Mumps virus detection during an outbreak in a highly unvaccinated population in British Columbia.

OBJECTIVES: Control measures of mumps involve isolation of those symptomatic or potentially exposed. Recent guidelines have recommended shortening the isolation period from 9 days to 5 days after the onset of parotitis, despite using mainly historical evidence. In British Columbia, mumps circulated in a predominantly unvaccinated population in 2008. We compared laboratory findings between the different vaccination groups and assessed the period of mumps viral detection after onset of parotitis. METHODS: Demographic and clinical data were collected according to guidelines during the course of the outbreak. Clinical specimens, including buccal swabs, urine, CSF and sera, were collected on a single visit upon presentation for diagnosis. Laboratory diagnosis of mumps was confirmed by either virus detection by PCR and/or isolation in cell culture from clinical specimens, or by serology. RESULTS: Laboratory testing confirmed mumps on 85 (74%) of 115 cases by virus detection and/or serology. Thirty-nine (78%) of 50 cases had virus detected within the first 5 days after onset of parotitis, with the rate highest in specimens collected early. However, virus could be detected in 5 (56%) of 9 cases after day 5 and up to day 9. CONCLUSION: Our study questions whether a 5-day isolation period is sufficient to prevent mumps transmission in a susceptible population. Our observations are based on single specimen submission, whereas an optimal study design would entail serial collection after presentation of parotitis, as this reflects true viral shedding. Further investigations are warranted to validate patient isolation guidelines.

Carboplatin and vinblastine for the treatment of metastatic transitional cell carcinoma of the urothelial tract.

Many patients with metastatic transitional-cell carcinoma (TCC) are not appropriate candidates for standard cisplatin-based combination, because of inadequate renal function, poor performance status (PS), and other comorbid medical conditions. We have evaluated the efficacy and toxicity of a combination of carboplatin and vinblastine (CV) as a palliative regimen in these patients. The medical records of patients with metastatic TCC, who had been treated with CV at the British Columbia Cancer Agency from 1995 until 1999, were retrospectively reviewed. Treatment consisted of carboplatin (area under the curve = 5) on day 1, and vinblastine (4 mg/m(2)) on days 1 and 8, repeated every 4 weeks. A total of 42 patients were included in this study, of whom 39 had measurable disease. Median age was 73 years. Fifty-two percent of patients had a PS (Eastern Cooperative Oncology Group) of 2 or 3. Node-only disease was present in 26% of patients, bone metastasis in 26%, and liver metastasis in 24%. A total of 119 cycles were administered. Grade IV granulocytopenia occurred in 26% of patients, grade III anemia in 12%, and there were 3 episodes of febrile neutropenia occurring in two patients. The major nonhematologic toxicity was grade III fatigue in 17% of patients. There were no grade IV nonhematologic toxicity or treatment-related deaths. The overall response rate was 33% (13 of 39). Five patients (13%) achieved a complete response and 8 patients (20%) a partial response. The median duration of response was 32 weeks and median overall survival for all patients was 26 weeks. The combination of carboplatin and vinblastine given in this schedule is a feasible, well-tolerated, and active alternative for patients with metastatic TCC unfit for standard chemotherapy.