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Qin W, Wang Y, Yang T, Xu XK, Meng XM, Zhao CJ, Li SY, Xie SY, Li KC, Su H. Outbreak of mumps in a student population with high vaccination coverage in China: time for two-dose vaccination. Hum Vaccin Immunother 2019; 15:2106-2111. [PMID: 30779678 DOI: 10.1080/21645515.2019.1581526] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
In 2016, an outbreak of mumps occurred in a primary school in China with a student population having high vaccination coverage. An unmatched case-control study was performed to identify risk factors contributing to this outbreak, and a retrospective cohort study was conducted to evaluate the effectiveness of mumps-containing vaccine (MuCV). A total of 97 cases were identified during the outbreak, and the overall attack rate was 8.2%. Among students with confirmed vaccination status, 90% had received at least one dose of MuCV. Cases were more likely than non-cases to report taking the school bus during the epidemic period (adjusted OR = 2.3, 95% CI: 1.4-3.7). Vaccine effectiveness (VE) was higher for two-dose MuCV (76%, 95% CI:49â€"89%) than for one-dose MuCV (59%, 95% CI: 36â€"74%. The protection afforded by both one-dose and two-dose MuCV waned over time, from 82% among students vaccinated within 5 years to 41% among those vaccinated more than 10 years previously for one-dose VE, and from 90% to 25% over the same time period for two-dose VE. We found that outbreaks of mumps can occur in schools despite high coverage of one-dose MuCV vaccination. Although the VE of both two-dose and one-dose MuCV wanes over time, the overall VE for two-dose MuCV was superior than that of one-dose MuCV. Therefore, a two-dose MuCV schedule through routine services is likely needed in order to control mumps epidemics in China.
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Affiliation(s)
- Wei Qin
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention , Lu'an , Anhui , China.,Chinese Field Epidemiology Training Program (CFETP), Chinese Center for Disease Control and Prevention , Beijing , China.,Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University , Hefei , China
| | - Yao Wang
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention , Lu'an , Anhui , China
| | - Tao Yang
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention , Lu'an , Anhui , China
| | - Xiao-Kang Xu
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention , Lu'an , Anhui , China
| | - Xiang-Mei Meng
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention , Lu'an , Anhui , China
| | - Chang-Jun Zhao
- Department of Expanded Program on Immunization, Jin'an District Center for Disease Control and Prevention , Lu'an , Anhui , China
| | - Shao-Yi Li
- Department of Expanded Program on Immunization, Jin'an District Center for Disease Control and Prevention , Lu'an , Anhui , China
| | - Shao-Yu Xie
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention , Lu'an , Anhui , China
| | - Kai-Chun Li
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention , Lu'an , Anhui , China
| | - Hong Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University , Hefei , China
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Mumps outbreaks: A problem in need of solutions. J Infect 2018; 76:503-506. [PMID: 29678496 DOI: 10.1016/j.jinf.2018.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/18/2018] [Accepted: 03/24/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To discuss what is presently known about recent mumps outbreaks and what solutions can be suggested to ensure more complete protection against mumps. METHODS PubMed was used to search for all of the studies published over the last 15 years using the key words "mumps" or "mumps virus" or "mumps vaccine". More than 1500 articles were found, but only those published in English or providing evidence-based data were included in the evaluation. RESULTS Prevention of mumps remains an unsolved problem. Available vaccines are effective but the protection they evoke declines over time. The use of booster doses can control outbreaks but it is not precisely defined whether they can prevent them. The rapid decline of antibody levels could limit the impact of the introduction of a third dose in the recommended immunization schedule. Furthermore, in most of the areas, mumps viral strains that are genetically different from those included in the vaccines are emerging and this might favour vaccine escape. However, also for this problem, its real relevance in favouring outbreak development is not precisely defined. CONCLUSIONS The true reasons for the development of mumps outbreaks in people with very high vaccination coverage are not clearly understood. The use of a booster dose or the preparation of vaccines containing the emerging serotypes are possible solutions, but both have some limitations. Further studies mainly devoted to improve our knowledge of the immune response to mumps vaccines are needed before long-term effective mumps vaccines can be prepared and outbreaks can be avoided.
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Hu W, Li Y, Han W, Xue L, Zhang W, Ma W, Bi P. Meteorological factors and the incidence of mumps in Fujian Province, China, 2005-2013: Non-linear effects. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 619-620:1286-1298. [PMID: 29734606 PMCID: PMC7112015 DOI: 10.1016/j.scitotenv.2017.11.108] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/09/2017] [Accepted: 11/09/2017] [Indexed: 04/14/2023]
Abstract
BACKGROUND Mumps is still an important public health issue in the world with several recent outbreaks. The seasonable distribution of the disease suggested that meteorological factors may influence the incidence of mumps. The aim of this study was to explore the possible association between meteorological factors and the incidence of mumps, and to provide scientific evidence to relevant health authorities for the disease control and prevention. METHODS We obtained the data of mumps cases and daily meteorological factors in Fujian Province in Eastern China over the period of 2005-2013. Using distributed lag non-linear model (DLNM) approach, we assessed the relationship between the meteorological factors and mumps incidence. RESULTS The effects of meteorological factors on the mumps incidence were all non-linear. Compared with the lowest risk values, the upper level of precipitation, atmospheric pressure and relative humidity could increase the risk of mumps, whereas the low level of wind velocity, temperature, diurnal temperature range and sunshine duration may also increase the risk. Moderate atmospheric pressure and low wind velocity had larger cumulative effects within 30lagdays and the relative risks were 10.02 (95%CI: 2.47-40.71) and 12.45 (95%CI: 1.40-110.78). For temperature, the cumulative effect within 30lagdays of minimum temperature was higher than that from maximum temperature in most populations. The cumulative effects of minimum temperature for males, children aged 10-14 and students were higher than those in other populations. CONCLUSIONS Meteorological factors, especially temperature and wind velocity, should be taken into consideration in the prevention and warning of possible mumps epidemic. Special attention should be paid to the vulnerable populations, such as teenagers and young adults.
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Affiliation(s)
- Wenqi Hu
- Department of Epidemiology, School of Public Health, Shandong University, 44 West Wenhua Road, Jinan, Shandong 250012, PR China
| | - Yuying Li
- Department of Epidemiology, School of Public Health, Shandong University, 44 West Wenhua Road, Jinan, Shandong 250012, PR China
| | - Weixiao Han
- Department of Epidemiology, School of Public Health, Shandong University, 44 West Wenhua Road, Jinan, Shandong 250012, PR China
| | - Li Xue
- Department of Epidemiology, School of Public Health, Shandong University, 44 West Wenhua Road, Jinan, Shandong 250012, PR China
| | - Wenchao Zhang
- Department of Epidemiology, School of Public Health, Shandong University, 44 West Wenhua Road, Jinan, Shandong 250012, PR China
| | - Wei Ma
- Department of Epidemiology, School of Public Health, Shandong University, 44 West Wenhua Road, Jinan, Shandong 250012, PR China; Climate Change and Health Center, Shandong University, 44 West Wenhua Road, Jinan, Shandong 250012, PR China.
| | - Peng Bi
- School of Public Health, The University of Adelaide, Level 8, Hughes Building, North Terrace Campus, Adelaide, SA 5005, Australia.
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Zamir CS, Schroeder H, Shoob H, Abramson N, Zentner G. Characteristics of a large mumps outbreak: Clinical severity, complications and association with vaccination status of mumps outbreak cases. Hum Vaccin Immunother 2016; 11:1413-7. [PMID: 25874726 DOI: 10.1080/21645515.2015.1021522] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
In recent years, large mumps outbreaks, involving mainly adolescents and young adults, have re-emerged in several countries. We investigated a large mumps outbreak, evaluated the association between mumps clinical severity (complications, hospitalization) and vaccination status (number of previous measles, mumps and rubella - MMR vaccine doses), and assessed vaccine effectiveness. The first mumps cases emerged in an ultra-orthodox boys' school in Jerusalem and were epidemiologically linked to the mumps outbreak in New York. Overall, 3130 mumps cases were notified in the Jerusalem district during September 2009-August 2011 (median age 13y, 64% males). Most cases were reported from community clinics. Patients with systemic symptoms and/or complications (419, 13.4%) were either hospitalized (n = 79) or treated in an emergency medical center (n = 340). The main complications included orchitis (3.8% males> age 12y) and meningoencephalitis (0.5%). The mumps virus genotype was G5. The distribution of previous MMR vaccine doses (n = 0,1,2) was: 24.8%, 28.3% and 46.9%, respectively. The number of previous vaccine doses was inversely associated with clinical severity. Adjusted values for MMR vaccine effectiveness against complications were estimated as 52.1% (95% CI -4 -78%) for one vaccine dose and 62.7% (95% CI 25.7-81.3%) for 2 doses. The outbreak was characterized by predominance of male students; the majority of whom had been previously vaccinated. The reported complication rate was relatively low. Vaccination status was associated with age and disease severity. The combination of limited mumps vaccine effectiveness and the specific school setting (dense learning and living conditions) probably contributed to the disease spread.
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Affiliation(s)
- C Stein Zamir
- a Jerusalem District Health Office; Ministry of Health ; Jerusalem , Israel
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Abstract
Recently, numerous large-scale mumps outbreaks have occurred in vaccinated populations. Clinical isolates sequenced from these outbreaks have invariably been of genotypes distinct from those of vaccine viruses, raising concern that certain mumps virus strains may escape vaccine-induced immunity. To investigate this concern, sera obtained from children 6 weeks after receipt of measles, mumps, and rubella (MMR) vaccine were tested for the ability to neutralize a carefully selected group of genetically diverse mumps virus strains. Although the geometric mean neutralizing antibody titer of the sera was lower against some virus strains than others, all viruses were readily neutralized, arguing against immune escape.
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Abstract
Mumps outbreaks in recent years have given rise to questions about the effectiveness of the mumps vaccine. This study examined the epidemiological data from a recent mumps outbreak in Israel and from outbreaks in other countries with high vaccination coverage, and considered whether long-established vaccination policies designed to protect against mumps are in need of revision. Of over 5000 case patients in the Israeli outbreak, half of whom were in the Jerusalem health district, nearly 40% were aged ≥15 years and, of those whose vaccination status was known, 78% had been fully vaccinated for their age - features similar to those in recent mumps outbreaks in Europe and North America. The epidemiological and laboratory evidence suggests that many previously vaccinated adolescents and young adults are now susceptible to mumps because their vaccine-based immunity has waned. Booster vaccination programmes for those at high risk of infection during mumps outbreaks - particularly those in congregate living environments - merit priority consideration.
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Malik T, Wolbert C, Mauldin J, Sauder C, Carbone KM, Rubin SA. Functional consequences of attenuating mutations in the haemagglutinin neuraminidase, fusion and polymerase proteins of a wild-type mumps virus strain. J Gen Virol 2007; 88:2533-2541. [PMID: 17698664 DOI: 10.1099/vir.0.82935-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Wild-type mumps viruses (MuVs) are highly neurotropic and, prior to widespread vaccination programmes, were a major cause of viral meningitis and encephalitis in most developed countries. At present, there are no markers for virus attenuation, apart from the failure of a passaged isolate to produce clinical symptoms in vaccinees. Indeed, some MuV vaccines have retained residual neurovirulence properties and have caused aseptic meningitis in vaccinees. Three amino acid changes associated with the neuroattenuation of a wild-type MuV strain were identified previously. This study evaluated the impact of these changes on the function of the respective proteins. The data demonstrated that the Ser-->Asp amino acid substitution at position 466 in the haemagglutinin-neuraminidase protein resulted in decreased receptor binding and neuraminidase activity, the Ala/Thr-->Thr selection in the fusion protein resulted in decreased fusion activity, and the Ile-->Val substitution in the polymerase resulted in increased replicative/transcriptional activity. These data suggest a polygenic component (i.e. specific and inter-related roles of these amino acid changes) to MuV neuroattenuation.
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Affiliation(s)
- Tahir Malik
- DVP/Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Bethesda, MD 20892, USA
| | - Candie Wolbert
- DVP/Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Bethesda, MD 20892, USA
| | - Jeremy Mauldin
- Department of Pharmacology, University of Virginia, Charlottesville, VA, USA
| | - Christian Sauder
- DVP/Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Bethesda, MD 20892, USA
| | - Kathryn M Carbone
- DVP/Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Bethesda, MD 20892, USA
| | - Steven A Rubin
- DVP/Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Bethesda, MD 20892, USA
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MUHSEN K, ABOUDY Y, MENDELSON E, GREEN M, COHEN D. Prevalence of mumps antibodies in the Israeli population in relation to mumps vaccination policy and incidence of disease. Epidemiol Infect 2007; 136:688-93. [PMID: 17608960 PMCID: PMC2870851 DOI: 10.1017/s0950268807008989] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We examined the prevalence of mumps antibodies in the Israeli population in relation to mumps vaccination policy and past and subsequent incidence of disease. The levels of specific IgG antibodies against mumps were tested in 3330 residual sera collected during 1997-1998 from an age-stratified population sample. Against the background of a consistent MMR vaccination coverage of >90%, the age- and sex-adjusted seropositivity to mumps was 77.0%. No significant differences between genders were found. Seropositivity in the 10-13 years age group, born just before the introduction of the MMR vaccine, was the lowest (59%). These birth cohorts were the target of an outbreak of mumps in 2005 that occurred among high-school students and military recruits. A trend of waning immunity was observed between the first and second vaccine doses. The seroepidemiological data demonstrate that immunity levels below the herd immunity threshold, along with social mixing and crowded conditions facilitated the occurrence of mumps outbreaks. Periodical serosurveys are an essential component in the evaluation of the vaccination policy against mumps.
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Affiliation(s)
- Kh. MUHSEN
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
- Israel Center for Disease Control, Ministry of Health, Gertner Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Y. ABOUDY
- Central Virological Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - E. MENDELSON
- Central Virological Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - M. S. GREEN
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
- Israel Center for Disease Control, Ministry of Health, Gertner Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - D. COHEN
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
- Israel Center for Disease Control, Ministry of Health, Gertner Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel
- Author for correspondence: Professor D. Cohen, Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel Aviv 69978, Israel. ()
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Declining population immunity to mumps among Israeli military recruits. Vaccine 2006; 24:6300-3. [PMID: 16844272 DOI: 10.1016/j.vaccine.2006.05.072] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2005] [Revised: 05/15/2006] [Accepted: 05/23/2006] [Indexed: 10/24/2022]
Abstract
Population-based seroepidemologic data on mumps have not been available in Israel since 1987, and the effects of mass immigration from the Commonwealth of Independent States during the 1990s have not been investigated. We conducted a seroprevalence study of mumps antibodies among 353 Israeli military recruits aged 18-19, based on a representative sample of sera collected in 1999. The overall seroprevalence rate was 83.3%, which was significantly lower than that measured in 1987 (94.1%, P<0.001). Foreign-born subjects had substantially lower seroporevalence rates than their native Israeli counterparts (68.5% versus 86.1%, P<0.001). Recent seroprevalence levels are below those required for herd immunity, and most likely contributed to an outbreak of mumps observed among young adults in Israel in 2005. Immigration appears to be a contributing factor to the decrease in population seroprevalence over time.
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Pugh RN, Akinosi B, Pooransingh S, Kumar J, Grant S, Livesley E, Linnane J, Ramaiah S. An outbreak of mumps in the metropolitan area of Walsall, UK. Int J Infect Dis 2002; 6:283-7. [PMID: 12718822 DOI: 10.1016/s1201-9712(02)90162-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To describe the epidemiology of excessive mumps cases during the year 2000, within the metropolitan area of Walsall, UK; to assess the impact of the mumps outbreak on morbidity; and to inform future communicable disease control strategy. METHODS Demographic records, school attendance, uptake of the measles-mumps-rubella (MMR) vaccine, and mumps-associated admission to hospital, were reviewed for all Walsall residents diagnosed and notified with mumps during the year 2000. RESULTS There were 200 mumps notifications in 2000 (76.6 per 100,000), representing the highest incidence in England. Only 91 of the notified cases were salivary antibody positive for mumps IgM, and 32 were negative, although 77 were not tested. Since 1990, annual totals have never previously exceeded 20. Over 90% of patients were <20 years old, with a peak age group of 10-14 years; 88% attended schools located within Walsall. The pattern of spread suggested that the outbreak proceeded through schools from north to south in the more deprived western half of the metropolitan area. Most cases (136, 68%) had received one (99, 49.5%) or two (37, 18.5%) doses of MMR vaccine; cases > or =20 years old had never received MMR. Six cases (aged 4-14 years) were admitted to hospital, all with a successful outcome, including one male with meningitis and one female with pancreatitis. Current uptake of the MMR vaccine at 24 months has dropped to below 90% in recent years, as in most parts of the UK. CONCLUSIONS Future mumps outbreaks in schools, and among older age groups, can be predicted, since most older children and young adults have received only one dose of MMR vaccine or no vaccination at all. Primary vaccine failure is well described in mumps, and cases during outbreaks can include recipients of two MMR vaccine doses. It was fortunate that no severe morbidity was associated with this outbreak (prior to MMR, two to four mumps deaths occurred annually in England and Wales). Measures to restore the uptake of MMR to the previous levels of above 90-95% will be necessary to reduce the risk of the mumps virus circulating within communities. Older children are susceptible, and it may be advisable to ensure second-dose MMR uptake while they are still at or when they leave school, or when they enter college, university or the military.
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Affiliation(s)
- R Nicholas Pugh
- Directorate of Public Health Medicine, Walsall Health Authority, Walsall, UK.
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