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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] [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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2
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Zhang N, Chen W, Chan PT, Yen HL, Tang JWT, Li Y. Close contact behavior in indoor environment and transmission of respiratory infection. INDOOR AIR 2020; 30:645-661. [PMID: 32259319 DOI: 10.1111/ina.12673] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/29/2020] [Accepted: 03/25/2020] [Indexed: 05/05/2023]
Abstract
Close contact was first identified as the primary route of transmission for most respiratory infections in the early 20th century. In this review, we synthesize the existing understanding of the mechanisms of close contact transmission. We focus on two issues: the mechanism of transmission in close contact, namely the transmission of the expired particles between two people, and the physical parameters of close contact that affect the exposure of particles from one individual to another, or how the nature of close contact plays a role in transmission. We propose the existence of three sub-routes of transmission: short-range airborne, large droplets, and immediate body-surface contact. We also distinguish a "body contact," which is defined with an interpersonal distance of zero, from a close contact. We demonstrate herein that the short-range airborne sub-route may be most common. The timescales over which data should be collected to assess the transmission risk during close contact events are much shorter than those required for the distant airborne or fomite routes. The current paucity of high-resolution data over short distances and timescales makes it very difficult to assess the risk of infection in these circumstances.
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Affiliation(s)
- Nan Zhang
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Wenzhao Chen
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Pak-To Chan
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Hui-Ling Yen
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Julian Wei-Tze Tang
- Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK
- Respiratory Sciences, University of Leicester, Leicester, UK
| | - Yuguo Li
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
- School of Public Health, The University of Hong Kong, Hong Kong, China
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3
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Beleni AI, Borgmann S. Mumps in the Vaccination Age: Global Epidemiology and the Situation in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081618. [PMID: 30065192 PMCID: PMC6121553 DOI: 10.3390/ijerph15081618] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 07/26/2018] [Accepted: 07/27/2018] [Indexed: 11/18/2022]
Abstract
Vaccination against mumps virus (MuV) (mostly measles-mumps-rubella) is routinely performed in more than 120 countries and has resulted in a distinct decrease of mumps incidence. However, alteration of mumps epidemiology has been observed in several countries after implementation of the vaccine but is sparsely documented. Moreover, outbreaks have occurred after starting vaccination, even in highly vaccinated populations. In the former German Democratic Republic (DDR) mumps was a notifiable disease but vaccination against mumps was not implemented. In the five eastern German states forming the DDR until 1990, mumps was not notifiable until 2001. Except for the lack of reporting between 1990–2000, data from Eastern Germany allow analysis of mumps epidemiology after initiating the vaccination campaign. For the period from 2001 to 2016 the data show that the incidence of mumps dropped notably after initiating vaccines, and was accompanied by an increase of the median age of patients with mumps. In Eastern Germany, no outbreaks were noted, while several outbreaks occurred in Western Germany, possibly due to a lower vaccination rate. Further literature analysis revealed that outbreaks were facilitated by waning immunity and crowding. Nevertheless, although vaccination prevented infection, the course of illness, once infected, was sometimes more complicated. In comparison to non-vaccinated populations, high rates of complicated courses occurred and were marked by orchitis, due to higher age of mumps patients. Therefore, refusing vaccination against mumps increases the risk of severe courses when living in a vaccinated population.
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Affiliation(s)
- Andrea-Ioana Beleni
- Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Stefan Borgmann
- Department of Infectious Diseases and Infection Control, Hospital of Ingolstadt, D-85049 Ingolstadt, Germany.
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Vaidya SR, Tilavat SM, Hamde VS, Bhattad DR. Outbreak of mumps virus genotype G infection in tribal individuals during 2016-17 in India. Microbiol Immunol 2018; 62:517-523. [DOI: 10.1111/1348-0421.12606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Sunil R. Vaidya
- Indian Council of Medical Research-National Institute of Virology; 20-A Dr Ambedkar Road Pune 411001 India
| | - Siddharth M. Tilavat
- Directorate of Medical and Health Services, State Health Society, Integrated Disease Surveillance Program; Shri Vinoba Bhave College Campus; Silvassa 396230 India
| | - Venkat S. Hamde
- Department of Microbiology; Yogeshwari Mahavidyalaya Ambajogai affiliated to Dr Babasaheb Ambedkar Marathwada University; Aurangabad 431004 India
| | - Divya R. Bhattad
- Indian Council of Medical Research-National Institute of Virology; 20-A Dr Ambedkar Road Pune 411001 India
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Bonwitt J, Kawakami V, Wharton A, Burke RM, Murthy N, Lee A, Dell B, Kay M, Duchin J, Hickman C, McNall RJ, Rota PA, Patel M, Lindquist S, DeBolt C, Routh J. Notes from the Field: Absence of Asymptomatic Mumps Virus Shedding Among Vaccinated College Students During a Mumps Outbreak - Washington, February-June 2017. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2017; 66:1307-1308. [PMID: 29190262 PMCID: PMC5708686 DOI: 10.15585/mmwr.mm6647a5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hamami D, Cameron R, Pollock KG, Shankland C. Waning Immunity Is Associated with Periodic Large Outbreaks of Mumps: A Mathematical Modeling Study of Scottish Data. Front Physiol 2017; 8:233. [PMID: 28487657 PMCID: PMC5404202 DOI: 10.3389/fphys.2017.00233] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/03/2017] [Indexed: 11/21/2022] Open
Abstract
Vaccination programs for childhood diseases, such as measles, mumps and rubella have greatly contributed to decreasing the incidence and impact of those diseases. Nonetheless, despite long vaccination programmes across the world, mumps has not yet been eradicated in those countries: indeed, large outbreaks continue. For example, in Scotland large outbreaks occurred in 2004, 2005, and 2015, despite introducing the MMR (Measles-Mumps-Rubella) vaccine more than 20 years ago. There are indications that this vaccine-preventable disease is re-emerging in highly vaccinated populations. Here we investigate whether the resurgence of mumps is due to waning immunity, and further, could a booster dose be the solution to eradicate mumps or would it just extend the period of waning immunity? Using mathematical modeling we enhance a seasonally-structured disease model with four scenarios: no vaccination, vaccinated individuals protected for life, vaccinated individuals at risk of waning immunity, and introduction of measures to increase immunity (a third dose, or a better vaccine). The model is parameterised from observed clinical data in Scotland 2004–2015 and the literature. The results of the four scenarios are compared with observed clinical data 2004–2016. While the force of infection is relatively sensitive to the duration of immunity and the number of boosters undertaken, we conclude that periodic large outbreaks of mumps will be sustained for all except the second scenario. This suggests that the current protocol of two vaccinations is optimal in the sense that while there are periodic large outbreaks, the severity of cases in vaccinated individuals is less than in unvaccinated individuals, and the size of the outbreaks does not decrease sufficiently with a third booster to make economic sense. This recommendation relies on continuous efforts to maintain high levels of vaccination uptake.
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Affiliation(s)
- Dalila Hamami
- Department of Computing Science, University of Oran1 Ahmed BenBellaOran, Algeria
| | | | | | - Carron Shankland
- Department of Computing Science and Mathematics, University of StirlingStirling, UK
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Hahné S, Schurink T, Wallinga J, Kerkhof J, van der Sande M, van Binnendijk R, de Melker H. Mumps transmission in social networks: a cohort study. BMC Infect Dis 2017; 17:56. [PMID: 28068914 PMCID: PMC5223546 DOI: 10.1186/s12879-016-2135-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 12/16/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Mumps emerged among highly vaccinated populations in the Netherlands. This offered a unique opportunity to study mumps virus transmission. In particular the extent to which asymptomatic infections in vaccinated people contribute to ongoing mumps virus transmission is uncertain. Insight into this could help project the future burden of mumps in vaccinated populations. We therefore studied the relative infectiousness of symptomatic and asymptomatic cases. METHODS In a cohort study we followed contacts of notified mumps cases (ring 1) and contacts' contacts (ring 2) for 40 days to ascertain symptoms of mumps and social contacts by weekly diaries and questionnaires, and mumps virus infections by taking finger stick dried blood spot specimens (DBS) that were tested for mumps-specific IgG antibodies. Mumps IgG concentrations >1500 RU/ml in a single sample, a four-fold increase in IgG antibody concentration in paired samples, or a positive oral fluid PCR were defined as recent infection. RESULTS We recruited 99 contacts (40 in ring 1 and 59 in ring 2) of 10 mumps index cases. The median age of participants was 23 years (range 18-57 years), 31 (31%) were male. At study entry, DBS of 4 out of 78 (5%) participants with samples showed serological evidence of recent mumps virus infection. Three of these reported mumps symptoms. Among the 59 participants who provided DBS at the beginning and end of the follow-up period, none had serological evidence of infection during this period. Of 72 participants who provided at least one oral fluid sample, one participant (1%) who also reported mumps symptoms, was found PCR positive. Of all 99 participants, the attack rate of self-reported mumps was 4% (95% CI 1.1-10.0%). Of the 5 laboratory confirmed mumps cases, 1 reported no mumps symptoms (percentage asymptomatic 20% (95% CI 0-71%)). Compared to non-students, students had larger households and more household members who were born after 1980 (p < 0.01 and <0.01, respectively). CONCLUSIONS We demonstrated that this prospective cohort study design allows for inference of the proportion of asymptomatic mumps infections. Because we only detected one asymptomatic mumps virus infection, we could not assess the relative infectiousness of asymptomatic mumps. Household characteristics of students differed from non-students. This may partly explain recent mumps epidemiology in the Netherlands.
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Affiliation(s)
- Susan Hahné
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720, BA, Bilthoven, The Netherlands.
| | - Tessa Schurink
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720, BA, Bilthoven, The Netherlands
| | - Jacco Wallinga
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720, BA, Bilthoven, The Netherlands
| | - Jeroen Kerkhof
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720, BA, Bilthoven, The Netherlands
| | - Marianne van der Sande
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720, BA, Bilthoven, The Netherlands
| | - Rob van Binnendijk
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720, BA, Bilthoven, The Netherlands
| | - Hester de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720, BA, Bilthoven, The Netherlands
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Gouma S, Hahné SJ, Gijselaar DB, Koopmans MP, van Binnendijk RS. Severity of mumps disease is related to MMR vaccination status and viral shedding. Vaccine 2016; 34:1868-73. [DOI: 10.1016/j.vaccine.2016.02.070] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 02/22/2016] [Accepted: 02/26/2016] [Indexed: 10/22/2022]
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Han WGH, Emmelot ME, Jaadar H, Ten Hulscher HI, van Els CACM, Kaaijk P. Development of an IFNγ ELISPOT for the analysis of the human T cell response against mumps virus. J Immunol Methods 2016; 431:52-9. [PMID: 26872407 DOI: 10.1016/j.jim.2016.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 02/07/2016] [Accepted: 02/08/2016] [Indexed: 11/30/2022]
Abstract
In the last decade, mumps virus (MuV) causes outbreaks in highly vaccinated populations. Sub-optimal T cell immunity may play a role in the susceptibility to mumps in vaccinated individuals. T cell responses to mumps virus have been demonstrated, yet the quality of the MuV-specific T cell response has not been analyzed using single cell immunological techniques. Here we developed an IFNγ ELISPOT assay to assess MuV-specific T cell responses in peripheral blood mononuclear cells (PBMC) of healthy (vaccinated) donors and mumps patients. Various in vitro MuV-specific stimulation methods of PBMC were compared, using either live or inactivated MuV alone or MuV-infected autologous antigen presenting cells, i.e. Epstein Barr Virus-transformed B lymphoblastoid cell lines (EBV-BLCL) or (mitogen pre-activated) PBMC, for their ability to recall IFNγ-producing responder cells measured by ELISPOT. For the detection of MuV-specific T cell responses, direct exposure (24h) to live MuV was the preferred stimulation method when assay sensitivity and practical reasons were considered. Notably, flowcytometric confirmation of data revealed that primarily T cells and NK cells produce IFNγ upon live MuV stimulation. Depleting PBMC from CD56(+) NK cells prior to stimulation with live MuV led to the enumeration of MuV-specific T cell responses by ELISPOT. Our assay constitutes a tool to evaluate memory MuV-specific T cell responses in MuV vaccinated or infected persons. Furthermore, this study provides evidence that live MuV not only induces IFNγ production by T cells, but also by NK cells.
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Affiliation(s)
- Wanda G H Han
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
| | - Maarten E Emmelot
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Haziz Jaadar
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Hinke I Ten Hulscher
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Cécile A C M van Els
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Patricia Kaaijk
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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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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Compés-Dea C, Guimbao-Bescós J, Gaspar-Escayola JI, Lázaro-Belanche MÁ, Aznar-Brieba A. [An outbreak of mumps in a high school: Estimation of vaccine effectiveness. Zaragoza 2011]. Enferm Infecc Microbiol Clin 2014; 33:385-90. [PMID: 25475656 DOI: 10.1016/j.eimc.2014.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 08/29/2014] [Accepted: 09/11/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Mumps outbreaks continue to occur, even after the consolidation of vaccination programs. An outbreak of mumps occurred in a high school in Zaragoza during December 2011. OBJECTIVE To describe the outbreak and estimate vaccine effectiveness. METHODS CASE DEFINITION unilateral or bilateral swelling of the parotid or other salivary glands for three or more days without any other apparent cause. REFERENCE POPULATION People attending the 'Parque Goya' High School or with transmission chain origin in the High School. OUTBREAK PERIOD From two days before the onset of symptoms of the first case to five days after the last case. Samples were collected for virus confirmation (IgM, urine culture and oropharyngeal exudate), and isolates were processed for genotyping. A retrospective cohort study was performed in two high school classrooms to estimate vaccine efficacy. Public health authorities conducted active surveillance, isolation of cases, and vaccination of susceptible contacts. RESULTS There were 27 cases. Twenty-one (77.8%) were vaccinated with two doses of Measles-Mumps-Rubella vaccine. Twelve (44%) were confirmed microbiologically. G1 genotype was determined in six cases. According to the cohort study, vaccine efficacy for one dose was 34% (95%CI: -44 to 70), and was 67% (95%CI: 28 to 83) for two doses. CONCLUSIONS Vaccine effectiveness was lower than expected. Early detection and isolation of cases have been instrumental in preventing new cases in schools.
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Affiliation(s)
- Cecilia Compés-Dea
- Sección de Vigilancia Epidemiológica, Subdirección Provincial de Salud Pública de Zaragoza, Departamento de Sanidad, Bienestar Social y Familia, Gobierno de Aragón, Zaragoza, España.
| | - Joaquín Guimbao-Bescós
- Sección de Vigilancia Epidemiológica, Subdirección Provincial de Salud Pública de Zaragoza, Departamento de Sanidad, Bienestar Social y Familia, Gobierno de Aragón, Zaragoza, España
| | - José Ignacio Gaspar-Escayola
- Sección de Vigilancia Epidemiológica, Subdirección Provincial de Salud Pública de Zaragoza, Departamento de Sanidad, Bienestar Social y Familia, Gobierno de Aragón, Zaragoza, España
| | - María Ángeles Lázaro-Belanche
- Sección de Vigilancia Epidemiológica, Subdirección Provincial de Salud Pública de Zaragoza, Departamento de Sanidad, Bienestar Social y Familia, Gobierno de Aragón, Zaragoza, España
| | - Amaya Aznar-Brieba
- Sección de Vigilancia Epidemiológica, Subdirección Provincial de Salud Pública de Zaragoza, Departamento de Sanidad, Bienestar Social y Familia, Gobierno de Aragón, Zaragoza, España
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BORGMANN S, SCHWAB F, SANTIBANEZ S, MANKERTZ A. Mumps virus infection in vaccinated patients can be detected by an increase in specific IgG antibodies to high titres: a retrospective study. Epidemiol Infect 2014; 142:2388-96. [PMID: 24423404 PMCID: PMC9151285 DOI: 10.1017/s0950268813003427] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 11/23/2013] [Accepted: 12/11/2013] [Indexed: 11/06/2022] Open
Abstract
Mumps outbreaks in highly vaccinated populations with genotype G have been reported repeatedly. Detection of these outbreaks can be difficult in a setting with relatively high vaccination coverage when acute cases of mumps are routinely diagnosed by IgM serology since this marker is not reliable for diagnosis of mumps re-infection. To learn whether diagnostic tests performed in a large private laboratory may be useful to detect mumps outbreaks retrospectively, we reviewed the results of almost 7000 mumps tests. Two groups were compared: group 1 comprised of 3438 samples from patients submitted by physicians and clinicians (it was assumed that these patients visited their doctor due to acute disease). Group 2 comprised of 3398 samples submitted from company medical officers and occupational physicians. Since these patients usually attend for routine check-ups and certification of immunity to vaccine-preventable diseases, these samples comprised a control group. From July 2010 to May 2011, a mumps virus outbreak with more than 300 cases occurred in Bavaria, Southeast Germany. Our study includes samples received for serological mumps tests from January 2009 until December 2011 (36 months). The two groups were analysed with regard to the number of IgM-positive cases per month and the level of IgG titre. We found a marked increase for both parameters in group 1 during the time of the outbreak, while the samples submitted by the occupational medical physicians did not display significant alterations. These parameters reflect the outbreak with high accuracy, indicating that a retrospective analysis of IgG titres may be a useful tool for detection of mumps outbreaks when, as was the case in Germany, (i) a nationwide notification system has not been implemented and (ii) a highly vaccinated population is affected.
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Affiliation(s)
- S. BORGMANN
- Synlab Medical Care Services, Medical Care Centre Weiden, Weiden, Germany
- Klinikum Ingolstadt, Department of Clinical Infectiology and Infection Control, Ingolstadt, Germany
| | - F. SCHWAB
- Institute of Hygiene and Environmental Medicine, Charité – University Medicine Berlin, Berlin, Germany
| | - S. SANTIBANEZ
- National Reference Centre Measles, Mumps, Rubella, Robert Koch Institute, Berlin, Germany
| | - A. MANKERTZ
- National Reference Centre Measles, Mumps, Rubella, Robert Koch Institute, Berlin, Germany
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13
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Risk factors for transmission of mumps in a highly vaccinated population in Orange County, NY, 2009-2010. Pediatr Infect Dis J 2014; 33:121-5. [PMID: 23995590 DOI: 10.1097/inf.0000000000000020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In 2009-2010, we investigated a mumps outbreak among a highly vaccinated Orthodox Jewish population in a village in Orange County, NY, to identify risk factors associated with mumps transmission among persons with 2 doses of mumps-containing vaccine. METHODS Demographic and epidemiologic characteristics were collected on students in grades 6-12 in 3 schools. A mumps case was defined as a student, who self-reported parotitis, orchitis, jaw swelling and/or a mumps-related complication or whose mumps illness was reported to the Orange County Health Department during September 1, 2009, to January 18, 2010. Log-binomial regression analyses were conducted separately for boys and girls as they attended different schools and had different hours of study. RESULTS Of the 2503 students with 2 documented doses of mumps-containing vaccine, 320 (13%) developed mumps. Risk of mumps increased with increasing number of mumps cases in the class [≥8 vs. ≤3 cases: boys aRR = 3.1; 95% confidence interval (CI): 2.0-5.0; girls aRR = 2.6; 95% CI: 1.6-4.1] and household (>1 vs. 0 cases: boys aRR = 4.3 95% CI: 3.7-5.6; girls aRR = 10.1 95% CI: 7.1-14.3). Age at first dose, time since last dose, time between first and second dose, school, class size, number of hours at school per week and household size were not significantly associated with having mumps. CONCLUSIONS Two doses of mumps-containing vaccine may not be as effective in outbreak settings with multiple, prolonged and intense exposure. Additional studies are required to understand why such mumps outbreaks occur and how they can be prevented in the future.
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Smits G, Mollema L, Hahné S, de Melker H, Tcherniaeva I, Waaijenborg S, van Binnendijk R, van der Klis F, Berbers G. Seroprevalence of mumps in The Netherlands: dynamics over a decade with high vaccination coverage and recent outbreaks. PLoS One 2013; 8:e58234. [PMID: 23520497 PMCID: PMC3592917 DOI: 10.1371/journal.pone.0058234] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 02/05/2013] [Indexed: 11/24/2022] Open
Abstract
Here we present mumps virus specific antibody levels in a large cross-sectional population-based serosurveillance study performed in the Netherlands in 2006/2007 (n = 7900). Results were compared with a similar study (1995/1996) and discussed in the light of recent outbreaks. Mumps antibodies were tested using a fluorescent bead-based multiplex immunoassay. Overall seroprevalence was 90.9% with higher levels in the naturally infected cohorts compared with vaccinated cohorts. Mumps virus vaccinations at 14 months and 9 years resulted in an increased seroprevalence and antibody concentration. The second vaccination seemed to be important in acquiring stable mumps antibody levels in the long term. In conclusion, the Dutch population is well protected against mumps virus infection. However, we identified specific age- and population groups at increased risk of mumps infection. Indeed, in 2007/2008 an outbreak has occurred in the low vaccination coverage groups emphasizing the predictive value of serosurveillance studies.
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Affiliation(s)
- Gaby Smits
- Laboratory for Infectious Diseases and Screening, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
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Snijders BEP, van Lier A, van de Kassteele J, Fanoy EB, Ruijs WLM, Hulshof F, Blauwhof A, Schipper M, van Binnendijk R, Boot HJ, de Melker HE, Hahné SJM. Mumps vaccine effectiveness in primary schools and households, the Netherlands, 2008. Vaccine 2012; 30:2999-3002. [PMID: 22381073 DOI: 10.1016/j.vaccine.2012.02.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 02/09/2012] [Accepted: 02/14/2012] [Indexed: 10/28/2022]
Abstract
To estimate the mumps vaccine effectiveness (VE) during a large genotype D mumps outbreak, we conducted a cross-sectional study in eight primary schools and associated households in the Netherlands. Questionnaires were used to collect information on the occurrence of mumps. Multivariate analyses were used to estimate VE. Among schoolchildren we estimated the VE against mumps. Among household contacts where the schoolchild was the index case we estimated the VE against mumps and against mumps infectiousness. In total 1175 children and 2281 household contacts participated in the study. The mumps attack rate among schoolchildren was 17%. The mumps VE in schoolchildren was 92% [95% confidence interval (CI) 83-96%] and 93% [85-97%] for one and two doses of the measles, mumps, rubella (MMR) vaccine, respectively. The adjusted mumps VE among household contacts was 67% [65-95%] and 11% [-4 to 88%] against mumps and mumps infectiousness, respectively. Our study indicates that the mumps component of the MMR vaccine offered adequate protection against mumps among schoolchildren. The relatively low VE among household contacts is of concern.
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Affiliation(s)
- Bianca E P Snijders
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
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