The reactivity of various human sera with mumps complement fixation antigens

Isolation of mumps virus from human beings with induced apparent or inapparent infections

Exposure of fifteen children to mumps virus of fifth amniotic passage in chick embryos led to involvement of the salivary glands in six, orchitis in the absence of other manifestations of mumps in one, and to no signs of illness in eight. Attempts to isolate virus from the saliva of these individuals gave the following results: 1. All patients with involvement of the salivary glands excreted virus beginning on the 11th to 15th day after exposure, 2 to 6 days prior to onset of clinical signs of disease and extending up to the 4th day of illness. 2. The patient with primary orchitis without any recognized involvement of the salivary glands excreted virus for 2 days, beginning on the 15th day after exposure and 10 days prior to his illness. 3. Six of the eight children classified as having inapparent infections because of their serologic response in the absence of clinical signs of illness, began to excrete virus on the 15th to 16th day after exposure for from 1 to 9 or more days. The epidemiologic significance of these data is discussed.

[A look back at 2 mumps outbreaks]

Two studies are presented. The first one concerns a mumps outbreak in a kindergarten in Geneva in June 1991. Of 26 children, nine (34.6%) got mumps. Of nine children vaccinated with the Rubini vaccine strain, seven had the disease as opposed to only one of 14 children vaccinated with the Urabe strain. The vaccine efficacy of the Rubini strain was estimated at 22% with a 95% confidence interval of -10% to 45%. The second study concerns a cluster of 112 mumps patients seen by a pediatrician in the Bernese Jura region between September 1992 and May 1993. A case-control study was carried out resulting in a vaccine efficacy estimate of 50% with a 95% confidence interval of -19% to 81%. Of the cases, 51 (45.5%) had been vaccinated against mumps, 50 of them (98%) with the Rubini vaccine strain. Of the controls, 30 (61.2%) had been vaccinated, 86.7% of them with Rubini. Methodological problems of case selection and their possible effects on the estimated vaccine efficacy are discussed. The results of these two studies have been confirmed by more recent investigations. In retrospect, we therefore conclude that small studies can serve as early indicators for epidemiological evidence and that they can be finally integrated into a more complete picture.

Symptomatic mumps virus reinfections

Although natural mumps virus infection is believed to induce lifelong immunity, our laboratory was confronted with 82 patients who developed mumps-evoking lesions but exhibited serological evidence of a booster immune response, namely a rise or a high titer of virus-specific IgG, without IgM. In order to provide arguments favoring the existence of recurrent mumps attacks, the age, symptomatology, and humoral response of these patients (group 1) were compared to that of 82 randomly selected true primary infected patients (group 2), 10 parainfluenza virus-infected patients (group 3), and 20 noninfected mumps-immune subjects (group 4). Enzyme-linked immunosorbent assay (ELISA) procedures with different viral antigenic preparations were used for determination of specific IgM, IgA, IgG, IgG subclasses, and IgG avidity. The patients of group 1, older than those of group 2 (28 vs. 10 years, P < 0.0001), presented a significantly less severe and less typical symptomatology. Against the whole virus they exhibited IgG of higher avidity (P < 0.001), a lower prevalence and titer of IgA (10 vs. 68%, P < 0.0001 and 278 vs. 5,009, P < 0.001, respectively). Values obtained for IgG 1, 2, and 3 were significantly different between the two groups. Prevalence and absorbance of nucleocapsid-directed IgG 3 were significantly lower in group 1 (27 vs. 46%, P < 0.01 and 0.444 vs. 0.869, P < 0.01, respectively). A significant discrepancy also allowed patients from group 1 to be distinguished from those of groups 3 and 4.(ABSTRACT TRUNCATED AT 250 WORDS)

A study on the pathogenesis of recurrent parotitis in childhood

Roentgenologic, histopathologic, electron microscopic, virologic and immunologic studies were performed to investigate the etiologic features of recurrent parotitis in children. When examined sialographically and histopathologically, it was considered that pathologic changes in the parotid gland had developed as latent chronic inflammation with mild glandular destruction long before the disease became manifest clinically with acute exacerbation. Proliferation of the duct epithelium in the regenerative process and increase of intraductal pressure due to obstruction of the salivary outflow were assumed to be the causative factors of dilative changes of the peripheral ductal system. Investigation of complement fixation antibody, hemoagglutination inhibition antibody and neutralization antibody responses to mumps virus showed that onset of the disease was unrelated to mumps infection in the majority of cases. Increase of complement fixation antibody titer to various viruses was observed in many cases during acute exacerbation, and were considered to have brought about secondary ascending bacterial infection of the parotid gland by lowering of the systemic resistance. Comparison of serums IgA, IgG, IgM and salivary IgA in these patients with those of control children did not reveal participation of immunodeficiency in the development of this disease. But judging from the results of the long-term clinical follow-up study it was difficult to disregard the possibility that physiological immaturity of the immune response in young children may play some role in onset and recurrent exacerbation of the disease.

Appearance and persistence of antibodies against different virus components after regular measles infections

Different measles virus-specific antibody activities in acute, early (11 to 40 days after rash) and late (4 to 20 years postinfection) convalescent sera and gamma globulin were determined. Early immunoglobulin G antibodies gave a poor neutralization, which was increased 10- to 60-fold by addition of anti-gamma globulin. There was a high degree of correlation between titers of hemolysis-inhibiting (HLI) and hemagglutinating-inhibiting (HI) antibodies. However, in one out of fifteen late convalescent sera an HLI antibody titer of 640 in the presence of titer of only 20 in HI tests with Tween 80-either-treated antigen was found. Similar findings were made with sera from two patients with multiple sclerosis included in a parallel study. A somewhat higher titer of HI antibodies was demonstrable in these three sera when untreated material was used as antigen. These findings are interpreted in the following way. Antibodies against the hemagglutinin can block not only virus-specific agglutination but also lysis of red cells. In contrast, antibodies against the hemolysin, besides blocking the biological activity of this component, carry only a slight HI activity. This HI activity can be detected only by use of antigen preparations containing hemagglutinin-associated hemolysin.Complement-fixation (CF) and immunodiffusion tests (the latter were carried out with antigen preparations treated with 0.25% sodium dodecyl sulfate) demonstrated that, in almost all cases, antibodies against nucleocapsid structures dominated quantitatively among antibodies appearing in connection with and persisting after regular measles infections. Generally, only low titers of antibodies reacting with purified small particle hemagglutinin (HA; 10 to 14S) or additional structural or nonstructural components were identified in CF and immunodiffusion tests.

Meningitis and encephalitis associated with mumps infection. A 10-year survey

During the 10-year period 1960-69, 137 patients in Ruchill Hospital were diagnosed by clinical and laboratory findings as mumps meningitis. Parotitis was detected in only 51 (37%). There was a male preponderance, 97: 40. 96% of the males were under 10 years old compared with 78% of the females. The peak incidence of patients with meningitis alone was in June-July, parotitis with meningitis was from November to January. All 137 meningitis patients made a good recovery. Of the 2 definite cases of mumps encephalitis 1 showed severe psychomotor sequelae. More of the total 139 patients showed rising titres to mumps `V' envelope antigen than to mumps `S' nucleoprotein antigen.

Mumps associated with coma or exanthems. A clinical study including an instance of dual mumps and varicella infection

Mumps should be included in the differential diagnosis of a comatose patient, particularly when mumps is prevalent in the community. Mumps encephalitis sometimes occurs with normal CSF cell count and protein content.

Some exanthems associated with mumps may represent dual infections. That mumps virus alone may produce a rash is suggested by a report cited and by one patient in this series.

Diagnostic virology

A review of the indications for viral diagnostic procedures has been presented. Specific diagnosis is unnecessary and impractical in every patient with a suspected viral illness. In certain instances, however, the documentation of a viral disease by culture or serology may be of great value to the patient. The pediatrician must therefore use his judgment as to when to study the patient, and should resist the temptation simply to tell an anxious parent, "Don't worry; it's just a virus".