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Yeshivas in Ocean and Hudson counties were part of the largest mumps outbreak in the United States since 2006, Center for Disease Control and Prevention (CDC) officials told The Jewish State.

Between June 28, 2009 -- when an 11-year-old boy who contracted mumps on a trip to the United Kingdom started showing symptoms at an Orthodox Jewish summer camp in New York -- and Jan. 29, 2010, a total of 1,521 outbreak-related cases of mumps have been reported in New York and New Jersey, with over 97 percent of the cases occurring in the Orthodox community, CDC said in a report Feb. 12.

Of the 159 outbreak-related mumps cases in New Jersey, over 90 percent came from Ocean County and are associated with "one rabbinical school" in the county, CDC epidemiologist Dr. Albert Barskey said in an interview. In addition to outbreak-related cases in Bergen, Passaic, and Essex counties, Barskey said the CDC learned after Jan. 29 (the end date on its report) of cases in Hudson County stemming from a yeshiva there.

Leslie Terjesen, a spokesperson for the Ocean County Health Department, said the county's outbreak-related mumps cases occurred in Lakewood, with the possible exception of a few cases on the outskirts of the township. She said the department couldn't reveal the institutions that were affected.

"Our epidemiologist is working very, very closely with doctors in the community to make sure everything is being reported," Terjesen said.

CDC officials also said they couldn't disclose the names of the Ocean and Hudson County yeshivas affected by mumps. Barskey said CDC believes an individual who was infected with mumps in Brooklyn brought the virus to the Ocean County yeshiva. Most mumps cases within the Jewish community occur among teenage males who spend long hours face-to-face with school instructors, providing ample opportunity for exposure, explained Dr. Greg Wallace, a CDC research medical officer.

"We do think that prolonged close contact does influence how many mumps cases you get," Wallace said.

Dawn Thomas, a spokesperson for the New Jersey Health Department, said that there have been 246 confirmed and probable cases of mumps in the state -- whether they were related to the outbreak or not -- since September 2009, including 234 in Ocean County, five in Passaic County, three in Essex County, and two in Bergen County. Since the students at the Hudson County yeshiva aren't residents of that county, New Jersey didn't attribute their mumps cases to Hudson County in its statistics, Barskey said. The Hudson Regional Health Commission didn't return a request for comment.

Mumps typically starts with a few days of fever, headache, muscle aches, tiredness, and loss of appetite, and is followed by swelling of salivary glands, according to CDC.

Sixty-one percent of cases in the outbreak occurred among individuals between the ages of 7 to 18, and 76 percent of the patients were male, CDC said. Eighty-eight percent of the patients had received at least one dose of mumps-containing vaccine, and 75 percent had received two doses. Wallace explained that the mumps vaccine is effective in one dose for a range of 73 to 91 percent of those who receive it, and in two does for 79-95 percent; by comparison, the measles vaccine is close to 100 percent effective in two doses and the rubella vaccine is 100 percent effective in just one dose, he said.

"We know that mumps outbreaks can occur in vaccinated communities," Wallace said.

Terjesen said Lakewood has seen 159 cases of mumps, including those related and unrelated to the outbreak, since Sept. 11, 2009. Patients range from the ages of 3 months to 62 years, she said. Nineteen of the patients had complications from the mumps, Terjesen said, including 17 with Orchitis (inflammation of the testicles), one from Oophoritis (inflammation of the ovaries), and one from Bell's palsy. Of the outbreak-related cases, seven came from individuals outside the Orthodox community, she said.

Karen Casey, nurse manager at Chemed Health, a Lakewood medical facility serving mostly the Orthodox community, said the recent mumps cases she has seen have been scattered among all ages, from infants to school children to adults.

"I couldn't really say that it's limited to one place or another," Casey said.

The number of mumps cases Chemed has been treating has gone down over the past few weeks, Casey said, crediting the county health department's efforts to make sure that children who contract the virus leave school immediately.

Kristine Brown, a spokesperson for Kimball Medical Center in Lakewood, said the center hasn't yet seen any patients with mumps in 2010.

"It actually seems to be calming down at this point," Casey said of the mumps situation.

Echoing CDC's sentiments, Casey said the closeness of schools and households is the primary reason for mumps in the Jewish community.

"If we are seeing [mumps] in children, we are seeing it in the whole family," she said.

Before the recent outbreak in New York and New Jersey, the largest mumps outbreak in the U.S. was a 4,000-case incidence over a three-month period in the Midwest in 2006, CDC said. CDC never identified the source for that outbreak, which took place primarily among college students in dorm settings, Barskey said.

Despite the fact that the mumps vaccine isn't as effective as vaccines for measles and rubella, the best way to control the virus is still with two-dose vaccine coverage in addition to early recognition and isolation, Wallace said. Mumps can be difficult to detect because individuals don't display many of the symptoms early on, he said, causing doctors to miss the virus before it spreads to other individuals.