1
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Di Pietrantonj C, Rivetti A, Marchione P, Debalini MG, Demicheli V. Vaccines for measles, mumps, rubella, and varicella in children. Cochrane Database Syst Rev 2021; 11:CD004407. [PMID: 34806766 PMCID: PMC8607336 DOI: 10.1002/14651858.cd004407.pub5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Measles, mumps, rubella, and varicella (chickenpox) are serious diseases that can lead to serious complications, disability, and death. However, public debate over the safety of the trivalent MMR vaccine and the resultant drop in vaccination coverage in several countries persists, despite its almost universal use and accepted effectiveness. This is an update of a review published in 2005 and updated in 2012. OBJECTIVES To assess the effectiveness, safety, and long- and short-term adverse effects associated with the trivalent vaccine, containing measles, rubella, mumps strains (MMR), or concurrent administration of MMR vaccine and varicella vaccine (MMR+V), or tetravalent vaccine containing measles, rubella, mumps, and varicella strains (MMRV), given to children aged up to 15 years. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2019, Issue 5), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to 2 May 2019), Embase (1974 to 2 May 2019), the WHO International Clinical Trials Registry Platform (2 May 2019), and ClinicalTrials.gov (2 May 2019). SELECTION CRITERIA We included randomised controlled trials (RCTs), controlled clinical trials (CCTs), prospective and retrospective cohort studies (PCS/RCS), case-control studies (CCS), interrupted time-series (ITS) studies, case cross-over (CCO) studies, case-only ecological method (COEM) studies, self-controlled case series (SCCS) studies, person-time cohort (PTC) studies, and case-coverage design/screening methods (CCD/SM) studies, assessing any combined MMR or MMRV / MMR+V vaccine given in any dose, preparation or time schedule compared with no intervention or placebo, on healthy children up to 15 years of age. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the methodological quality of the included studies. We grouped studies for quantitative analysis according to study design, vaccine type (MMR, MMRV, MMR+V), virus strain, and study settings. Outcomes of interest were cases of measles, mumps, rubella, and varicella, and harms. Certainty of evidence of was rated using GRADE. MAIN RESULTS We included 138 studies (23,480,668 participants). Fifty-one studies (10,248,159 children) assessed vaccine effectiveness and 87 studies (13,232,509 children) assessed the association between vaccines and a variety of harms. We included 74 new studies to this 2019 version of the review. Effectiveness Vaccine effectiveness in preventing measles was 95% after one dose (relative risk (RR) 0.05, 95% CI 0.02 to 0.13; 7 cohort studies; 12,039 children; moderate certainty evidence) and 96% after two doses (RR 0.04, 95% CI 0.01 to 0.28; 5 cohort studies; 21,604 children; moderate certainty evidence). The effectiveness in preventing cases among household contacts or preventing transmission to others the children were in contact with after one dose was 81% (RR 0.19, 95% CI 0.04 to 0.89; 3 cohort studies; 151 children; low certainty evidence), after two doses 85% (RR 0.15, 95% CI 0.03 to 0.75; 3 cohort studies; 378 children; low certainty evidence), and after three doses was 96% (RR 0.04, 95% CI 0.01 to 0.23; 2 cohort studies; 151 children; low certainty evidence). The effectiveness (at least one dose) in preventing measles after exposure (post-exposure prophylaxis) was 74% (RR 0.26, 95% CI 0.14 to 0.50; 2 cohort studies; 283 children; low certainty evidence). The effectiveness of Jeryl Lynn containing MMR vaccine in preventing mumps was 72% after one dose (RR 0.24, 95% CI 0.08 to 0.76; 6 cohort studies; 9915 children; moderate certainty evidence), 86% after two doses (RR 0.12, 95% CI 0.04 to 0.35; 5 cohort studies; 7792 children; moderate certainty evidence). Effectiveness in preventing cases among household contacts was 74% (RR 0.26, 95% CI 0.13 to 0.49; 3 cohort studies; 1036 children; moderate certainty evidence). Vaccine effectiveness against rubella, using a vaccine with the BRD2 strain which is only used in China, is 89% (RR 0.11, 95% CI 0.03 to 0.42; 1 cohort study; 1621 children; moderate certainty evidence). Vaccine effectiveness against varicella (any severity) after two doses in children aged 11 to 22 months is 95% in a 10 years follow-up (rate ratio (rr) 0.05, 95% CI 0.03 to 0.08; 1 RCT; 2279 children; high certainty evidence). Safety There is evidence supporting an association between aseptic meningitis and MMR vaccines containing Urabe and Leningrad-Zagreb mumps strains, but no evidence supporting this association for MMR vaccines containing Jeryl Lynn mumps strains (rr 1.30, 95% CI 0.66 to 2.56; low certainty evidence). The analyses provide evidence supporting an association between MMR/MMR+V/MMRV vaccines (Jeryl Lynn strain) and febrile seizures. Febrile seizures normally occur in 2% to 4% of healthy children at least once before the age of 5. The attributable risk febrile seizures vaccine-induced is estimated to be from 1 per 1700 to 1 per 1150 administered doses. The analyses provide evidence supporting an association between MMR vaccination and idiopathic thrombocytopaenic purpura (ITP). However, the risk of ITP after vaccination is smaller than after natural infection with these viruses. Natural infection of ITP occur in 5 cases per 100,000 (1 case per 20,000) per year. The attributable risk is estimated about 1 case of ITP per 40,000 administered MMR doses. There is no evidence of an association between MMR immunisation and encephalitis or encephalopathy (rate ratio 0.90, 95% CI 0.50 to 1.61; 2 observational studies; 1,071,088 children; low certainty evidence), and autistic spectrum disorders (rate ratio 0.93, 95% CI 0.85 to 1.01; 2 observational studies; 1,194,764 children; moderate certainty). There is insufficient evidence to determine the association between MMR immunisation and inflammatory bowel disease (odds ratio 1.42, 95% CI 0.93 to 2.16; 3 observational studies; 409 cases and 1416 controls; moderate certainty evidence). Additionally, there is no evidence supporting an association between MMR immunisation and cognitive delay, type 1 diabetes, asthma, dermatitis/eczema, hay fever, leukaemia, multiple sclerosis, gait disturbance, and bacterial or viral infections. AUTHORS' CONCLUSIONS: Existing evidence on the safety and effectiveness of MMR/MMRV vaccines support their use for mass immunisation. Campaigns aimed at global eradication should assess epidemiological and socioeconomic situations of the countries as well as the capacity to achieve high vaccination coverage. More evidence is needed to assess whether the protective effect of MMR/MMRV could wane with time since immunisation.
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Affiliation(s)
- Carlo Di Pietrantonj
- Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI, Azienda Sanitaria Locale ASL AL, Alessandria, Italy
| | - Alessandro Rivetti
- Dipartimento di Prevenzione - S.Pre.S.A.L, ASL CN2 Alba Bra, Alba, Italy
| | - Pasquale Marchione
- Signal Management Unit, Post-Marketing Surveillance Department, Italian Medicine Agency - AIFA, Rome, Italy
| | | | - Vittorio Demicheli
- Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI, Azienda Sanitaria Locale ASL AL, Alessandria, Italy
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2
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Wu H, Wang F, Tang D, Han D. Mumps Orchitis: Clinical Aspects and Mechanisms. Front Immunol 2021; 12:582946. [PMID: 33815357 PMCID: PMC8013702 DOI: 10.3389/fimmu.2021.582946] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 03/04/2021] [Indexed: 12/12/2022] Open
Abstract
The causative agent of mumps is a single-stranded, non-segmented, negative sense RNA virus belonging to the Paramyxoviridae family. Besides the classic symptom of painfully swollen parotid salivary glands (parotitis) in mumps virus (MuV)-infected men, orchitis is the most common form of extra-salivary gland inflammation. Mumps orchitis frequently occurs in young adult men, and leads to pain and swelling of the testis. The administration of MuV vaccines in children has been proven highly effective in reducing the incidence of mumps. However, a recent global outbreak of mumps and the high rate of orchitis have recently been considered as threats to male fertility. The pathogenesis of mumps orchitis remains largely unclear due to lack of systematic clinical data analysis and animal models studies. The alarming increase in the incidence of mumps orchitis and the high risk of the male fertility have thus become a major health concern. Recent studies have revealed the mechanisms by which MuV-host cells interact and MuV infection induces inflammatory responses in testicular cells. In this mini-review, we highlight advances in our knowledge of the clinical aspects and possible mechanisms of mumps orchitis.
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Affiliation(s)
- Han Wu
- Department of Immunology, Shenzhen University School of Medicine, Shenzhen, China.,Institute of Basic Medical Sciences, School of Basic Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Fei Wang
- Institute of Basic Medical Sciences, School of Basic Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Dongdong Tang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Daishu Han
- Institute of Basic Medical Sciences, School of Basic Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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3
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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.
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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
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Wang F, Chen R, Jiang Q, Wu H, Gong M, Liu W, Yu X, Zhang W, Han R, Liu A, Chen Y, Han D. Roles of Sialic Acid, AXL, and MER Receptor Tyrosine Kinases in Mumps Virus Infection of Mouse Sertoli and Leydig Cells. Front Microbiol 2020; 11:1292. [PMID: 32695074 PMCID: PMC7336603 DOI: 10.3389/fmicb.2020.01292] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/20/2020] [Indexed: 01/08/2023] Open
Abstract
The mumps virus (MuV) causes epidemic parotitis. MuV also frequently infects the testis and induces orchitis, an important etiological factor contributing to male infertility. However, mechanisms underlying MuV infection of the testis remain unknown. Here, we describe that sialic acid, AXL, and MER receptor tyrosine kinases regulate MuV entry and replication in mouse major testicular cells, including Sertoli and Leydig cells. Sialic acid, AXL, and MER were present in Sertoli and Leydig cells. Sialic acid specifically mediated MuV entry into Sertoli and Leydig cells, whereas both AXL and MER facilitated MuV replication within cells through the inhibition of cellular innate antiviral responses. Mechanistically, the inhibition of type 1 interferon signaling by AXL and MER is essential for MuV replication in Sertoli and Leydig cells. Our findings provide novel insights into the mechanisms behind MuV infection and replication in the testis.
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Affiliation(s)
- Fei Wang
- Peking Union Medical College, School of Basic Medicine, Chinese Academy of Medical Sciences, Institute of Basic Medical Sciences, Beijing, China
| | - Ran Chen
- Peking Union Medical College, School of Basic Medicine, Chinese Academy of Medical Sciences, Institute of Basic Medical Sciences, Beijing, China
| | - Qian Jiang
- Peking Union Medical College, School of Basic Medicine, Chinese Academy of Medical Sciences, Institute of Basic Medical Sciences, Beijing, China
| | - Han Wu
- Peking Union Medical College, School of Basic Medicine, Chinese Academy of Medical Sciences, Institute of Basic Medical Sciences, Beijing, China
| | - Maolei Gong
- Peking Union Medical College, School of Basic Medicine, Chinese Academy of Medical Sciences, Institute of Basic Medical Sciences, Beijing, China
| | - Weihua Liu
- Peking Union Medical College, School of Basic Medicine, Chinese Academy of Medical Sciences, Institute of Basic Medical Sciences, Beijing, China
| | - Xiaoqin Yu
- Peking Union Medical College, School of Basic Medicine, Chinese Academy of Medical Sciences, Institute of Basic Medical Sciences, Beijing, China
| | - Wenjing Zhang
- Peking Union Medical College, School of Basic Medicine, Chinese Academy of Medical Sciences, Institute of Basic Medical Sciences, Beijing, China
| | - Ruiqin Han
- Peking Union Medical College, School of Basic Medicine, Chinese Academy of Medical Sciences, Institute of Basic Medical Sciences, Beijing, China
| | - Aijie Liu
- Peking Union Medical College, School of Basic Medicine, Chinese Academy of Medical Sciences, Institute of Basic Medical Sciences, Beijing, China
| | - Yongmei Chen
- Peking Union Medical College, School of Basic Medicine, Chinese Academy of Medical Sciences, Institute of Basic Medical Sciences, Beijing, China
| | - Daishu Han
- Peking Union Medical College, School of Basic Medicine, Chinese Academy of Medical Sciences, Institute of Basic Medical Sciences, Beijing, China
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5
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Di Pietrantonj C, Rivetti A, Marchione P, Debalini MG, Demicheli V. Vaccines for measles, mumps, rubella, and varicella in children. Cochrane Database Syst Rev 2020; 4:CD004407. [PMID: 32309885 PMCID: PMC7169657 DOI: 10.1002/14651858.cd004407.pub4] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Measles, mumps, rubella, and varicella (chickenpox) are serious diseases that can lead to serious complications, disability, and death. However, public debate over the safety of the trivalent MMR vaccine and the resultant drop in vaccination coverage in several countries persists, despite its almost universal use and accepted effectiveness. This is an update of a review published in 2005 and updated in 2012. OBJECTIVES To assess the effectiveness, safety, and long- and short-term adverse effects associated with the trivalent vaccine, containing measles, rubella, mumps strains (MMR), or concurrent administration of MMR vaccine and varicella vaccine (MMR+V), or tetravalent vaccine containing measles, rubella, mumps, and varicella strains (MMRV), given to children aged up to 15 years. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2019, Issue 5), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to 2 May 2019), Embase (1974 to 2 May 2019), the WHO International Clinical Trials Registry Platform (2 May 2019), and ClinicalTrials.gov (2 May 2019). SELECTION CRITERIA We included randomised controlled trials (RCTs), controlled clinical trials (CCTs), prospective and retrospective cohort studies (PCS/RCS), case-control studies (CCS), interrupted time-series (ITS) studies, case cross-over (CCO) studies, case-only ecological method (COEM) studies, self-controlled case series (SCCS) studies, person-time cohort (PTC) studies, and case-coverage design/screening methods (CCD/SM) studies, assessing any combined MMR or MMRV / MMR+V vaccine given in any dose, preparation or time schedule compared with no intervention or placebo, on healthy children up to 15 years of age. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the methodological quality of the included studies. We grouped studies for quantitative analysis according to study design, vaccine type (MMR, MMRV, MMR+V), virus strain, and study settings. Outcomes of interest were cases of measles, mumps, rubella, and varicella, and harms. Certainty of evidence of was rated using GRADE. MAIN RESULTS We included 138 studies (23,480,668 participants). Fifty-one studies (10,248,159 children) assessed vaccine effectiveness and 87 studies (13,232,509 children) assessed the association between vaccines and a variety of harms. We included 74 new studies to this 2019 version of the review. Effectiveness Vaccine effectiveness in preventing measles was 95% after one dose (relative risk (RR) 0.05, 95% CI 0.02 to 0.13; 7 cohort studies; 12,039 children; moderate certainty evidence) and 96% after two doses (RR 0.04, 95% CI 0.01 to 0.28; 5 cohort studies; 21,604 children; moderate certainty evidence). The effectiveness in preventing cases among household contacts or preventing transmission to others the children were in contact with after one dose was 81% (RR 0.19, 95% CI 0.04 to 0.89; 3 cohort studies; 151 children; low certainty evidence), after two doses 85% (RR 0.15, 95% CI 0.03 to 0.75; 3 cohort studies; 378 children; low certainty evidence), and after three doses was 96% (RR 0.04, 95% CI 0.01 to 0.23; 2 cohort studies; 151 children; low certainty evidence). The effectiveness (at least one dose) in preventing measles after exposure (post-exposure prophylaxis) was 74% (RR 0.26, 95% CI 0.14 to 0.50; 2 cohort studies; 283 children; low certainty evidence). The effectiveness of Jeryl Lynn containing MMR vaccine in preventing mumps was 72% after one dose (RR 0.24, 95% CI 0.08 to 0.76; 6 cohort studies; 9915 children; moderate certainty evidence), 86% after two doses (RR 0.12, 95% CI 0.04 to 0.35; 5 cohort studies; 7792 children; moderate certainty evidence). Effectiveness in preventing cases among household contacts was 74% (RR 0.26, 95% CI 0.13 to 0.49; 3 cohort studies; 1036 children; moderate certainty evidence). Vaccine effectiveness against rubella is 89% (RR 0.11, 95% CI 0.03 to 0.42; 1 cohort study; 1621 children; moderate certainty evidence). Vaccine effectiveness against varicella (any severity) after two doses in children aged 11 to 22 months is 95% in a 10 years follow-up (rate ratio (rr) 0.05, 95% CI 0.03 to 0.08; 1 RCT; 2279 children; high certainty evidence). Safety There is evidence supporting an association between aseptic meningitis and MMR vaccines containing Urabe and Leningrad-Zagreb mumps strains, but no evidence supporting this association for MMR vaccines containing Jeryl Lynn mumps strains (rr 1.30, 95% CI 0.66 to 2.56; low certainty evidence). The analyses provide evidence supporting an association between MMR/MMR+V/MMRV vaccines (Jeryl Lynn strain) and febrile seizures. Febrile seizures normally occur in 2% to 4% of healthy children at least once before the age of 5. The attributable risk febrile seizures vaccine-induced is estimated to be from 1 per 1700 to 1 per 1150 administered doses. The analyses provide evidence supporting an association between MMR vaccination and idiopathic thrombocytopaenic purpura (ITP). However, the risk of ITP after vaccination is smaller than after natural infection with these viruses. Natural infection of ITP occur in 5 cases per 100,000 (1 case per 20,000) per year. The attributable risk is estimated about 1 case of ITP per 40,000 administered MMR doses. There is no evidence of an association between MMR immunisation and encephalitis or encephalopathy (rate ratio 0.90, 95% CI 0.50 to 1.61; 2 observational studies; 1,071,088 children; low certainty evidence), and autistic spectrum disorders (rate ratio 0.93, 95% CI 0.85 to 1.01; 2 observational studies; 1,194,764 children; moderate certainty). There is insufficient evidence to determine the association between MMR immunisation and inflammatory bowel disease (odds ratio 1.42, 95% CI 0.93 to 2.16; 3 observational studies; 409 cases and 1416 controls; moderate certainty evidence). Additionally, there is no evidence supporting an association between MMR immunisation and cognitive delay, type 1 diabetes, asthma, dermatitis/eczema, hay fever, leukaemia, multiple sclerosis, gait disturbance, and bacterial or viral infections. AUTHORS' CONCLUSIONS Existing evidence on the safety and effectiveness of MMR/MMRV vaccines support their use for mass immunisation. Campaigns aimed at global eradication should assess epidemiological and socioeconomic situations of the countries as well as the capacity to achieve high vaccination coverage. More evidence is needed to assess whether the protective effect of MMR/MMRV could wane with time since immunisation.
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Affiliation(s)
- Carlo Di Pietrantonj
- Azienda Sanitaria Locale ASL AL, Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI, Via Venezia 6, Alessandria, Italy, 15121
| | - Alessandro Rivetti
- ASL CN2 Alba Bra, Dipartimento di Prevenzione - S.Pre.S.A.L, Via Vida 10, Alba, Piemonte, Italy, 12051
| | - Pasquale Marchione
- Italian Medicine Agency - AIFA, Signal Management Unit, Post-Marketing Surveillance Department, Via del Tritone 181, Rome, Italy, 00187
| | | | - Vittorio Demicheli
- Azienda Sanitaria Locale ASL AL, Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI, Via Venezia 6, Alessandria, Italy, 15121
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Bartholomeus E, De Neuter N, Suls A, Elias G, van der Heijden S, Keersmaekers N, Jansens H, Van Tendeloo V, Beutels P, Laukens K, Ogunjimi B, Mortier G, Meysman P, Van Damme P. Transcriptomic profiling of different responder types in adults after a Priorix® vaccination. Vaccine 2020; 38:3218-3226. [PMID: 32165045 DOI: 10.1016/j.vaccine.2020.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/24/2020] [Accepted: 03/01/2020] [Indexed: 12/12/2022]
Abstract
Thanks to the recommendation of a combined Measles/Mumps/Rubella (MMR) vaccine, like Priorix®, these childhood diseases are less common now. This is beneficial to limit the spread of these diseases and work towards their elimination. However, the measles, mumps and rubella antibody titers show a large variability in short- and long-term immunity. The recent outbreaks worldwide of measles and mumps and previous studies, which mostly focused on only one of the three virus responses, illustrate that there is a clear need for better understanding the immune responses after vaccination. Our healthy cohort was already primed with the MMR antigens in their childhood. In this study, the adult volunteers received one Priorix® vaccine dose at day 0. First, we defined 4 different groups of responders, based on their antibody titers' evolution over 4 time points (Day 0, 21, 150 and 365). This showed a high variability within and between individuals. Second, we determined transcriptome profiles using 3'mRNA sequencing at day 0, 3 and 7. Using two analytical approaches, "one response group per time point" and "a time comparison per response group", we correlated the short-term gene expression profiles to the different response groups. In general, the list of differentially expressed genes is limited, however, most of them are clearly immune-related and upregulated at day 3 and 7, compared to the baseline day 0. Depending on the specific response group there are overlapping signatures for two of the three viruses. Antibody titers and transcriptomics data showed that an additional Priorix vaccination does not facilitate an equal immune response against the 3 viruses or among different vaccine recipients.
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Affiliation(s)
- Esther Bartholomeus
- Department of Medical Genetics, University of Antwerp/Antwerp University Hospital, Edegem, Belgium; AUDACIS, Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing, University of Antwerp, Antwerp, Belgium.
| | - Nicolas De Neuter
- AUDACIS, Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing, University of Antwerp, Antwerp, Belgium; Adrem Data Lab, Department of Mathematics and Computer Science, University of Antwerp, Antwerp, Belgium; Biomedical Informatics Research Network Antwerp (biomina), University of Antwerp, Antwerp, Belgium
| | - Arvid Suls
- Department of Medical Genetics, University of Antwerp/Antwerp University Hospital, Edegem, Belgium; AUDACIS, Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing, University of Antwerp, Antwerp, Belgium
| | - George Elias
- AUDACIS, Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing, University of Antwerp, Antwerp, Belgium; Laboratory of Experimental Hematology (LEH), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Sanne van der Heijden
- Laboratory of Experimental Hematology (LEH), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Nina Keersmaekers
- AUDACIS, Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing, University of Antwerp, Antwerp, Belgium; Centre for Health Economics Research & Modeling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Hilde Jansens
- Department of Laboratory Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Viggo Van Tendeloo
- AUDACIS, Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing, University of Antwerp, Antwerp, Belgium; Laboratory of Experimental Hematology (LEH), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Philippe Beutels
- AUDACIS, Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing, University of Antwerp, Antwerp, Belgium; Centre for Health Economics Research & Modeling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Kris Laukens
- AUDACIS, Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing, University of Antwerp, Antwerp, Belgium; Adrem Data Lab, Department of Mathematics and Computer Science, University of Antwerp, Antwerp, Belgium; Biomedical Informatics Research Network Antwerp (biomina), University of Antwerp, Antwerp, Belgium
| | - Benson Ogunjimi
- AUDACIS, Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing, University of Antwerp, Antwerp, Belgium; Laboratory of Experimental Hematology (LEH), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium; Centre for Health Economics Research & Modeling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium; Department of Paediatrics, Antwerp University Hospital, Edegem, Belgium.
| | - Geert Mortier
- Department of Medical Genetics, University of Antwerp/Antwerp University Hospital, Edegem, Belgium; AUDACIS, Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing, University of Antwerp, Antwerp, Belgium
| | - Pieter Meysman
- AUDACIS, Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing, University of Antwerp, Antwerp, Belgium; Adrem Data Lab, Department of Mathematics and Computer Science, University of Antwerp, Antwerp, Belgium; Biomedical Informatics Research Network Antwerp (biomina), University of Antwerp, Antwerp, Belgium
| | - Pierre Van Damme
- AUDACIS, Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing, University of Antwerp, Antwerp, Belgium; Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
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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: 31] [Impact Index Per Article: 7.8] [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.
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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.
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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
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Abstract
Addressing vaccine compliance problems is of particular relevance and significance to public health. Despite resurgence of vaccine-preventable diseases and public awareness of vaccine importance, why is it so challenging to boost population vaccination coverage to desired levels especially in the wake of declining vaccine uptake? To understand this puzzling phenomenon, here we study how social imitation dynamics of vaccination can be impacted by the presence of imperfect vaccine, which only confers partial protection against the disease. Besides weighing the perceived cost of vaccination with the risk of infection, the effectiveness of vaccination is also an important factor driving vaccination decisions. We discover that there can exist multiple stable vaccination equilibria if vaccine efficacy is below a certain threshold. Furthermore, our bifurcation analysis reveals the occurrence of hysteresis loops of vaccination rate with respect to changes in the perceived vaccination cost as well as in the vaccination effectiveness. Moreover, we find that hysteresis is more likely to arise in spatial populations than in well-mixed populations, even for parameter choices that do not allow for bifurcation in the latter. Our work shows that hysteresis can appear as an unprecedented roadblock for the recovery of vaccination uptake, thereby helping explain the persistence of vaccine compliance problem.
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Affiliation(s)
- Xingru Chen
- Department of Mathematics, Dartmouth College, Hanover, NH 03755, USA
| | - Feng Fu
- Department of Mathematics, Dartmouth College, Hanover, NH 03755, USA
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
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Clemmons NS, Redd SB, Gastañaduy PA, Marin M, Patel M, Fiebelkorn AP. Characteristics of Large Mumps Outbreaks in the United States, July 2010–December 2015. Clin Infect Dis 2018; 68:1684-1690. [DOI: 10.1093/cid/ciy779] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 09/07/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- Nakia S Clemmons
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan B Redd
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paul A Gastañaduy
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mona Marin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Manisha Patel
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy Parker Fiebelkorn
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Differences in antigenic sites and other functional regions between genotype A and G mumps virus surface proteins. Sci Rep 2018; 8:13337. [PMID: 30190529 PMCID: PMC6127219 DOI: 10.1038/s41598-018-31630-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/22/2018] [Indexed: 11/08/2022] Open
Abstract
The surface proteins of the mumps virus, the fusion protein (F) and haemagglutinin-neuraminidase (HN), are key factors in mumps pathogenesis and are important targets for the immune response during mumps virus infection. We compared the predicted amino acid sequences of the F and HN genes from Dutch mumps virus samples from the pre-vaccine era (1957-1982) with mumps virus genotype G strains (from 2004 onwards). Genotype G is the most frequently detected mumps genotype in recent outbreaks in vaccinated communities, especially in Western Europe, the USA and Japan. Amino acid differences between the Jeryl Lynn vaccine strains (genotype A) and genotype G strains were predominantly located in known B-cell epitopes and in N-linked glycosylation sites on the HN protein. There were eight variable amino acid positions specific to genotype A or genotype G sequences in five known B-cell epitopes of the HN protein. These differences may account for the reported antigenic differences between Jeryl Lynn and genotype G strains. We also found amino acid differences in and near sites on the HN protein that have been reported to play a role in mumps virus pathogenesis. These differences may contribute to the occurrence of genotype G outbreaks in vaccinated communities.
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Ramanathan R, Voigt EA, Kennedy RB, Poland GA. Knowledge gaps persist and hinder progress in eliminating mumps. Vaccine 2018; 36:3721-3726. [PMID: 29784466 PMCID: PMC6031229 DOI: 10.1016/j.vaccine.2018.05.067] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/10/2018] [Accepted: 05/12/2018] [Indexed: 01/27/2023]
Abstract
Mumps, a common childhood disease in the pre-vaccine era that causes swelling of the parotid salivary glands, can lead to orchitis, viral meningitis, and sensorineural deafness. While the incidence of disease decreased dramatically after the vaccine was added to standard vaccination schedules, the disease has made a substantial resurgence in recent years. As a result, it becomes critical to examine the factors involved in recurring outbreaks. Although low and incomplete vaccination coverage may be a key reason, it does not fully explain the issue due to the high rate of occurrence in populations with high vaccination coverage rates. Multiple studies suggest that waning immunity and secondary vaccine failure play a large role, the effects of which were previously masked by subclinical boosting. Significant knowledge gaps persist around the exact role and mechanism of waning immunity and demonstrate the need for more research in this area, as well as a reevaluation of mumps vaccine policy.
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Affiliation(s)
- R Ramanathan
- Mayo Vaccine Research Group, Mayo Clinic, Rochester, MN 55905, USA
| | - E A Voigt
- Mayo Vaccine Research Group, Mayo Clinic, Rochester, MN 55905, USA
| | - R B Kennedy
- Mayo Vaccine Research Group, Mayo Clinic, Rochester, MN 55905, USA
| | - G A Poland
- Mayo Vaccine Research Group, Mayo Clinic, Rochester, MN 55905, USA.
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Lewnard JA, Grad YH. Vaccine waning and mumps re-emergence in the United States. Sci Transl Med 2018; 10:eaao5945. [PMID: 29563321 PMCID: PMC5899613 DOI: 10.1126/scitranslmed.aao5945] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/10/2017] [Indexed: 11/02/2022]
Abstract
After decades of declining mumps incidence amid widespread vaccination, the United States and other developed countries have experienced a resurgence in mumps cases over the last decade. Outbreaks affecting vaccinated individuals and communities with high vaccine coverage have prompted concerns about the effectiveness of the live attenuated vaccine currently in use. It is unclear whether immune protection wanes or whether the vaccine protects inadequately against currently circulating mumps virus lineages. Synthesizing data from six studies of mumps vaccine effectiveness, we estimated that vaccine-derived immune protection against mumps wanes on average 27 years (95% confidence interval, 16 to 51 years) after vaccination. After accounting for this waning, we found no evidence that the emergence of heterologous virus genotypes contributed to changes in vaccine effectiveness over time. A mathematical model of mumps transmission confirmed the central role of waning immunity to the vaccine in the re-emergence of mumps cases. Outbreaks from 2006 to the present among young adults, and outbreaks in the late 1980s and early 1990s among adolescents, aligned with peaks in mumps susceptibility of these age groups predicted to be due to loss of vaccine-derived protection. In contrast, evolution of mumps virus strains escaping immune pressure would be expected to cause a higher proportion of cases among children, not adolescents and young adults as observed. Routine use of a third vaccine dose at 18 years of age, or booster dosing throughout adulthood, may be a strategy to prevent mumps re-emergence and should be assessed in clinical trials.
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Affiliation(s)
- Joseph A Lewnard
- Center for Communicable Disease Dynamics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Yonatan H Grad
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Liu Y, Liu Z, Deng X, Hu Y, Wang Z, Lu P, Guo H, Sun X, Xu Y, Tang F, Zhu FC. Waning immunity of one-dose measles-mumps-rubella vaccine to mumps in children from kindergarten to early school age: a prospective study. Expert Rev Vaccines 2018; 17:445-452. [PMID: 29478347 DOI: 10.1080/14760584.2018.1445529] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND In China, one dose measles-mumps-rubella vaccine (MMR) was administered to children aged 18-24 months. The mumps incidence was still high. Data on the waning immunity to mumps after MMR vaccination are limited. This study aimed to describe the waning immunity to mumps in kindergarten and primary school children to provide a scientific basis for confirming an optimal age for a second dose. METHODS An observational, prospective study on one-dose MMR in children in kindergarten and primary school was conducted from 2015 to 2016. Waning immunity to mumps in terms of seropositivity and geometric antibody concentration (GMC) with time was analyzed. RESULTS In total, 7436 eligible subjects in kindergarten (3435) and primary school (4001) were included in 2015. The overall GMC (201.7 U/ml) and seropositivity (75.4%) to mumps antibodies in 2016 were significantly lower compared to those in 2015 (218.7 U/ml, 78.4%). Asymptomatic infection occurred within one year in 8.8% of children who received one-dose MMR. CONCLUSIONS Children who received one-dose MMR in kindergarten and primary school were at high risk of mumps infection, and waning immunity occurred with time. Determining the optimal age for the second dose of MMR in children should be prioritized to prevent mumps epidemics.
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Affiliation(s)
- Yuanbao Liu
- a Department of Expanded Programme on Immunization , Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
| | - Zhihao Liu
- b Department of Health education , Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
| | - Xiuying Deng
- a Department of Expanded Programme on Immunization , Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
| | - Ying Hu
- a Department of Expanded Programme on Immunization , Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
| | - Zhiguo Wang
- a Department of Expanded Programme on Immunization , Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
| | - Peishan Lu
- a Department of Expanded Programme on Immunization , Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
| | - Hongxiong Guo
- a Department of Expanded Programme on Immunization , Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
| | - Xiang Sun
- a Department of Expanded Programme on Immunization , Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
| | - Yan Xu
- a Department of Expanded Programme on Immunization , Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
| | - Fenyang Tang
- a Department of Expanded Programme on Immunization , Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
| | - Feng-Cai Zhu
- c Department of Vaccine Clinical Evaluation , Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
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Smetana J, Chlibek R, Hanovcova I, Sosovickova R, Smetanova L, Polcarova P, Gal P, Dite P. Serological survey of mumps antibodies in adults in the Czech Republic and the need for changes to the vaccination strategy. Hum Vaccin Immunother 2018; 14:887-893. [PMID: 29206078 DOI: 10.1080/21645515.2017.1412021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Mumps outbreaks, especially in adolescents and young adults, have been reported in the Czech Republic. The aim of the presented study was to determine the seroprevalence of specific IgG antibodies against mumps in the adult population of the Czech Republic. The study was designed as a multicenter serological survey of adults aged 18 years and over. Specific IgG antibodies against mumps were detected in blood samples using an enzyme-linked immunosorbent assay (ELISA). A total of 1,911 serum samples were examined. The overall seropositivity reached 55.3%. In individual age groups, the highest seropositivity 63% (63.5-65.2%) was recorded in adults aged 40 years and over; the lowest seropositivity was found in adults aged 18-29 years (27.4%). The difference in seropositivity rate between the 18-29 years age group and the 40 years and over age groups was statistically significant (p < 0.001). Only the 18-29 years age group included both vaccinated and unvaccinated (born in the pre-vaccine era) individuals. In vaccinated individuals, seropositivity was reported in only 19.1% of persons; in unvaccinated individuals, seropositivity reached 48.2%. Our results demonstrate the long-term persistence of antibodies following natural infection and the decrease in seropositivity that occurs after vaccination over time. This immunity waning may account for the higher susceptibility of adolescents and young adults to mumps. Therefore, the current vaccination program in the Czech Republic could be considered as less effective. It will be modified with the shifting of the second dose of vaccine from two years of age to the preschool age.
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Affiliation(s)
- Jan Smetana
- a Department of Epidemiology , Faculty of Military Health Sciences, University of Defence , Hradec Kralove , Czech Republic
| | - Roman Chlibek
- a Department of Epidemiology , Faculty of Military Health Sciences, University of Defence , Hradec Kralove , Czech Republic
| | - Irena Hanovcova
- a Department of Epidemiology , Faculty of Military Health Sciences, University of Defence , Hradec Kralove , Czech Republic
| | - Renata Sosovickova
- a Department of Epidemiology , Faculty of Military Health Sciences, University of Defence , Hradec Kralove , Czech Republic
| | - Libuse Smetanova
- b Department of Rehabilitation , University Hospital , Hradec Kralove , Czech Republic
| | - Petra Polcarova
- a Department of Epidemiology , Faculty of Military Health Sciences, University of Defence , Hradec Kralove , Czech Republic
| | - Peter Gal
- c Military Health Institute , Ceske Budejovice , Czech Republic
| | - Petr Dite
- a Department of Epidemiology , Faculty of Military Health Sciences, University of Defence , Hradec Kralove , Czech Republic.,d Military Health Institute , Brno , Czech Republic
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Gopakumar K. Tackling mumps in a public health setting: loopholes in disease surveillance. Public Health 2017; 152:51-54. [DOI: 10.1016/j.puhe.2017.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 05/08/2017] [Accepted: 07/23/2017] [Indexed: 10/19/2022]
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Gu XX, Plotkin SA, Edwards KM, Sette A, Mills KHG, Levy O, Sant AJ, Mo A, Alexander W, Lu KT, Taylor CE. Waning Immunity and Microbial Vaccines-Workshop of the National Institute of Allergy and Infectious Diseases. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2017; 24:e00034-17. [PMID: 28490424 PMCID: PMC5498725 DOI: 10.1128/cvi.00034-17] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Since the middle of the 20th century, vaccines have made a significant public health impact by controlling infectious diseases globally. Although long-term protection has been achieved with some vaccines, immunity wanes over time with others, resulting in outbreaks or epidemics of infectious diseases. Long-term protection against infectious agents that have a complex life cycle and antigenic variation remains a key challenge. Novel strategies to characterize the short- and long-term immune responses to vaccines and to induce immune responses that mimic natural infection have recently emerged. New technologies and approaches in vaccinology, such as adjuvants, delivery systems, and antigen formulations, have the potential to elicit more durable protection and fewer adverse reactions; together with in vitro systems, these technologies have the capacity to model and accelerate vaccine development. The National Institute of Allergy and Infectious Diseases (NIAID) held a workshop on 19 September 2016 that focused on waning immunity to selected vaccines (for Bordetella pertussis, Salmonella enterica serovar Typhi, Neisseria meningitidis, influenza, mumps, and malaria), with an emphasis on identifying knowledge gaps, future research needs, and how this information can inform development of more effective vaccines for infectious diseases.
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Affiliation(s)
- Xin-Xing Gu
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | | | | | - Alessandro Sette
- La Jolla Institute of Allergy and Immunology, La Jolla, California, USA
| | - Kingston H G Mills
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Ofer Levy
- Precision Vaccines Program, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Andrea J Sant
- University of Rochester Medical Center, Rochester, New York, USA
| | - Annie Mo
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - William Alexander
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Kristina T Lu
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Christopher E Taylor
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
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Challenges in Interpretation of Diagnostic Test Results in a Mumps Outbreak in a Highly Vaccinated Population. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2017; 24:CVI.00542-16. [PMID: 28003216 DOI: 10.1128/cvi.00542-16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 12/14/2016] [Indexed: 11/20/2022]
Abstract
In spite of a greatly reduced incidence rate due to vaccination, mumps outbreaks continue to occur in several areas of the world, sometimes in vaccinated populations. This article describes an outbreak in a highly vaccinated population in southwestern Ontario, Canada, and the challenges encountered in interpreting the results of diagnostic tests used in the outbreak. During the outbreak, patients were interviewed and classified according to the outbreak case definition, and specimens were collected for diagnostic testing according to Ontario guidelines. Twenty-seven individuals were classified as confirmed cases (n = 19) or suspect cases (n = 8) according to the case definition, only 9 of which were laboratory-confirmed cases: 7 confirmed by reverse transcriptase PCR (RT-PCR) and 2 by IgM serology. All 19 confirmed cases represented patients who were associated with secondary schools in the local area and had been vaccinated against mumps with one (n = 2) or two (n = 17) doses of the measles-mumps-rubella (MMR) vaccine. This is the first published report of an outbreak of mumps in Ontario in which all confirmed cases had been vaccinated against the disease. It highlights the limitations of and difficulties in interpreting current mumps diagnostic tests when used in vaccinated individuals.
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James SH. Measles, Mumps and Rubella Viruses. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00163-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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20
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Rasti M, Makvandi M, Neisi N, Azaran A, Rastegarvand N, Khalafkhany D, Jahangirnezhad E, Teimoori A, Hadian M, Shabani A, Shamsizadeh A, Nikfar R, Varnaseri M. Three cases of mumps virus and enterovirus coinfection in children with enteroviral meningitis. Medicine (Baltimore) 2016; 95:e5610. [PMID: 27930588 PMCID: PMC5266060 DOI: 10.1097/md.0000000000005610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Several viruses are responsible for aseptic meningitis; however, in the region of Southwest Iran, the role played by each virus is still not very well known. The aim of this study is to determine the relative frequencies of mumps virus, herpes viruses, and enteroviruses, as well as coinfections among them, in patients with aseptic meningitis.In this cross-sectional study, samples of cerebrospinal fluid were collected between December 2012 and December 2013 from patients under 14 years, who were hospitalized in Abuzar Children's Hospital in Ahvaz, Southwest Iran (the only children's hospital in Khuzestan province and Southwest Iran).All 66 cerebrospinal fluid samples and corresponding clinical data were collected from patients with aseptic meningitis by specialists, and with the patients' consent. The DNA and RNA were extracted from these samples and subjected to polymerase chain reaction as well as reverse transcription polymerase chain reaction (RT-PCR) for detection of mumps virus, herpes viruses, and enteroviruses. Nine of the samples (3 mumps-positive and 6 enterovirus-positive) were sequenced. The mumps virus sequences were investigated for possible mutations in the SH and partial HN regions.Up to 39 patients (59.09%) were found to be positive for enteroviruses, 3 (4.5%) for mumps virus, and 1 (1.5%) for herpes viruses (specifically, the varicella-zoster virus). Two patients (3.03%) had a mumps virus and enterovirus coinfection. Among the 3 detected mumps virus samples, 1 belonged to genotype B, while the others belonged to genotype N. Six sequenced enteroviruses indicated the highest similarity with Echovirus 30. An amino acid substitution at position 51 (N→T) was detected in the HN region of genotype N mumps virus samples, in comparison to the reference strain.
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Affiliation(s)
- Mojtaba Rasti
- Health Research Institute, Infectious and Tropical Disease Research Center
| | - Manoochehr Makvandi
- Health Research Institute, Infectious and Tropical Disease Research Center
- Virology Department, Faculty of Medicine
| | | | | | - Nasrin Rastegarvand
- Cellular and Molecular Research Center, Ahvaz Jundishapur University of Medical Science, Ahvaz
| | | | | | | | | | | | | | - Roya Nikfar
- Aboozar Children's Hospital
- Faculty of Medicine
| | - Mehran Varnaseri
- Razi Hospital, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
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Abstract
Vaccines and extended vaccination programs have had an extensive impact on morbidity and mortality rates due to infectious diseases. Because of the continuous and extensive use of vaccines in industrialized countries, many infectious diseases such as poliomyelitis, diphtheria and measles have been reduced to near-extinction. However, in recent years, many countries including the United States of America, the United Kingdom and Belgium, have been confronted with a resurgence of mumps and pertussis, despite high vaccination coverage for both vaccines. In this commentary, possible causes of this resurgence will be discussed, such as the occurrence of adapted microbes, failure to vaccinate and primary and secondary vaccine failure. Additional research of the immunological mechanisms is clearly needed to support the development of possible new and more immunogenic vaccines against mumps and pertussis. Meanwhile, extensive vaccination campaigns with both vaccines remain necessary.
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Affiliation(s)
- Martine Sabbe
- a Service of Epidemiology of Infectious Diseases , Department of Public Health and Surveillance, Scientific Institute of Public Health , Brussels , Belgium
| | - Corinne Vandermeulen
- b KU Leuven - University of Leuven , Department of Pharmaceutical and Pharmacological Sciences, Leuven University Vaccinology Center (LUVAC) , Leuven , Belgium
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Mankertz A, Beutel U, Schmidt FJ, Borgmann S, Wenzel JJ, Ziegler P, Weißbrich B, Santibanez S. Laboratory-based investigation of suspected mumps cases submitted to the German National Reference Centre for Measles, Mumps, and Rubella, 2008 to 2013. Int J Med Microbiol 2015; 305:619-26. [PMID: 26358914 DOI: 10.1016/j.ijmm.2015.08.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
From 2008 to 2013, sample sets from 534 patients displaying clinical symptoms of mumps were submitted to the German Reference Centre for Measles, Mumps and Rubella. Mumps virus infection was confirmed in 216 cases (40%) by PCR and/or serology. Confirmed cases were more frequently seen in male than in female patients (128 vs. 81); the age group predominantly affected was 15 to 29 years old (65%, median age: 26.4 years). The majority of the confirmed cases had a remote history of vaccination with one or two doses of a mumps-containing vaccine (69%). Our results indicate that mumps virus caused two outbreaks in Bavaria in 2008 and 2010/2011 and a third one in Lower Saxony in 2011. Mumps virus genotype G was preponderantly detected from 2008 to 2013. For 107 of the 216 patients with a confirmed mumps infection, we correlated the results from PCR and serology. PCR detected cases during the first week after onset of symptoms (74% positive results). PCR worked best with throat swabs and oral fluids (61% and 60% positive results, respectively). IgM was more reliable with a longer time after onset of symptoms (67%), but indirect IgM serology was of insufficient sensitivity for vaccinated mumps cases (30%); the IgM μ-capture assay detected more cases in this group. Mumps virus is able to initiate an infection in vaccinated patients (secondary vaccine failure, SVF) although it is unclear to what extent. Since SVF does occur in highly vaccinated populations and IgM will not increase to detectable levels in all SVF patients, we strongly recommend using PCR plus serology tests to avoid false-negative diagnoses in vaccinated individuals with clinical signs of mumps.
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Affiliation(s)
- Annette Mankertz
- Robert Koch-Institute, National Reference Centre Measles, Mumps, Rubella, Seestr. 10, D-13353 Berlin, Germany.
| | | | | | - Stefan Borgmann
- Klinikum Ingolstadt, Department of Clinical Infectiology and Infection Control, Ingolstadt, Germany
| | - Jürgen J Wenzel
- Institute of Clinical Microbiology and Hygiene, Regensburg University Medical Center, Regensburg, Germany
| | - Peter Ziegler
- Public Health Department Landshut, Landshut, Germany
| | - Benedikt Weißbrich
- Institute of Virology and Immunobiology, University Würzburg, Würzburg, Germany
| | - Sabine Santibanez
- Robert Koch-Institute, National Reference Centre Measles, Mumps, Rubella, Seestr. 10, D-13353 Berlin, Germany
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Leuridan E, Maertens K, Wautier M, Hutse V, Theeten H. Susceptibility to measles, mumps, and rubella in 5-year-old children in Flanders, Belgium. Eur J Pediatr 2015; 174:925-32. [PMID: 25579232 DOI: 10.1007/s00431-014-2481-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/28/2014] [Accepted: 12/12/2014] [Indexed: 11/29/2022]
Abstract
UNLABELLED The second dose of an MMR vaccine is a catch up for persons who did not receive the first dose or for primary vaccine failures. Catch up doses can be scheduled according to convenience into the program of the country. The second MMR dose is often administered at the age of 5 years, before school entry. Some countries chose to implement the second dose at the age of 10-13 years, as is the case for Belgium. The here presented long-term follow-up of a cohort of children, set up originally to analyze maternal antibodies against vaccine preventable diseases, offers a unique opportunity to evaluate ad interim the current long-interval MMR vaccination schedule in Belgium. After 1 MMR dose at 12 months of age, rubella immunity is almost intact at 5 years of age (94.5 % is seropositive), measles seropositivity scores 86.8 %, and mumps 32 %, measured with ELISA. A seroneutralization (SN) test for mumps antibodies reveals much higher seropositivity rates (88 %). Using a regression model on the log (IgG) titer for all antigens, no influence was found from any of the studied variables, except for girls who had a significantly higher rubella IgG titer (p=0.002) compared to boys. CONCLUSION The data show considerable susceptibility to mumps and measles in 5-year-old children, confirming a previously conducted seroprevalence study (2006). Both advantages and disadvantages of shortening or enlarging the vaccine schedule are discussed.
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Affiliation(s)
- E Leuridan
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium,
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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.
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Affiliation(s)
- Sun Hee Park
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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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.
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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
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Kaaijk P, Gouma S, Hulscher HI, Han WG, Kleijne DE, van Binnendijk RS, van Els CA. Dynamics of the serologic response in vaccinated and unvaccinated mumps cases during an epidemic. Hum Vaccin Immunother 2015; 11:1754-61. [PMID: 26047038 PMCID: PMC4514281 DOI: 10.1080/21645515.2015.1040967] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 03/26/2015] [Accepted: 04/09/2015] [Indexed: 12/31/2022] Open
Abstract
In the last decade, several mumps outbreaks were reported in various countries despite high vaccination coverage. In most cases, young adults were affected who have acquired immunity against mumps solely by vaccination and not by previous wild-type mumps virus infection. To investigate mumps-specific antibody levels, functionality and dynamics during a mumps epidemic, blood samples were obtained longitudinally from 23 clinical mumps cases, with or without a prior history of vaccination, and from 20 healthy persons with no serological evidence of recent mumps virus infection. Blood samples from mumps cases were taken 1-2 months and 7-10 months after onset of disease. Both vaccinated and unvaccinated mumps cases had significantly higher geomean concentrations of mumps-specific IgG (resp. 13,617 RU/ml (95% CI of 9,574-19,367 RU/ml) vs. 1,552 (445-5412) RU/ml at 1-2 months; and 6,514 (5,247-8,088) RU/ml vs. 1,143 (480-2,725) RU/ml at 7-10 months) than healthy controls (169 (135-210) RU/ml) (p = 0.001). Patterns in virus-neutralizing (VN) antibody responses against the mumps vaccine virus were similar, vaccinated and unvaccinated mumps cases had significantly higher ND50 values at both time points of sampling (resp 4,695 (3,779-5,832) RU/ml vs. 1,533 (832-2,825) RU/ml at 1-2 months; 2,478 (1,968-3,122) RU/ml vs. 1,221 (1,029-1,449) RU/ml at 7-10 months) compared with (previously vaccinated) healthy controls (122 (196-76)) RU/ml) (p = 0.001) The unvaccinated mumps cases had significantly lower mumps-specific IgG and VN antibody concentrations at both sampling points compared with previously vaccinated cases, but their antibody concentrations did not differ significantly at the 2 time points. In contrast, the mumps-specific IgG and VN antibody concentrations of the previously vaccinated mumps cases were significantly higher within the first 2 months after onset of mumps and declined thereafter, characteristic for a secondary response. A moderate correlation was found between the level of mumps-specific IgG serum antibodies and VN antibodies for the mumps cases (r = 0.64; p<0.001).
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Affiliation(s)
- Patricia Kaaijk
- Centre for Infectious Disease Control; National Institute for Public Health and the Environment (RIVM); Bilthoven, the Netherlands
| | - Sigrid Gouma
- Centre for Infectious Disease Control; National Institute for Public Health and the Environment (RIVM); Bilthoven, the Netherlands
- Department of Viroscience; Erasmus University Medical Center; Rotterdam, the Netherlands
| | - Hinke I Hulscher
- Centre for Infectious Disease Control; National Institute for Public Health and the Environment (RIVM); Bilthoven, the Netherlands
| | - Wanda G Han
- Centre for Infectious Disease Control; National Institute for Public Health and the Environment (RIVM); Bilthoven, the Netherlands
| | - Deborah E Kleijne
- Centre for Infectious Disease Control; National Institute for Public Health and the Environment (RIVM); Bilthoven, the Netherlands
| | - Rob S van Binnendijk
- Centre for Infectious Disease Control; National Institute for Public Health and the Environment (RIVM); Bilthoven, the Netherlands
| | - Cécile A van Els
- Centre for Infectious Disease Control; National Institute for Public Health and the Environment (RIVM); Bilthoven, the Netherlands
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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.
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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.
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Braeye T, Linina I, De Roy R, Hutse V, Wauters M, Cox P, Mak R. Mumps increase in Flanders, Belgium, 2012–2013: Results from temporary mandatory notification and a cohort study among university students. Vaccine 2014; 32:4393-4398. [DOI: 10.1016/j.vaccine.2014.06.069] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 06/03/2014] [Accepted: 06/13/2014] [Indexed: 11/17/2022]
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29
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Ladbury G, Ostendorf S, Waegemaekers T, van Binnendijk R, Boot H, Hahne S. Smoking and older age associated with mumps in an outbreak in a group of highly-vaccinated individuals attending a youth club party, the Netherlands, 2012. ACTA ACUST UNITED AC 2014; 19:20776. [PMID: 24786261 DOI: 10.2807/1560-7917.es2014.19.16.20776] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe a mumps outbreak in a highly-vaccinated population attending a party at a youth club. In a retrospective cohort study with 60 of approximately 100 participants responding, vaccination status was verified for 58/59 respondents, of whom 54 were vaccinated twice and four once. The attack rate was 22% (13 cases, all vaccinated), with smoking at the party (risk ratio (RR) 3.1; 95% confidence interval (CI): 1.6–6.0, p=0.001) and age ≥21 years (RR 4.7; 95% CI: 2.1–10.2, p<0.0001) as risk factors for disease in the binominal regression analysis. Mild upper respiratory illness was also highly prevalent in those who did not meet the mumps case definition (n=46) after the party, suggesting that mumps virus infection may cause mild disease in vaccinated individuals. Our investigation adds toevidence that crowded social events and smoking may facilitate spread of mumps virus among vaccinated populations, with waning immunity playing a role. The suggestion that mumps virus infection in vaccinated individuals may manifest as mild upper respiratory illness could have implications for transmission and warrants further investigation.
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Affiliation(s)
- G Ladbury
- Dutch National Institute for Public Health and the Environment (RIVM), Bilthoven
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30
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Abrams S, Beutels P, Hens N. Assessing mumps outbreak risk in highly vaccinated populations using spatial seroprevalence data. Am J Epidemiol 2014; 179:1006-17. [PMID: 24573540 DOI: 10.1093/aje/kwu014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Mumps is a potentially severe viral infection. The incidence of mumps has declined dramatically in high-income countries since the introduction of mumps antigen-containing vaccines. However, recent large outbreaks of mumps in highly vaccinated populations suggest waning of vaccine-induced immunity and primary vaccine failure. In this paper we present a simple method for identifying geographic regions with high outbreak potential, demonstrated using 2006 mumps seroprevalence data from Belgium and Belgian vaccination coverage data. Predictions of the outbreak potential in terms of the effective reproduction number in future years signal an increased risk of new mumps outbreaks. Literature reviews on serological information for both primary vaccine failure and waning immunity provide essential information for our predictions. Tailor-made additional vaccination campaigns would be valuable for decreasing local pockets of susceptibility, thereby reducing the risk of future large-scale mumps outbreaks.
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31
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Demicheli V, Rivetti A, Debalini MG, Di Pietrantonj C. Vaccines for measles, mumps and rubella in children. ACTA ACUST UNITED AC 2013. [DOI: 10.1002/ebch.1948] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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32
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Takla A, Böhmer MM, Klinc C, Kurz N, Schaffer A, Stich H, Stöcker P, Wichmann O, Koch J. Outbreak-related mumps vaccine effectiveness among a cohort of children and of young adults in Germany 2011. Hum Vaccin Immunother 2013; 10:140-5. [PMID: 24091837 DOI: 10.4161/hv.26642] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Mumps outbreaks in populations with high 2-dose vaccination coverage and among young adults are increasingly reported. However, data on the duration of vaccine-induced protection conferred by mumps vaccines are scarce. As part of a supra-regional outbreak in Germany 2010/11, we conducted two retrospective cohort studies in a primary school and among adult ice hockey teams to determine mumps vaccine effectiveness (VE). Via questionnaires we collected information on demography, clinical manifestations, and reviewed vaccination cards. We estimated VE as 1-RR, RR being the rate ratio of disease among two-times or one-time mumps-vaccinated compared with unvaccinated persons. The response rate was 92.6% (100/108--children cohort) and 91.7% (44/48--adult cohort). Fourteen cases were identified in the children and 6 in the adult cohort. In the children cohort (mean age: 9 y), 2-dose VE was 91.9% (95% CI 81.0-96.5%). In the adult cohort (mean age: 26 y), no cases occurred among the 13 2-times vaccinated, while 1-dose VE was 50.0% (95% CI -9.4-87.1%). Average time since last vaccination showed no significant difference for cases and non-cases, but cases were younger at age of last mumps vaccination (children cohort: 2 vs. 3 y, P=0.04; adult cohort: 1 vs. 4 y, P=0.03). We did not observe signs of waning immunity in the children cohort. Due to the small sample size VE in the adult cohort should be interpreted with caution. Given the estimated VE, very high 2-dose vaccination coverage is required to prevent future outbreaks. Intervention efforts to increase coverage must especially target young adults who received<2 vaccinations during childhood.
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Affiliation(s)
- Anja Takla
- Immunization Unit; Robert Koch Institute; Berlin, Germany; Postgraduate Training for Applied Epidemiology (PAE); Robert Koch Institute; Berlin, Germany; European Programme for Intervention Epidemiology Training (EPIET); European Centre for Disease Prevention and Control; Stockholm, Sweden
| | - Merle M Böhmer
- Postgraduate Training for Applied Epidemiology (PAE); Robert Koch Institute; Berlin, Germany; European Programme for Intervention Epidemiology Training (EPIET); European Centre for Disease Prevention and Control; Stockholm, Sweden; Bavarian Health and Food Safety Authority (LGL); Institute for Health; Oberschleißheim, Germany
| | - Christina Klinc
- Bavarian Health and Food Safety Authority (LGL); Institute for Health; Oberschleißheim, Germany
| | - Norbert Kurz
- Public Health Authorities-City of Nuremberg; Nuremberg, Germany
| | - Alice Schaffer
- Public Health Authorities-City of Nuremberg; Nuremberg, Germany
| | - Heribert Stich
- Public Health Authorities-District of Erding; Erding, Germany
| | - Petra Stöcker
- Bavarian Health and Food Safety Authority (LGL); Institute for Health; Oberschleißheim, Germany
| | - Ole Wichmann
- Immunization Unit; Robert Koch Institute; Berlin, Germany
| | - Judith Koch
- Immunization Unit; Robert Koch Institute; Berlin, Germany
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Gobet A, Mayet A, Journaux L, Dia A, Aigle L, Dubrous P, Michel R. Mumps among highly vaccinated people: investigation of an outbreak in a French Military Parachuting Unit, 2013. J Infect 2013; 68:101-2. [PMID: 24035994 DOI: 10.1016/j.jinf.2013.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 09/02/2013] [Accepted: 09/05/2013] [Indexed: 10/26/2022]
Affiliation(s)
- A Gobet
- Centre d'épidémiologie et de santé publique des armées, Marseille, France
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34
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35
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Poethko-Müller C, Mankertz A. Seroprevalence of measles-, mumps- and rubella-specific IgG antibodies in German children and adolescents and predictors for seronegativity. PLoS One 2012; 7:e42867. [PMID: 22880124 PMCID: PMC3412821 DOI: 10.1371/journal.pone.0042867] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 07/12/2012] [Indexed: 11/18/2022] Open
Abstract
We have undertaken a seroprevalence study with more than 13,000 children, who had been included in the German KIGGS survey, a representative sample of children and adolescents 0-17 years of age. The IgG titres against measles, mumps and rubella were determined in 1 to 17 year olds While 88.8% of the children were MMR-vaccinated at least once, 76.8% of children aged 1 to 17 years showed prevalence of antibodies to MMR. The highest seronegativity was seen with respect to mumps. Gender differences were most pronounced with regard to rubella IgG titres: girls aged 14 to 17 years were best protected, although seronegativity in 6.8% of this vulnerable group still shows the need of improvement. Search for predictors of missing seroprevalence identified young age to be the most important predictor. Children living in the former West and children born outside of Germany had a higher risk of lacking protection against measles and rubella, while children with a migration background but born in Germany were less often seronegative to measles antibodies than their German contemporaries. An association of seronegativity and early vaccination was seen for measles but not for mumps and rubella. A high maternal educational level was associated with seronegativity to measles and rubella. In vaccinated children, seronegativity was highest for mumps and lowest for rubella. For mumps, high differences were observed for seronegativity after one-dose and two-dose vaccination, respectively. Seronegativity increases as time since last vaccination passes thus indicating significant waning effects for all three components of MMR.
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36
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Leuridan E, Goeyvaerts N, Hens N, Hutse V, Van Damme P. Maternal mumps antibodies in a cohort of children up to the age of 1 year. Eur J Pediatr 2012; 171:1167-73. [PMID: 22395563 DOI: 10.1007/s00431-012-1691-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 02/07/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED The duration of the presence of maternal mumps antibodies in a prospective cohort study is presented. Immunoglobulin G against mumps was portioned with a commercial ELISA test (Euroimmun® anti-mumps Virus AT ELISA, Germany) on samples from 213 mother-child pairs at seven time points between pregnancy and 12 months of age. Non-linear mixed models were used to model maternal antibody decay in infants. The model-based median time to loss of antibodies was 3.6 months. The median child-specific time to loss of antibodies in children of naturally immune women (3.8 months) and children of vaccinated women (2.4 months) differed significantly (p = 0.025). The log antibody level of the mother and the log birth weight were correlated with the duration of maternal antibodies in infants (p < 0.0001). CONCLUSION Children of vaccinated women loose maternal mumps antibodies significantly earlier in life compared to children of naturally infected women. If early administration (<12 months) of the combined measles, mumps, and rubella vaccine is needed, maternal mumps antibodies are not expected to interfere with infant humoral vaccine responses.
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Affiliation(s)
- E Leuridan
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, WHO Collaborating Centre for Control and Prevention of Infectious Diseases, University of Antwerp, UA-CDE-R 2.13, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.
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37
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Seroepidemiology of mumps in Europe (1996-2008): why do outbreaks occur in highly vaccinated populations? Epidemiol Infect 2012; 141:651-66. [PMID: 22687578 DOI: 10.1017/s0950268812001136] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Mumps outbreaks have recently been recorded in a number of highly vaccinated populations. We related seroprevalence, epidemiological and vaccination data from 18 European countries participating in The European Sero-Epidemiology Network (ESEN) to their risk of mumps outbreaks in order to inform vaccination strategies. Samples from national population serum banks were collected, tested for mumps IgG antibodies and standardized for international comparisons. A comparative analysis between countries was undertaken using age-specific mumps seroprevalence data and information on reported mumps incidence, vaccine strains, vaccination programmes and vaccine coverage 5-12 years after sera collection. Mean geometric mumps antibody titres were lower in mumps outbreak countries [odds ratio (OR) 0·09, 95% confidence interval (CI) 0·01-0·71)]. MMR1 vaccine coverage ⩾95% remained protective in a multivariable model (P < 0·001), as did an interval of 4-8 years between doses (OR 0·08, 95% CI 0·01-0·85). Preventing outbreaks and controlling mumps probably requires several elements, including high-coverage vaccination programmes with MMR vaccine with 4-8 years between doses.
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38
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Goeyvaerts N, Hens N, Theeten H, Aerts M, Damme PV, Beutels P. Estimating vaccination coverage for the trivalent measles-mumps-rubella vaccine from trivariate serological data. Stat Med 2012; 31:1432-49. [DOI: 10.1002/sim.4481] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 11/08/2011] [Indexed: 11/10/2022]
Affiliation(s)
- Nele Goeyvaerts
- Interuniversity Institute for Biostatistics and statistical Bioinformatics; Hasselt University; Agoralaan 1 Gebouw D, B3590 Diepenbeek Belgium
| | - Niel Hens
- Interuniversity Institute for Biostatistics and statistical Bioinformatics; Hasselt University; Agoralaan 1 Gebouw D, B3590 Diepenbeek Belgium
- Centre for Health Economics Research and Modeling Infectious Diseases and Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute; University of Antwerp; Universiteitsplein 1, B2610 Wilrijk Belgium
| | - Heidi Theeten
- Centre for Health Economics Research and Modeling Infectious Diseases and Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute; University of Antwerp; Universiteitsplein 1, B2610 Wilrijk Belgium
| | - Marc Aerts
- Interuniversity Institute for Biostatistics and statistical Bioinformatics; Hasselt University; Agoralaan 1 Gebouw D, B3590 Diepenbeek Belgium
| | - Pierre Van Damme
- Centre for Health Economics Research and Modeling Infectious Diseases and Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute; University of Antwerp; Universiteitsplein 1, B2610 Wilrijk Belgium
| | - Philippe Beutels
- Centre for Health Economics Research and Modeling Infectious Diseases and Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute; University of Antwerp; Universiteitsplein 1, B2610 Wilrijk Belgium
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Abstract
BACKGROUND Mumps, measles and rubella (MMR) are serious diseases that can lead to potentially fatal illness, disability and death. However, public debate over the safety of the trivalent MMR vaccine and the resultant drop in vaccination coverage in several countries persists, despite its almost universal use and accepted effectiveness. OBJECTIVES To assess the effectiveness and adverse effects associated with the MMR vaccine in children up to 15 years of age. SEARCH METHODS For this update we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, PubMed (July 2004 to May week 2, 2011) and Embase.com (July 2004 to May 2011). SELECTION CRITERIA We used comparative prospective or retrospective trials assessing the effects of the MMR vaccine compared to placebo, do nothing or a combination of measles, mumps and rubella antigens on healthy individuals up to 15 years of age. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed methodological quality of the included studies. One review author arbitrated in case of disagreement. MAIN RESULTS We included five randomised controlled trials (RCTs), one controlled clinical trial (CCT), 27 cohort studies, 17 case-control studies, five time-series trials, one case cross-over trial, two ecological studies, six self controlled case series studies involving in all about 14,700,000 children and assessing effectiveness and safety of MMR vaccine. Based on the available evidence, one MMR vaccine dose is at least 95% effective in preventing clinical measles and 92% effective in preventing secondary cases among household contacts.Effectiveness of at least one dose of MMR in preventing clinical mumps in children is estimated to be between 69% and 81% for the vaccine prepared with Jeryl Lynn mumps strain and between 70% and 75% for the vaccine containing the Urabe strain. Vaccination with MMR containing the Urabe strain has demonstrated to be 73% effective in preventing secondary mumps cases. Effectiveness of Jeryl Lynn containing MMR in preventing laboratory-confirmed mumps cases in children and adolescents was estimated to be between 64% to 66% for one dose and 83% to 88% for two vaccine doses. We did not identify any studies assessing the effectiveness of MMR in preventing rubella.The highest risk of association with aseptic meningitis was observed within the third week after immunisation with Urabe-containing MMR (risk ratio (RR) 14.28; 95% confidence interval (CI) from 7.93 to 25.71) and within the third (RR 22.5; 95% CI 11.8 to 42.9) or fifth (RR 15.6; 95% CI 10.3 to 24.2) weeks after immunisation with the vaccine prepared with the Leningrad-Zagreb strain. A significant risk of association with febrile seizures and MMR exposure during the two previous weeks (RR 1.10; 95% CI 1.05 to 1.15) was assessed in one large person-time cohort study involving 537,171 children aged between three months and five year of age. Increased risk of febrile seizure has also been observed in children aged between 12 to 23 months (relative incidence (RI) 4.09; 95% CI 3.1 to 5.33) and children aged 12 to 35 months (RI 5.68; 95% CI 2.31 to 13.97) within six to 11 days after exposure to MMR vaccine. An increased risk of thrombocytopenic purpura within six weeks after MMR immunisation in children aged 12 to 23 months was assessed in one case-control study (RR 6.3; 95% CI 1.3 to 30.1) and in one small self controlled case series (incidence rate ratio (IRR) 5.38; 95% CI 2.72 to 10.62). Increased risk of thrombocytopenic purpura within six weeks after MMR exposure was also assessed in one other case-control study involving 2311 children and adolescents between one month and 18 years (odds ratio (OR) 2.4; 95% CI 1.2 to 4.7). Exposure to the MMR vaccine was unlikely to be associated with autism, asthma, leukaemia, hay fever, type 1 diabetes, gait disturbance, Crohn's disease, demyelinating diseases, bacterial or viral infections. AUTHORS' CONCLUSIONS The design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate. The evidence of adverse events following immunisation with the MMR vaccine cannot be separated from its role in preventing the target diseases.
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Affiliation(s)
- Vittorio Demicheli
- Servizio Regionale di Riferimento per l’Epidemiologia, SSEpi-SeREMI - Cochrane Vaccines Field, Azienda Sanitaria Locale ASL AL,Alessandria, Italy.
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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]
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Abstract
Recently, numerous large-scale mumps outbreaks have occurred in vaccinated populations. Clinical isolates sequenced from these outbreaks have invariably been of genotypes distinct from those of vaccine viruses, raising concern that certain mumps virus strains may escape vaccine-induced immunity. To investigate this concern, sera obtained from children 6 weeks after receipt of measles, mumps, and rubella (MMR) vaccine were tested for the ability to neutralize a carefully selected group of genetically diverse mumps virus strains. Although the geometric mean neutralizing antibody titer of the sera was lower against some virus strains than others, all viruses were readily neutralized, arguing against immune escape.
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Rümke H, Loch H, Hoppenbrouwers K, Vandermeulen C, Malfroot A, Helm K, Douha M, Willems P. Immunogenicity and safety of a measles–mumps–rubella–varicella vaccine following a 4-week or a 12-month interval between two doses. Vaccine 2011; 29:3842-9. [DOI: 10.1016/j.vaccine.2011.02.067] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 01/17/2011] [Accepted: 02/13/2011] [Indexed: 10/18/2022]
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Abstract
BACKGROUND Moldova experienced a nationwide mumps outbreak between 2007 and 2008. Single-dose monovalent mumps vaccination at 15 to 18 months was introduced in 1983, replaced by a 2-dose MMR schedule at age 1 and 6 to 7 years in 2002. We investigated the outbreak to quantify its extent, explore the role of primary and secondary vaccine failure, and provide control recommendations. METHODS We analyzed national mumps surveillance and vaccination coverage data to estimate vaccine effectiveness (VE) using the screening method. A retrospective cohort study in 5 educational institutions was conducted to determine age-specific attack rates (ARs) and VE. We compared vaccine strain-specific ARs. Isolation and genotyping of mumps virus strains were performed. RESULTS Of 31,142 cases reported during October 2007 and July 2008, 80% were in 15- to 24-year-olds. Of cases with information (66%), 92% were vaccinated once, 4% twice. One-dose mumps VE estimates based on surveillance data over 1997-2001 declined from 91% (95% CI: 88%-92%) in 2-year-olds to 72% (70%-74%) in 15- to 19-year-olds. In the cohort study (n = 1589), VE was -40% (-120% to 20%) for 1 dose. For 2 doses it was 62% (-43% to 90%) in 13- to 15-year-olds. ARs were higher in individuals vaccinated with Urabe strains (43%) than with Leningrad-Zagreb strains (14%, P < 0.001). Mumps virus genotype G5 was identified. CONCLUSIONS Low effectiveness of single-dose mumps vaccination was the main cause of the outbreak. Waning immunity may have contributed to this. The risk of mumps in 2-dose vaccinees was low. Other countries in which large population groups have received <2 doses of mumps vaccine may face similar outbreaks.
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Are we hitting immunity targets? The 2006 age-specific seroprevalence of measles, mumps, rubella, diphtheria and tetanus in Belgium. Epidemiol Infect 2010; 139:494-504. [PMID: 20587123 DOI: 10.1017/s0950268810001536] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Susceptibility to vaccine-preventable diseases in Belgium in 2006 was estimated from a serum survey. Immunoglobulins against measles, mumps, rubella (MMR) and diphtheria at all available ages (1-65 years), and against tetanus in >40-year-olds, were measured by ELISA. Age-standardized overall seronegativity for MMR was low (3·9%, 8·0%, 10·4%, respectively). However, the World Health Organization's targets for measles elimination were not met in 5- to 24-year-olds and about 1 in 7 women at childbearing age (15-39 years) were seronegative for rubella. In adults >40 years, tetanus immunity (87·2%, >0·16 IU/ml) largely exceeded diphtheria immunity (20-45%, >0·1 IU/ml). Despite free universal vaccination against MMR for more than 20 years and against diphtheria and tetanus for almost 60 years, our study revealed specific age groups remaining at risk for infection with these pathogens.
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Vandermeulen C, Verhoye L, Vaidya S, Clement F, Brown KE, Hoppenbrouwers K, Leroux-Roels G. Detection of mumps virus-specific memory B cells by transfer of peripheral blood mononuclear cells into immune-deficient mice. Immunology 2010; 131:33-9. [PMID: 20586811 DOI: 10.1111/j.1365-2567.2010.03263.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Waning immunity to mumps after one or two doses of the measles, mumps and rubella (MMR) vaccine has been described. Using a human peripheral blood lymphocyte (PBL)-severe combined immunodeficiency (SCID) mouse model, MMR vaccine recipients with undetectable and high antibody titres against mumps were compared for the presence of circulating mumps-specific memory B cells. Peripheral blood mononuclear cells (PBMC) from six donors (three subjects with undetectable and three with high antibody titres against mumps) were injected into the spleens of non-obese diabetic (NOD)-SCID mice (three mice per subject). Mice were pretreated with TMbeta1 and total body irradiation to improve engraftment. In vivo production of human antibodies against mumps was evaluated in mouse plasma on days 7, 10 and 13 with a commercial enzyme-linked immunosorbent assay (ELISA), functional reduction neutralization test. Three donors had mumps antibody titres below the detection limit (titre < 230) and three had high antibody titres (range 5700-7300). None of the mice injected with PBMC from subjects with undetectable antibody titres showed detectable human antibody titres, despite the presence of cell-mediated immunity in two of the three donors. Seven out of nine mice injected with PBMC from subjects with high antibody titres acquired detectable antibody titres for mumps in their plasma. PBMC from vaccinees without detectable serum antibodies against mumps virus were unable to induce secretion of anti-mumps antibodies in the blood of recipient mice, whereas PBMC from vaccinees with high antibody titres were able to do so. This observation suggests that the frequency of mumps-specific memory B cells is very low in vaccinees with undetectable antibody titres. These individuals may therefore be at risk of developing mumps disease upon encounter with wild-type virus.
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Abstract
Although the WHO recommends the use of genotyping as a tool for epidemiological surveillance for mumps, limited data on mumps virus (MV) genotype circulation that may be used to trace the patterns of virus spread are available. We describe the first complete series of data from Spain. The small hydrophobic region was sequenced from 237 MV-positive samples from several regions of Spain collected between 1996 and 2007. Six different genotypes were identified: A, C, D (D1), G (G1, G2), H (H1, H2), and J. Genotype H1 was predominant during the epidemic that occurred from 1999 to 2003 but was replaced by genotype G1 as the dominant genotype in the epidemic that occurred from 2005 to 2007. The same genotype G1 strain caused concomitant outbreaks in different parts of the world (the United States, Canada, and the United Kingdom). The remaining genotypes (genotypes A, C, D, and J) appeared in sporadic cases or small limited outbreaks. This pattern of circulation seems to reflect continuous viral circulation at the national level, despite the high rates of vaccine coverage.
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47
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Schaffer K, Morgan-Capner P. Measles, mumps and rubella viruses. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00152-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Guidelines for the Prevention and Control of Mumps Outbreaks in Canada. Can Commun Dis Rep 2010; 36:1-46. [DOI: 10.14745/ccdr.v36i00as1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Schreiber A, Hershman G. Non-HIV Viral Infections of the Salivary Glands. Oral Maxillofac Surg Clin North Am 2009; 21:331-8. [DOI: 10.1016/j.coms.2009.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Castilla J, García Cenoz M, Arriazu M, Fernández-Alonso M, Martínez-Artola V, Etxeberria J, Irisarri F, Barricarte A. Effectiveness of Jeryl Lynn-containing vaccine in Spanish children. Vaccine 2009; 27:2089-93. [PMID: 19356610 DOI: 10.1016/j.vaccine.2009.02.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Revised: 01/23/2009] [Accepted: 02/02/2009] [Indexed: 10/21/2022]
Abstract
We evaluated the effectiveness of the Jeryl Lynn strain vaccine in a large outbreak of mumps in Navarre, Spain, 2006-2008. Each of the 241 cases of mumps occurring in children over 15 months of age born between 1998 and 2005 was compared with 5 controls individually matched by sex, birth date, district of residence and paediatrician. Vaccination history was obtained blindly from clinical records. Conditional logistic regression was used to obtain the matched odds ratios (ORs), and effectiveness was calculated as 1-OR. Some 70% of cases had received one dose of measles-mumps-rubella vaccine, and 24% had received two doses. Overall vaccine effectiveness was 72% (95% CI, 39-87%). Two doses were more effective (83%; 54-94%) than a single dose (66%; 25-85%). Among vaccinated children, risk was higher in those who had received the first dose after 36 months of age (OR=3.1; 1.2-8.4) and those who had received the second dose 3 or more years before study enrolment (OR=10.2; 1.5-70.7). Early waning of immunity in children after the second dose may contribute to reduced vaccine effectiveness for mumps prevention.
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