Parents should get a second mumps vaccine shot for their kids even if they are pre-Kindergarten aged, health officials in Johnson County have recommended.

At least 36 cases of mumps reported in the county involve school-aged children. The total number of children infected by the disease has jumped to 48. Denton, Dallas, Collin and Tarrant counties have also reported mumps cases, but Johnson County has been hit the hardest.

Employees at Grumps restaurant in Cleburne said they have been instructed to constantly scrub counters and tables and use hand sanitizer many times an hour as the mumps disease has become a real fear throughout the county.

In Dallas County, health official Christopher Perkins said, “So, maybe there might need to be an adjustment to the vaccine regime – or another dose might need to be added later on in childhood or the late teens. And also, we need to remind adults need to be current on their vaccines as well.”

According to CDC, more than 4,000 cases of mumps have already been reported nationwide, roughly triple the total number of cases reported in 2015.

Mumps is a viral illness and it rarely causes serious complications. The list of common symptoms includes swelling in the cheek and neck, pain in the jaw and fever, which can be eased using over-the-counter medications.