Compliance with Exclusion Requirements to Prevent Mumps Transmission

To the Editor: Control of com-municable diseases often relies in part on school and workplace exclusion. Exclusion policies are also likely to play a role in pandemic infl uenza control and currently are used as policy for control of several vaccine-preventable diseases, including mumps (1). Mumps virus is typically present in saliva from 2–3 days before to 4–5 days after onset of parotitis. However, virus has been isolated from saliva as early as 6 days before and as late as 9 days after the fi rst signs of salivary gland involvement (2). In Illinois, persons with mumps are excluded from school and the workplace for 9 days after onset of parotitis (3) to reduce transmission of mumps virus. However, exclusion policy is not consistent among all states. For example, persons diagnosed with mumps in Iowa are excluded from school and the workplace for 5 days, whereas persons with mumps in New York and California are excluded for 9 days. Illinois experienced a mumps outbreak during 2006 that resulted in 796 cases. We describe a telephone survey administered during April–June 2006, to a convenience sample of 174 persons >9 days after onset of parotitis during this outbreak to assess compliance with school and workplace exclusion requirements. The survey response rate was 68% (174/257). Among 94 (54%) persons with mumps who had attended school, 85 (93%) of 91 spent time at home after they began experiencing parotitis, and 6 (7%) of 91 did not stay home from school. Most persons were told by local health department staff, student health services staff, or their medical provider to remain at home for 9 days. Among persons with mumps who spent some time away from school, 48 (56%) of 85 remained at home for >9 days. However, 37 (44%) of 85 persons did not remain at home for the entire exclusion period (median 5 days; range 1–8 days). Among 111 (64%) persons who worked outside the home, 93 (87%) of 107 spent time at home after they began experiencing parotitis. Among persons who spent time away from work, 53 (57%) of 93 remained at home for >9 days. However, many persons (41%, 38/93) remained at home for fewer than the 9 days required by the state (median 5 days, range 1–8 days) after onset of paroti-tis. Reasons for complete noncom-pliance (not remaining at home from work during any part of the exclusion period) included not …