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Rolfes MA, Millman AJ, Talley P, Elbadawi LI, Kramer NA, Barnes JR, Blanton L, Davis JP, Cole S, Dreisig JJ, Garten R, Haupt T, Jackson MA, Kocharian A, Leifer D, Lynfield R, Martin K, McHugh L, Robinson S, Turabelidze G, Webber LA, Pearce Weinberg M, Wentworth DE, Finelli L, Jhung MA. Influenza-Associated Parotitis During the 2014-2015 Influenza Season in the United States. Clin Infect Dis 2018; 67:485-492. [PMID: 29617957 PMCID: PMC6295667 DOI: 10.1093/cid/ciy136] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/13/2018] [Indexed: 02/06/2023] Open
Abstract
Background During the 2014-2015 influenza season in the United States, 256 cases of influenza-associated parotitis were reported from 27 states. We conducted a case-control study and laboratory investigation to further describe this rare clinical manifestation of influenza. Methods During February 2015-April 2015, we interviewed 50 cases (with parotitis) and 124 ill controls (without parotitis) with laboratory-confirmed influenza; participants resided in 11 states and were matched by age, state, hospital admission status, and specimen collection date. Influenza viruses were characterized using real-time polymerase chain reaction and next-generation sequencing. We compared cases and controls using conditional logistic regression. Specimens from additional reported cases were also analyzed. Results Cases, 73% of whom were aged <20 years, experienced painful (86%), unilateral (68%) parotitis a median of 4 (range, 0-16) days after onset of systemic or respiratory symptoms. Cases were more likely than controls to be male (76% vs 51%; P = .005). We detected influenza A(H3N2) viruses, genetic group 3C.2a, in 100% (32/32) of case and 92% (105/108) of control specimens sequenced (P = .22). Influenza B and A(H3N2) 3C.3 and 3C.3b genetic group virus infections were detected in specimens from additional cases. Conclusions Influenza-associated parotitis, as reported here and in prior sporadic case reports, seems to occur primarily with influenza A(H3N2) virus infection. Because of the different clinical and infection control considerations for mumps and influenza virus infections, we recommend clinicians consider influenza in the differential diagnoses among patients with acute parotitis during the influenza season.
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Affiliation(s)
- Melissa A Rolfes
- Epidemic Intelligence Service, Atlanta, Georgia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alexander J Millman
- Epidemic Intelligence Service, Atlanta, Georgia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pamela Talley
- Epidemic Intelligence Service, Atlanta, Georgia
- Minnesota Department of Health, St. Paul, Madison
| | - Lina I Elbadawi
- Epidemic Intelligence Service, Atlanta, Georgia
- Bureau of Communicable Disease, Wisconsin Division of Public Health, Madison
| | - Natalie A Kramer
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John R Barnes
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lenee Blanton
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeffrey P Davis
- Bureau of Communicable Disease, Wisconsin Division of Public Health, Madison
| | - Stefanie Cole
- Michigan Department of Health and Human Services, Lansing
| | - John J Dreisig
- New Hampshire Division of Public Health Services, Concord
| | - Rebecca Garten
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thomas Haupt
- Bureau of Communicable Disease, Wisconsin Division of Public Health, Madison
| | | | - Anna Kocharian
- Bureau of Communicable Disease, Wisconsin Division of Public Health, Madison
| | - Daniel Leifer
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Karen Martin
- Minnesota Department of Health, St. Paul, Madison
| | - Lisa McHugh
- Communicable Disease Service, New Jersey Department of Health, Trenton
| | - Sara Robinson
- Maine Center for Disease Control and Prevention, Maine Department of Health and Human Services, Augusta
| | | | - Lori A Webber
- Maine Center for Disease Control and Prevention, Maine Department of Health and Human Services, Augusta
| | - Meghan Pearce Weinberg
- Epidemic Intelligence Service, Atlanta, Georgia
- Michigan Department of Health and Human Services, Lansing
| | - David E Wentworth
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lyn Finelli
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael A Jhung
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
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Elbadawi LI, Talley P, Rolfes MA, Millman AJ, Reisdorf E, Kramer NA, Barnes JR, Blanton L, Christensen J, Cole S, Danz T, Dreisig JJ, Garten R, Haupt T, Isaac BM, Jackson MA, Kocharian A, Leifer D, Martin K, McHugh L, McNall RJ, Palm J, Radford KW, Robinson S, Rosen JB, Sakthivel SK, Shult P, Strain AK, Turabelidze G, Webber LA, Weinberg MP, Wentworth DE, Whitaker BL, Finelli L, Jhung MA, Lynfield R, Davis JP. Non-mumps Viral Parotitis During the 2014-2015 Influenza Season in the United States. Clin Infect Dis 2018; 67:493-501. [PMID: 29617951 PMCID: PMC6240917 DOI: 10.1093/cid/ciy137] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 02/13/2018] [Indexed: 12/17/2022] Open
Abstract
Background During the 2014-2015 US influenza season, 320 cases of non-mumps parotitis (NMP) among residents of 21 states were reported to the Centers for Disease Control and Prevention (CDC). We conducted an epidemiologic and laboratory investigation to determine viral etiologies and clinical features of NMP during this unusually large occurrence. Methods NMP was defined as acute parotitis or other salivary gland swelling of >2 days duration in a person with a mumps- negative laboratory result. Using a standardized questionnaire, we collected demographic and clinical information. Buccal samples were tested at the CDC for selected viruses, including mumps, influenza, human parainfluenza viruses (HPIVs) 1-4, adenoviruses, cytomegalovirus, Epstein-Barr virus (EBV), herpes simplex viruses (HSVs) 1 and 2, and human herpes viruses (HHVs) 6A and 6B. Results Among the 320 patients, 65% were male, median age was 14.5 years (range, 0-90), and 67% reported unilateral parotitis. Commonly reported symptoms included sore throat (55%) and fever (48%). Viruses were detected in 210 (71%) of 294 NMP patients with adequate samples for testing, ≥2 viruses were detected in 37 samples, and 248 total virus detections were made among all samples. These included 156 influenza A(H3N2), 42 HHV6B, 32 EBV, 8 HPIV2, 2 HPIV3, 3 adenovirus, 4 HSV-1, and 1 HSV-2. Influenza A(H3N2), HHV6B, and EBV were the most frequently codetected viruses. Conclusions Our findings suggest that, in addition to mumps, clinicians should consider respiratory viral (influenza) and herpes viral etiologies for parotitis, particularly among patients without epidemiologic links to mumps cases or outbreaks.
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Affiliation(s)
- Lina I Elbadawi
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Bureau of Communicable Diseases, Wisconsin Division of Public Health, Madison
| | - Pamela Talley
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Minnesota Department of Health, St. Paul, Atlanta, Georgia
| | - Melissa A Rolfes
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alexander J Millman
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Natalie A Kramer
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John R Barnes
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lenee Blanton
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Stefanie Cole
- Michigan Department of Health and Human Services, Lansing
| | - Tonya Danz
- Wisconsin State Laboratory of Hygiene, Madison
| | - John J Dreisig
- New Hampshire Division of Public Health Services, Concord
| | - Rebecca Garten
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thomas Haupt
- Bureau of Communicable Diseases, Wisconsin Division of Public Health, Madison
| | - Beth M Isaac
- New York City Department of Health & Mental Hygiene Bureau of Immunization, Queens
- CSTE/CDC Applied Epidemiology Fellowship, Atlanta, Georgia
| | | | - Anna Kocharian
- Bureau of Communicable Diseases, Wisconsin Division of Public Health, Madison
| | - Daniel Leifer
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Karen Martin
- Minnesota Department of Health, St. Paul, Atlanta, Georgia
| | - Lisa McHugh
- Communicable Disease Service, New Jersey Department of Health, Trenton
| | - Rebecca J McNall
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Palm
- Minnesota Department of Health, St. Paul, Atlanta, Georgia
| | - Kay W Radford
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sara Robinson
- Maine Center for Disease Control and Prevention, Maine Department of Health and Human Services, Augusta
| | - Jennifer B Rosen
- New York City Department of Health & Mental Hygiene Bureau of Immunization, Queens
| | | | - Peter Shult
- Wisconsin State Laboratory of Hygiene, Madison
| | - Anna K Strain
- Minnesota Department of Health, St. Paul, Atlanta, Georgia
| | | | - Lori A Webber
- Maine Center for Disease Control and Prevention, Maine Department of Health and Human Services, Augusta
| | - Meghan Pearce Weinberg
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Michigan Department of Health and Human Services, Lansing
| | - David E Wentworth
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brett L Whitaker
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lyn Finelli
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael A Jhung
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ruth Lynfield
- Minnesota Department of Health, St. Paul, Atlanta, Georgia
| | - Jeffrey P Davis
- Bureau of Communicable Diseases, Wisconsin Division of Public Health, Madison
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