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MUMPS:. (You “mumpsed out” yet?). A pre cautionary tale. Gaynor Watson-Creed, MSc, MD, CCFP, FRCP(C) Medical Officer of Health, Capital District Health Authority (Halifax). And lo, an outbreak was borne…. There once was a student with cheek lumps Who knew not what to do with these bumps.

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You mumpsed out yet

MUMPS:

(You “mumpsed out” yet?)

A precautionary tale

Gaynor Watson-Creed, MSc, MD, CCFP, FRCP(C)

Medical Officer of Health, Capital District Health Authority (Halifax)


And lo, an outbreak was borne…

There once was a student with cheek lumps

Who knew not what to do with these bumps.

So to Halifax s/he fled

To go bar-hopping instead

And so gave his/her hosts the great gift of the mumps.


About halifax cdha
About Halifax (CDHA)

  • 4 amalgamated municipalities (HRM) + East Hants

  • 5 post secondary institutions + Nova Scotia Community College (4 campuses)

  • 420 family docs – private offices, not hospital based

  • 2 large tertiary-care hospitals (11 campuses; 10000 employed at CDHA; 3000 at IWK)

  • Department of National Defense – 8700 personnel, 120 hcws

  • Coast Guard

  • Population: approx 400 000


About nova scotia
About Nova Scotia

  • Population – 913 000

  • Proportion of persons aged 20-24 – 56 000

  • Proportion of persons aged 15-19 – 62 000

  • 5 additional universities + Nova Scotia Community College (9 campuses)

  • DND, Coast Guard


Where we ve been
Where we’ve been…

PHAC; November 9, 2007




Our definition of the precautionary principle
Our definition of the precautionary principle:

In the absence of certainty as to what to do, we will use our best knowledge and understanding of what MIGHT work to control this outbreak.

PRIMARY ASSUMPTION: that risk of mumps and of outbreak required doing something


Applying precaution during mumps twice unlucky
APPLYING PRECAUTION during mumps: twice unlucky…

  • Early in the outbreak

    • aggressive case finding

    • aggressive contact tracing

    • aggressive case management

    • aggressive contact management

  • Purpose

    • to find as many cases as possible (stop spread)

    • to find as many contacts as possible (stop spread)

  • 2. Mid outbreak

    • aggressive management of health care workers

  • Purpose

    • to prevent hcws from bringing mumps into the institutions


  • Finding and achieving new normal
    Finding and achieving “New Normal”

    Public Health Services

    Other Health Care Responses

    “NEW NORMAL”

    Activity Levels (Operational)

    “Denouement”

    Baseline operations

    Time


    Outcomes:

    Cases continued to accumulate

    Cases became “mumpsed out” – non compliance

    Contacts difficult to find

    Massive document management challenges

    PHS staff overtaken by OH and IC response

    Exhausted staff – and new programs and other PH challenges on the horizon!


    Our ethical dilemnas became these
    Our ethical dilemnas became these…

    • What is the appropriate response to an outbreak in the face of other public health burdens? When is doing nothing ok?

    • What was the harm to the public from our precautionary approach to mumps?

    • What was the harm to our organization(s) from our precautionary approach to mumps?


    Con t
    (con’t)…

    • Can you know in advance of applying the principle that the burden of applying the precautionary approach might outweigh the benefit (e.g. during an evolving outbreak)?

    • Can you “take it back”?

    …We did, but not without issues…


    Thank you questions
    Thank you. Questions?

    “Thank goodness we have the opportunity to learn these things through mumps and not_____________.”


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