Alaska public health officials are trying to slow the spread of the ongoing mumps outbreak with new recommendations for patients and health providers.

All Alaska residents are now eligible for a third dose of the MMR vaccine — which provides protection against measles, mumps and rubella — if it has been at least five years since their second dose, according to a Feb. 21 public health advisory. The new regulations come as mumps continues to spread outside of Anchorage, making it difficult for public health officials to identify those at high risk of being infected, according to the release.

Since an outbreak began in Anchorage last summer, 214 confirmed and 33 probable cases of the mumps have been reported to the Alaska Section of Epidemiology. The public health advisory recommends that health care providers ensure patients are up-to-date for vaccination schedules published by the Centers for Disease Control and Prevention. These include giving two doses of MMR vaccine to children 6 years and under, with the first dose given between 12 and 15 months. Adults born after 1957 who have only received on dose of the vaccine and are at higher-risk of contracting the disease, such as health care workers, international travelers and college students, should also receive a second MMR dose.

The Department of Health and Social Services also recommends that those in areas where mumps is circulating and who interact in group settings, such as day care facilities, work, schools and churches, receive second or third doses of the MMR vaccine.

Mumps is a reportable illness, which means that health care providers are required to notify public health officials if they come across any cases.

The 2017 Anchorage outbreak greatly surpassed the number of mumps cases seen in recent years in the state. In the last five years, Alaska has seen one or fewer cases of a mumps per year, according to data provided online by the Alaska Department of Health and Social Services.

Symptoms of mumps are fever, headaches, muscle aches, tiredness, loss of appetite and swollen salivary glands. In some cases, the virus can cause complications like meningitis, encephalitis and permanent hearing loss. The virus generally takes 16 to 18 days to incubate and is most infectious two days before the onset of symptoms, according to the CDC.

For those who are already infected, the best ways to prevent transmission is to wash your hands, cover your mouth when coughing and avoid contact with others.