1
|
Rubalskaia TS, Erokhov DV, Zherdeva PE, Milikhina AV, Gadzhiewa AA, Tikhonova NT. [Mumps virus (Paramyxoviridae: Orthorubulavirus: Mumps orthorubulavirus) genotyping as a component of laboratory confirmation of infection]. Vopr Virusol 2023; 68:59-65. [PMID: 36961236 DOI: 10.36233/0507-4088-157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Indexed: 03/13/2023]
Abstract
INTRODUCTION Mumps is a viral infection of high social significance. National program Elimination of measles and rubella and achievement of a stable sporadic incidence of epidemic mumps in the Russian Federation (20212025) sets the aim of gradual integration of mumps surveillance into the existing measles and rubella surveillance system. One of the key components of surveillance system is a laboratory confirmation of mumps cases. There are two approaches for laboratory confirmation of mumps cases, based on serological or molecular genetic methods. The aim of the work is molecular genetic characteristic of the mumps viruses (MuVs) circulated in the Russian Federation in 2022. MATERIALS AND METHODS Samples of swabs from the inner surface of the cheek of 11 patients with mumps were collected for the study. Viral RNA was isolated directly from the samples. The isolated RNA was used as a matrix for RT-PCR. PCR products were sequenced using the Sanger method, and phylogenetic analysis was performed using the MEGA-X software. RESULTS The MuV genotype G was detected in all samples. Phylogenetic analysis showed the presence of two virus genetic groups G-1 and G-2 that were significantly different from the viruses circulating in other countries. CONCLUSION The identification of two MuV genetic groups in a limited area suggests a high genetic diversity of the pathogen.
Collapse
Affiliation(s)
- T S Rubalskaia
- Gabrichevsky Moscow Research Institute of Epidemiology and Microbiology Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing
| | - D V Erokhov
- Gabrichevsky Moscow Research Institute of Epidemiology and Microbiology Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing
| | - P E Zherdeva
- Gabrichevsky Moscow Research Institute of Epidemiology and Microbiology Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing
| | - A V Milikhina
- Center for Hygiene and Epidemiology in the Republic of Dagestan
| | - A A Gadzhiewa
- Center for Hygiene and Epidemiology in the Republic of Dagestan
| | - N T Tikhonova
- Gabrichevsky Moscow Research Institute of Epidemiology and Microbiology Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing
| |
Collapse
|
2
|
Promoting a Culturally Adapted Policy to Deal with the COVID-19 Crisis in the Haredi Population in Israel. J Racial Ethn Health Disparities 2022; 9:2508-2517. [PMID: 34791614 PMCID: PMC8597873 DOI: 10.1007/s40615-021-01186-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 12/29/2022]
Abstract
COVID-19 has caused high morbidity and mortality in Israel but, as in other countries, not all groups were equally affected. Haredi Jews (often called ultra-Orthodox), a religious minority, were disproportionately harmed by the pandemic. This group has distinctive cultural, lifestyle, and demographic characteristics, which may be related to these higher COVID-19 rates and call for policies specifically adapted for this community. This paper describes in detail the steps the Israeli Ministry of Health (MoH) took to try to improve the quality of care and prevent morbidity in the Haredi population through working in cooperation with the leadership and members of the Haredi community and strengthening mutual trust in order to increase adherence to government regulations and recommendations. This case study is based on the unique perspective of the two people who worked in the Israeli MoH and led the initiative as well as a review of relevant government documents and statistics. It discusses to what extent the initiative seemed to have been successful and what lessons can be learned not only for Haredim but for other religious and/or minority groups and closed communities in Israel and elsewhere.
Collapse
|
3
|
Response to Vaccination against Mumps in Medical Students: Two Doses Are Needed. Viruses 2021; 13:v13071311. [PMID: 34372517 PMCID: PMC8310302 DOI: 10.3390/v13071311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022] Open
Abstract
Mumps is a vaccine-preventable infectious disease diffuse worldwide. The implementation of mumps vaccination reduced largely the spread of infection. On 11,327 Medical School students the prevalence of mumps positive antibodies was evaluated according to dose/doses of vaccine, year of birth and sex. Compliance to mumps vaccine was low in students born before 1990 but increased consistently after this year, above all compliance to two doses, due to the implementation of the vaccine offer. Positivity of mumps antibodies is significantly (p < 0.0001) lower in students vaccinated once (71.2%) compared to those vaccinated twice (85.4%). In addition, students born after 1995, largely vaccinated twice, showed a seropositivity near to 90%. Further, females had a significantly (p < 0.0001) higher proportion of positive antibodies after vaccination than males, both one (74.6% vs. 64.7%) and two doses (86.8% vs. 82.9%). Finally, seropositivity after two vaccine doses remains high (86.1%) even 15 years after the second dose. In conclusion, the research highlighted that vaccination against mumps reaches a good level of coverage only after two doses of vaccine persisting at high levels over 15 years and induces a more significant response in females.
Collapse
|
4
|
What Affects Maternal Response to Measles Vaccinations? Examining the Health Beliefs Model (HBM). SCI 2021. [DOI: 10.3390/sci3020020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Renewed measles outbreaks in recent years indicate that despite the routine availability of vaccines for a disease that is considered contagious, dangerous and deadly, many anti-vaccinationists do not vaccinate their children, which consequently endangers public health. This study aimed to investigate the factors that influence mothers to vaccinate their children, and whether the Health Belief Model (HBM) could predict compliance or non-compliance. Methods: This was a quantitative correlational research, using a 40-item questionnaire administered to 181 mothers in Israel. Results: The findings indicated two main factors that affected mothers’ intention to vaccinate their children against measles: first, their perception of the vaccine’s advantages, and second, their perception of the severity of the disease. It was also found that the HBM variables significantly affected the intention to administer vaccines. Conclusion: Consequently, raising public awareness of the vaccine’s advantages and importance to preventing mass infection, as well as attempts by the health system and practitioners to understand the motivations of anti-vaccinationists (including health beliefs and cultural sensitivities) could significantly increase the percentage of vaccinated children, and eradicate the measles epidemic.
Collapse
|
5
|
Zerbo O, Modaressi S, Glanternik JR, Goddard K, Ross P, Lewis N, Klein NP. Identification and description of mumps cases in a non-outbreak setting and evaluation of the effectiveness of mumps-containing vaccines over time. Hum Vaccin Immunother 2020; 16:3098-3102. [PMID: 32401599 PMCID: PMC8641587 DOI: 10.1080/21645515.2020.1756153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Mumps outbreaks among previously vaccinated young adults raise concerns regarding waning vaccine immunity. This study identified, described and assessed the changing incidence of mumps cases following mumps-containing vaccination (MMR/MMRV) in a non-mumps outbreak setting. Potential cases between 1996 and 2018 were identified by the international classification of disease codes or by mumps laboratory test orders among Kaiser Permanente Northern California members. Medical charts were reviewed to confirm diagnoses, timing relative to vaccination and clinical characteristics. Among 474 potential cases, 257 (54.2%) were confirmed after chart review. A third of the cases were <10 years old at diagnosis and 48% were over 25 years. Most cases (92.2%) had parotitis and 5% of males had orchitis. Mumps rates decreased from 8.5 to 1.8/1,000,000 person-years as time since the second MMR/MMRV dose increased from <2 years to ≥10 years. Similarly, rates decreased from 16.3 to 3/1,000,000 person-years after at least 1 dose of MMR/MMRV. Mumps rates were higher among children aged ≤10 years compared with older age groups. In conclusion, in the context of a non-outbreak setting, this study suggests that waning of vaccine immunity to mumps appeared to have minimal clinical impact.
Collapse
Affiliation(s)
- Ousseny Zerbo
- Vaccine Study Center, Division of Research, Kaiser Permanente , Oakland, CA, USA
| | - Sharareh Modaressi
- Vaccine Study Center, Division of Research, Kaiser Permanente , Oakland, CA, USA
| | - Julia R Glanternik
- Vaccine Study Center, Division of Research, Kaiser Permanente , Oakland, CA, USA
| | - Kristin Goddard
- Vaccine Study Center, Division of Research, Kaiser Permanente , Oakland, CA, USA
| | - Pat Ross
- Vaccine Study Center, Division of Research, Kaiser Permanente , Oakland, CA, USA
| | - Ned Lewis
- Vaccine Study Center, Division of Research, Kaiser Permanente , Oakland, CA, USA
| | - Nicola P Klein
- Vaccine Study Center, Division of Research, Kaiser Permanente , Oakland, CA, USA
| |
Collapse
|
6
|
Pang H, Zhou Y, Zhao W, Jiang Q. Epidemiological changes in mumps infections between 1990 and 2017 in urban area of Shanghai, China. Hum Vaccin Immunother 2020; 17:1358-1365. [PMID: 33175643 PMCID: PMC8078658 DOI: 10.1080/21645515.2020.1827610] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
2-dose measles-mumps-rubella (MMR) vaccine was recommended for children in Shanghai in November 1996 and incorporated into Shanghai immunization program in December 2008. We described the mumps epidemiology and assessed impact of the 2-dose MMR vaccination in Changning district, Shanghai, 1990–2017. We obtained the MMR vaccination coverage for children born during 1995–2015 and examined the incidence and disease characteristics of mumps during 1990–2017. The 1st dose MMR coverage had maintained above 95% since 1999 birth cohort. The 2nd dose MMR coverage reached above 90% since 2006 birth cohort. A total of 13,388 cases were reported during 1990–2017. The incidence decreased from 315.2 per 100,000 population in 1990 to 8.8 per 100,000 population in 2017. Of the 13,388 cases, 7585 (56.7%) were male and 91.7% were 1–14 years of age and 86.8% were children in kindergartens and students in schools. Compared with 1990–1996, the incidence had a significant decrease in 0–4 and ≥15 years in 1997–2008 and in all age groups in 2009–2017. A later birth cohort was associated with a lower incidence in children covered by MMR vaccination. In Conclusions, the incidence of mumps has dramatically declined with high coverage of 2-dose MMR in Changning district, Shanghai. Children in kindergartens and schools are still the most affected populations. An increase in incidence in adults has not occurred after 20 years of MMR vaccination. Long-term surveillance is needed to fully evaluate the impact of MMR vaccination policy.
Collapse
Affiliation(s)
- Hong Pang
- Changning Center for Disease Control and Prevention, Shanghai, China
| | - Yibiao Zhou
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Wensui Zhao
- Changning Center for Disease Control and Prevention, Shanghai, China
| | - Qingwu Jiang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| |
Collapse
|
7
|
Waning immunity and re-emergence of measles and mumps in the vaccine era. Curr Opin Virol 2020; 40:48-54. [PMID: 32634672 DOI: 10.1016/j.coviro.2020.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/14/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022]
Abstract
Vaccine-preventable diseases (VPD) including measles and mumps have been re-emerging in countries with sustained high vaccine coverage. For mumps, waning immunity has been recognized as a major contributor to recent outbreaks. Although unvaccinated individuals account for most cases in recent measles outbreaks, the role of immune waning remains unclear. Accumulating serological and epidemiological evidence suggests that natural immunity induced by infection may be more durable compared to vaccine-induced immunity. As the proportion of population immunity via vaccination gradually increases and boosting through natural exposures becomes rare, risk of outbreaks may increase. Mechanistic insights into the coupled immuno-epidemiological dynamics of waning and boosting will be important to understand optimal vaccination strategies to combat VPD re-emergence and achieve eradication.
Collapse
|
8
|
Mumps outbreak in Copperbelt province, Zambia: Epidemiological characteristics. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2019. [DOI: 10.1016/j.cegh.2018.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
9
|
Qin W, Wang Y, Yang T, Xu XK, Meng XM, Zhao CJ, Li SY, Xie SY, Li KC, Su H. Outbreak of mumps in a student population with high vaccination coverage in China: time for two-dose vaccination. Hum Vaccin Immunother 2019; 15:2106-2111. [PMID: 30779678 DOI: 10.1080/21645515.2019.1581526] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
In 2016, an outbreak of mumps occurred in a primary school in China with a student population having high vaccination coverage. An unmatched case-control study was performed to identify risk factors contributing to this outbreak, and a retrospective cohort study was conducted to evaluate the effectiveness of mumps-containing vaccine (MuCV). A total of 97 cases were identified during the outbreak, and the overall attack rate was 8.2%. Among students with confirmed vaccination status, 90% had received at least one dose of MuCV. Cases were more likely than non-cases to report taking the school bus during the epidemic period (adjusted OR = 2.3, 95% CI: 1.4-3.7). Vaccine effectiveness (VE) was higher for two-dose MuCV (76%, 95% CI:49â€"89%) than for one-dose MuCV (59%, 95% CI: 36â€"74%. The protection afforded by both one-dose and two-dose MuCV waned over time, from 82% among students vaccinated within 5 years to 41% among those vaccinated more than 10 years previously for one-dose VE, and from 90% to 25% over the same time period for two-dose VE. We found that outbreaks of mumps can occur in schools despite high coverage of one-dose MuCV vaccination. Although the VE of both two-dose and one-dose MuCV wanes over time, the overall VE for two-dose MuCV was superior than that of one-dose MuCV. Therefore, a two-dose MuCV schedule through routine services is likely needed in order to control mumps epidemics in China.
Collapse
Affiliation(s)
- Wei Qin
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention , Lu'an , Anhui , China.,Chinese Field Epidemiology Training Program (CFETP), Chinese Center for Disease Control and Prevention , Beijing , China.,Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University , Hefei , China
| | - Yao Wang
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention , Lu'an , Anhui , China
| | - Tao Yang
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention , Lu'an , Anhui , China
| | - Xiao-Kang Xu
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention , Lu'an , Anhui , China
| | - Xiang-Mei Meng
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention , Lu'an , Anhui , China
| | - Chang-Jun Zhao
- Department of Expanded Program on Immunization, Jin'an District Center for Disease Control and Prevention , Lu'an , Anhui , China
| | - Shao-Yi Li
- Department of Expanded Program on Immunization, Jin'an District Center for Disease Control and Prevention , Lu'an , Anhui , China
| | - Shao-Yu Xie
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention , Lu'an , Anhui , China
| | - Kai-Chun Li
- Department of Expanded Program on Immunization, Lu'an Municipal Center for Disease Control and Prevention , Lu'an , Anhui , China
| | - Hong Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University , Hefei , China
| |
Collapse
|
10
|
Mercader S, McGrew M, Sowers SB, Williams NJ, Bellini WJ, Hickman CJ. Development and Use of an Endpoint Titration Assay To Characterize Mumps IgG Avidity following Measles, Mumps, and Rubella Vaccination and Wild-Type Mumps Infection. mSphere 2018; 3:e00320-18. [PMID: 30209129 PMCID: PMC6135962 DOI: 10.1128/msphere.00320-18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/02/2018] [Indexed: 11/29/2022] Open
Abstract
Waning mumps IgG antibody and incomplete IgG avidity maturation may increase susceptibility to mumps virus infection in some vaccinees. To measure mumps IgG avidity, serum specimens serially diluted to the endpoint were incubated on a commercial mumps-specific IgG enzyme immunoassay and treated with the protein denaturant diethylamine (60 mM, pH 10). End titer avidity indices (etAIs [percent ratio of detected diethylamine-resistant IgG at endpoint]) were calculated. Unpaired serum specimens (n = 108) from 15-month-old children living in a low-incidence setting were collected 1 month and 2 years after the first measles, mumps, and rubella vaccine dose (MMR1) and tested for mumps avidity. Per the receiver operating characteristic curve, the avidity assay is accurate (area under the curve, 0.994; 95% confidence interval [CI], 0.956 to 1.000), 96.5% sensitive (95% CI, 87.9 to 99.6%), and 92.2% specific (95% CI, 81.1 to 97.8%) at an etAI of 30%. When 9 sets of paired serum specimens collected 1 to 60 months post-MMR1 were tested for mumps and measles IgG avidity using comparable methods, the mumps etAI increased from 11% to 40 to 60% in 6 months. From 6 to 60 months, avidity was sustained at a mean etAI of 50% (95% CI, 46 to 54%), significantly lower (P < 0.0001) than the mean measles etAI of 80% (95% CI, 74 to 86%). Mean etAIs in children 2 years post-MMR1 (n = 51), unvaccinated adults with distant mumps disease (n = 29), and confirmed mumps cases (n = 23) were 54, 62, and 57%, respectively. A mumps-specific endpoint avidity assay was developed and validated, and mumps avidity was determined to be generally sustained at etAIs of 40 to 60%, reaching etAIs of >80% in some individuals.IMPORTANCE Numerous outbreaks of mumps have occurred in the United States among two-dose measles-mumps-rubella (MMR)-vaccinated populations since 2006. The avidity of mumps-specific IgG antibodies may affect susceptibility to mumps virus infection in some vaccinated individuals. To accurately measure mumps avidity, we developed and validated a mumps-specific IgG avidity assay that determines avidity at the endpoint titer of serially diluted serum specimens, providing results that are independent of IgG concentration. At low antibody titers, endpoint methods are considered more accurate than methods that determine avidity at a single dilution. We determined that 6 months after the first MMR dose, mumps IgG avidity is high and generally sustained at avidity indices of 40 to 60%, reaching values of >80% in some individuals. Additionally, 4% (4/103) of individuals had avidity indices of ≤30% (low avidity) 2 years after vaccination. Inadequate mumps avidity maturation may be one factor influencing susceptibility to mumps virus infection among previously vaccinated or naturally infected individuals.
Collapse
Affiliation(s)
- Sara Mercader
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marcia McGrew
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sun B Sowers
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nobia J Williams
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - William J Bellini
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carole J Hickman
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
11
|
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
| |
Collapse
|
12
|
Yu G, Yang R, Wei Y, Yu D, Zhai W, Cai J, Long B, Chen S, Tang J, Zhong G, Qin J. Spatial, temporal, and spatiotemporal analysis of mumps in Guangxi Province, China, 2005-2016. BMC Infect Dis 2018; 18:360. [PMID: 30068308 PMCID: PMC6090846 DOI: 10.1186/s12879-018-3240-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 07/05/2018] [Indexed: 12/27/2022] Open
Abstract
Background The resurgence of mumps around the world occurs frequently in recent years. As the country with the largest number of cases in the world, the status of mumps epidemics in China is not yet clear. This study, taking the relatively serious epidemic province of Guangxi as the example, aimed to examine the spatiotemporal pattern and epidemiological characteristics of mumps, and provide a scientific basis for the effective control of this disease and formulation of related health policies. Methods Geographic information system (GIS)-based spatiotemporal analyses, including spatial autocorrelation analysis, Kulldorff’s purely spatial and space-time scan statistics, were applied to detect the location and extent of mumps high-risk areas. Spatial empirical Bayesian (SEB) was performed to smoothen the rate for eliminating the instability of small-area data. Results A total of 208,470 cases were reported during 2005 and 2016 in Guangxi. Despite the fluctuations in 2006 and 2011, the overall mumps epidemic continued to decline. Bimodal seasonal distribution (mainly from April to July) were found and students aged 5–9 years were high-incidence groups. Though results of the global spatial autocorrelation based on the annual incidence largely varied, the spatial distribution of the average annual incidence of mumps was nonrandom with the significant Moran’s I. Spatial cluster analysis detected high-value clusters, mainly located in the western, northern and central parts of Guangxi. Spatiotemporal scan statistics identified almost the same high-risk areas, and the aggregation time was mainly concentrated in 2009–2012. Conclusion The incidence of mumps in Guangxi exhibited spatial heterogeneity in 2005–2016. Several spatial and spatiotemporal clusters were identified in this study, which might assist the local government to develop targeted health strategies, allocate health resources reasonably and increase the efficiency of disease prevention. Electronic supplementary material The online version of this article (10.1186/s12879-018-3240-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Guoqi Yu
- Department of Environmental and Occupational Health, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Rencong Yang
- Guangxi Center for Disease Control and Prevention, Institute of Vaccination, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Yi Wei
- Department of Environmental and Occupational Health, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Dongmei Yu
- Department of Environmental and Occupational Health, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Wenwen Zhai
- Department of Health Related Social and Behavioral Science, West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Jiansheng Cai
- Department of Environmental and Occupational Health, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Bingshuang Long
- Department of Environmental and Occupational Health, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Shiyi Chen
- Department of Environmental and Occupational Health, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Jiexia Tang
- Department of Environmental and Occupational Health, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Ge Zhong
- Guangxi Center for Disease Control and Prevention, Institute of Vaccination, Nanning, Guangxi Zhuang Autonomous Region, China.
| | - Jian Qin
- Department of Environmental and Occupational Health, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.
| |
Collapse
|
13
|
Indenbaum V, Hübschen JM, Stein-Zamir C, Mendelson E, Sofer D, Hindiyeh M, Anis E, Abramson N, Haas EJ, Yosef Y, Dukhan L, Singer SR. Ongoing mumps outbreak in Israel, January to August 2017. ACTA ACUST UNITED AC 2018; 22:30605. [PMID: 28877843 PMCID: PMC5587898 DOI: 10.2807/1560-7917.es.2017.22.35.30605] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 08/31/2017] [Indexed: 12/04/2022]
Abstract
In Israel, 262 mumps cases were registered between 1 January and 28 August 2017 despite a vaccine coverage of ≥ 96%. The majority (56.5%) of cases were adolescents and young adults between 10 and 24 years of age. Nearly twice as many cases were reported in males than in females. Sequence information identified genotype G and suggested specific transmission chains in different religious communities, with the Muslim population in Jerusalem being most severely affected.
Collapse
Affiliation(s)
- Viki Indenbaum
- National Center for Measles/Mumps/Rubella, Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Tel Hashomer, Israel.,These authors contributed equally to this article and share first authorship
| | - Judith M Hübschen
- These authors contributed equally to this article and share first authorship.,Infectious Diseases Research Unit, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Chen Stein-Zamir
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel
| | - Ella Mendelson
- National Center for Measles/Mumps/Rubella, Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Tel Hashomer, Israel
| | - Danit Sofer
- National Center for Measles/Mumps/Rubella, Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Tel Hashomer, Israel
| | - Musa Hindiyeh
- National Center for Measles/Mumps/Rubella, Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Tel Hashomer, Israel
| | - Emilia Anis
- Division of Epidemiology, Ministry of Health, Jerusalem, Israel
| | - Nitza Abramson
- Jerusalem District Health Office, Ministry of Health, Jerusalem, Israel
| | - Eric J Haas
- Division of Epidemiology, Ministry of Health, Jerusalem, Israel
| | - Yochi Yosef
- Southern District Health Office, Ministry of Health, Beersheba, Israel
| | - Larisa Dukhan
- Southern District Health Office, Ministry of Health, Beersheba, Israel
| | | |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Tafuri S, Gallone MS, Larocca AMV, Germinario C. How will the MMR universal mass vaccination change the epidemiologic pattern of mumps? A 2012 Italian serosurvey. Am J Infect Control 2016; 44:1420-1421. [PMID: 27156389 DOI: 10.1016/j.ajic.2016.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 03/03/2016] [Accepted: 03/03/2016] [Indexed: 10/21/2022]
Abstract
To investigate the changes in the epidemiologic pattern of mumps, we carried out a serosurvey among young adults from Apulia, Italy. A convenience sample of 1,764 blood donors were enrolled in 2012: 93.4% (95% confidence interval, 92.1-94.5) showed a positive antimumps immunoglobulin G titre, geometric mean titer was 2.05. Results were consistent with previously published data on the immunogenicity of mumps vaccine but showed a lack of immunity (10% of people aged 18-26 years susceptible for mumps). Future research must be focused on the long-time immunogenicity of the mumps vaccine.
Collapse
|
16
|
Yitshak-Sade M, Davidovitch N, Novack L, Grotto I. Ethnicity and immunization coverage among schools in Israel. ETHNICITY & HEALTH 2016; 21:439-451. [PMID: 26304468 DOI: 10.1080/13557858.2015.1068281] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Recent years have seen a global trend of declining immunization rates of recommended vaccines that is more pronounced among school-age children. Ethnic disparities in child immunization rates have been reported in several countries. We investigated an effect of ethnicity on the vaccination rates of immunizations routinely administered within schools in Israel. DESIGN Data were collected from the Ministry of Health database regarding immunization coverage for all registered Israeli schools (3736) in the years 2009-2011. Negative binomial regression was used to assess the association between school ethnicity and immunization coverage while controlling for school characteristics. RESULTS The lowest immunization coverage was found in Bedouin schools (median values of 75.1%, 81.5% and 0% for the first, second and eighth grades, respectively) in 2011. During this year, vaccination coverage in the first and second grades in Jewish schools was 1.51 and 1.35 times higher, respectively, compared to Bedouin schools. In the years 2009 and 2010, no significant increase in risk for lower vaccination rate was observed in Bedouin schools, and children in Arab and Druze schools were more likely to have been vaccinated. CONCLUSION The lower vaccination refusal rate found in Bedouin schools supports the hypothesis that difficulties related to accessibility constitute the main problem rather than noncompliance with the recommended vaccination protocol for school-age children, featuring higher socio-economic status groups. Our study emphasizes the importance of identifying, beyond the national-level data, subpopulation groups at risk for non-vaccination. This knowledge is essential to administrative-level policy-makers for the allocation of resources and the planning of intervention programs.
Collapse
Affiliation(s)
- Maayan Yitshak-Sade
- a Faculty of Health Sciences , Ben-Gurion University of the Negev , Beer-Sheva , Israel
- b Clinical Research Center , Soroka University Medical Center , Beer-Sheva , Israel
| | - Nadav Davidovitch
- c Department of Health Systems Management , Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Lena Novack
- d Department of Public Health , Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Itamar Grotto
- d Department of Public Health , Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer-Sheva , Israel
- e Ministry of Health , Jerusalem , Israel
| |
Collapse
|
17
|
Vygen S, Fischer A, Meurice L, Mounchetrou Njoya I, Gregoris M, Ndiaye B, Ghenassia A, Poujol I, Stahl JP, Antona D, Le Strat Y, Levy-Bruhl D, Rolland P. Waning immunity against mumps in vaccinated young adults, France 2013. ACTA ACUST UNITED AC 2016; 21:30156. [PMID: 26987576 DOI: 10.2807/1560-7917.es.2016.21.10.30156] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 10/19/2015] [Indexed: 11/20/2022]
Abstract
In 2013, 15 clusters of mumps were notified in France; 72% (82/114) of the cases had been vaccinated twice with measles-mumps-rubella vaccine. To determine whether the risk of mumps increased with time since the last vaccination, we conducted a case-control study among clusters in universities and military barracks. A confirmed case had an inflammation of a salivary gland plus laboratory confirmation in 2013. A probable case presented with inflammation of a salivary gland in 2013 either lasting for > 2 days or with epidemiological link to a confirmed case. Controls had no mumps symptoms and attended the same university course, student party or military barracks. We collected clinical and vaccination data via web questionnaire and medical records. We calculated adjusted odds ratios (aOR) using logistic regression. 59% (50/85) of cases and 62% (199/321) of controls had been vaccinated twice. The odds of mumps increased for twice-vaccinated individuals by 10% for every year that had passed since the second dose (aOR 1.10; 95% confidence interval (CI): 1.02-1.19; p = 0.02). Mumps immunity waned with increasing time since vaccination. Our findings contributed to the French High Council of Public Health's decision to recommend a third MMR dose during outbreaks for individuals whose second dose dates > 10 years.
Collapse
Affiliation(s)
- Sabine Vygen
- French Institute for Public Health Surveillance (InVS), Department of Coordination of Alerts and Regions (DCAR), Regional office in Aquitaine
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Havlíčková M, Limberková R, Smíšková D, Herrmannová K, Jiřincová H, Nováková L, Lexová P, Kynčl J, Arientová S, Marešová V. Mumps in the Czech Republic in 2013: Clinical Characteristics, Mumps Virus Genotyping, and Epidemiological Links. Cent Eur J Public Health 2016; 24:22-8. [PMID: 27070966 DOI: 10.21101/cejph.a4512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 11/18/2015] [Indexed: 11/15/2022]
Abstract
AIM The aim of the study was to map the incidence of mumps in the Czech Republic in terms of clinical symptoms, epidemiological links, and characteristics of circulating genotypes. METHODS Patients with suspected mumps examined in the Infectious Diseases Clinic of the Na Bulovce Hospital in 2013 were enrolled in the study. Buccal swab specimens were tested by means of nucleic acid detection (RT-qPCR) and when positive, they were cultured in tissue culture. Sequencing was carried out using the BigDye Terminator v3.1 Cycle Sequencing Kit and Genetic Analyzer 3500. The SeqScape software was used for the analysis of sequencing data and filtering out low quality reads. The phylogenetic analysis and genotyping were performed using the Mega 6 software. To generate the phylogenetic tree, all sequences were aligned by the MAFFT tool and the alignment obtained was edited using the BioEdit software. In all patients, selected biochemical markers (C-reactive protein, white blood cell count and serum amylase) were measured. The EPIDAT system used for reporting infectious diseases, record keeping, and data analysis in the Czech Republic was the source of statistical data. RESULTS Eighty-nine patients with suspected mumps were examined in the Na Bulovce Hospital and 65 of them were laboratory confirmed with mumps: 40 males (61.5%) and 25 females (38.5%). The mean age of the study cohort was 25.9 years (median age of 23 years, age range from 10 to 73 years) and 14 patients were under 18 years of age. Thirty-four (52.3%) patients were vaccinated in childhood, 28 (43.1%) were unvaccinated, and for three persons, vaccination data were not available. A severe course of the disease was reported in 15 (23.1%) patients. Fourteen of them needed hospitalization because of orchitis (9 males) and meningitis (5 patients). One patient with orchitis was treated on an outpatient basis. The need for hospitalization tended to be lower in the unvaccinated patients (14.7% vs. 35.7%, p=0.076). In 2013, 1,553 cases of mumps were reported to the EPIDAT system. Of these, 640 were laboratory confirmed. The most often reported complications were orchitis (90 cases, i.e. 10.3%) and meningitis (21 cases, i.e. 1.4%). Orchitis was diagnosed in 30.3% of the unvaccinated and in 6.4% of the vaccinated males. Meningitis occurred in 3.1% of the unvaccinated and in 1.0% of the vaccinated patients. CONCLUSION Despite the emergence of mumps among the vaccinated population, the present study has confirmed a positive effect of the vaccine, particularly on the incidence of complications and inflammatory markers. All 30 sequenced mumps virus strains were assigned to group G. A secondary vaccine failure due to waning immunity seems to be a plausible explanation for the rise in mumps cases.
Collapse
Affiliation(s)
- Martina Havlíčková
- Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
| | - Radomíra Limberková
- Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
| | - Dita Smíšková
- Clinic for Infectious, Parasitic and Tropical Diseases, Na Bulovce Hospital, Prague, Czech Republic
| | - Kristýna Herrmannová
- Clinic for Infectious, Parasitic and Tropical Diseases, Na Bulovce Hospital, Prague, Czech Republic
| | - Helena Jiřincová
- Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
| | - Ludmila Nováková
- Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
| | - Pavla Lexová
- Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
| | - Jan Kynčl
- Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
| | - Simona Arientová
- Department of Infectious Diseases, 1st Faculty of Medicine, Charles University in Prague and Military University Hospital Prague, Prague, Czech Republic
| | - Vilma Marešová
- Clinic for Infectious, Parasitic and Tropical Diseases, Na Bulovce Hospital, Prague, Czech Republic
| |
Collapse
|
19
|
Zamir CS, Schroeder H, Shoob H, Abramson N, Zentner G. Characteristics of a large mumps outbreak: Clinical severity, complications and association with vaccination status of mumps outbreak cases. Hum Vaccin Immunother 2016; 11:1413-7. [PMID: 25874726 DOI: 10.1080/21645515.2015.1021522] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
In recent years, large mumps outbreaks, involving mainly adolescents and young adults, have re-emerged in several countries. We investigated a large mumps outbreak, evaluated the association between mumps clinical severity (complications, hospitalization) and vaccination status (number of previous measles, mumps and rubella - MMR vaccine doses), and assessed vaccine effectiveness. The first mumps cases emerged in an ultra-orthodox boys' school in Jerusalem and were epidemiologically linked to the mumps outbreak in New York. Overall, 3130 mumps cases were notified in the Jerusalem district during September 2009-August 2011 (median age 13y, 64% males). Most cases were reported from community clinics. Patients with systemic symptoms and/or complications (419, 13.4%) were either hospitalized (n = 79) or treated in an emergency medical center (n = 340). The main complications included orchitis (3.8% males> age 12y) and meningoencephalitis (0.5%). The mumps virus genotype was G5. The distribution of previous MMR vaccine doses (n = 0,1,2) was: 24.8%, 28.3% and 46.9%, respectively. The number of previous vaccine doses was inversely associated with clinical severity. Adjusted values for MMR vaccine effectiveness against complications were estimated as 52.1% (95% CI -4 -78%) for one vaccine dose and 62.7% (95% CI 25.7-81.3%) for 2 doses. The outbreak was characterized by predominance of male students; the majority of whom had been previously vaccinated. The reported complication rate was relatively low. Vaccination status was associated with age and disease severity. The combination of limited mumps vaccine effectiveness and the specific school setting (dense learning and living conditions) probably contributed to the disease spread.
Collapse
Affiliation(s)
- C Stein Zamir
- a Jerusalem District Health Office; Ministry of Health ; Jerusalem , Israel
| | | | | | | | | |
Collapse
|
20
|
Santacruz-Sanmartín E, Hincapié-Palacio D, Ospina MC, Perez-Toro O, Bernal-Restrepo LM, Buitrago-Giraldo S, Lenis-Ballesteros V, Díaz FJ. Seroprevalence of mumps in an epidemic period in Medellín, Colombia. Vaccine 2015; 33:5606-5612. [DOI: 10.1016/j.vaccine.2015.08.088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 08/26/2015] [Accepted: 08/31/2015] [Indexed: 11/30/2022]
|
21
|
Abstract
Routine vaccination against mumps has markedly reduced its incidence. However, the incidence of mumps continuously has increased since 2007. In 2013, a large mumps epidemic occurred in Korea, and this epidemic is still an ongoing problem. This epidemic occurred primarily in school settings and affected vaccinated adolescents, predominantly male students. The recent resurgence of mumps is caused by multiple factors: suboptimal effectiveness of the current mumps vaccines, use of the Rubini strain vaccine, waning immunity in the absence of natural boosting due to the marked reduction in the mumps incidence, genotype mismatch between the vaccine and circulating mumps virus strains, and environmental conditions that foster intense exposures. Containment of mumps outbreaks is challenging because the sensitivity of diagnostic tests is low among vaccinees and control measures are less efficient because of the inherent nature of the mumps virus. Despite the suboptimal vaccine effectiveness in outbreak settings, maintaining the high vaccine coverage is an important strategy to prevent mumps outbreaks, given that the routine use of mumps vaccines has substantially reduced the incidence of mumps and its complications as compared with that in the pre-vaccine era. In order to control the current mumps epidemic and prevent further outbreaks, we need to better understand the dynamics of mumps among vaccinated populations and the changing epidemiology in Korea. Concerted efforts should be made to systematically monitor the immunization status of the Korean population and to improve diagnosis efficiency. Furthermore, more effective mumps vaccines need to be developed in the future.
Collapse
Affiliation(s)
- Sun Hee Park
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
22
|
Jin L, Örvell C, Myers R, Rota PA, Nakayama T, Forcic D, Hiebert J, Brown KE. Genomic diversity of mumps virus and global distribution of the 12 genotypes. Rev Med Virol 2014; 25:85-101. [DOI: 10.1002/rmv.1819] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/14/2014] [Accepted: 10/15/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Li Jin
- Virus Reference Department, Reference Microbiology Services; Public Health England; London UK
| | - Claes Örvell
- Division of Clinical Virology; Huddinge University Hospital; Stockholm Sweden
| | - Richard Myers
- Virus Reference Department, Reference Microbiology Services; Public Health England; London UK
| | - Paul A. Rota
- Centers for Disease Control and Prevention; Atlanta USA
| | | | - Dubravko Forcic
- University of Zagreb; Centre for Research and Knowledge Transfer in Biotechnology; Zagreb Croatia
| | - Joanne Hiebert
- National Microbiology Laboratory; Public Health Agency of Canada; Winnipeg Canada
| | - Kevin E. Brown
- Virus Reference Department, Reference Microbiology Services; Public Health England; London UK
| |
Collapse
|
23
|
Hukic M, Hajdarpasic A, Ravlija J, Ler Z, Baljic R, Dedeic Ljubovic A, Moro A, Salimović-Besic I, Sausy A, Muller CP, Hübschen JM. Mumps outbreak in the Federation of Bosnia and Herzegovina with large cohorts of susceptibles and genetically diverse strains of genotype G, Bosnia and Herzegovina, December 2010 to September 2012. Euro Surveill 2014; 19. [DOI: 10.2807/1560-7917.es2014.19.33.20879] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A mumps outbreak reported from the Federation of Bosnia and Herzegovina involved 7,895 cases between December 2010 and September 2012. This was the largest outbreak in the country since the introduction of the measles, mumps and rubella vaccine in 1980. The highest disease incidence was found among 15 to 19 year-olds. About 39% (3,050/7,895) of cases reported to be unvaccinated; the vaccination status of 31% (2,426/7,895) was unknown. A seroprevalence study among 150 asymptomatic contacts to mumps cases showed that about one third (45/150) were susceptible to mumps. Among 105 clinically suspected mumps patients hospitalised at the Clinical Centre of the University of Sarajevo, orchitis (60% of all males: 51/85) and meningitis (9%: 9/105) were the most common complications. Among 57 outbreak sequences obtained for the small hydrophobic gene, eight different variants of genotype G viruses were identified. The outbreak affected mainly age groups comprising individuals who were not vaccinated during or after the Bosnian war, as well as cantons with single dose immunisation policies until 2001. In addition to issues related to vaccination of individuals, differential responses to vaccines and vaccine strains, waning of antibodies and potentially also the genetically diverse variants of genotype G may have compounded the size and duration of the outbreak. Our report emphasizes the need for supplementary immunisation programmes in particular for adolescents and young adults.
Collapse
Affiliation(s)
- M Hukic
- Institute of Clinical Microbiology, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - A Hajdarpasic
- Centre for Genetics, Faculty of Medicine, University of Sarajevo, Laboratory for Molecular Medicine, Sarajevo, Bosnia and Herzegovina
| | - J Ravlija
- Institute of Public Health of Federation Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
| | - Z Ler
- Institute of Public Health of Federation Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
| | - R Baljic
- Clinic for Infectious Diseases, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - A Dedeic Ljubovic
- Institute of Clinical Microbiology, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - A Moro
- Institute of Clinical Microbiology, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - I Salimović-Besic
- Institute of Clinical Microbiology, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - A Sausy
- Institute of Immunology, World Health Organization European Regional Reference Laboratory for Measles and Rubella, Centre de Recherche Public de la Santé /Laboratoire National de Santé, Luxembourg, Luxembourg
| | - C P Muller
- Institute of Immunology, World Health Organization European Regional Reference Laboratory for Measles and Rubella, Centre de Recherche Public de la Santé /Laboratoire National de Santé, Luxembourg, Luxembourg
| | - J M Hübschen
- Institute of Immunology, World Health Organization European Regional Reference Laboratory for Measles and Rubella, Centre de Recherche Public de la Santé /Laboratoire National de Santé, Luxembourg, Luxembourg
| |
Collapse
|
24
|
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.
Collapse
|
25
|
Fiebelkorn AP, Lawler J, Curns AT, Brandeburg C, Wallace GS. Mumps postexposure prophylaxis with a third dose of measles-mumps-rubella vaccine, Orange County, New York, USA. Emerg Infect Dis 2014; 19:1411-7. [PMID: 23965729 PMCID: PMC3810923 DOI: 10.3201/eid1909.130299] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Although the measles-mumps-rubella (MMR) vaccine is not recommended for mumps postexposure prophylaxis (PEP), data on its effectiveness are limited. During the 2009–2010 mumps outbreak in the northeastern United States, we assessed effectiveness of PEP with a third dose of MMR vaccine among contacts in Orthodox Jewish households who were given a third dose within 5 days of mumps onset in the household’s index patient. We compared mumps attack rates between persons who received a third MMR dose during the first incubation period after onset in the index patient and 2-dose vaccinated persons who had not. Twenty-eight (11.7%) of 239 eligible household members received a third MMR dose as PEP. Mumps attack rates were 0% among third-dose recipients versus 5.2% among 2-dose recipients without PEP (p = 0.57). Although a third MMR dose administered as PEP did not have a significant effect, it may offer some benefits in specific outbreak contexts.
Collapse
|
26
|
Kutty PK, Lawler J, Rausch-Phung E, Ortega-Sanchez IR, Goodell S, Schulte C, Pollock L, Valure B, Hudson J, Gallagher K, Blog D. Epidemiology and the economic assessment of a mumps outbreak in a highly vaccinated population, Orange County, New York, 2009-2010. Hum Vaccin Immunother 2014; 10:1373-81. [PMID: 24633360 PMCID: PMC4896528 DOI: 10.4161/hv.28389] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 02/19/2014] [Accepted: 02/28/2014] [Indexed: 11/19/2022] Open
Abstract
Studies assessing the economic burden of a mumps outbreak in a highly vaccinated population are limited. The Orange County Health Department (OCHD), New York State Department of Health (NYS DOH), and the Centers for Disease Control and Prevention conducted a mumps investigation in an affected village with a highly vaccinated population. To understand the epidemiology, standardized mumps case definition and active surveillance were used to identify mumps cases. In addition, an economic assessment of a combined outbreak investigation and third dose measles-mumps-rubella (MMR) vaccine intervention conducted by OCHD and NYS DOH was performed; estimated by retrospectively evaluating public health response-related activities including use of a third dose of MMR vaccine. From September 24, 2009, through June 15, 2010, 790 mumps cases were reported-64% were male and highest attack rate was among 11-17 year age group (99.1 cases per 1000 individuals). Of the 658 cases with known vaccination history, 83.6% had documentation of 2 doses of mumps containing vaccine. No deaths were reported. The 2 major exposure settings were schools (71.8%) and households (22.5%). Approximately 7736 h of public health personnel time were expended with the total approximate cost of US $463,000, including US $34,392 for MMR vaccine-the estimated cost per household was US $827. Mumps continues to be endemic in many parts of the world, resulting in importations into the United States. Large mumps outbreaks similar to this in highly vaccinated populations may require considerable investigation and control activities.
Collapse
Affiliation(s)
- Preeta Krishnan Kutty
- National Center for Immunization and Respiratory Diseases; Centers for Disease Control and Prevention; Atlanta, GA USA
| | | | | | - Ismael R Ortega-Sanchez
- National Center for Immunization and Respiratory Diseases; Centers for Disease Control and Prevention; Atlanta, GA USA
| | | | - Cynthia Schulte
- Bureau of Immunization; New York State Department of Health; Albany, NY USA
| | - Lynn Pollock
- Bureau of Immunization; New York State Department of Health; Albany, NY USA
| | | | - Jean Hudson
- Orange County Health Department; Goshen, NY USA
| | - Kathleen Gallagher
- National Center for Immunization and Respiratory Diseases; Centers for Disease Control and Prevention; Atlanta, GA USA
| | - Debra Blog
- Bureau of Immunization; New York State Department of Health; Albany, NY USA
| |
Collapse
|
27
|
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.
Collapse
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
| |
Collapse
|
28
|
Takla A, Wichmann O, Klinc C, Hautmann W, Rieck T, Koch J. Mumps epidemiology in Germany 2007-11. Euro Surveill 2013; 18:20557. [DOI: 10.2807/1560-7917.es2013.18.33.20557] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In Germany, mumps has been notifiable until 2013 only in the five Eastern federal states (EFS) of former East Germany. Due to different immunisation policies until 1990 and varying vaccination coverages thereafter, mumps incidences cannot be extrapolated to the 11 Western federal states (WFS). We studied mumps-related International Classification of Diseases (ICD-10) code diagnoses claimed through statutory health insurances between 2007 and 2011 to estimate countrywide mumps incidences in the outpatient sector, and compared them with case numbers from ambulatory notification data. Overall, 32,330 outpatient mumps cases were claimed. Annual incidence ranged between 9.3/100,000 and 11.8/100,000 and showed a significant decreasing trend. Compared with EFS, mumps incidence in WFS was higher and indicated a shift towards older age groups. Notified outpatient case numbers in EFS were 13-fold lower and from voluntary surveillance during an outbreak in the WFS Bavaria 8-fold lower than from insurance data (n=316 versus n=4,217 and n=238 versus 1,995, respectively). Of all notified cases with available information, 75.4% (EFS) and 57.6% (Bavaria) were unvaccinated; 6.8% (EFS) and 19.3% (Bavaria) required hospitalisation. In Germany, mumps is still endemic despite decades of vaccination, with considerable underreporting in the established notification systems.
Collapse
Affiliation(s)
- A Takla
- European Programme for Intervention Epidemiology Training (EPIET), Stockholm, Sweden
- Postgraduate Training for Applied Epidemiology (PAE), Berlin, Germany
- Immunization Unit, Robert Koch Institute, Berlin, Germany
| | - O Wichmann
- Immunization Unit, Robert Koch Institute, Berlin, Germany
| | - C Klinc
- Bavarian Health and Food Safety Authority (LGL), Oberschleißheim, Germany
| | - W Hautmann
- Bavarian Health and Food Safety Authority (LGL), Oberschleißheim, Germany
| | - T Rieck
- Charité – University Medical Center, Berlin, Germany
- Immunization Unit, Robert Koch Institute, Berlin, Germany
| | - J Koch
- Immunization Unit, Robert Koch Institute, Berlin, Germany
| |
Collapse
|
29
|
Falldefinitionen zur Übermittlung von Erkrankungs- und Todesfällen sowie von Erregernachweisen von Mumps, Pertussis, Röteln und Varizellen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013. [DOI: 10.1007/s00103-013-1696-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
30
|
Epidemiology of a mumps outbreak in a highly vaccinated island population and use of a third dose of measles-mumps-rubella vaccine for outbreak control--Guam 2009 to 2010. Pediatr Infect Dis J 2013; 32:374-80. [PMID: 23099425 PMCID: PMC6893844 DOI: 10.1097/inf.0b013e318279f593] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite high 2-dose measles-mumps-rubella (MMR) vaccine coverage, a large mumps outbreak occurred on the US Territory of Guam during 2009 to 2010, primarily in school-aged children. METHODS We implemented active surveillance in April 2010 during the outbreak peak and characterized the outbreak epidemiology. We administered third doses of MMR vaccine to eligible students aged 9-14 years in 7 schools with the highest attack rates (ARs) between May 18, 2010, and May 21, 2010. Baseline surveys, follow-up surveys and case-reports were used to determine mumps ARs. Adverse events postvaccination were monitored. RESULTS Between December 1, 2009, and December 31, 2010, 505 mumps cases were reported. Self-reported Pohnpeians and Chuukese had the highest relative risks (54.7 and 19.7, respectively) and highest crowding indices (mean: 3.1 and 3.0 persons/bedroom, respectively). Among 287 (57%) school-aged case-patients, 270 (93%) had ≥2 MMR doses. A third MMR dose was administered to 1068 (33%) eligible students. Three-dose vaccinated students had an AR of 0.9/1000 compared with 2.4/1000 among students vaccinated with ≤2 doses >1 incubation period postintervention, but the difference was not significant (P = 0.67). No serious adverse events were reported. CONCLUSIONS This mumps outbreak occurred in a highly vaccinated population. The highest ARs occurred in ethnic minority populations with the highest household crowding indices. After the third dose MMR intervention in highly affected schools, 3-dose recipients had an AR 60% lower than students with ≤2 doses, but the difference was not statistically significant and the intervention occurred after the outbreak peaked. This outbreak may have persisted due to crowding at home and high student contact rates.
Collapse
|
31
|
Anis E, Grotto I, Moerman L, Kaliner E, Warshavsky B, Slater PE, Lev B. Rubella in Israel after the MMR vaccine: Elimination or containment? J Public Health Policy 2013; 34:288-301. [DOI: 10.1057/jphp.2013.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
32
|
Fiebelkorn AP, Rosen JB, Brown C, Zimmerman CM, Renshowitz H, D'Andrea C, Gallagher KM, Harpaz R, Zucker JR. Environmental factors potentially associated with mumps transmission in yeshivas during a mumps outbreak among highly vaccinated students: Brooklyn, New York, 2009-2010. Hum Vaccin Immunother 2013; 9:189-94. [PMID: 23442590 PMCID: PMC3667936 DOI: 10.4161/hv.22415] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 09/24/2012] [Accepted: 09/30/2012] [Indexed: 11/19/2022] Open
Abstract
During 2009-2010, a large US mumps outbreak occurred affecting two-dose vaccinated 9th-12th grade Orthodox Jewish boys attending all-male yeshivas (private, traditional Jewish schools). Our objective was to understand mumps transmission dynamics in this well-vaccinated population. We surveyed 9th-12th grade male yeshivas in Brooklyn, NY with reported mumps case-students between 9/1/2009 and 3/30/2010. We assessed vaccination coverage, yeshiva environmental factors (duration of school day, density, mixing, duration of contact), and whether environmental factors were associated with increased mumps attack rates. Ten yeshivas comprising 1769 9th-12th grade students and 264 self-reported mumps cases were included. The average yeshiva attack rate was 14.5% (median: 13.5%, range: 1-31%), despite two-dose measles-mumps-rubella vaccine coverage between 90-100%. School duration was 9-15.5 h/day; students averaged 7 h face-to-face/day with 1-4 study partners. Average daily mean density was 6.6 students per 100 square feet. The number of hours spent face-to-face with a study partner and the number of partners per day showed significant positive associations (p < 0.05) with classroom mumps attack rates in univariate analysis, but these associations did not persist in multivariate analysis. This outbreak was characterized by environmental factors unique to the yeshiva setting (e.g., densely populated environment, prolonged face-to-face contact, mixing among infected students). However, these features were present in all included yeshivas, limiting our ability to discriminate differences. Nonetheless, mumps transmission requires close contact, and these environmental factors may have overwhelmed vaccine-mediated protection increasing the likelihood of vaccine failure among yeshiva students.
Collapse
Affiliation(s)
- Amy Parker Fiebelkorn
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Barskey AE, Schulte C, Rosen JB, Handschur EF, Rausch-Phung E, Doll MK, Cummings KP, Alleyne EO, High P, Lawler J, Apostolou A, Blog D, Zimmerman CM, Montana B, Harpaz R, Hickman CJ, Rota PA, Rota JS, Bellini WJ, Gallagher KM. Mumps outbreak in Orthodox Jewish communities in the United States. N Engl J Med 2012; 367:1704-13. [PMID: 23113481 DOI: 10.1056/nejmoa1202865] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND By 2005, vaccination had reduced the annual incidence of mumps in the United States by more than 99%, with few outbreaks reported. However, in 2006, a large outbreak occurred among highly vaccinated populations in the United States, and similar outbreaks have been reported worldwide. The outbreak described in this report occurred among U.S. Orthodox Jewish communities during 2009 and 2010. METHODS Cases of salivary-gland swelling and other symptoms clinically compatible with mumps were investigated, and demographic, clinical, laboratory, and vaccination data were evaluated. RESULTS From June 28, 2009, through June 27, 2010, a total of 3502 outbreak-related cases of mumps were reported in New York City, two upstate New York counties, and one New Jersey county. Of the 1648 cases for which clinical specimens were available, 50% were laboratory-confirmed. Orthodox Jewish persons accounted for 97% of case patients. Adolescents 13 to 17 years of age (27% of all patients) and males (78% of patients in that age group) were disproportionately affected. Among case patients 13 to 17 years of age with documented vaccination status, 89% had previously received two doses of a mumps-containing vaccine, and 8% had received one dose. Transmission was focused within Jewish schools for boys, where students spend many hours daily in intense, face-to-face interaction. Orchitis was the most common complication (120 cases, 7% of male patients ≥12 years of age), with rates significantly higher among unvaccinated persons than among persons who had received two doses of vaccine. CONCLUSIONS The epidemiologic features of this outbreak suggest that intense exposures, particularly among boys in schools, facilitated transmission and overcame vaccine-induced protection in these patients. High rates of two-dose coverage reduced the severity of the disease and the transmission to persons in settings of less intense exposure.
Collapse
Affiliation(s)
- Albert E Barskey
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|