contact with infected fluids from the mouth, nose or throat. Those who are infected without complications typically recover within two weeks, according to the Centers for Disease Control and Prevention.
Rare complications can include brain infections like meningitis or encephalitis, hearing loss, and testicle or ovarian swelling that can lead to sterility.
University officials urged students showing any of the symptoms to contact the campus' health center at 410-617-5055 or their personal health care provider, and to stay home from school, work or social gatherings.
While a two-part series of vaccinations known as MMR (for measles, mumps and rubella) has made mumps a rare disease in the United States, it still is relatively more common in other countries. Many outbreaks have been traced to people who have contracted the virus while traveling to other parts of the world, before bringing it back and spreading it, despite widespread vaccination.
"It can spread then from the [initial] case to other cases pretty easily if it isn't diagnosed properly," Haile said.
Since 2005, mumps cases have been scarce in Maryland, with eight to 12 cases reported in most years, according to state health department data.
The only exception was 2006, when 48 cases were reported in Maryland during a nationwide epidemic that was the largest in nearly two decades. It is not known how that outbreak began, but it centered on Iowa college campuses and spread across the country, largely in the Midwest.
In the most significant outbreak since then, more than 1,500 cases were reported in New York and New Jersey in 2009. That outbreak was thought to originate from an 11-year-old boy who contracted mumps on a trip to the United Kingdom and spread the disease through a New York summer camp.
Students on the Loyola campus interviewed Thursday said they were on alert for the disease, but were not concerned about their health.
Meghan Beretta, a sophomore from Passaic County, N.J., said someone in her history class came down with the virus, but it was shortly before spring break, so she didn't expect to have a high risk of exposure.
"I've been pretty healthy," Beretta said.
There is some worry among students trying to avoid a bout of illness — "It's been the subject of jokes when anybody has a cold or anything," said John Kelley, a sophomore from Fairfax, Va.
"But it doesn't pose a lot of concerns for me in my day-to-day life," Kelley said.
Cause: Viral infection
Symptoms: Swelling and tenderness of salivary and other glands, testicles, ovaries; low-grade fever; headache; loss of appetite
Incubation period: 16-18 days
Transmission: Spread via coughing, other contact with saliva or other mouth, nose and throat fluids
Prevention: MMR vaccine series considered 90 percent effective; isolation used to prevent spread of virus