1
|
Hayden ME, Burns L, Farquhar S, Tanabe KO, Bernheim RG, Holstege CP. Using an Exposure Call Center to Help Mitigate Outbreaks, Such as COVID-19, on a University Campus. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:725-728. [PMID: 37097205 DOI: 10.1097/phh.0000000000001750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Rapid identification and management of close contacts is an important component of an effective university mitigation strategy for highly contagious infectious diseases such as measles and coronavirus disease-2019 (COVID-19). Institutions of higher education must plan for an associated large influx of calls that can overwhelm standard student health and local public health operations. In fall 2020, a large state public university's Department of Student Health and Wellness created a dedicated exposure call center (ECC), in close collaboration with the local public health department, to quickly assess students who learned of a COVID-19 exposure outside of the formal contact tracing process. The ECC operated 7 days a week and fielded 3361 calls: 3187 from students and 174 from staff, faculty, and parents. The ECC provided rapid assessment and guidance for students with COVID-19 exposure, allowing for prompt quarantine and medical assessment when warranted. Call centers can increase the bandwidth of university health centers and also reduce the burden on health care providers and other public health resources during periods of crisis or high demand.
Collapse
Affiliation(s)
- Meredith E Hayden
- Departments of Student Health and Wellness (Drs Hayden and Holstege and Mss Burns, Farquhar, and Tanabe), Public Health Sciences (Ms Bernheim), and Emergency Medicine and Pediatrics (Dr Holstege), University of Virginia, Charlottesville, Virginia
| | | | | | | | | | | |
Collapse
|
2
|
Kidokoro M, Shiino T, Yamaguchi T, Nariai E, Kodama H, Nakata K, Sano T, Gotou K, Kisu T, Maruyama T, Kuba Y, Sakata W, Higashi T, Kiyota N, Sakai T, Yahiro S, Nagita A, Watanabe K, Hirokawa C, Hamabata H, Fujii Y, Yamamoto M, Yokoi H, Sakamoto M, Saito H, Shibata C, Inada M, Fujitani M, Minagawa H, Ito M, Shima A, Murano K, Katoh H, Kato F, Takeda M, Suga S. Nationwide and long-term molecular epidemiologic studies of mumps viruses that circulated in Japan between 1986 and 2017. Front Microbiol 2022; 13:728831. [PMID: 36386684 PMCID: PMC9650061 DOI: 10.3389/fmicb.2022.728831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/21/2022] [Indexed: 11/25/2022] Open
Abstract
In Japan, major mumps outbreaks still occur every 4–5 years because of low mumps vaccine coverage (30–40%) owing to the voluntary immunization program. Herein, to prepare for a regular immunization program, we aimed to reveal the nationwide and long-term molecular epidemiological trends of the mumps virus (MuV) in Japan. Additionally, we performed whole-genome sequencing (WGS) using next-generation sequencing to assess results from conventional genotyping using MuV sequences of the small-hydrophobic (SH) gene. We analyzed 1,064 SH gene sequences from mumps clinical samples and MuV isolates collected from 25 prefectures from 1986 to 2017. The results showed that six genotypes, namely B (110), F (1), G (900), H (3), J (41), and L (9) were identified, and the dominant genotypes changed every decade in Japan since the 1980s. Genotype G has been exclusively circulating since the early 2000s. Seven clades were identified for genotype G using SH sequence-based classification. To verify the results, we performed WGS on 77 representative isolates of genotype G using NGS and phylogenetically analyzed them. Five clades were identified with high bootstrap values and designated as Japanese clade (JPC)-1, -2, -3, -4, -5. JPC-1 and -3 accounted for over 80% of the total genotype G isolates (68.3 and 13.8%, respectively). Of these, JPC-2 and -5, were newly identified clades in Japan through this study. This is the first report describing the nationwide and long-term molecular epidemiology of MuV in Japan. The results provide information about Japanese domestic genotypes, which is essential for evaluating the mumps elimination progress in Japan after the forthcoming introduction of the mumps vaccine into Japan’s regular immunization program. Furthermore, the study shows that WGS analysis using NGS is more accurate than results obtained from conventional SH sequence-based classification and is a powerful tool for accurate molecular epidemiology studies.
Collapse
Affiliation(s)
- Minoru Kidokoro
- Department of Quality Assurance, Radiation Safety, and Information Management, National Institute of Infectious Diseases, Tokyo, Japan
- *Correspondence: Minoru Kidokoro,
| | - Teiichiro Shiino
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tomohiro Yamaguchi
- Public Hygiene Division, Gifu Prefectural Tono Region Public Health Center, Tajimi, Japan
| | - Eri Nariai
- Department of Health and Food Safety, Ishikawa Prefectural Institute of Public Health and Environmental Science, Kanazawa, Japan
| | - Hiroe Kodama
- Department of Health and Food Safety, Ishikawa Prefectural Institute of Public Health and Environmental Science, Kanazawa, Japan
| | - Keiko Nakata
- Division of Virology, Osaka Institute of Public Health, Osaka, Japan
| | - Takako Sano
- Division of Microbiology, Kanagawa Prefectural Institute of Public Health, Chigasaki, Japan
| | - Keiko Gotou
- Division of Virology, Ibaraki Prefectural Institute of Public Health, Mito, Ibaraki, Japan
| | - Tomoko Kisu
- Virus Research Center, Clinical Research Division, Sendai National Hospital, Sendai, Japan
| | - Tomomi Maruyama
- Department of Infectious Diseases, Gifu Prefectural Research Institute for Health and Environmental Sciences, Kakamigahara, Japan
| | - Yumani Kuba
- Department of Medical Microbiology and zoology, Okinawa Prefectural Institute of Health and Environment, Uruma, Japan
| | - Wakako Sakata
- Kitakyushu City Institute of Health and Environmental Sciences, Kitakyushu, Japan
| | - Teruaki Higashi
- Kitakyushu City Institute of Health and Environmental Sciences, Kitakyushu, Japan
| | - Naoko Kiyota
- Department of Microbiology, Kumamoto Prefectural Institute of Public-Health and Environmental Science, Uto, Japan
| | - Takashi Sakai
- Department of Microbiology, Kumamoto Prefectural Institute of Public-Health and Environmental Science, Uto, Japan
| | - Shunsuke Yahiro
- Department of Microbiology, Kumamoto Prefectural Institute of Public-Health and Environmental Science, Uto, Japan
| | - Akira Nagita
- Department of Pediatrics, Mizushima Central Hospital, Kurashiki, Japan
| | - Kaori Watanabe
- Virology Section, Niigata Prefectural Institute of Public Health and Environmental Sciences, Niigata, Japan
| | - Chika Hirokawa
- Virology Section, Niigata Prefectural Institute of Public Health and Environmental Sciences, Niigata, Japan
| | | | - Yoshiki Fujii
- Division of Biological Science, Hiroshima City Institute of Public Health, Hiroshima, Japan
| | - Miwako Yamamoto
- Division of Biological Science, Hiroshima City Institute of Public Health, Hiroshima, Japan
| | - Hajime Yokoi
- Health Science Division, Chiba City Institute of Health and Environment, Chiba, Japan
| | - Misako Sakamoto
- Health Science Division, Chiba City Institute of Health and Environment, Chiba, Japan
| | - Hiroyuki Saito
- Department of Microbiology, Akita Prefectural Research Center for Public Health and Environment, Akita, Japan
| | - Chihiro Shibata
- Department of Microbiology, Akita Prefectural Research Center for Public Health and Environment, Akita, Japan
| | - Machi Inada
- Virology and Epidemiology Division, Nara Prefecture Institute of Health, Sakurai, Japan
| | - Misako Fujitani
- Virology and Epidemiology Division, Nara Prefecture Institute of Health, Sakurai, Japan
| | - Hiroko Minagawa
- Laboratory of Virology, Aichi Prefectural Institute of Public Health, Nagoya, Japan
| | - Miyabi Ito
- Laboratory of Virology, Aichi Prefectural Institute of Public Health, Nagoya, Japan
| | - Akari Shima
- Microbiology Division, Saga Prefectural Institute of Public Health and Pharmaceutical Research, Saga, Japan
| | - Keiko Murano
- Department of Virology III, National Institute of Infectious Diseases, Tokyo, Japan
| | - Hiroshi Katoh
- Department of Virology III, National Institute of Infectious Diseases, Tokyo, Japan
| | - Fumihiro Kato
- Department of Virology III, National Institute of Infectious Diseases, Tokyo, Japan
| | - Makoto Takeda
- Department of Virology III, National Institute of Infectious Diseases, Tokyo, Japan
| | - Shigeru Suga
- Department of Pediatrics, National Hospital Organization Mie National Hospital, Tsu, Japan
| | | |
Collapse
|
3
|
Akhter S, Robbins M, Curtis P, Hinshaw B, Wells EM. Online survey of university students' perception, awareness and adherence to COVID-19 prevention measures. BMC Public Health 2022; 22:964. [PMID: 35562731 PMCID: PMC9103602 DOI: 10.1186/s12889-022-13356-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/29/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Determining factors correlated with protective measures against COVID-19 is important to improve public health response. This study describes student opinions related to university COVID-19 preventive measures. METHODS In fall 2020, 643 US university students completed an online survey on perception, awareness, and adherence to COVID-19 preventive measures. Outcomes included protocol effectiveness (self or others), protocol adherence (self or others), consequences of protocol violation, knowledge of violations, and level of concern for COVID-19. Multiple linear regression models determined correlates of outcome variables. Covariates included gender, race, residence, area of study, class, and knowledge of someone with a positive COVID-19 test. RESULTS Overall, students agreed with protective measures (equivalent to higher scores). In adjusted linear models, females (versus males) had significantly higher scores for protocol effectiveness (self) (p < 0.001), consequences of protocol violation (p = 0.005), and concern about COVID-19 (p < 0.001). Asian/Pacific Islander (versus white) had significantly higher scores for protocol effectiveness (self) (p < 0.001), consequences of protocol violation (p = 0.008), and concern about COVID-19 (p = 0.001). Graduate students (versus freshman) had higher scores for protocol effectiveness (self) (p < 0.001), protocol adherence (self) (p = 0.004) and concern about COVID-19 (p < 0.001). In contrast, participants who had a positive COVID-19 test had significantly lower scores for protocol effectiveness (self) (p = 0.02), protocol adherence (self) (p = 0.004), and consequences of protocol violation (p = 0.008). CONCLUSION Overall, females, Asian/Pacific Islanders, and graduate students were more likely to agree with or adhere to COVID-19 prevention guidelines but those who tested positive for COVID-19 were less likely to do so. These results may inform future prevention efforts.
Collapse
Affiliation(s)
- Salma Akhter
- grid.169077.e0000 0004 1937 2197School of Health Sciences, Purdue University, West Lafayette, IN USA
| | - Meredith Robbins
- grid.169077.e0000 0004 1937 2197School of Health Sciences, Purdue University, West Lafayette, IN USA
| | - Perry Curtis
- grid.169077.e0000 0004 1937 2197School of Health Sciences, Purdue University, West Lafayette, IN USA
| | - Belle Hinshaw
- grid.169077.e0000 0004 1937 2197School of Health Sciences, Purdue University, West Lafayette, IN USA
| | - Ellen M. Wells
- grid.169077.e0000 0004 1937 2197School of Health Sciences, Purdue University, West Lafayette, IN USA ,grid.169077.e0000 0004 1937 2197Department of Public Health, Purdue University, West Lafayette, IN USA
| |
Collapse
|
4
|
Connell AR, Connell J, Leahy TR, Hassan J. Mumps Outbreaks in Vaccinated Populations-Is It Time to Re-assess the Clinical Efficacy of Vaccines? Front Immunol 2020; 11:2089. [PMID: 33072071 PMCID: PMC7531022 DOI: 10.3389/fimmu.2020.02089] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/31/2020] [Indexed: 01/05/2023] Open
Abstract
History illustrates the remarkable public health impact of mass vaccination, by dramatically improving life expectancy and reducing the burden of infectious diseases and co-morbidities worldwide. It has been perceived that if an individual adhered to the MMR vaccine schedule that immunity to mumps virus (MuV) would be lifelong. Recent mumps outbreaks in individuals who had received two doses of the Measles Mumps Rubella (MMR) vaccine has challenged the efficacy of the MMR vaccine. However, clinical symptoms, complications, viral shedding and transmission associated with mumps infection has been shown to be reduced in vaccinated individuals, demonstrating a benefit of this vaccine. Therefore, the question of what constitutes a good mumps vaccine and how its impact is assessed in this modern era remains to be addressed. Epidemiology of the individuals most affected by the outbreaks (predominantly young adults) and variance in the circulating MuV genotype have been well-described alluding to a collection of influences such as vaccine hesitancy, heterogeneous vaccine uptake, primary, and/or secondary vaccine failures. This review aims to discuss in detail the interplay of factors thought to be contributing to the current mumps outbreaks seen in highly vaccinated populations. In addition, how mumps diagnoses has progressed and impacted the understanding of mumps infection since a mumps vaccine was first developed, the limitations of current laboratory tests in confirming protection in vaccinated individuals and how vaccine effectiveness is quantified are also considered. By highlighting knowledge gaps within this area, this state-of-the-art review proposes a change of perspective regarding the impact of a vaccine in a highly vaccinated population from a clinical, diagnostic and public perspective, highlighting a need for a paradigm shift on what is considered vaccine immunity.
Collapse
Affiliation(s)
- Anna R. Connell
- National Children's Research Centre, Children's Health Ireland, Dublin, Ireland
| | - Jeff Connell
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - T. Ronan Leahy
- Children's Health Ireland, Dublin, Ireland
- Department of Pediatrics, University of Dublin, Trinity College, Dublin, Ireland
| | - Jaythoon Hassan
- National Children's Research Centre, Children's Health Ireland, Dublin, Ireland
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| |
Collapse
|
5
|
Mumps: an Update on Outbreaks, Vaccine Efficacy, and Genomic Diversity. Clin Microbiol Rev 2020; 33:33/2/e00151-19. [PMID: 32102901 DOI: 10.1128/cmr.00151-19] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Mumps is an acute viral infection characterized by inflammation of the parotid and other salivary glands. Persons with mumps are infectious from 2 days before through 5 days after parotitis onset, and transmission is through respiratory droplets. Despite the success of mumps vaccination programs in the United States and parts of Europe, a recent increase in outbreaks of mumps virus infections among fully vaccinated populations has been reported. Although the effectiveness of the mumps virus component of the measles-mumps-rubella (MMR) vaccine is suboptimal, a range of contributing factors has led to these outbreaks occurring in high-vaccination-coverage settings, including the intensity of exposure, the possibility of vaccine strain mismatch, delayed implementation of control measures due to the timeliness of reporting, a lack of use of appropriate laboratory tests (such as reverse transcription-PCR), and time since last vaccination. The resurgence of mumps virus infections among previously vaccinated individuals over the past decade has prompted discussions about new strategies to mitigate the risk of future outbreaks. The decision to implement a third dose of the MMR vaccine in response to an outbreak should be considered in discussions with local public health agencies. Traditional public health measures, including the isolation of infectious persons, timely contact tracing, and effective communication and awareness education for the public and medical community, should remain key interventions for outbreak control. Maintaining high mumps vaccination coverage remains key to U.S. and global efforts to reduce disease incidence and rates of complications.
Collapse
|
6
|
Barrabeig I, Antón A, Torner N, Pumarola T, Costa J, Domínguez À. Mumps: MMR vaccination and genetic diversity of mumps virus, 2007-2011 in Catalonia, Spain. BMC Infect Dis 2019; 19:954. [PMID: 31706275 PMCID: PMC6842476 DOI: 10.1186/s12879-019-4496-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 09/23/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mumps is a vaccine-preventable disease but outbreaks have been reported in persons vaccinated with two doses of MMR vaccine. The objective was to describe the demographic features, vaccination effectiveness and genetic mumps virus diversity among laboratory-confirmed cases between 2007 and 2011 in Catalonia. METHODS Cases and outbreaks of mumps notified to the notifiable diseases system of Catalonia between 2007 and 2011 retrospectively registered were included. Public health care centres provided written immunization records to regional public health staff to determine the vaccination history. Saliva and serum specimens were collected from suspected cases for laboratory-confirmation using real-time reverse-transcriptase PCR (rtRT-PCR) or serological testing. Phylogenetic analysis of the complete SH gene (316 nucleotides) and complete coding HN protein (1749 nucleotides) sequences was made. Categorical variables were compared using the Chi-square or Fisher's tests and continuous variables using the Student test. Vaccination effectiveness by number of MMR doses was estimated using the screening method. RESULTS During the study period, 581 confirmed cases of mumps were notified (incidence rate 1.6 cases/100,000 persons-year), of which 60% were male. Three hundred sixty-four laboratory-confirmed cases were reported, of which 44% were confirmed by rtRT-PCR. Of the 289 laboratory-confirmed cases belonging to vaccination cohorts, 33.5% (97) had received one dose of MMR vaccine and 50% (145) two doses. Based on phylogenetic analyses of 316-nucleotide and 174-nucleotide SH sequences, the viruses belonging to viral genotypes were: genotype G (126), genotype D (23), genotype H (2), genotype F (2), genotype J (1), while one remained uncharacterized. Amino acid differences were detected between circulating strains and the Jeryl Lynn vaccine strains, although the majority of amino acid substitutions were genotype-specific. Fifty-one outbreaks were notified that included 324 confirmed mumps cases. Genotype G was the most frequent genotype detected. The family (35%), secondary schools (25%) and community outbreaks (18%) were the most frequent settings. CONCLUSIONS Our study shows that genotype G viruses are the most prevalent in Catalonia. Most cases occurred in people who had received two doses of MMR, suggesting inadequate effectiveness of the Jeryl Lynn vaccine strain. The possible factors related are discussed.
Collapse
Affiliation(s)
- Irene Barrabeig
- Epidemiological Surveillance and Response to Public Health Emergencies Unit in Barcelona South, Agency of Public Health of Catalonia, Generalitat of Catalonia., Hospital Universitari de Bellvitge, Edifici antiga escola d'infermeria, 3a planta, Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Spain.
- CIBER Epidemiología y Salud Pública, Institut of Health Carlos III, Madrid, Spain.
| | - Andrés Antón
- Virology Unit, Centre de Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain
| | - Núria Torner
- Epidemiological Surveillance and Response to Public Health Emergencies Unit in Barcelona South, Agency of Public Health of Catalonia, Generalitat of Catalonia., Hospital Universitari de Bellvitge, Edifici antiga escola d'infermeria, 3a planta, Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Spain
- CIBER Epidemiología y Salud Pública, Institut of Health Carlos III, Madrid, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Tomàs Pumarola
- Virology Unit, Centre de Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain
| | - Josep Costa
- Virology Unit, Centre de Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain
- CIBER Enfermedades Hepáticas y Digestivas, Institute of Health Carlos III, Madrid, Spain
| | - Àngela Domínguez
- CIBER Epidemiología y Salud Pública, Institut of Health Carlos III, Madrid, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| |
Collapse
|
7
|
Alkam D, Jenjaroenpun P, Wongsurawat T, Udaondo Z, Patumcharoenpol P, Robeson M, Haselow D, Mason W, Nookaew I, Ussery D, Jun SR. Genomic characterization of mumps viruses from a large-scale mumps outbreak in Arkansas, 2016. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2019; 75:103965. [PMID: 31319177 PMCID: PMC6832845 DOI: 10.1016/j.meegid.2019.103965] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 07/02/2019] [Accepted: 07/12/2019] [Indexed: 11/22/2022]
Abstract
In 2016, a year-long large-scale mumps outbreak occurred in Arkansas among a highly-vaccinated population. A total of 2954 mumps cases were identified during this outbreak. The majority of cases (1676 (57%)) were school-aged children (5-17 years), 1536 (92%) of these children had completed the mumps vaccination schedule. To weigh the possibility that the mumps virus evaded vaccine-induced immunity in the affected Arkansas population, we established a pipeline for genomic characterization of the outbreak strains. Our pipeline produces whole-genome sequences along with phylogenetic analysis of the outbreak mumps virus strains. We collected buccal swab samples of patients who tested positive for the mumps virus during the 2016 Arkansas outbreak, and used the portable Oxford Nanopore Technology to sequence the extracted strains. Our pipeline identified the genotype of the Arkansas mumps strains as genotype G and presented a genome-based phylogenetic tree with superior resolution to a standard small hydrophobic (SH) gene-based tree. We phylogenetically compared the Arkansas whole-genome sequences to all publicly available mumps strains. While these analyses show that the Arkansas mumps strains are evolutionarily distinct from the vaccine strains, we observed no correlation between vaccination history and phylogenetic grouping. Furthermore, we predicted potential B-cell epitopes encoded by the Arkansas mumps strains using a random forest prediction model trained on antibody-antigen protein structures. Over half of the predicted epitopes of the Jeryl-Lynn vaccine strains in the Hemagglutinin-Neuraminidase (HN) surface glycoprotein (a major target of neutralizing antibodies) region are missing in the Arkansas mumps strains. In-silico analyses of potential epitopes may indicate that the Arkansas mumps strains display antigens with reduced immunogenicity, which may contribute to reduced vaccine effectiveness. However, our in-silico findings should be assessed by robust experiments such as cross neutralization assays. Metadata analysis showed that vaccination history had no effect on the evolution of the Arkansas mumps strains during this outbreak. We conclude that the driving force behind the spread of the mumps virus in the 2016 Arkansas outbreak remains undetermined.
Collapse
Affiliation(s)
- Duah Alkam
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205, USA.
| | - Piroon Jenjaroenpun
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205, USA.
| | - Thidathip Wongsurawat
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205, USA.
| | - Zulema Udaondo
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205, USA.
| | - Preecha Patumcharoenpol
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205, USA.
| | - Michael Robeson
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205, USA.
| | - Dirk Haselow
- Arkansas Department of Health, 4815 W Markham St, Little Rock, AR 72205, USA.
| | - William Mason
- Arkansas Department of Health, 4815 W Markham St, Little Rock, AR 72205, USA.
| | - Intawat Nookaew
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205, USA; Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205, USA.
| | - David Ussery
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205, USA; Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205, USA.
| | - Se-Ran Jun
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205, USA.
| |
Collapse
|
8
|
Rolfes MA, Millman AJ, Talley P, Elbadawi LI, Kramer NA, Barnes JR, Blanton L, Davis JP, Cole S, Dreisig JJ, Garten R, Haupt T, Jackson MA, Kocharian A, Leifer D, Lynfield R, Martin K, McHugh L, Robinson S, Turabelidze G, Webber LA, Pearce Weinberg M, Wentworth DE, Finelli L, Jhung MA. Influenza-Associated Parotitis During the 2014-2015 Influenza Season in the United States. Clin Infect Dis 2018; 67:485-492. [PMID: 29617957 PMCID: PMC6295667 DOI: 10.1093/cid/ciy136] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/13/2018] [Indexed: 02/06/2023] Open
Abstract
Background During the 2014-2015 influenza season in the United States, 256 cases of influenza-associated parotitis were reported from 27 states. We conducted a case-control study and laboratory investigation to further describe this rare clinical manifestation of influenza. Methods During February 2015-April 2015, we interviewed 50 cases (with parotitis) and 124 ill controls (without parotitis) with laboratory-confirmed influenza; participants resided in 11 states and were matched by age, state, hospital admission status, and specimen collection date. Influenza viruses were characterized using real-time polymerase chain reaction and next-generation sequencing. We compared cases and controls using conditional logistic regression. Specimens from additional reported cases were also analyzed. Results Cases, 73% of whom were aged <20 years, experienced painful (86%), unilateral (68%) parotitis a median of 4 (range, 0-16) days after onset of systemic or respiratory symptoms. Cases were more likely than controls to be male (76% vs 51%; P = .005). We detected influenza A(H3N2) viruses, genetic group 3C.2a, in 100% (32/32) of case and 92% (105/108) of control specimens sequenced (P = .22). Influenza B and A(H3N2) 3C.3 and 3C.3b genetic group virus infections were detected in specimens from additional cases. Conclusions Influenza-associated parotitis, as reported here and in prior sporadic case reports, seems to occur primarily with influenza A(H3N2) virus infection. Because of the different clinical and infection control considerations for mumps and influenza virus infections, we recommend clinicians consider influenza in the differential diagnoses among patients with acute parotitis during the influenza season.
Collapse
Affiliation(s)
- Melissa A Rolfes
- Epidemic Intelligence Service, Atlanta, Georgia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alexander J Millman
- Epidemic Intelligence Service, Atlanta, Georgia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pamela Talley
- Epidemic Intelligence Service, Atlanta, Georgia
- Minnesota Department of Health, St. Paul, Madison
| | - Lina I Elbadawi
- Epidemic Intelligence Service, Atlanta, Georgia
- Bureau of Communicable Disease, Wisconsin Division of Public Health, Madison
| | - Natalie A Kramer
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John R Barnes
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lenee Blanton
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeffrey P Davis
- Bureau of Communicable Disease, Wisconsin Division of Public Health, Madison
| | - Stefanie Cole
- Michigan Department of Health and Human Services, Lansing
| | - John J Dreisig
- New Hampshire Division of Public Health Services, Concord
| | - Rebecca Garten
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thomas Haupt
- Bureau of Communicable Disease, Wisconsin Division of Public Health, Madison
| | | | - Anna Kocharian
- Bureau of Communicable Disease, Wisconsin Division of Public Health, Madison
| | - Daniel Leifer
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Karen Martin
- Minnesota Department of Health, St. Paul, Madison
| | - Lisa McHugh
- Communicable Disease Service, New Jersey Department of Health, Trenton
| | - Sara Robinson
- Maine Center for Disease Control and Prevention, Maine Department of Health and Human Services, Augusta
| | | | - Lori A Webber
- Maine Center for Disease Control and Prevention, Maine Department of Health and Human Services, Augusta
| | - Meghan Pearce Weinberg
- Epidemic Intelligence Service, Atlanta, Georgia
- Michigan Department of Health and Human Services, Lansing
| | - David E Wentworth
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lyn Finelli
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael A Jhung
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
9
|
Elbadawi LI, Talley P, Rolfes MA, Millman AJ, Reisdorf E, Kramer NA, Barnes JR, Blanton L, Christensen J, Cole S, Danz T, Dreisig JJ, Garten R, Haupt T, Isaac BM, Jackson MA, Kocharian A, Leifer D, Martin K, McHugh L, McNall RJ, Palm J, Radford KW, Robinson S, Rosen JB, Sakthivel SK, Shult P, Strain AK, Turabelidze G, Webber LA, Weinberg MP, Wentworth DE, Whitaker BL, Finelli L, Jhung MA, Lynfield R, Davis JP. Non-mumps Viral Parotitis During the 2014-2015 Influenza Season in the United States. Clin Infect Dis 2018; 67:493-501. [PMID: 29617951 PMCID: PMC6240917 DOI: 10.1093/cid/ciy137] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 02/13/2018] [Indexed: 12/17/2022] Open
Abstract
Background During the 2014-2015 US influenza season, 320 cases of non-mumps parotitis (NMP) among residents of 21 states were reported to the Centers for Disease Control and Prevention (CDC). We conducted an epidemiologic and laboratory investigation to determine viral etiologies and clinical features of NMP during this unusually large occurrence. Methods NMP was defined as acute parotitis or other salivary gland swelling of >2 days duration in a person with a mumps- negative laboratory result. Using a standardized questionnaire, we collected demographic and clinical information. Buccal samples were tested at the CDC for selected viruses, including mumps, influenza, human parainfluenza viruses (HPIVs) 1-4, adenoviruses, cytomegalovirus, Epstein-Barr virus (EBV), herpes simplex viruses (HSVs) 1 and 2, and human herpes viruses (HHVs) 6A and 6B. Results Among the 320 patients, 65% were male, median age was 14.5 years (range, 0-90), and 67% reported unilateral parotitis. Commonly reported symptoms included sore throat (55%) and fever (48%). Viruses were detected in 210 (71%) of 294 NMP patients with adequate samples for testing, ≥2 viruses were detected in 37 samples, and 248 total virus detections were made among all samples. These included 156 influenza A(H3N2), 42 HHV6B, 32 EBV, 8 HPIV2, 2 HPIV3, 3 adenovirus, 4 HSV-1, and 1 HSV-2. Influenza A(H3N2), HHV6B, and EBV were the most frequently codetected viruses. Conclusions Our findings suggest that, in addition to mumps, clinicians should consider respiratory viral (influenza) and herpes viral etiologies for parotitis, particularly among patients without epidemiologic links to mumps cases or outbreaks.
Collapse
Affiliation(s)
- Lina I Elbadawi
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Bureau of Communicable Diseases, Wisconsin Division of Public Health, Madison
| | - Pamela Talley
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Minnesota Department of Health, St. Paul, Atlanta, Georgia
| | - Melissa A Rolfes
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alexander J Millman
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Natalie A Kramer
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John R Barnes
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lenee Blanton
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Stefanie Cole
- Michigan Department of Health and Human Services, Lansing
| | - Tonya Danz
- Wisconsin State Laboratory of Hygiene, Madison
| | - John J Dreisig
- New Hampshire Division of Public Health Services, Concord
| | - Rebecca Garten
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thomas Haupt
- Bureau of Communicable Diseases, Wisconsin Division of Public Health, Madison
| | - Beth M Isaac
- New York City Department of Health & Mental Hygiene Bureau of Immunization, Queens
- CSTE/CDC Applied Epidemiology Fellowship, Atlanta, Georgia
| | | | - Anna Kocharian
- Bureau of Communicable Diseases, Wisconsin Division of Public Health, Madison
| | - Daniel Leifer
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Karen Martin
- Minnesota Department of Health, St. Paul, Atlanta, Georgia
| | - Lisa McHugh
- Communicable Disease Service, New Jersey Department of Health, Trenton
| | - Rebecca J McNall
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Palm
- Minnesota Department of Health, St. Paul, Atlanta, Georgia
| | - Kay W Radford
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sara Robinson
- Maine Center for Disease Control and Prevention, Maine Department of Health and Human Services, Augusta
| | - Jennifer B Rosen
- New York City Department of Health & Mental Hygiene Bureau of Immunization, Queens
| | | | - Peter Shult
- Wisconsin State Laboratory of Hygiene, Madison
| | - Anna K Strain
- Minnesota Department of Health, St. Paul, Atlanta, Georgia
| | | | - Lori A Webber
- Maine Center for Disease Control and Prevention, Maine Department of Health and Human Services, Augusta
| | - Meghan Pearce Weinberg
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Michigan Department of Health and Human Services, Lansing
| | - David E Wentworth
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brett L Whitaker
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lyn Finelli
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael A Jhung
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ruth Lynfield
- Minnesota Department of Health, St. Paul, Atlanta, Georgia
| | - Jeffrey P Davis
- Bureau of Communicable Diseases, Wisconsin Division of Public Health, Madison
| |
Collapse
|
10
|
L’Huillier AG, Eshaghi A, Racey CS, Ogbulafor K, Lombos E, Higgins RR, Alexander DC, Kristjanson E, Maregmen J, Gubbay JB, Mazzulli T. Laboratory testing and phylogenetic analysis during a mumps outbreak in Ontario, Canada. Virol J 2018; 15:98. [PMID: 29866178 PMCID: PMC5987625 DOI: 10.1186/s12985-018-0996-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/01/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In September 2009, a mumps outbreak originated in New York and spread to Northeastern USA and Canada. This study compares the performance of different diagnostic testing methods used in Ontario and describes molecular characteristics of the outbreak strain. METHODS Between September 2009 and February 2010, specimens from suspect cases were submitted to Public Health Ontario Laboratory for mumps serology, culture and/or real-time reverse-transcriptase PCR (rRT-PCR) testing. rRT-PCR-positive specimens underwent genotyping at Canada's National Microbiology Laboratory. Whole genome sequencing was performed on four outbreak and three sporadic viral culture isolates. RESULTS Six hundred ninety-eight patients had IgM serology testing, of which 255 (37%) had culture and rRT-PCR. Among those, 35/698 (5%) were IgM positive, 39/255 (15%) culture positive and 47/255 (18%) rRT-PCR-positive. Buccal swabs had the highest rRT-PCR positivity (21%). The outbreak isolates were identical to that in the New York outbreak occurring at the same time. Nucleotide and amino acid identity with the Jeryl Lynn vaccine strain ranged from 85.0-94.5% and 82.4-99.4%, depending on the gene and coding sequences. Homology of the HN protein, the main immunogenic mumps virus protein, was found to be 94.5 and 95.3%, when compared to Jeryl Lynn vaccine major and minor components, respectively. CONCLUSIONS Despite higher sensitivity than serology, rRT-PCR testing is underutilized. Further work is needed to better understand the suboptimal match of the HN gene between the outbreak strain and the Jeryl Lynn vaccine strain.
Collapse
Affiliation(s)
- Arnaud G. L’Huillier
- Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 Canada
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
| | - Alireza Eshaghi
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
| | - C. Sarai Racey
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
- Present address: Dalla Lana School of Public Health, 155 College Street, Toronto, Ontario M5T 3M7 Canada
| | - Katherene Ogbulafor
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
| | - Ernesto Lombos
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
| | - Rachel R. Higgins
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
| | - David C. Alexander
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
- Present address: Cadham Provincial Laboratory, Winnipeg, Manitoba R3C 3Y1 Canada
| | - Erik Kristjanson
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
| | - Jocelyn Maregmen
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
| | - Jonathan B. Gubbay
- Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 Canada
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
- University of Toronto, 27 King’s College Circle, Toronto, Ontario M5S 1A1 Canada
| | - Tony Mazzulli
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
- University of Toronto, 27 King’s College Circle, Toronto, Ontario M5S 1A1 Canada
- Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G 1X5 Canada
| |
Collapse
|
11
|
Nunn A, Masud S, Krajden M, Naus M, Jassem AN. Diagnostic Yield of Laboratory Methods and Value of Viral Genotyping during an Outbreak of Mumps in a Partially Vaccinated Population in British Columbia, Canada. J Clin Microbiol 2018; 56:e01954-17. [PMID: 29491021 PMCID: PMC5925731 DOI: 10.1128/jcm.01954-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/26/2018] [Indexed: 11/20/2022] Open
Abstract
Mumps remains endemic in North America despite routine use of the measles, mumps, and rubella (MMR) vaccine. In 2016, an outbreak of mumps in British Columbia, Canada, provided an opportunity to determine the diagnostic utility of laboratory testing methods. Specimens from patients with clinical mumps were tested for infection using a commercial enzyme-linked immunosorbent assay (ELISA) for antibody detection and an in-house reverse transcriptase PCR (RT-PCR) targeting viral fusion and small hydrophobic (SH) genes. Viral genotyping was performed by SH gene sequencing. Laboratory data was linked with epidemiologic case data. Of the 139 confirmed cases, 94 (68%) had reported or documented history of MMR vaccination. Specimens were typically collected 1 day (for buccal and IgM tests) or 2 days (for urine tests) after symptom onset. Most confirmed cases (69%) were confirmed by buccal swab RT-PCR. Among cases tested by multiple methods, the percent positivity for buccal swab RT-PCR was 90% (96/107) compared to 43% (30/69) for both IgM ELISA and urine RT-PCR. Mumps IgM detection was higher in confirmed cases with no history of vaccination than in those with history (64% versus 34%, P = 0.02). The outbreak strain was identified as genotype G related to MuVi/Sheffield.GBR/1.05 but with conserved variations in five nucleotides within the SH gene that allowed linkage of geographically distinct cases. In conclusion, RT-PCR of buccal specimens had the highest diagnostic yield during a mumps outbreak in a partially vaccinated population. To optimize mumps diagnostic potential, clinicians should collect specimens depending on when the patient presents for care and their immunization history.
Collapse
Affiliation(s)
- Alexandra Nunn
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Shazia Masud
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Monika Naus
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Agatha N Jassem
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
12
|
Cheng WY, Liu MT. Molecular characteristics of mumps viruses isolated in Taiwan from 2006 to 2016. Heliyon 2018; 4:e00518. [PMID: 29560442 PMCID: PMC5857618 DOI: 10.1016/j.heliyon.2018.e00518] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 01/15/2018] [Indexed: 11/17/2022] Open
Abstract
Sixteen mumps virus (MuV) sequences collected in Taiwan between 2006 and 2016 were characterized as genotype F (n = 1), G (n = 7), H (n = 4), J (n = 2), and K (n = 2). Mumps genotype F strain was imported from China in 2008 which was in accordance with the epidemic genotype in China. The Philippines was indicated as export country of three genotype H strains in 2007-2010 and Vietnam as export country of one genotype K strain in 2016 that matched with genotypes described in previous reports. Four strains of genotype G were imported from Japan, Thailand, Malaysia and Myanmar individually indicated that genotype G spreads widely in Asia as well as in the global. In this study, mumps strains of genotype G was first reported in relation to import from Malaysia and Myanmar. Furthermore, Indonesia was referred to export MuV of genotype J in 2007 for the first time. Molecular genotyping benefits the differentiation of circulating mumps viruses and can be used to investigate the transmission pathways. The dynamic genotypes of imported cases revealed the epidemic genotypes in nearby countries.
Collapse
Affiliation(s)
- Wen-Yueh Cheng
- Centers for Disease Control, Ministry of Health and Welfare, Taiwan, R.O.C. No. 161, Kun-Yang Street, Taipei, 11561, Taiwan, ROC
| | | |
Collapse
|
13
|
Latner DR, Parker Fiebelkorn A, McGrew M, Williams NJ, Coleman LA, McLean HQ, Rubin S, Hickman CJ. Mumps Virus Nucleoprotein and Hemagglutinin-Specific Antibody Response Following a Third Dose of Measles Mumps Rubella Vaccine. Open Forum Infect Dis 2017; 4:ofx263. [PMID: 29308410 DOI: 10.1093/ofid/ofx263] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/07/2017] [Indexed: 11/12/2022] Open
Abstract
Background Recent mumps outbreaks among 2-dose measles mumps rubella (MMR) vaccine recipients have raised questions regarding the potential benefits of a third dose of vaccine (MMR3). If MMR3 provides a sustained elevation in mumps antibody, it may be beneficial for certain at-risk groups or as an outbreak control measure. Methods Sera were collected immediately prior to MMR3 and at 1 month and 1 year post-MMR3 from 656 healthy adults aged 18-28 years in a nonoutbreak setting. Immunoglobulin G (IgG) was measured by enzyme-linked immunosorbent assay (ELISA) using whole mumps virus (commercial ELISA), hemagglutinin (HN; major neutralizing target), and nucleoprotein (NP; immunodominant) antigens. ELISA measurements were compared with in vitro plaque reduction neutralization (PRN) titers, and baseline antibody was compared with post-MMR3 levels. Results There were modest but statistically significant (P < .05) increases in mumps antibody at 1 month post-MMR3 by all 3 ELISA methods and by PRN titer. At 1 year post-MMR3, mumps antibody declined toward baseline but remained elevated (P < .05). The correlation between PRN titers and ELISA measurements was poor (r2 = .49), although sera with the highest amount of HN IgG also had the highest PRN titers. Conclusions Individuals with the lowest baseline PRN titers had the largest increase in frequency of samples that became positive for HN and NP by ELISA. A third dose of MMR may benefit certain individuals with a low level of mumps virus-neutralizing antibody, especially in the context of an outbreak or other high-risk setting. Additionally, poor correlation among serologic tests does not allow effective prediction of PRN titer by ELISA.
Collapse
Affiliation(s)
- Donald R Latner
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy Parker Fiebelkorn
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marcia McGrew
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nobia J Williams
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Laura A Coleman
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Foundation, Marshfield, Wisconsin.,Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Huong Q McLean
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Foundation, Marshfield, Wisconsin
| | - Steven Rubin
- Center for Biologics Evaluation and Research, Food and Drug Administration, Bethesda, Maryland
| | - Carole J Hickman
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
14
|
Patel LN, Arciuolo RJ, Fu J, Giancotti FR, Zucker JR, Rakeman JL, Rosen JB. Mumps Outbreak Among a Highly Vaccinated University Community-New York City, January-April 2014. Clin Infect Dis 2017; 64:408-412. [PMID: 27927872 DOI: 10.1093/cid/ciw762] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 11/14/2016] [Indexed: 11/12/2022] Open
Abstract
Background On 14 January 2014, a vaccinated student presented with parotitis. Mumps immunoglobulin M (IgM) testing was negative and reverse-transcription polymerase chain reaction (RT-PCR) testing was not performed, resulting in a missed diagnosis and the start of an outbreak at a New York City (NYC) university. Methods Mumps case investigations included patient interviews, medical records review, and laboratory testing including mumps serology and RT-PCR. Case patients were considered linked to the outbreak if they attended or had epidemiologic linkage to the university. Epidemiologic, clinical, and laboratory data for outbreak cases residing in NYC were analyzed. Results Fifty-six NYC residents with mumps were identified with onset between 12 January and 30 April 2014. Fifty-three cases (95%) were university students, 1 (2%) was a staff member, and 2 (4%) had epidemiologic links to the university. The median age was 20 years (range 18-37 years). All cases had parotitis. Three cases were hospitalized, including 1 of 2 cases with orchitis. Fifty-four (96%) cases had received ≥1 mumps-containing vaccine, 1 (2%) was unvaccinated due to religious exemption, and 1 (2%) had unknown vaccination status. Two of the 44 (5%) cases tested by serology were mumps IgM positive, and 27 of the 40 (68%) tested by RT-PCR were positive. Conclusions Mumps outbreaks can occur in highly vaccinated populations. Mumps should be considered in patients with parotitis regardless of vaccination status. RT-PCR is the preferred testing method; providers should not rely on IgM testing alone. High vaccination coverage and control measures likely limited the extent of the outbreak.
Collapse
Affiliation(s)
- Leena N Patel
- Public Health/Preventive Medicine Residency Program, Division of Epidemiology, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Robert J Arciuolo
- Bureau of Immunization, New York City Department of Health and Mental Hygiene, Queens, New York, USA.,Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship, Atlanta, Georgia, USA
| | - Jie Fu
- Public Health Laboratory, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Francesca R Giancotti
- Public Health Laboratory, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Jane R Zucker
- Bureau of Immunization, New York City Department of Health and Mental Hygiene, Queens, New York, USA.,National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer L Rakeman
- Public Health Laboratory, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Jennifer B Rosen
- Bureau of Immunization, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| |
Collapse
|
15
|
Cui A, Zhu Z, Hu Y, Deng X, Sun Z, Zhang Y, Mao N, Xu S, Fang X, Gao H, Si Y, Lei Y, Zheng H, He J, Wu H, Xu W. Mumps Epidemiology and Mumps Virus Genotypes Circulating in Mainland China during 2013-2015. PLoS One 2017; 12:e0169561. [PMID: 28085897 PMCID: PMC5234798 DOI: 10.1371/journal.pone.0169561] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 12/19/2016] [Indexed: 11/18/2022] Open
Abstract
With the implementation of mumps virus (MuV) vaccination in the expanded program on immunization (EPI) in mainland China since 2008, the incidence of mumps has decreased, and the natural epidemic pattern of mumps has slightly changed during 2013-2015. The two epidemic peaks (April-July and November-December) became less obvious than those observed from 2004 to 2012. Children and adolescents younger than 15, particularly in the five-to-nine-year-old age group, remain the target group and should be the focus of high-quality immunization activities in mainland China. However, it was also found that the incidence and reported cases of mumps decreased in each age group during 2013-2015, particularly in the five-to-nine-year-old and ten-to-fourteen-year-old age groups. The proportion of mumps cases among adults in some provinces also increased. Unlike the changes in the epidemiological characteristics of mumps affected by vaccination, the data of MuV virology surveillance indicated that most of the MuV transmission chains have not yet been effectively interrupted, and MuV remains a natural epidemic pattern in mainland China. In the MuV virology surveillance, 194 MuV strains during 2013-2015 were isolated from 10 of 31 provinces in mainland China. Based on the phylogenetic analysis of the small hydrophobic (SH) gene, both genotype F (99.0%) and G (1.0%) were identified, and genotype F was still the predominant genotype continuously circulating in mainland China. Representative genotype F and G strains isolated in China from 1995 to 2012 were selected for further analysis. The results indicated that there were multiple transmission chains within genotype F, with no obvious geographical or time differences. The high genetic diversity of genotype F strains could be a result of the continuous transmission and evolution of the MuV in mainland China. Genotype G was also detected in four provinces in mainland China. Because of the limited epidemiological data, it was uncertain whether the genotype G MuV strains found in 2011 and 2013 were imported from other countries. Therefore, combined high-quality epidemiological and virological surveillance is necessary for mumps control; it can also be used to observe the changes in epidemiological characteristics and viral transmission of mumps over time after mumps-containing vaccine (MuCV) implementation and to provide a comprehensive epidemiological and genetic baseline for mumps elimination in mainland China.
Collapse
Affiliation(s)
- Aili Cui
- WHO WPRO Regional Reference Measles/Rubella Laboratory and Key Laboratory of Medical Virology Ministry of Health, National Institute for Viral Disease Control and Prevention, Beijing, People’s Republic of China
| | - Zhen Zhu
- WHO WPRO Regional Reference Measles/Rubella Laboratory and Key Laboratory of Medical Virology Ministry of Health, National Institute for Viral Disease Control and Prevention, Beijing, People’s Republic of China
| | - Ying Hu
- Jiangsu Provincial Centers for Disease Control and Prevention, Nanjing, People’s Republic of China
| | - Xiuying Deng
- Jiangsu Provincial Centers for Disease Control and Prevention, Nanjing, People’s Republic of China
| | - Zhaodan Sun
- Heilongjiang Provincial Centers for Disease Control and Prevention, Ha’erbin, People’s Republic of China
| | - Yan Zhang
- WHO WPRO Regional Reference Measles/Rubella Laboratory and Key Laboratory of Medical Virology Ministry of Health, National Institute for Viral Disease Control and Prevention, Beijing, People’s Republic of China
| | - Naiying Mao
- WHO WPRO Regional Reference Measles/Rubella Laboratory and Key Laboratory of Medical Virology Ministry of Health, National Institute for Viral Disease Control and Prevention, Beijing, People’s Republic of China
| | - Songtao Xu
- WHO WPRO Regional Reference Measles/Rubella Laboratory and Key Laboratory of Medical Virology Ministry of Health, National Institute for Viral Disease Control and Prevention, Beijing, People’s Republic of China
| | - Xueqiang Fang
- Shandong Provincial Centers for Disease Control and Prevention, Jinan, People’s Republic of China
| | - Hui Gao
- Shanxi Provincial Centers for Disease Control and Prevention, Taiyuan, People’s Republic of China
| | - Yuan Si
- Shannxi Provincial Centers for Disease Control and Prevention, Xi’an, People’s Republic of China
| | - Yake Lei
- Hubei Provincial Centers for Disease Control and Prevention, Wuhan, People’s Republic of China
| | - Huanying Zheng
- Guangdong Provincial Centers for Disease Control and Prevention, Guangzhou, People’s Republic of China
| | - Jilan He
- Sichuan Provincial Centers for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Hongwei Wu
- Affiliated hospital of Beihua University, Jilin, People’s Republic of China
| | - Wenbo Xu
- WHO WPRO Regional Reference Measles/Rubella Laboratory and Key Laboratory of Medical Virology Ministry of Health, National Institute for Viral Disease Control and Prevention, Beijing, People’s Republic of China
| |
Collapse
|
16
|
Halassy B, Kurtović T, Brgles M, Lang Balija M, Forčić D. Factors influencing preclinical in vivo evaluation of mumps vaccine strain immunogenicity. Hum Vaccin Immunother 2016; 11:2446-54. [PMID: 26376015 DOI: 10.1080/21645515.2015.1062191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Immunogenicity testing in animals is a necessary preclinical assay for demonstration of vaccine efficacy the results of which are often the basis for the decision whether to proceed or withdraw the further development of the novel vaccine candidate. However, in vivo assays are rarely, if at all, optimized and validated. Here we clearly demonstrate the importance of in vivo assay (mumps virus immunogenicity testing in guinea pigs) optimization for gaining reliable results and the suitability of Fractional factorial design of experiments (DoE) for such a purpose. By the use of DoE with resolution IV (2IV((4-1))) we clearly revealed that the parameters significantly increasing assay sensitivity were interval between animal immunizations followed by the body weight of experimental animals. The quantity (0 versus 2%) of the stabilizer (fetal bovine serum, FBS) in the sample was shown as non-influencing parameter in DoE setup. However, the separate experiment investigating only the FBS influence, and performed under other parameters optimally set, showed that FBS also influences the results of immunogenicity assay. Such finding indicated that (a) factors with strong influence on the measured outcome can hide the effects of parameters with modest/low influence and (b) the matrix of mumps virus samples to be compared for immunogenicity must be identical for reliable virus immunogenicity comparison. Finally the 3 mumps vaccine strains widely used for decades in the licensed vaccines were for the first time compared in an animal model, and results obtained were in line with their reported immunogenicity in human population supporting the predictive power of the optimized in vivo assay.
Collapse
Affiliation(s)
- B Halassy
- a University of Zagreb; Center for Research and Knowledge Transfer in Biotechnology ; Zagreb , Croatia.,b Center of Excellence for Viral Immunology and Vaccines ; CERVirVac; Zagreb , Croatia
| | - T Kurtović
- a University of Zagreb; Center for Research and Knowledge Transfer in Biotechnology ; Zagreb , Croatia.,b Center of Excellence for Viral Immunology and Vaccines ; CERVirVac; Zagreb , Croatia
| | - M Brgles
- a University of Zagreb; Center for Research and Knowledge Transfer in Biotechnology ; Zagreb , Croatia.,b Center of Excellence for Viral Immunology and Vaccines ; CERVirVac; Zagreb , Croatia
| | - M Lang Balija
- c Institute of Immunology Inc.; Quality Control Department ; Zagreb , Croatia
| | - D Forčić
- a University of Zagreb; Center for Research and Knowledge Transfer in Biotechnology ; Zagreb , Croatia.,b Center of Excellence for Viral Immunology and Vaccines ; CERVirVac; Zagreb , Croatia
| |
Collapse
|
17
|
Virus genotypes and responses of serum-specific antibodies in children with primary mumps and mumps reinfection. Pediatr Res 2015; 78:580-4. [PMID: 26267156 DOI: 10.1038/pr.2015.141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 04/29/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Research on children with mumps reinfection after natural infection is limited; there are currently no studies on virus-specific antibody responses in paired sera or genotyping of isolated viruses. METHODS This study included 281 children (147 boys and 134 girls, age: 1.2-15.9 y) with primary mumps (240), mumps reinfection after natural infection (9), mumps after previous vaccination (26), and vaccine-associated mumps (6). We measured mumps-specific serum antibodies and analyzed isolated virus genes. RESULTS During acute illness, series-specific IgM and IgG titers exceeded cutoff values in 240 and 232 children with primary mumps, respectively. During convalescence, IgM antibodies were positive in seven and negative in two of nine children with mumps reinfection occurring after natural infection; among 26 previously vaccinated children, 13 were positive and 13 negative. Mumps viruses were isolated from viral cultures from 42 of the 51 children. Except for 6 vaccine-associated cases, all remaining 36 cases of isolated mumps virus were identified as genotype G. CONCLUSION These results suggest that measurement of IgM antibody on any day of acute illness may be indicative of primary mumps but may be inconsistent for diagnosing mumps reinfection after natural infection or previous vaccination.
Collapse
|
18
|
Chen CC, Lu CC, Su BH, Chen KT. Epidemiologic features of mumps in Taiwan from 2006 to 2011: a new challenge for public health policy. World J Pediatr 2015; 11:141-7. [PMID: 25416005 DOI: 10.1007/s12519-014-0525-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 03/21/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The adoption of a second dose of the measles-mumps-rubella (MMR) vaccine among Taiwanese school children began in 2001. However, during that time, mumps cases continued to occur. The purpose of the present study was to assess the epidemiology and vaccination policy for mumps in Taiwan. METHODS We examined the data on mumps cases collected by the Taiwan Centers for Disease Control (Taiwan CDC) between 2006 and 2011. RESULTS During the 6-year study period, a total of 6612 cases of mumps were reported to the Taiwan CDC. Of the patients with known vaccination status, 62% received one dose of the MMR vaccine or no vaccine. The incidence of mumps ranged from 4.18 to 5.28 per 100 000 population and peaked in 2007. Males had a higher incidence of mumps than females (5.9 vs. 3.7 per 100 000 population; P=0.024). Children between 5 and 6 years of age had the highest incidence of mumps, and those 20 years and older had the lowest incidence. Compared to those who received two doses of the MMR vaccine, patients who were not vaccinated or received a single dose of the vaccine had a higher risk of suffering from complications and/or hospitalization. CONCLUSIONS In Taiwan, more than 60% of mumps cases received either no dose or one dose of the MMR vaccine. Monitoring mumps through biological testing and instituting a second dose of the MMR vaccine for children is needed for the elimination of mumps in Taiwan.
Collapse
Affiliation(s)
- Chian-Ching Chen
- Department of Business Administration, National Taiwan University of Science and Technology, Taipei, China
| | | | | | | |
Collapse
|
19
|
Abstract
Routine vaccination against mumps has markedly reduced its incidence. However, the incidence of mumps continuously has increased since 2007. In 2013, a large mumps epidemic occurred in Korea, and this epidemic is still an ongoing problem. This epidemic occurred primarily in school settings and affected vaccinated adolescents, predominantly male students. The recent resurgence of mumps is caused by multiple factors: suboptimal effectiveness of the current mumps vaccines, use of the Rubini strain vaccine, waning immunity in the absence of natural boosting due to the marked reduction in the mumps incidence, genotype mismatch between the vaccine and circulating mumps virus strains, and environmental conditions that foster intense exposures. Containment of mumps outbreaks is challenging because the sensitivity of diagnostic tests is low among vaccinees and control measures are less efficient because of the inherent nature of the mumps virus. Despite the suboptimal vaccine effectiveness in outbreak settings, maintaining the high vaccine coverage is an important strategy to prevent mumps outbreaks, given that the routine use of mumps vaccines has substantially reduced the incidence of mumps and its complications as compared with that in the pre-vaccine era. In order to control the current mumps epidemic and prevent further outbreaks, we need to better understand the dynamics of mumps among vaccinated populations and the changing epidemiology in Korea. Concerted efforts should be made to systematically monitor the immunization status of the Korean population and to improve diagnosis efficiency. Furthermore, more effective mumps vaccines need to be developed in the future.
Collapse
Affiliation(s)
- Sun Hee Park
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
20
|
Lee KY. A common immunopathogenesis mechanism for infectious diseases: the protein-homeostasis-system hypothesis. Infect Chemother 2015; 47:12-26. [PMID: 25844259 PMCID: PMC4384454 DOI: 10.3947/ic.2015.47.1.12] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Indexed: 01/09/2023] Open
Abstract
It was once believed that host cell injury in various infectious diseases is caused solely by pathogens themselves; however, it is now known that host immune reactions to the substances from the infectious agents and/or from the injured host cells by infectious insults are also involved. All biological phenomena in living organisms, including biochemical, physiological and pathological processes, are performed by the proteins that have various sizes and shapes, which in turn are controlled by an interacting network within the living organisms. The author proposes that this network is controlled by the protein homeostasis system (PHS), and that the immune system is one part of the PHS of the host. Each immune cell in the host may recognize and respond to substances, including pathogenic proteins (PPs) that are toxic to target cells of the host, in ways that depend on the size and property of the PPs. Every infectious disease has its own set of toxic substances, including PPs, associated with disease onset, and the PPs and the corresponding immune cells may be responsible for the inflammatory processes that develop in those infectious diseases.
Collapse
Affiliation(s)
- Kyung-Yil Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea. ; Department of Pediatrics, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea
| |
Collapse
|
21
|
Rubin S, Eckhaus M, Rennick LJ, Bamford CGG, Duprex WP. Molecular biology, pathogenesis and pathology of mumps virus. J Pathol 2015; 235:242-52. [PMID: 25229387 PMCID: PMC4268314 DOI: 10.1002/path.4445] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 09/10/2014] [Accepted: 09/14/2014] [Indexed: 11/06/2022]
Abstract
Mumps is caused by the mumps virus (MuV), a member of the Paramyxoviridae family of enveloped, non-segmented, negative-sense RNA viruses. Mumps is characterized by painful inflammatory symptoms, such as parotitis and orchitis. The virus is highly neurotropic, with laboratory evidence of central nervous system (CNS) infection in approximately half of cases. Symptomatic CNS infection occurs less frequently; nonetheless, prior to the introduction of routine vaccination, MuV was a leading cause of aseptic meningitis and viral encephalitis in many developed countries. Despite being one of the oldest recognized diseases, with a worldwide distribution, surprisingly little attention has been given to its study. Cases of aseptic meningitis associated with some vaccine strains and a global resurgence of cases, including in highly vaccinated populations, has renewed interest in the virus, particularly in its pathogenesis and the need for development of clinically relevant models of disease. In this review we summarize the current state of knowledge on the virus, its pathogenesis and its clinical and pathological outcomes.
Collapse
Affiliation(s)
- Steven Rubin
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Michael Eckhaus
- Division of Veterinary Resources, National Institutes of Health, Bethesda, MD, USA
| | - Linda J Rennick
- Department of Microbiology, Boston University School of Medicine, MA, USA
| | | | - W Paul Duprex
- Department of Microbiology, Boston University School of Medicine, MA, USA
| |
Collapse
|
22
|
Jin L, Örvell C, Myers R, Rota PA, Nakayama T, Forcic D, Hiebert J, Brown KE. Genomic diversity of mumps virus and global distribution of the 12 genotypes. Rev Med Virol 2014; 25:85-101. [DOI: 10.1002/rmv.1819] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/14/2014] [Accepted: 10/15/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Li Jin
- Virus Reference Department, Reference Microbiology Services; Public Health England; London UK
| | - Claes Örvell
- Division of Clinical Virology; Huddinge University Hospital; Stockholm Sweden
| | - Richard Myers
- Virus Reference Department, Reference Microbiology Services; Public Health England; London UK
| | - Paul A. Rota
- Centers for Disease Control and Prevention; Atlanta USA
| | | | - Dubravko Forcic
- University of Zagreb; Centre for Research and Knowledge Transfer in Biotechnology; Zagreb Croatia
| | - Joanne Hiebert
- National Microbiology Laboratory; Public Health Agency of Canada; Winnipeg Canada
| | - Kevin E. Brown
- Virus Reference Department, Reference Microbiology Services; Public Health England; London UK
| |
Collapse
|
23
|
Maillet M, Bouvat E, Robert N, Baccard-Longère M, Morel-Baccard C, Morand P, Vabret A, Stahl JP. Mumps outbreak and laboratory diagnosis. J Clin Virol 2014; 62:14-9. [PMID: 25542464 DOI: 10.1016/j.jcv.2014.11.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 10/29/2014] [Accepted: 11/02/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several mumps outbreaks have been reported in Europe and in the United States among highly vaccinated populations. Biological diagnosis is classically based on the detection of mumps-specific IgM, but the ability of serological tests to confirm mumps infection seems to be limited among vaccinated patients. OBJECTIVES We aim to report a mumps outbreak in an engineering school in Grenoble, France, from February to June 2013 and results of the biological testing. STUDY DESIGN WHO definitions were used to define cases. Mumps--specific IgM and IgG were assessed by a commercially available EIA. Mumps RNA detection by real time reverse transcriptase polymerase chain reaction tests (RT-PCR) and mumps genotyping were performed by the French National Reference Centre for Paramyxoviridae. RESULTS Sixty two mumps patient-cases were identified using WHO case definitions, 20 being biologically explored, of which 17 were confirmed by biological tests. Vaccination status was documented for 27 patients/62: 4 (14.8%) patients had received one dose of MMR vaccine, and 23 (85.2) two doses of MMR vaccine. Among the biologically explored patients, 83% had a positive RT PCR at the first sampling whereas only 45% had positive or equivocal IgM. All the genotyped strains were genotype G. CONCLUSIONS Mumps laboratory diagnosis in a highly vaccinated population is challenging. Serological tests among vaccinated patients should be interpreted cautiously and confirmed by RT-PCR tests at the beginning of a mumps outbreak.
Collapse
Affiliation(s)
- Mylène Maillet
- Infectious Diseases Department, Grenoble University Hospital, France.
| | - Eric Bouvat
- Inter-University Health Center, Grenoble, France
| | | | | | | | - Patrice Morand
- Virology Department, Grenoble University Hospital, France; Unit of Virus Host Cell Interactions UMI 3265 UJF-EMBL-CNRS, Grenoble, France.
| | - Astrid Vabret
- National Reference Centre for Paramyxoviridae, Caen University Hospital, France.
| | - Jean-Paul Stahl
- Infectious Diseases Department, Grenoble University Hospital, France.
| |
Collapse
|
24
|
BORGMANN S, SCHWAB F, SANTIBANEZ S, MANKERTZ A. Mumps virus infection in vaccinated patients can be detected by an increase in specific IgG antibodies to high titres: a retrospective study. Epidemiol Infect 2014; 142:2388-96. [PMID: 24423404 PMCID: PMC9151285 DOI: 10.1017/s0950268813003427] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 11/23/2013] [Accepted: 12/11/2013] [Indexed: 11/06/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- S. BORGMANN
- Synlab Medical Care Services, Medical Care Centre Weiden, Weiden, Germany
- Klinikum Ingolstadt, Department of Clinical Infectiology and Infection Control, Ingolstadt, Germany
| | - F. SCHWAB
- Institute of Hygiene and Environmental Medicine, Charité – University Medicine Berlin, Berlin, Germany
| | - S. SANTIBANEZ
- National Reference Centre Measles, Mumps, Rubella, Robert Koch Institute, Berlin, Germany
| | - A. MANKERTZ
- National Reference Centre Measles, Mumps, Rubella, Robert Koch Institute, Berlin, Germany
| |
Collapse
|
25
|
Kutty PK, Lawler J, Rausch-Phung E, Ortega-Sanchez IR, Goodell S, Schulte C, Pollock L, Valure B, Hudson J, Gallagher K, Blog D. Epidemiology and the economic assessment of a mumps outbreak in a highly vaccinated population, Orange County, New York, 2009-2010. Hum Vaccin Immunother 2014; 10:1373-81. [PMID: 24633360 PMCID: PMC4896528 DOI: 10.4161/hv.28389] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 02/19/2014] [Accepted: 02/28/2014] [Indexed: 11/19/2022] Open
Abstract
Studies assessing the economic burden of a mumps outbreak in a highly vaccinated population are limited. The Orange County Health Department (OCHD), New York State Department of Health (NYS DOH), and the Centers for Disease Control and Prevention conducted a mumps investigation in an affected village with a highly vaccinated population. To understand the epidemiology, standardized mumps case definition and active surveillance were used to identify mumps cases. In addition, an economic assessment of a combined outbreak investigation and third dose measles-mumps-rubella (MMR) vaccine intervention conducted by OCHD and NYS DOH was performed; estimated by retrospectively evaluating public health response-related activities including use of a third dose of MMR vaccine. From September 24, 2009, through June 15, 2010, 790 mumps cases were reported-64% were male and highest attack rate was among 11-17 year age group (99.1 cases per 1000 individuals). Of the 658 cases with known vaccination history, 83.6% had documentation of 2 doses of mumps containing vaccine. No deaths were reported. The 2 major exposure settings were schools (71.8%) and households (22.5%). Approximately 7736 h of public health personnel time were expended with the total approximate cost of US $463,000, including US $34,392 for MMR vaccine-the estimated cost per household was US $827. Mumps continues to be endemic in many parts of the world, resulting in importations into the United States. Large mumps outbreaks similar to this in highly vaccinated populations may require considerable investigation and control activities.
Collapse
Affiliation(s)
- Preeta Krishnan Kutty
- National Center for Immunization and Respiratory Diseases; Centers for Disease Control and Prevention; Atlanta, GA USA
| | | | | | - Ismael R Ortega-Sanchez
- National Center for Immunization and Respiratory Diseases; Centers for Disease Control and Prevention; Atlanta, GA USA
| | | | - Cynthia Schulte
- Bureau of Immunization; New York State Department of Health; Albany, NY USA
| | - Lynn Pollock
- Bureau of Immunization; New York State Department of Health; Albany, NY USA
| | | | - Jean Hudson
- Orange County Health Department; Goshen, NY USA
| | - Kathleen Gallagher
- National Center for Immunization and Respiratory Diseases; Centers for Disease Control and Prevention; Atlanta, GA USA
| | - Debra Blog
- Bureau of Immunization; New York State Department of Health; Albany, NY USA
| |
Collapse
|
26
|
Latner DR, McGrew M, Williams NJ, Sowers SB, Bellini WJ, Hickman CJ. Estimates of mumps seroprevalence may be influenced by antibody specificity and serologic method. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2014; 21:286-97. [PMID: 24371258 PMCID: PMC3957677 DOI: 10.1128/cvi.00621-13] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 12/20/2013] [Indexed: 01/21/2023]
Abstract
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.
Collapse
Affiliation(s)
- Donald R Latner
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | | | | |
Collapse
|
27
|
Barskey AE, Juieng P, Whitaker BL, Erdman DD, Oberste MS, Chern SWW, Schmid DS, Radford KW, McNall RJ, Rota PA, Hickman CJ, Bellini WJ, Wallace GS. Viruses Detected Among Sporadic Cases of Parotitis, United States, 2009-2011. J Infect Dis 2013; 208:1979-86. [DOI: 10.1093/infdis/jit408] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
28
|
Šantak M, Lang-Balija M, Ivancic-Jelecki J, Košutić-Gulija T, Ljubin-Sternak S, Forcic D. Antigenic differences between vaccine and circulating wild-type mumps viruses decreases neutralization capacity of vaccine-induced antibodies. Epidemiol Infect 2013; 141:1298-309. [PMID: 22954346 PMCID: PMC9151871 DOI: 10.1017/s0950268812001896] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 07/10/2012] [Accepted: 08/03/2012] [Indexed: 11/07/2022] Open
Abstract
A recent resurgence of mumps in doubly vaccinated cohorts has been observed, identifying genotype G as the current predominant genotype. In this study, the neutralization efficacy of guinea pig sera immunized with three vaccine viruses: L-Zagreb, Urabe AM9 and JL5, was tested against seven mumps viruses: three vaccine strains and four wild-type strains (two of genotype G, one of genotype C, one of genotype D) isolated during 1998-2011. All sera neutralized all viruses although at different levels. The neutralization efficiency of sera decreases several fold by temporal order of virus isolation. Therefore, we concluded that gradual evolution of mumps viruses, rather than belonging to a certain genotype, results in an antigenic divergence from the vaccine strains that decrease the neutralization capacity of vaccine-induced antibodies. Moreover, the amino-acid sequence alignment revealed three new potentially relevant regions for escape from neutralization, i.e. 113-130, 375-403 and 440-443.
Collapse
Affiliation(s)
- M Šantak
- Institute of Immunology, Department for Research and Development, Zagreb, Croatia.
| | | | | | | | | | | |
Collapse
|
29
|
Epidemiology of a mumps outbreak in a highly vaccinated island population and use of a third dose of measles-mumps-rubella vaccine for outbreak control--Guam 2009 to 2010. Pediatr Infect Dis J 2013; 32:374-80. [PMID: 23099425 PMCID: PMC6893844 DOI: 10.1097/inf.0b013e318279f593] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite high 2-dose measles-mumps-rubella (MMR) vaccine coverage, a large mumps outbreak occurred on the US Territory of Guam during 2009 to 2010, primarily in school-aged children. METHODS We implemented active surveillance in April 2010 during the outbreak peak and characterized the outbreak epidemiology. We administered third doses of MMR vaccine to eligible students aged 9-14 years in 7 schools with the highest attack rates (ARs) between May 18, 2010, and May 21, 2010. Baseline surveys, follow-up surveys and case-reports were used to determine mumps ARs. Adverse events postvaccination were monitored. RESULTS Between December 1, 2009, and December 31, 2010, 505 mumps cases were reported. Self-reported Pohnpeians and Chuukese had the highest relative risks (54.7 and 19.7, respectively) and highest crowding indices (mean: 3.1 and 3.0 persons/bedroom, respectively). Among 287 (57%) school-aged case-patients, 270 (93%) had ≥2 MMR doses. A third MMR dose was administered to 1068 (33%) eligible students. Three-dose vaccinated students had an AR of 0.9/1000 compared with 2.4/1000 among students vaccinated with ≤2 doses >1 incubation period postintervention, but the difference was not significant (P = 0.67). No serious adverse events were reported. CONCLUSIONS This mumps outbreak occurred in a highly vaccinated population. The highest ARs occurred in ethnic minority populations with the highest household crowding indices. After the third dose MMR intervention in highly affected schools, 3-dose recipients had an AR 60% lower than students with ≤2 doses, but the difference was not statistically significant and the intervention occurred after the outbreak peaked. This outbreak may have persisted due to crowding at home and high student contact rates.
Collapse
|
30
|
Comparison of the sensitivity of laboratory diagnostic methods from a well-characterized outbreak of mumps in New York city in 2009. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2013; 20:391-6. [PMID: 23324519 DOI: 10.1128/cvi.00660-12] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A mumps outbreak in upstate New York in 2009 at a summer camp for Orthodox Jewish boys spread into Orthodox Jewish communities in the Northeast, including New York City. The availability of epidemiologic information, including vaccination records and parotitis onset dates, allowed an enhanced analysis of laboratory methods for mumps testing. Serum and buccal swab samples were collected from 296 confirmed cases with onsets from September through December 2009. All samples were tested using the Centers for Disease Control and Prevention (CDC) capture IgM enzyme immunoassay (EIA) and a real-time reverse transcription-PCR (rRT-PCR) that targets the short hydrophobic gene. A subset of the samples (n = 205) was used to evaluate 3 commercial mumps IgM assays and to assess the sensitivity of using an alternative target gene (nucleoprotein) in the rRT-PCR protocol. Among 115 cases of mumps with 2 documented doses of measles, mumps, and rubella (MMR) vaccine, the CDC capture IgM EIA detected IgM in 51% of serum samples compared to 9% to 24% using three commercial IgM assays. The rRT-PCR that targeted the nucleoprotein gene increased RNA detection by 14% compared to that obtained with the original protocol. The ability to detect IgM improved when serum was collected 3 days or more after symptom onset, whereas sensitivity of RNA detection by rRT-PCR declined when buccal swabs were collected later than 2 days after onset. Selection of testing methods and timing of sample collection are important factors in the ability to confirm infection among vaccinated persons. These results reinforce the need to use virus detection assays in addition to serologic tests.
Collapse
|
31
|
|
32
|
Barskey AE, Schulte C, Rosen JB, Handschur EF, Rausch-Phung E, Doll MK, Cummings KP, Alleyne EO, High P, Lawler J, Apostolou A, Blog D, Zimmerman CM, Montana B, Harpaz R, Hickman CJ, Rota PA, Rota JS, Bellini WJ, Gallagher KM. Mumps outbreak in Orthodox Jewish communities in the United States. N Engl J Med 2012; 367:1704-13. [PMID: 23113481 DOI: 10.1056/nejmoa1202865] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND By 2005, vaccination had reduced the annual incidence of mumps in the United States by more than 99%, with few outbreaks reported. However, in 2006, a large outbreak occurred among highly vaccinated populations in the United States, and similar outbreaks have been reported worldwide. The outbreak described in this report occurred among U.S. Orthodox Jewish communities during 2009 and 2010. METHODS Cases of salivary-gland swelling and other symptoms clinically compatible with mumps were investigated, and demographic, clinical, laboratory, and vaccination data were evaluated. RESULTS From June 28, 2009, through June 27, 2010, a total of 3502 outbreak-related cases of mumps were reported in New York City, two upstate New York counties, and one New Jersey county. Of the 1648 cases for which clinical specimens were available, 50% were laboratory-confirmed. Orthodox Jewish persons accounted for 97% of case patients. Adolescents 13 to 17 years of age (27% of all patients) and males (78% of patients in that age group) were disproportionately affected. Among case patients 13 to 17 years of age with documented vaccination status, 89% had previously received two doses of a mumps-containing vaccine, and 8% had received one dose. Transmission was focused within Jewish schools for boys, where students spend many hours daily in intense, face-to-face interaction. Orchitis was the most common complication (120 cases, 7% of male patients ≥12 years of age), with rates significantly higher among unvaccinated persons than among persons who had received two doses of vaccine. CONCLUSIONS The epidemiologic features of this outbreak suggest that intense exposures, particularly among boys in schools, facilitated transmission and overcame vaccine-induced protection in these patients. High rates of two-dose coverage reduced the severity of the disease and the transmission to persons in settings of less intense exposure.
Collapse
Affiliation(s)
- Albert E Barskey
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Mumps virus diagnosis and genotyping using a novel single RT-PCR. J Clin Virol 2011; 52:359-62. [DOI: 10.1016/j.jcv.2011.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 09/01/2011] [Accepted: 09/12/2011] [Indexed: 12/20/2022]
|
34
|
Abstract
Mumps virus (MuV) causes an acute infection in humans characterized by a wide array of symptoms ranging from relatively mild manifestations, such as parotitis, to more-severe complications, such as meningitis and encephalitis. Widespread mumps vaccination has reduced mumps incidence dramatically; however, outbreaks still occur in vaccinated populations. The V protein of MuV, when expressed in cell culture, blocks interferon (IFN) expression and signaling and interleukin-6 (IL-6) signaling. In this work, we generated a recombinant MuV incapable of expressing the V protein (rMuVΔV). The rescued MuV was derived from a clinical wild-type isolate from a recent outbreak in the United States (MuV(Iowa/US/06), G genotype). Analysis of the virus confirmed the roles of V protein in blocking IFN expression and signaling and IL-6 signaling. We also found that the rMuV(Iowa/US/06)ΔV virus induced high levels of IL-6 expression in vitro, suggesting that V plays a role in reducing IL-6 expression. In vivo, the rMuV(Iowa/US/06)ΔV virus was highly attenuated, indicating that the V protein plays an essential role in viral virulence.
Collapse
|
35
|
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.
Collapse
|
36
|
Xu P, Li Z, Sun D, Lin Y, Wu J, Rota PA, He B. Rescue of wild-type mumps virus from a strain associated with recent outbreaks helps to define the role of the SH ORF in the pathogenesis of mumps virus. Virology 2011; 417:126-36. [PMID: 21676427 DOI: 10.1016/j.virol.2011.05.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 05/08/2011] [Accepted: 05/09/2011] [Indexed: 11/28/2022]
Abstract
Mumps virus (MuV) causes acute infections in humans. In recent years, MuV has caused epidemics among highly vaccinated populations. The largest outbreak in the U.S. in the past 20 years occurred in 2005-2006 with over 5000 reported cases in which the majority of the cases was in vaccinated young adults. We sequenced the complete genome of a representative strain from the epidemic (MuV-IA). MuV-IA is a member of genotype G, the same genotype of MuV that was associated with the outbreak in the UK in 2004-2005. We constructed a reverse genetics system for MuV-IA (rMuV-IA), and rescued a virus lacking the open reading frame (ORF) of the SH gene (rMuV∆SH). rMuV∆SH infection in L929 cells induced increased NF-κB activation, TNF-α production and apoptosis compared to rMuV-IA. rMuV∆SH was attenuated in an animal model. These results indicated that the SH ORF of MuV plays a significant role in interfering with TNF-α signaling and viral pathogenesis during virus infection.
Collapse
Affiliation(s)
- Pei Xu
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, GA 30602, USA
| | | | | | | | | | | | | |
Collapse
|
37
|
Enzyme-linked immunospot assay detection of mumps-specific antibody-secreting B cells as an alternative method of laboratory diagnosis. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2010; 18:35-42. [PMID: 21047998 DOI: 10.1128/cvi.00284-10] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although high measles, mumps, and rubella (MMR) vaccination coverage has been successful in dramatically reducing mumps disease in the United States, mumps (re)infections occasionally occur in individuals who have been either previously vaccinated or naturally infected. Standard diagnostics that detect virus or virus-specific antibody are dependable for confirming primary mumps infection in immunologically naïve persons, but these methods perform inconsistently for individuals with prior immune exposure. We hypothesized that detection of activated mumps-specific antibody-secreting B cells (ASCs) by enzyme-linked immunospot (ELISPOT) assay could be used as a more reliable diagnostic. To test this, a time course of virus-specific ASC responses was measured by ELISPOT assay following MMR vaccination of 16 previously vaccinated or naturally exposed adult volunteers. Mumps-specific ASCs were detectable in 68% of these individuals at some point during the first 3 weeks following revaccination. In addition, mumps-specific ASCs were detected in 7/7 previously vaccinated individuals who recently had been infected as part of a confirmed mumps outbreak. These data suggest that ELISPOT detection of mumps-specific ASCs has the potential for use as an alternative method of diagnosis when suspect cases cannot be confirmed by detection of IgM or virus. In addition, it was determined that mumps-specific memory B cells are detected at a much lower frequency than measles- or rubella-specific cells, suggesting that mumps infection may not generate robust B-cell memory.
Collapse
|
38
|
Molecular epidemiological evaluation of the recent resurgence in mumps virus infections in Ireland. J Clin Microbiol 2010; 48:3288-94. [PMID: 20660212 DOI: 10.1128/jcm.00434-10] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Mumps is a vaccine-preventable disease; however, outbreaks have been reported in a number of countries with childhood immunization programs, particularly among young adults at the tertiary stage of education. We have retrospectively investigated the epidemiological, virological, and serological factors associated with mumps cases identified in Ireland from 2004 to 2009. Genetic analysis of mumps virus strain variability demonstrated that a single genotype, genotype G, was circulating, and it was also detected in cerebrospinal fluid samples obtained from patients with meningitis. We observed that younger individuals were disproportionately affected with neurological sequelae following mumps virus infection, and the average age of patients with mumps virus RNA detected in cerebrospinal fluid was 19.25 years (median, 19 years; range, 14 to 24 years). Our analysis showed a 4-fold rise in mumps cases in 2008-2009 and an increased incidence in infection in those >or=30 years of age. Over a 6-year period (2004 to 2009), a total of 7,805 serum samples were investigated; of this number, 1,813 (23%) were positive for mumps virus-specific IgM. We observed a strong bias for acute mumps virus infection in males compared to females (P < 10(-32)) that was independent of vaccination status.
Collapse
|