Mumps virus infection in vaccinated patients can be detected by an increase in specific IgG antibodies to high titres: a retrospective study

Mumps outbreaks in highly vaccinated populations with genotype G have been reported repeatedly. Detection of these outbreaks can be difficult in a setting with relatively high vaccination coverage when acute cases of mumps are routinely diagnosed by IgM serology since this marker is not reliable for diagnosis of mumps re-infection. To learn whether diagnostic tests performed in a large private laboratory may be useful to detect mumps outbreaks retrospectively, we reviewed the results of almost 7000 mumps tests. Two groups were compared: group 1 comprised of 3438 samples from patients submitted by physicians and clinicians (it was assumed that these patients visited their doctor due to acute disease). Group 2 comprised of 3398 samples submitted from company medical officers and occupational physicians. Since these patients usually attend for routine check-ups and certification of immunity to vaccine-preventable diseases, these samples comprised a control group. From July 2010 to May 2011, a mumps virus outbreak with more than 300 cases occurred in Bavaria, Southeast Germany. Our study includes samples received for serological mumps tests from January 2009 until December 2011 (36 months). The two groups were analysed with regard to the number of IgM-positive cases per month and the level of IgG titre. We found a marked increase for both parameters in group 1 during the time of the outbreak, while the samples submitted by the occupational medical physicians did not display significant alterations. These parameters reflect the outbreak with high accuracy, indicating that a retrospective analysis of IgG titres may be a useful tool for detection of mumps outbreaks when, as was the case in Germany, (i) a nationwide notification system has not been implemented and (ii) a highly vaccinated population is affected.

Environmental factors in a population-based inception cohort of inflammatory bowel disease patients in Europe--an ECCO-EpiCom study

BACKGROUND AND AIMS

The incidence of inflammatory bowel disease (IBD) is increasing in Eastern Europe possibly due to changes in environmental factors towards a more "westernised" standard of living. The aim of this study was to investigate differences in exposure to environmental factors prior to diagnosis in Eastern and Western European IBD patients.

METHODS

The EpiCom cohort is a population-based, prospective inception cohort of 1560 unselected IBD patients from 31 European countries covering a background population of 10.1 million. At the time of diagnosis patients were asked to complete an 87-item questionnaire concerning environmental factors.

RESULTS

A total of 1182 patients (76%) answered the questionnaire, 444 (38%) had Crohn's disease (CD), 627 (53%) ulcerative colitis (UC), and 111 (9%) IBD unclassified. No geographic differences regarding smoking status, caffeine intake, use of oral contraceptives, or number of first-degree relatives with IBD were found. Sugar intake was higher in CD and UC patients from Eastern Europe than in Western Europe while fibre intake was lower (p<0.01). Daily consumption of fast food as well as appendectomy before the age of 20 was more frequent in Eastern European than in Western European UC patients (p<0.01). Eastern European CD and UC patients had received more vaccinations and experienced fewer childhood infections than Western European patients (p<0.01).

CONCLUSIONS

In this European population-based inception cohort of unselected IBD patients, Eastern and Western European patients differed in environmental factors prior to diagnosis. Eastern European patients exhibited higher occurrences of suspected risk factors for IBD included in the Western lifestyle.

[Seroprevalence of measles, rubella, mumps and varicella in health workers in the Community of Madrid]

BACKGROUND

The vaccination of health workers has a large repercussion on the health of the workers, the patients and the population in general. Due to this, we proposed to discover the serological status for varicella, rubella, mumps and measles in the workers of a tertiary hospital in Madrid.

METHODS

We have conducted a retrospective epidemiological study of 1060 health workers, obtaining information such as age, sex, service area, employment status, pre-exposure vaccination and post-vaccination serology and vaccination status.

RESULTS

In the population studied, 90.1% were protected against varicella, 65.6% against mumps, 95.6% against rubella and 92.9% against measles. There is no better protection against these illnesses for workers who treat patients directly, workers who treat immunosuppressed patients or for workers in services or units with a higher risk of infection.

CONCLUSION

There is no better protection against varicella, rubella, mumps and measles for the workers who have higher risk of infection at work; and the workers who treat patients, that if they suffer these diseases, this could put their health at risk.

Assessing mumps outbreak risk in highly vaccinated populations using spatial seroprevalence data

Mumps is a potentially severe viral infection. The incidence of mumps has declined dramatically in high-income countries since the introduction of mumps antigen-containing vaccines. However, recent large outbreaks of mumps in highly vaccinated populations suggest waning of vaccine-induced immunity and primary vaccine failure. In this paper we present a simple method for identifying geographic regions with high outbreak potential, demonstrated using 2006 mumps seroprevalence data from Belgium and Belgian vaccination coverage data. Predictions of the outbreak potential in terms of the effective reproduction number in future years signal an increased risk of new mumps outbreaks. Literature reviews on serological information for both primary vaccine failure and waning immunity provide essential information for our predictions. Tailor-made additional vaccination campaigns would be valuable for decreasing local pockets of susceptibility, thereby reducing the risk of future large-scale mumps outbreaks.

[Rate and clinical characteristics of mumps reinfection]

Mumps infection is anecdotally believed to occur only once over a lifetime. However, in recent years, it has gradually come to be recognized among pediatricians that mumps reinfection is not a rare condition, and some criteria for the mumps reinfection have been proposed. One of the widely accepted criteria is levels higher than 25.8 IU/dl of serum IgG antibodies against the mumps virus and lower than 2.0 IU/dl of serum IgM antibodies. From July 2010 to June 2011, 45 patients with acute swelling of the major salivary gland(s) were enrolled into our survey of mumps reinfection in Tsuchiura Kyodo General hospital. Serum IgG and IgM antibodies against the mumps virus were measured at the initial visit. Ten cases were diagnosed as having primary infection with the mumps virus, while the other 10 cases were diagnosed as having reinfection with the mumps virus according to the criteria. The present study suggests that mumps reinfection is a common condition in patients with acute swelling of the major salivary glands in adulthood.

Estimates of mumps seroprevalence may be influenced by antibody specificity and serologic method

Neutralizing antibodies are assumed to be essential for protection against mumps virus infection, but their measurement is labor- and time-intensive. For this reason, enzyme-linked immunosorbent assays (ELISAs) are typically used to measure mumps-specific IgG levels. However, since there is poor correlation between mumps neutralization titers and ELISAs that measure the presence of mumps-specific IgG levels, ELISAs that better correlate with neutralization are needed. To address this issue, we measured mumps antibody levels by plaque reduction neutralization, by a commercial ELISA (whole-virus antigen), and by ELISAs specific for the mumps nucleoprotein and hemagglutinin. The results indicate that differences in the antibody response to the individual mumps proteins could partially explain the lack of correlation among various serologic tests. Furthermore, the data indicate that some seropositive individuals have low levels of neutralizing antibody. If neutralizing antibody is important for protection, this suggests that previous estimates of immunity based on whole-virus ELISAs may be overstated.

Difficulties in eliminating measles and controlling rubella and mumps: a cross-sectional study of a first measles and rubella vaccination and a second measles, mumps, and rubella vaccination

Background

The reported coverage of the measles–rubella (MR) or measles–mumps–rubella (MMR) vaccine is greater than 99.0% in Zhejiang province. However, the incidence of measles, mumps, and rubella remains high. In this study, we assessed MMR seropositivity and disease distribution by age on the basis of the current vaccination program, wherein the first dose of MR is administered at 8 months and the second dose of MMR is administered at 18–24 months.

Methods

Cross-sectional serological surveys of MMR antibodies were conducted by collecting epidemiological data in Zhejiang province, China in 2011. In total, 1015 participants were randomly selected from two surveillance sites. Serum MMR-specific immunoglobulin G levels were tested by enzyme-linked immunosorbent assay. The geometric mean titers and seroprevalence with 95% confidence intervals (CIs) were calculated by age and gender. Proportions of different dose of vaccine by age by vaccine were also identified. Statistically significant differences between categories were assessed by the Chi-square test.

Results

Over 95% seroprevalence rates of measles were seen in all age groups except <7 months infants. Children aged 5–9 years were shown lower seropositivity rates of mumps while elder adolescences and young adults were presented lower rubella seroprevalence. Especially, rubella seropositivity was significantly lower in female adults than in male. Nine measles cases were unvaccinated or unknown vaccination history. Among them, 66.67% (6/9) patients were aged 20–29 years while 33.33% (3/9) were infants aged 8–12 months. In addition, 57.75% (648/1122) patients with mumps were children aged 5–9 years, and 50.54% (94/186) rubella cases were aged 15–39 years.

Conclusions

A timely two-dose MMR vaccination schedule is recommended, with the first dose at 8 months and the second dose at 18–24 months. An MR vaccination speed-up campaign may be necessary for elder adolescents and young adults, particularly young females.

[Genotyping results, laboratory diagnosis, and epidemiology of the mumps virus circulating in the Czech Republic in 2012]

GOAL

To extend the present routine serological diagnosis of mumps with the methods of direct detection of the pathogen and subsequent genotyping of the isolated viruses in an attempt to obtain more detailed data on recent mumps viruses circulating in the Czech Republic. Sub-goals were to point out the particularities of the laboratory examination in the population with a high vaccine coverage and to evaluate the current epidemiological situation.

MATERIAL AND METHODS

Altogether 47 buccal swabs from patients with suspected mumps were included in the study. Clinical specimens collected at the onset of clinical symptoms were obtained from five administrative regions of the Czech Republic from February 2012 to December 2012. Vero cell cultures were used for virus isolation and isolates were identified using real-time quantitative polymerase chain reaction (RT-qPCR). Genotyping was performed by the WHO Regional Reference Laboratory for Measles, Mumps, and Rubella (RRL MMR), Robert Koch Institute, Berlin. The EPIDAT system was used as a source of epidemiological data.

RESULTS

From 47 buccal swabs, 20 mumps viruses were isolated on Vero cells and in seven other specimens, the presence of viral RNA without positive isolation was only detected by RT-qPCR. Nineteen isolates were referred for genotyping. The phylogenetic analysis of the SH gene classified them into genotype G, as four variants. In both 2011 and 2012, most cases occurred in vaccinated patients (80%), with 15-19-year-olds being the most affected age group. The leading complication was orchitis, followed by meningitis. More complications were reported in non-vaccinated individuals.

CONCLUSIONS

The increased incidence of mumps cases in the Czech Republic in 2012 was due primarily to genotype G, the leading cause of mumps in most European countries since 2005. The presence of genotype G was first reported in the Czech Republic in 2006. In the context of the unfavourable epidemiological trend, molecular epidemiological studies including genotyping of recent mumps virus strains appear to be necessary. A detailed monitoring could be helpful in elucidating the pattern of virus circulation and in designing strategies to control emerging outbreaks. The vaccination efficacy in relation to the causative genotype and possible role of waning immunity in mumps outbreaks are the issues that need to be addressed.

Mumps in Poland in 2012

BACKGROUND

Vaccination against mumps, introduced initially as recommended, from 2003 is mandatory in Poland and given as two dose scheme with MMR vaccine (mumps, measles, and rubella). Despite observed decline in mumps incidence for over a decade which is a result of conducted vaccinations, mumps is still a common childhood disease in Poland.

AIM

To assess epidemiological situation of mumps in Poland in 2012, including vaccination coverage in Polish population, in comparison to previous years.

METHODS

The descriptive analysis was based on data retrieved from routine mandatory surveillance system and published in the annual bulletins "Infectious diseases and poisonings in Poland in 2012" and "Vaccinations in Poland in 2012" (Czarkowski MP i in., Warszawa 2013, NIZP-PZH i GIS). Mumps cases were classified according to the criteria of surveillance case definition implemented in the European Union (Commission Decision of 28 April 2008 amending Decision 2002/253/EC). National Immunisation Programme for year 2012 was also used.

RESULTS

In total, there were 2779 mumps cases registered in Poland in 2012. Incidence of mumps was 7.2 per 100 000 and it was higher by 7.5% in comparison with 2011 and lower by 19.4% in comparison to median for the years 2006-2010. The highest incidence rate was observed among children aged 5 years (71.8 per 100 000). Incidence in women (5.9) was lower than in men (8.6). In 2012, 25 people were hospitalized due to mumps. Vaccination coverage of children aged 3 years in Poland in 2012 was 97.9%.

CONCLUSIONS

Systematic execution of mumps vaccination in accordance with the National Immunisation Programme resulted in a significant decrease in the number of registered cases. Due to the high vaccination coverage further decline in the number of cases is expected.

[Mumps vaccine virus transmission]

In this work we report the mumps vaccine virus shedding based on the laboratory confirmed cases of the mumps virus (MuV) infection. The likely epidemiological sources of the transmitted mumps virus were children who were recently vaccinated with the mumps vaccine containing Leningrad-Zagreb or Leningrad-3 MuV. The etiology of the described cases of the horizontal transmission of both mumps vaccine viruses was confirmed by PCR with the sequential restriction analysis.

Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP)

This report is a compendium of all current recommendations for the prevention of measles, rubella, congenital rubella syndrome (CRS), and mumps. The report presents the recent revisions adopted by the Advisory Committee on Immunization Practices (ACIP) on October 24, 2012, and also summarizes all existing ACIP recommendations that have been published previously during 1998-2011 (CDC. Measles, mumps, and rubella--vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 1998;47[No. RR-8]; CDC. Revised ACIP recommendation for avoiding pregnancy after receiving a rubellacontaining vaccine. MMWR 2001;50:1117; CDC. Updated recommendations of the Advisory Committee on Immunization Practices [ACIP] for the control and elimination of mumps. MMWR 2006;55:629-30; and, CDC. Immunization of healthcare personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2011;60[No. RR-7]). Currently, ACIP recommends 2 doses of MMR vaccine routinely for children with the first dose administered at age 12 through 15 months and the second dose administered at age 4 through 6 years before school entry. Two doses are recommended for adults at high risk for exposure and transmission (e.g., students attending colleges or other post-high school educational institutions, healthcare personnel, and international travelers) and 1 dose for other adults aged ≥18 years. For prevention of rubella, 1 dose of MMR vaccine is recommended for persons aged ≥12 months. At the October 24, 2012 meeting, ACIP adopted the following revisions, which are published here for the first time. These included: • For acceptable evidence of immunity, removing documentation of physician diagnosed disease as an acceptable criterion for evidence of immunity for measles and mumps, and including laboratory confirmation of disease as a criterion for acceptable evidence of immunity for measles, rubella, and mumps. • For persons with human immunodeficiency virus (HIV) infection, expanding recommendations for vaccination to all persons aged ≥12 months with HIV infection who do not have evidence of current severe immunosuppression; recommending revaccination of persons with perinatal HIV infection who were vaccinated before establishment of effective antiretroviral therapy (ART) with 2 appropriately spaced doses of MMR vaccine once effective ART has been established; and changing the recommended timing of the 2 doses of MMR vaccine for HIV-infected persons to age 12 through 15 months and 4 through 6 years. • For measles postexposure prophylaxis, expanding recommendations for use of immune globulin administered intramuscularly (IGIM) to include infants aged birth to 6 months exposed to measles; increasing the recommended dose of IGIM for immunocompetent persons; and recommending use of immune globulin administered intravenously (IGIV) for severely immunocompromised persons and pregnant women without evidence of measles immunity who are exposed to measles. As a compendium of all current recommendations for the prevention of measles, rubella, congenital rubella syndrome (CRS), and mumps, the information in this report is intended for use by clinicians as baseline guidance for scheduling of vaccinations for these conditions and considerations regarding vaccination of special populations. ACIP recommendations are reviewed periodically and are revised as indicated when new information becomes available.

The Thasian epidemic of mumps during the 5th century BC

This article briefly reminds the readers of the huge importance of Hippocrates observation about the epidemic of mumps in Thasos during the fifth century BC. By putting great emphasis on the value of observation of the disease process, mainly from the practical point of view, the Corpus Hippocraticum gave us the first written detailed description of the disease.

Estimation of vaccine efficacy and critical vaccination coverage in partially observed outbreaks

Classical approaches to estimate vaccine efficacy are based on the assumption that a person's risk of infection does not depend on the infection status of others. This assumption is untenable for infectious disease data where such dependencies abound. We present a novel approach to estimating vaccine efficacy in a Bayesian framework using disease transmission models. The methodology is applied to outbreaks of mumps in primary schools in the Netherlands. The total study population consisted of 2,493 children in ten primary schools, of which 510 (20%) were known to have been infected, and 832 (33%) had unknown infection status. The apparent vaccination coverage ranged from 12% to 93%, and the apparent infection attack rate varied from 1% to 76%. Our analyses show that vaccination reduces the probability of infection per contact substantially but not perfectly ([Formula: see text] = 0.933; 95CrI: 0.908-0.954). Mumps virus appears to be moderately transmissible in the school setting, with each case yielding an estimated 2.5 secondary cases in an unvaccinated population ([Formula: see text] = 2.49; 95%CrI: 2.36-2.63), resulting in moderate estimates of the critical vaccination coverage (64.2%; 95%CrI: 61.7-66.7%). The indirect benefits of vaccination are highest in populations with vaccination coverage just below the critical vaccination coverage. In these populations, it is estimated that almost two infections can be prevented per vaccination. We discuss the implications for the optimal control of mumps in heterogeneously vaccinated populations.

Seroprevalence of mumps in The Netherlands: dynamics over a decade with high vaccination coverage and recent outbreaks

Here we present mumps virus specific antibody levels in a large cross-sectional population-based serosurveillance study performed in the Netherlands in 2006/2007 (n = 7900). Results were compared with a similar study (1995/1996) and discussed in the light of recent outbreaks. Mumps antibodies were tested using a fluorescent bead-based multiplex immunoassay. Overall seroprevalence was 90.9% with higher levels in the naturally infected cohorts compared with vaccinated cohorts. Mumps virus vaccinations at 14 months and 9 years resulted in an increased seroprevalence and antibody concentration. The second vaccination seemed to be important in acquiring stable mumps antibody levels in the long term. In conclusion, the Dutch population is well protected against mumps virus infection. However, we identified specific age- and population groups at increased risk of mumps infection. Indeed, in 2007/2008 an outbreak has occurred in the low vaccination coverage groups emphasizing the predictive value of serosurveillance studies.

[Analysis on genetic characteristics of mumps virus strains circulating in Hunan province in 2011]

OBJECTIVE

To be acquainted with genetic characteristics and variation of mumps virus strains circulating in Hunan province.

METHODS

Mumps virus (MV) strains were isolated using Vero/ SLAM cells. The small hydrophobic protein (SH) genes of MV isolates were sequenced, and the sequences were analysed phylogenetically between the isolated strains and other reference mumps strains.

RESULTS

4 mumps virus strains were isolated from 16 specimens collected in 2011 from different regions of Hunan province. The genotype of isolated strains were supposed to be F type.

CONCLUSION

Genotype F is the main genotype of circulating strains in Hunan province in 2011 and there is no variation between genotype.

Environmental factors potentially associated with mumps transmission in yeshivas during a mumps outbreak among highly vaccinated students: Brooklyn, New York, 2009-2010

During 2009-2010, a large US mumps outbreak occurred affecting two-dose vaccinated 9th-12th grade Orthodox Jewish boys attending all-male yeshivas (private, traditional Jewish schools). Our objective was to understand mumps transmission dynamics in this well-vaccinated population. We surveyed 9th-12th grade male yeshivas in Brooklyn, NY with reported mumps case-students between 9/1/2009 and 3/30/2010. We assessed vaccination coverage, yeshiva environmental factors (duration of school day, density, mixing, duration of contact), and whether environmental factors were associated with increased mumps attack rates. Ten yeshivas comprising 1769 9th-12th grade students and 264 self-reported mumps cases were included. The average yeshiva attack rate was 14.5% (median: 13.5%, range: 1-31%), despite two-dose measles-mumps-rubella vaccine coverage between 90-100%. School duration was 9-15.5 h/day; students averaged 7 h face-to-face/day with 1-4 study partners. Average daily mean density was 6.6 students per 100 square feet. The number of hours spent face-to-face with a study partner and the number of partners per day showed significant positive associations (p < 0.05) with classroom mumps attack rates in univariate analysis, but these associations did not persist in multivariate analysis. This outbreak was characterized by environmental factors unique to the yeshiva setting (e.g., densely populated environment, prolonged face-to-face contact, mixing among infected students). However, these features were present in all included yeshivas, limiting our ability to discriminate differences. Nonetheless, mumps transmission requires close contact, and these environmental factors may have overwhelmed vaccine-mediated protection increasing the likelihood of vaccine failure among yeshiva students.

Increased incidence of mumps in the Czech Republic in the years 2011 and 2012

A nation-wide vaccination against mumps that had been launched in the Czech Republic in 1987 eliminated great outbreaks (up to 100,000 cases per year) of this disease in 1955-1988, but did not prevent small outbreaks (a few thousand cases per year) in 1995-1996, 2005-2007, and 2010-2012. The extent of these small outbreaks shows an increasing trend. The article describes mumps outbreaks in the Czech Republic in 2011 and 2012 with the aim to bring additional data contributing to the clarification of repeated outbreak triggers. In the years 2011 and 2012 there have been reported 2885 and 3902 mumps cases, respectively, in the Czech Republic. Similarly to other countries, a shift in the age-specific incidence of the disease towards higher age has been found, with the highest occurrence seen in the age group of 15-19 years. Men were slightly more affected than women. Clinical complications and vaccination status of patients were also observed.

Mumps in Poland in 2011

INTRODUCTION

In 2011, similarly to previous years a decline was observed in the number of recorded cases of mumps. This favourable epidemiological situation is a result of mumps vaccination program, which from 2003 became mandatory given as two dose schemes with MMR vaccine (mumps, measles, and rubella).

AIM

The aim of this work was to assess mumps epidemiological situation in Poland in 2011, in comparison to previous years.

MATERIAL AND METHODS

The assessment of mumps epidemiological situation in Poland in 2011 was conducted by using the results of analyzed data for infectious diseases published in a yearly bulletin "Infectious diseases and poisoning in Poland in 2011" and in yearly bulletin "Preventative immunisation in Poland in 2011" Czarkowski MP and in, Warsaw, NIZP- PZH and GIS. Also used "Case definitions for infectious disease developed for epidemiological surveillance in the years 2009-2011 " (Department of Epidemiology, NIZP-PZH), as well as Preventative vaccination program 2011.

RESULTS

In 2011 there were 2585 reported cases of mumps. Incidence of mumps was lower 6.7/100 in comparison with 2010 (7.2/100), as well as almost twice lower than a median for the years 2005-2009. The highest incidents rate of mumps 52.0/100,000 was recorded among children at the age 5-9 years of age. Incidence in women was lower (5.6) than in men (7.9). In 2011, 24 people were hospitalized due to mumps.

CONCLUSION

Systematic implementation of vaccination program against mumps as according to Inoculation Calendar has resulted in a significant decline in the number of reported cases.

Prevalence of measles, mumps, rubella, and varicella susceptibility among health science students in a University in India

BACKGROUND

Health science students (HSS) are at increased risk of contracting and transmitting viral diseases such as measles, mumps, rubella, and varicella (chickenpox). This study was undertaken to determine the prevalence of susceptibility of HSS to these infections.

METHODS

Using a cross-sectional design, 790 HSS of Manipal University, Manipal, India, answered a questionnaire and provided a blood sample which was tested for specific IgG antibodies to measles, mumps, rubella and varicella by ELISA (Enzygnost(®)).

RESULTS

The study group was comprised of medical (53.9%), nursing (16.6%), and allied health (29.5%) students. Among the overall group (n = 790), the prevalence of serological susceptibility to measles, mumps, rubella, and varicella were 9.5%, 32.0%, 16.6%, and 25.8%, respectively. Among the subgroup of vaccinated subjects, susceptibility to measles, mumps, rubella, and varicella were 7.9%, 34.7%, 10.7%, and 35.2%, respectively.

CONCLUSION

HSS susceptible to measles, mumps, rubella, and/or varicella are at risk of acquiring these diseases during their training period. In addition, they may be a potential source for nosocomial transmission posing a risk to immunocompromised patients. Hence, in the Indian setting, HSS should be immunized against measles, mumps, rubella, and varicella at the time of joining the medical school.

Centers for Disease Control and Prevention (CDC). Mumps outbreak on a university campus--California, 2011

Mumps is a vaccine-preventable viral disease characterized by swelling of the salivary glands; serious complications (e.g., meningitis, encephalitis, orchitis, or oophoritis) can occur. On September 29, 2011, the California Department of Public Health (CDPH) confirmed by polymerase chain reaction (PCR) three cases of mumps among students recently evaluated at their university's student health services with symptoms suggestive of mumps. An investigation by CDPH, student health services, and the local health department identified 29 mumps cases. The presumed source patient was an unvaccinated student with a history of recent travel to Western Europe, where mumps is circulating. The student had mumps symptoms >28 days before the onset of symptoms among the patients confirmed on September 29. Recognizing that at least two generations of transmission had occurred before public health authorities were alerted, measles, mumps, and rubella (MMR) vaccine was provided as a control measure. This outbreak demonstrates the potential value of requiring MMR vaccination (including documentation of immunization or other evidence of immunity) before college enrollment, heightened clinical awareness, and timely reporting of suspected mumps patients to public health authorities.

Mumps: burden of disease in France

This article provides a review of the epidemiological data on mumps in France since 1986. The results of 26 years of monitoring in general practice by the Sentinel network are analysed, such as hospitalisation data between 2004 and 2010, as well as mortality data between 2000 and 2009. The annual incidence rate has plummeted between 1986 and 2011, from 859 cases per 100,000 inhabitants [95% CI: 798-920] to 9 cases per 100,000 inhabitants [95% CI: 4-14]. A change in the age distribution is significant with an increase of Relative Illness Ratio (RIR) for patients over 20 years. Since 2000, vaccine status has also changed, and the majority of recent mumps cases occur among previously vaccinated patients. The average annual hospitalisation rate is 3.2 per 1 million inhabitants. Mumps was identified as the initial cause of death in 1 case every 5 years. This study estimates the burden of mumps disease in France.

[SH protein genetic characterization analysis of wild-type mumps virus isolated in Liaoning province from 2008 to 2011]

A total of 13 mumps virus strains were isolated using Vero/Slam cell line from the patients' throat swabs and urines during mumps outbreaks and sporadics in liaoning Province from 2008 to 2011. Fragments of 316 nucleotides containing SH genes from 13 mumps virus isolates were amplified by RT-PCR, the PCR products were sequenced and analyzed. Based on the 316 nucleotides of SH gene, the phylogenetic trees were constructed with WHO mumps reference strains downloaded from GenBank and 13 mumps virus strains. It showed that the 12 mumps virus strains in 2008-2011 belonged to F genotype, nucleotide acids and amino acids similarities were 94.9%-100.0% and 83.3%-100.0%. Compared to the F reference strains, nucleotide acids and amino acids similarities were 92.4%-97.2% and 96.5% 84.2%, indicating that liaoning mumps strains had large genotype variation. Furthermore, compared to other genotype mumps strains, 6 nucleotides mutations (C(Nt65), C(Nt105), G(Nt137), C(Nt192), C(Nt239), G(NT262)) in SH gene were shared in all of liaoning F genotype mumps viruses. However these mutations were not found in other genotypes of mumps viruses. Conserved amino acids in SH protein of some liaoning mumps strains had changed (S to P at position 2 P to L at position 6 T to N at positon 23 L to P/R at position 48). The genotype specific triplet IML (at position 28-30) was changed to TMP in strain 2008-001-007 2011-015 s, nucleotide acids and amino acids similarities of strain 2008-001-07 were 87.5% and 79.8%, compared to F reference strains respectively, and 96.8% and 97.4% respectively compared to the G reference strains, in dicating strain 2008-001-07 belonged to G genotype,which was first found in mainland China.

Seroprevalence of measles-, mumps- and rubella-specific IgG antibodies in German children and adolescents and predictors for seronegativity

We have undertaken a seroprevalence study with more than 13,000 children, who had been included in the German KIGGS survey, a representative sample of children and adolescents 0-17 years of age. The IgG titres against measles, mumps and rubella were determined in 1 to 17 year olds While 88.8% of the children were MMR-vaccinated at least once, 76.8% of children aged 1 to 17 years showed prevalence of antibodies to MMR. The highest seronegativity was seen with respect to mumps. Gender differences were most pronounced with regard to rubella IgG titres: girls aged 14 to 17 years were best protected, although seronegativity in 6.8% of this vulnerable group still shows the need of improvement. Search for predictors of missing seroprevalence identified young age to be the most important predictor. Children living in the former West and children born outside of Germany had a higher risk of lacking protection against measles and rubella, while children with a migration background but born in Germany were less often seronegative to measles antibodies than their German contemporaries. An association of seronegativity and early vaccination was seen for measles but not for mumps and rubella. A high maternal educational level was associated with seronegativity to measles and rubella. In vaccinated children, seronegativity was highest for mumps and lowest for rubella. For mumps, high differences were observed for seronegativity after one-dose and two-dose vaccination, respectively. Seronegativity increases as time since last vaccination passes thus indicating significant waning effects for all three components of MMR.

Long-term epidemiologic longitudinal study on the effect of vaccines on public inoculation

Public vaccination policies in Japan for several viruses have achieved favorable results. To accurately evaluate their overall effectiveness, we conducted a 45- year epidemiological survey of measles, varicella and mumps cases at our clinic. The number of patients with measles was found to be significantly decreased with the single-dose vaccination provided at public expense. However, we also witnessed an increasing trend of infection at a later age. The vaccination rates for varicella and mumps were relatively low because of their optional availability in Japan, and thus they cannot be considered to confer public protection. Although localized to a particular region, our results show that it is important to increase the immunization rate of vaccines for large-scale protection against viral infections through public programs.

Type 1 diabetes and measles, mumps and rubella childhood infections within the Italian Insulin-dependent Diabetes Registry

AIMS

Several studies confirmed the growing rate of Type 1 diabetes mellitus in childhood coinciding with increasing diagnosis of viral infections. A study investigating the incidence of Type 1 diabetes during 1996-1997 showed a higher notification of viral infections in the Pavia District. The aim was to confirm these results.

METHODS

This study evaluated the relationship between new cases of Type 1 diabetes and those of measles, mumps and rubella in 1996-2001, analysing data of newly-diagnosed Type 1 diabetes children, aged 0-14 years and enrolled into the RIDI (Italian Insulin-dependent Diabetes Registry) during the same years. Measles, rubella and mumps rates were calculated using as denominator the estimated 'population at risk', represented by the number of 0- to 14 year-old subjects who did not undergo the MMR (measles, mumps and rubella) vaccination. In order to investigate the association between Type 1 diabetes incidence and measles, rubella and mumps respectively, Spearman's rank correlation was used.

RESULTS

The analysis of the whole Registries data did not at first show any statistical significance between age-standardized Type 1 diabetes incidence density and estimated rates of measles, mumps and rubella notifications. Excluding data from Sardinia Registry, a significant association was observed between Type 1 diabetes incidence and mumps (P = 0.034) and rubella (P = 0.014), respectively, while there was no statistical significance between the incidence of measles cases and diabetes rates (P = 0.269).

CONCLUSIONS

According to our findings, mumps and rubella viral infections are associated with the onset of Type 1 diabetes. The statistical significance observed after exclusion of the Sardinian data suggests that other environmental factors may operate over populations with different genetic susceptibility.

Ongoing mumps outbreak in Novi Sad, the autonomous province of Vojvodina, Serbia, January to April 2012

From 16 January to 30 April 2012, a total of 119 cases of mumps were notified in Novi Sad, Serbia. Of these cases, 89 (75%), were among students. The average age of cases was 22 years-old (range 3-37). The outbreak is still ongoing in Novi Sad and is spreading to other parts of the Vojvodina province. As of 30 April, 209 cases have been notified in the province among those 119 from Novi Sad.

[Comparative analysis on the complete genome sequence of mumps epidemic strain and mumps vaccine strain S79 isolated in Zhejiang province, China between year 2005 and 2010]

OBJECTIVE

To compare the differences in the complete genome sequence between mumps epidemic strain and mumps vaccine strain S79 isolated in Zhejiang province.

METHODS

A total of 4 mumps epidemic strains, which were separated from Zhejiang province during 2005 to 2010, named as ZJ05-1, ZJ06-3, ZJ08-1 and ZJ10-1 were selected in the study. The complete genome sequences were amplified using RT-PCR. The genetic differences between vaccine strain S79 and other genotype strains were compared; while the genetic-distance was calculated and the evolution was analyzed.

RESULTS

The biggest difference between the 4 epidemic strains and the vaccine strain S79 was found on the membrane associated protein gene; whose average nucleotide differential number was 42.5 +/- 3.0 and the average variant ratio was 13.6%; while the mean amino acid differential number was 12.8 +/- 1.5 and the average variant ratio was 22.4%. The smallest difference among the 4 epidemic strains and the vaccine strain was found in stromatin genes, whose average nucleotide differential number was 73.8 +/- 2.5 and the average variant ratio was 5.9%; while the mean amino acid differential number was 3.0 +/- 0.8 and the average variant ratio was 0.8%. The dn/ds value of the stromatin genes of the 4 epidemic strains reached the highest, as 0.6526; but without any positive pressure (dn/ds < 1, chi2 = 0.87, P > 0.05). There were mutations happened on the known antigen epitope, as 8th amino acid of membrane associated protein genes and on the 336th and 356th amino acid of hemagglutinin/neuraminidase proteins. Compared with the vaccine strain, the glycosylation sites of ZJ05-1, ZJ06-3, ZJ08-1 and ZJ10-1 increased 1, 1, 2 and 2 respectively. The complete amino acid sequence of all strains showed that there were 17 characteristic sites found on the genotype-F mumps strain. Within the complete genome, the genetic-distance between epidemic strains and vaccine strains in Zhejiang province (0.071) was significantly larger than the genetic-distance between strains in Yunnan province (0.013); the difference showing statistical significance (t = 4.14, P < 0.05). Except nucleocapsid protein genes, all the genes shared similar evolution tree.

CONCLUSION

There were significant differences found in the genes between mumps epidemic strain and mumps vaccine in Zhejiang province.

An epidemiological investigation of mumps outbreak in a slum of Kolkata

An unexpected clustering of mumps cases were reported in a slum of Kolkata during early part of 2009. An epidemiological investigation was initiated with a view to assess the characteristics and determinants of the disease, and implications of such clustering of cases in a slum of Kolkata. Data were collected through house to house visit using predesigned schedule and epidemiological case sheet. The propagated outbreak existed for fifteen weeks yielding 104 clinical cases. On the whole, attack rate was 4.7%, the highest and lowest being in 6-10 years (11.68%) and above 15 years (0.94%), respectively. The parotid swelling was bilateral in 92.3% of cases; fever was the most common general symptom, reportedly present in 92.3% of study subjects. The overall mean duration of parotid swelling was 6.85 +/- 1.89 days. Morbidity from mumps far exceeds the mortality rate. Improved ventilation of living rooms, personal & oral hygiene; isolation of cases, upgradation of routine immunization, better nutrition etc. were recommended at family & community level and introduction of MMR vaccine in National Immunization Schedule was suggested.

Mumps in prison: description of an outbreak in Manitoba, Canada

OBJECTIVE

There is a lack of published information on the management of mumps in a prison setting. We describe an outbreak of mumps that occurred in a medium-security correctional centre (Milner Ridge) in Manitoba, Canada.

METHODS

A case definition of mumps consistent with that in the document "Guidelines for the Prevention and Control of Mumps Outbreaks in Canada" was adopted. Cell culture, polymerase chain reaction, and serology were used for case confirmation.

RESULTS

Five confirmed cases of mumps infection were identified at the Milner Ridge Correctional Centre between January 12 and February 5, 2009. One additional confirmed case and 3 additional probable cases were identified at a second correctional centre. Outbreak control at Milner Ridge was accomplished by cohorting the affected units of the centre, providing education on mumps, deferring transfers, and monitoring for further cases. Vaccination was offered to inmates and staff on the assumption, based on average inmate age, that the majority of inmates would have previously received, at most, a single dose of mumps-containing vaccine.

CONCLUSION

An outbreak of mumps in a correctional setting was successfully contained via implementation and tailoring of basic infection control measures, and vaccination of inmates and staff. Given the relatively young age of many inmates and the parallels between prisons and dormitories, it could be argued that inmates may represent another group of individuals for whom a second dose of mumps vaccine (if not received in childhood) would be beneficial as primary prophylaxis.

[Mumps makes a comeback]

After vaccination of Dutch children against mumps started in 1987 through the National Immunisation Programme the incidence of mumps decreased greatly. However, outbreaks of mumps have been occurring since the end of 2009, especially among students. We describe a vaccinated 20-year-old woman with uncomplicated mumps, a vaccinated 20-year-old student with mumps orchitis, and an unvaccinated 14-year-old boy who developed one-sided permanent deafness as a complication of mumps. Mumps outbreaks are likely caused by factors including incomplete protection following vaccination, waning of immunity, and intensive crowding. Mumps currently affects mainly people who were vaccinated more than 10 years ago. Outbreak response concentrates on surveillance, outbreak investigations, disease awareness, and provision of catch up vaccination to unvaccinated or incompletely vaccinated students. Adequate surveillance, important for building evidence for possible changes in mumps vaccination recommendations, depends on recognizing mumps and its complications.

[Mumps in Poland in 2010]

INTRODUCTION

Despite of the decline in the incidence rate of mumps which is the main result of the modifications of the Polish Immunization Programme (the vaccination against mumps has become obligatory since 2003), it is still a disease which occurs frequently in children.

OBJECTIVES

The main objective of the present article was to analyze the epidemiological situation of mumps in Poland in 2010 in comparison with the data from previous year. This paper was based on aggregated data published in "Infectious diseases and poisonings in Poland in 2010", "Vaccinations in Poland in 2010", "Case definitions for the infectious diseases used for the surveillance purposes in 2009-2011" and Polish Immunization Programme for 2010.

RESULTS

In Poland in 2010, 2 754 cases of mumps were reported. The incidence rate was 7.2 per 100 000 and was lower in comparison with the incidence rate observed in 2009 (7.7) and five times lower than the median incidence reported in 2004-2008. The highest incidence rate was observed in the children aged 5-9 years (53.9). Thirty two out of2 574 notified cases were hospitalized (1.16%).

CONCLUSIONS

Realization of the vaccination against mumps using conjugate MMR (measles-mumps-rubella) vaccine contributed to the decrease in the incidence rate of mumps in Polish population. The high vaccination coverage implies that the incidence rate of mumps will be still decreasing.

[Study of a population-wide epidemic outbreak of mumps virus G1 in Jerez de la Frontera (Spain)]

OBJECTIVES

To characterize the mumps outbreak, assess the effectiveness of vaccines and discuss prevention and control measures.

DESIGN

Observational cross-sectional study of cases by person, place, and time.

LOCATION

City Jerez de la Frontera and 8 Primary Care centres.

PARTICIPANTS

A total of 116 cases of mumps were reported throughout seven months, with the last case in June 2008.

MEASUREMENTS

MAIN OUTCOMES

age, sex, place of study or work, symptoms start date, clinical description, complications, and genotype of virus isolation, history and vaccination compositions. Calculation of total vaccine effectiveness. Active case finding and contact studies were performed on the families, work places and leisure areas.

RESULTS

The mean age of the cases was 16.24 years(SD 10.6). The majority (68.96%) of the cases were children at school and 31.03% arose from family and work areas. Mumps vaccine coverage rates were above 90%. The complete vaccine effectiveness (2 doses); for those under 20 years-old it was: 99.84% (95% CI=99.77 - 99.89), being lower in schools with the highest attack rate, immunised with current vaccine from Jeryl Lynn strain: 71.01% (95% CI=55.85 80.97). Two doses of this strain were used in 13.79% of the cases. Susceptible populations were vaccinated at the start of the outbreak: 11,381 doses used in schools and 93 outside schools.

CONCLUSIONS

An outbreak of mumps virus G 1 population with high rates of mumps vaccine coverage, with areas with low vaccine effectiveness with current vaccine. Mass vaccination of population has contributed to the resolution of the outbreak.

Mumps epidemic in orthodox religious low-vaccination communities in the Netherlands and Canada, 2007 to 2009

We assessed the epidemiological characteristics of a mumps virus epidemic (genotype D) that occurred in the Netherlands between August 2007 and May 2009 and its association with a subsequent mumps outbreak in Canada. In the Netherlands, five data sources were used: notifications (only mandatory since the end of 2008) (56 cases), laboratory confirmation data (177 cases), a sentinel general practitioner (GP) database (275 cases), hospitalisation data (29 cases) and weekly virological reports (96 cases). The median age of cases in the notification, laboratory and GP databases ranged from 13 to 15 years. The proportion of cases that were unvaccinated ranged from 65% to 85% in the notification, laboratory and GP databases. Having orthodox Protestant beliefs was the main reason for not being vaccinated. In Canada, a mumps virus strain indistinguishable from the Dutch epidemic strain was detected between February and October 2008 in an orthodox Protestant community with historical and family links to the affected community in the Netherlands, suggesting that spread to Canada had occurred. Prevention and control of vaccine-preventable diseases among population subgroups with low vaccination coverage remains a priority.

Transmission of mumps virus from mumps-vaccinated individuals to close contacts

During a recent mumps epidemic in the Netherlands caused by a genotype D mumps virus strain, we investigated the potential of vaccinated people to spread mumps disease to close contacts. We compared mumps viral titers of oral fluid specimens obtained by quantitative PCR from vaccinated (n=60) and unvaccinated (n=111) mumps patients. We also investigated the occurrence of mumps infection among the household contacts of vaccinated mumps patients. We found that viral titers are higher for unvaccinated patients than for vaccinated patients during the 1st 3 days after onset of disease. While no symptomatic cases were reported among the household contacts (n=164) of vaccinated mumps patients (n=36), there were cases with serological evidence of asymptomatic infection among vaccinated household contacts (9 of 66 vaccinated siblings). For two of these siblings, the vaccinated index patient was the most probable source of infection. We conclude that, in this particular outbreak, the risk of a close contact becoming infected by vaccinated patients was small, but present.

Ongoing large mumps outbreak in the Federation of Bosnia and Herzegovina, Bosnia and Herzegovina, December 2010 to July 2011

From December 2010 until the end of July 2011, 5,261 mumps cases were recorded in the Federation of Bosnia and Herzegovina, Bosnia and Herzegovina, leading to an incidence of 225.8 per 100,000. Fifteen to 19 year-olds (43%) were most affected and 62% of cases were male. Mumps-specific IgM antibodies were found in about 70% of sera investigated, complications were reported in 41% of 81 hospitalised patients. The outbreak affected mainly those unvaccinated or unaware of their vaccination status and is probably due to vaccination failures during the war and postwar period (1992–1998).

Mumps in prison: description of an outbreak in Manitoba, Canada

OBJECTIVE

There is a lack of published information on the management of mumps in a prison setting. We describe an outbreak of mumps that occurred in a medium-security correctional centre (Milner Ridge) in Manitoba, Canada.

METHODS

A case definition of mumps consistent with that in the document "Guidelines for the Prevention and Control of Mumps Outbreaks in Canada" was adopted. Cell culture, polymerase chain reaction, and serology were used for case confirmation.

RESULTS

Five confirmed cases of mumps infection were identified at the Milner Ridge Correctional Centre between January 12 and February 5, 2009. One additional confirmed case and 3 additional probable cases were identified at a second correctional centre. Outbreak control at Milner Ridge was accomplished by cohorting the affected units of the centre, providing education on mumps, deferring transfers, and monitoring for further cases. Vaccination was offered to inmates and staff on the assumption, based on average inmate age, that the majority of inmates would have previously received, at most, a single dose of mumps-containing vaccine.

CONCLUSION

An outbreak of mumps in a correctional setting was successfully contained via implementation and tailoring of basic infection control measures, and vaccination of inmates and staff. Given the relatively young age of many inmates and the parallels between prisons and dormitories, it could be argued that inmates may represent another group of individuals for whom a second dose of mumps vaccine (if not received in childhood) would be beneficial as primary prophylaxis.

The role of schools in the spread of mumps among unvaccinated children: a retrospective cohort study

BACKGROUND

In the Netherlands, epidemics of vaccine preventable diseases are largely confined to an orthodox protestant minority with religious objections to vaccination. The clustering of unvaccinated children in orthodox protestant schools can foster the spread of epidemics. School closure has nevertheless not been practiced up until now. A mumps epidemic in 2007-2008 gave us an opportunity to study the role of schools in the spread of a vaccine preventable disease in a village with low vaccination coverage.

METHODS

A retrospective cohort study was conducted among the students in four elementary schools and their siblings. The following information was collected for each child: having had the mumps or not and when, school, age, MMR vaccination status, household size, presence of high school students in the household, religious denomination, and home village. The spread of mumps among unvaccinated children was compared for the four schools in a Kaplan-Meier analysis using a log-rank test. Cox proportional hazard analyses were performed to test for the influence of other factors. To correct for confounding, a univariate Cox regression model with only school included as a determinant was compared to a multivariate regression model containing all possible confounders.

RESULTS

Out of 650 households with children at the schools, 54% completed a questionnaire, which provided information on 1191 children. For the unvaccinated children (N = 769), the Kaplan-Meier curves showed significant differences among the schools in their cumulative attack rates. After correction for confounding, the Cox regression analysis showed the hazard of mumps to be higher in one orthodox protestant school compared to the other (hazard ratio 1.43, p < 0.001). Household size independently influenced the hazard of mumps (hazard ratio 1.44, p < 0.005) with children in larger households running a greater risk.

CONCLUSION

If and when unvaccinated children got mumps was determined by the particular school the children and their siblings attended, and by the household size. This finding suggests that school closure can influence the spread of an epidemic among orthodox protestant populations, provided that social distancing is adhered to as well. Further research on the effects of school closure on the final attack rate is nevertheless recommended.

An assessment of mumps vaccine effectiveness by dose during an outbreak in Canada

BACKGROUND

This investigation was done to assess vaccine effectiveness of one and two doses of the measles, mumps and rubella (MMR) vaccine during an outbreak of mumps in Ontario. The level of coverage required to reach herd immunity and interrupt community transmission of mumps was also estimated.

METHODS

Information on confirmed cases of mumps was retrieved from Ontario's integrated Public Health Information System. Cases that occurred between Sept. 1, 2009, and June 10, 2010, were included. Selected health units supplied coverage data from the Ontario Immunization Record Information System. Vaccine effectiveness by dose was calculated using the screening method. The basic reproductive number (R(0)) represents the average number of new infections per case in a fully susceptible population, and R(0) values of between 4 and 10 were considered for varying levels of vaccine effectiveness.

RESULTS

A total of 134 confirmed cases of mumps were identified. Information on receipt of MMR vaccine was available for 114 (85.1%) cases, of whom 63 (55.3%) reported having received only one dose of vaccine; 32 (28.1%) reported having received two doses. Vaccine effectiveness of one dose of the MMR vaccine ranged from 49.2% to 81.6%, whereas vaccine effectiveness of two doses ranged from 66.3% to 88.0%. If we assume vaccine effectiveness of 85% for two doses of the vaccine, vaccine coverage of 88.2% and 98.0% would be needed to interrupt community transmission of mumps if the corresponding reproductive values were four and six.

INTERPRETATION

Our estimates of vaccine effectiveness of one and two doses of mumps-containing vaccine were consistent with the estimates that have been reported in other outbreaks. Outbreaks occurring in Ontario and elsewhere serve as a warning against complacency over vaccination programs.

[Genetic characteristics on the small hydrophobic protein and hemagglutinin-neuraminidase genes of mumps virus in Yunnan province, China from 2007 to 2009]

OBJECTIVE

To analyze genetic characterization of the small hydrophobic and hemagglutinin-neuraminidase genes of mumps virus (MuV) isolated in Yunnan province, China from 2007 to 2009.

METHODS

Fourteen MuV strains were isolated in Yunnan, China from 2007 to 2009. Using RT-PCR, the SH gene fragments contained 316 nucleotides in all strains and HN gene of six strains were sequenced. The sequences were aligned with other mumps virus sequences downloaded from GenBank using Mega 4.1 software.

RESULTS

Fourteen isolated strains were closely related to other reference strains of F genotypes. In SH gene, the homology of nucleotide and amino acid among the fourteen isolated strains were 98.3% - 100.0% and 96.5% - 100.0%, respectively, and 92.6% - 99.4% and 87.7% - 100.0% of homology when compared with that of strains isolated from other provinces in China, respectively. Wsh1 and Wsh2 strains had less homology when compared to other strains of F genotypes. The fourteen strains had homology of 84.5% - 85.1% and 77.2% compared to vaccine strains on nucleotide and amino acid, respectively, and had homology of 83.4% - 90.9% and 70.1% - 86.0% compared to that of other genotypes. In HN gene, the homology of nucleotide and amino acid among the six isolated strains were 99.3% - 99.5% and 99.1% - 99.7%, respectively, and also 99.8% and 99.8% of homology respectively when compared to the SP strain in China. All the six strains had homology of 92.4% - 93.2% and 95.5% - 96.4% when compared to the vaccine strains on nucleotide and amino acid, respectively, and had homology of 94.7% - 96.8% and 95.5% - 99.1% compared to other genotypes.

CONCLUSION

Fourteen strains isolated in Yunnan from 2007 to 2009 belonged to F genotype of MuV while the HN gene seemed more conservative than SH gene.

Ongoing outbreak of mumps infection in Oban, Scotland, November 2010 to January 2011

We report on an ongoing outbreak of 119 cases of mumps virus infection in the Oban area of Scotland,from 29 November 2010 to 31 January 2011. The median age of cases was 20 years, with the highest incidence in the 13-19-year-olds. A total of 53 cases had received two doses of measles-mumps-rubella (MMR) vaccine,in accordance with the United Kingdom vaccination schedule, while 33 had received only one dose and 30 had not been vaccinated.

Measles among healthcare workers: a potential for nosocomial outbreaks

We report here 14 cases of measles among healthcare workers (HCWs) in Public Hospitals of Marseilles, France that occurred between April and November 2010. All cases but one were under 30 years of age. Following the identification of these cases, we checked the immune status among 154 HCWs who volunteered to take part in the study and showed that 93% and 88% were immune against measles and mumps respectively. HCWs non-immunised against measles were all under 30 years of age.

Detection of measles, mumps, and rubella viruses

Measles, mumps, and rubella are infections caused by RNA viruses of the same name and are vaccine preventable. The vaccines are frequently administered in a trivalent form. Laboratory diagnostic methods can include indirect detection via antibody (IgM and IgG) detection methods and direct detection by viral culture or viral genome detection. There are challenges for the laboratory in areas with low prevalence due to high vaccine uptake. In those areas, routine serological methods such as IgM detection may have a reduced positive predictive value and thus require confirmation by other methods. Direct detection of viral genomic material using reverse transcription polymerase chain reaction (RT-PCR) methodologies can play an important role for laboratory confirmation of acute infections. Furthermore, genotyping of these three viruses provides useful molecular epidemiological data for differentiating vaccine from wild-type strains, linking cases and outbreaks, and tracking geographic spread and elimination. The purpose of this chapter is to provide guidance for the laboratory diagnosis of measles, mumps, and rubella virus infections. Where assays are commercially available or previously published, the appropriate references are provided as well as brief comments on the interpretation of results. Detailed protocols are provided for the molecular assays which have been developed and more commonly applied in recent years.