1
|
Wu H, Wang F, Tang D, Han D. Mumps Orchitis: Clinical Aspects and Mechanisms. Front Immunol 2021; 12:582946. [PMID: 33815357 PMCID: PMC8013702 DOI: 10.3389/fimmu.2021.582946] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 03/04/2021] [Indexed: 12/12/2022] Open
Abstract
The causative agent of mumps is a single-stranded, non-segmented, negative sense RNA virus belonging to the Paramyxoviridae family. Besides the classic symptom of painfully swollen parotid salivary glands (parotitis) in mumps virus (MuV)-infected men, orchitis is the most common form of extra-salivary gland inflammation. Mumps orchitis frequently occurs in young adult men, and leads to pain and swelling of the testis. The administration of MuV vaccines in children has been proven highly effective in reducing the incidence of mumps. However, a recent global outbreak of mumps and the high rate of orchitis have recently been considered as threats to male fertility. The pathogenesis of mumps orchitis remains largely unclear due to lack of systematic clinical data analysis and animal models studies. The alarming increase in the incidence of mumps orchitis and the high risk of the male fertility have thus become a major health concern. Recent studies have revealed the mechanisms by which MuV-host cells interact and MuV infection induces inflammatory responses in testicular cells. In this mini-review, we highlight advances in our knowledge of the clinical aspects and possible mechanisms of mumps orchitis.
Collapse
Affiliation(s)
- Han Wu
- Department of Immunology, Shenzhen University School of Medicine, Shenzhen, China.,Institute of Basic Medical Sciences, School of Basic Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Fei Wang
- Institute of Basic Medical Sciences, School of Basic Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Dongdong Tang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Daishu Han
- Institute of Basic Medical Sciences, School of Basic Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
2
|
Mumps outbreaks: A problem in need of solutions. J Infect 2018; 76:503-506. [PMID: 29678496 DOI: 10.1016/j.jinf.2018.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/18/2018] [Accepted: 03/24/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To discuss what is presently known about recent mumps outbreaks and what solutions can be suggested to ensure more complete protection against mumps. METHODS PubMed was used to search for all of the studies published over the last 15 years using the key words "mumps" or "mumps virus" or "mumps vaccine". More than 1500 articles were found, but only those published in English or providing evidence-based data were included in the evaluation. RESULTS Prevention of mumps remains an unsolved problem. Available vaccines are effective but the protection they evoke declines over time. The use of booster doses can control outbreaks but it is not precisely defined whether they can prevent them. The rapid decline of antibody levels could limit the impact of the introduction of a third dose in the recommended immunization schedule. Furthermore, in most of the areas, mumps viral strains that are genetically different from those included in the vaccines are emerging and this might favour vaccine escape. However, also for this problem, its real relevance in favouring outbreak development is not precisely defined. CONCLUSIONS The true reasons for the development of mumps outbreaks in people with very high vaccination coverage are not clearly understood. The use of a booster dose or the preparation of vaccines containing the emerging serotypes are possible solutions, but both have some limitations. Further studies mainly devoted to improve our knowledge of the immune response to mumps vaccines are needed before long-term effective mumps vaccines can be prepared and outbreaks can be avoided.
Collapse
|
3
|
Rubin S, Eckhaus M, Rennick LJ, Bamford CGG, Duprex WP. Molecular biology, pathogenesis and pathology of mumps virus. J Pathol 2015; 235:242-52. [PMID: 25229387 PMCID: PMC4268314 DOI: 10.1002/path.4445] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 09/10/2014] [Accepted: 09/14/2014] [Indexed: 11/06/2022]
Abstract
Mumps is caused by the mumps virus (MuV), a member of the Paramyxoviridae family of enveloped, non-segmented, negative-sense RNA viruses. Mumps is characterized by painful inflammatory symptoms, such as parotitis and orchitis. The virus is highly neurotropic, with laboratory evidence of central nervous system (CNS) infection in approximately half of cases. Symptomatic CNS infection occurs less frequently; nonetheless, prior to the introduction of routine vaccination, MuV was a leading cause of aseptic meningitis and viral encephalitis in many developed countries. Despite being one of the oldest recognized diseases, with a worldwide distribution, surprisingly little attention has been given to its study. Cases of aseptic meningitis associated with some vaccine strains and a global resurgence of cases, including in highly vaccinated populations, has renewed interest in the virus, particularly in its pathogenesis and the need for development of clinically relevant models of disease. In this review we summarize the current state of knowledge on the virus, its pathogenesis and its clinical and pathological outcomes.
Collapse
Affiliation(s)
- Steven Rubin
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Michael Eckhaus
- Division of Veterinary Resources, National Institutes of Health, Bethesda, MD, USA
| | - Linda J Rennick
- Department of Microbiology, Boston University School of Medicine, MA, USA
| | | | - W Paul Duprex
- Department of Microbiology, Boston University School of Medicine, MA, USA
| |
Collapse
|
4
|
BORGMANN S, SCHWAB F, SANTIBANEZ S, MANKERTZ A. Mumps virus infection in vaccinated patients can be detected by an increase in specific IgG antibodies to high titres: a retrospective study. Epidemiol Infect 2014; 142:2388-96. [PMID: 24423404 PMCID: PMC9151285 DOI: 10.1017/s0950268813003427] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 11/23/2013] [Accepted: 12/11/2013] [Indexed: 11/06/2022] Open
Abstract
Mumps outbreaks in highly vaccinated populations with genotype G have been reported repeatedly. Detection of these outbreaks can be difficult in a setting with relatively high vaccination coverage when acute cases of mumps are routinely diagnosed by IgM serology since this marker is not reliable for diagnosis of mumps re-infection. To learn whether diagnostic tests performed in a large private laboratory may be useful to detect mumps outbreaks retrospectively, we reviewed the results of almost 7000 mumps tests. Two groups were compared: group 1 comprised of 3438 samples from patients submitted by physicians and clinicians (it was assumed that these patients visited their doctor due to acute disease). Group 2 comprised of 3398 samples submitted from company medical officers and occupational physicians. Since these patients usually attend for routine check-ups and certification of immunity to vaccine-preventable diseases, these samples comprised a control group. From July 2010 to May 2011, a mumps virus outbreak with more than 300 cases occurred in Bavaria, Southeast Germany. Our study includes samples received for serological mumps tests from January 2009 until December 2011 (36 months). The two groups were analysed with regard to the number of IgM-positive cases per month and the level of IgG titre. We found a marked increase for both parameters in group 1 during the time of the outbreak, while the samples submitted by the occupational medical physicians did not display significant alterations. These parameters reflect the outbreak with high accuracy, indicating that a retrospective analysis of IgG titres may be a useful tool for detection of mumps outbreaks when, as was the case in Germany, (i) a nationwide notification system has not been implemented and (ii) a highly vaccinated population is affected.
Collapse
Affiliation(s)
- S. BORGMANN
- Synlab Medical Care Services, Medical Care Centre Weiden, Weiden, Germany
- Klinikum Ingolstadt, Department of Clinical Infectiology and Infection Control, Ingolstadt, Germany
| | - F. SCHWAB
- Institute of Hygiene and Environmental Medicine, Charité – University Medicine Berlin, Berlin, Germany
| | - S. SANTIBANEZ
- National Reference Centre Measles, Mumps, Rubella, Robert Koch Institute, Berlin, Germany
| | - A. MANKERTZ
- National Reference Centre Measles, Mumps, Rubella, Robert Koch Institute, Berlin, Germany
| |
Collapse
|
5
|
Fiebelkorn AP, Coleman LA, Belongia EA, Freeman SK, York D, Bi D, Zhang C, Ngo L, Rubin S. Mumps antibody response in young adults after a third dose of measles-mumps-rubella vaccine. Open Forum Infect Dis 2014; 1:ofu094. [PMID: 25734162 PMCID: PMC4324223 DOI: 10.1093/ofid/ofu094] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 09/16/2014] [Indexed: 12/05/2022] Open
Abstract
Baseline mumps antibody titers were high-seropositive for 93.4% of subjects, low-seropositive for 5.8%, and seronegative for <1%. One month after a third measles-mumps-rubella vaccine dose, mumps titers had a modest but significant increase. One year later, titers returned to near baseline. Background Mumps outbreaks in populations with high 2-dose measles-mumps-rubella (MMR) vaccine coverage raise the question whether a third dose of MMR vaccine (MMR3) is needed. However, data on the immunogenicity of MMR3 are limited. We assessed mumps virus neutralizing antibody levels pre- and post-MMR3 in a nonoutbreak setting. Methods Mumps antibody titers were assessed at baseline, 1 month, and 1 year after MMR3 in subjects aged 18–28 years. Results At baseline, 5 of 656 (0.8%) subjects had seronegative mumps neutralizing antibody titers and 38 (5.8%) had low titers. One year post-MMR3, these numbers declined to 3 (0.5%) and 16 (2.4%), respectively. Subjects with low baseline titers were more likely to have low 1-month and 1-year titers (R2 = 0.81–0.87, P < .0001). Compared to baseline, geometric mean titers were significantly higher at 1 month (P < .0001) and 1 year (P < .01) post-MMR3; however, reverse cumulative distribution curves showed only minimal shifts in mumps titers from baseline to 1 month and 1 year. Conclusions Very few subjects had negative or low baseline mumps titers. Nonetheless, mumps titers had modest but significant increases when measured 1 month and 1 year post-MMR3. This temporary increase in titers could decrease susceptibility to disease during outbreaks, but may have limited value for routine use in vaccinated populations.
Collapse
Affiliation(s)
- Amy Parker Fiebelkorn
- National Center for Immunization and Respiratory Diseases , Centers for Disease Control and Prevention , Atlanta, Georgia
| | | | | | | | - Daphne York
- Marshfield Clinic Research Foundation , Wisconsin
| | - Daoling Bi
- National Center for Immunization and Respiratory Diseases , Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Cheryl Zhang
- Center for Biologics Evaluation and Research , Food and Drug Administration , Bethesda, Maryland
| | - Laurie Ngo
- Center for Biologics Evaluation and Research , Food and Drug Administration , Bethesda, Maryland
| | - Steven Rubin
- Center for Biologics Evaluation and Research , Food and Drug Administration , Bethesda, Maryland
| |
Collapse
|
6
|
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
|
7
|
Soye KJ, Trottier C, Di Lenardo TZ, Restori KH, Reichman L, Miller WH, Ward BJ. In vitro inhibition of mumps virus by retinoids. Virol J 2013; 10:337. [PMID: 24225020 PMCID: PMC3829803 DOI: 10.1186/1743-422x-10-337] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 10/30/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Mumps virus (MuV) is a highly infectious paramyxovirus closely related to measles virus (MeV). Despite the availability of a mumps vaccine, outbreaks continue to occur and no treatment options are available. Vitamin A and other naturally occurring retinoids inhibit the replication of MeV in vitro. METHODS Anti-viral effects of retinoids were observed in cell culture using the myelomonocytic U937, NB4/R4, and Huh7/7.5 cells. Observations of anti-viral effect were quantified using TCID50 analysis. Molecular properties of the antiviral effect were analysed using quantitative RT-PCR and western blot. RESULTS The current work demonstrates that retinoids inhibit MuV in vitro due to up-regulation of type I interferon (IFN) and IFN stimulated genes. This effect is mediated by nuclear retinoid receptor signalling and RIG-I is required. The antiviral retinoid-induced state makes cells less permissive to viral replication from subsequent challenge with either MuV or MeV for less than 12 hours. CONCLUSIONS These results demonstrate that retinoids inhibit MuV replication in uninfected bystander cells through a retinoid inducible gene I (RIG-I), retinoic acid receptor (RAR) and IFN dependent manner making them refractory to subsequent rounds of viral replication. These observations raise the possibility that pharmacological doses of retinoids might have clinical benefit in MuV infection.
Collapse
Affiliation(s)
- Kaitlin J Soye
- Research Institute of the McGill University Health Center, Department of Infectious Diseases, McGill University, Montreal, Quebec, Canada
- Segal Cancer Centre, Lady Davis Institute for Medical Research, SMBD Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Claire Trottier
- Research Institute of the McGill University Health Center, Department of Infectious Diseases, McGill University, Montreal, Quebec, Canada
- Segal Cancer Centre, Lady Davis Institute for Medical Research, SMBD Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Thomas Z Di Lenardo
- Research Institute of the McGill University Health Center, Department of Infectious Diseases, McGill University, Montreal, Quebec, Canada
- Segal Cancer Centre, Lady Davis Institute for Medical Research, SMBD Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Katherine H Restori
- Research Institute of the McGill University Health Center, Department of Infectious Diseases, McGill University, Montreal, Quebec, Canada
- Segal Cancer Centre, Lady Davis Institute for Medical Research, SMBD Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Lee Reichman
- Research Institute of the McGill University Health Center, Department of Infectious Diseases, McGill University, Montreal, Quebec, Canada
| | - Wilson H Miller
- Segal Cancer Centre, Lady Davis Institute for Medical Research, SMBD Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Brian J Ward
- Research Institute of the McGill University Health Center, Department of Infectious Diseases, McGill University, Montreal, Quebec, Canada
- Montreal General Hospital, 1650 Cedar Ave., Room L10-309, Montreal, Quebec H3G 1A4, Canada
| |
Collapse
|
8
|
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
|
9
|
|
10
|
Barskey AE, Schulte C, Rosen JB, Handschur EF, Rausch-Phung E, Doll MK, Cummings KP, Alleyne EO, High P, Lawler J, Apostolou A, Blog D, Zimmerman CM, Montana B, Harpaz R, Hickman CJ, Rota PA, Rota JS, Bellini WJ, Gallagher KM. Mumps outbreak in Orthodox Jewish communities in the United States. N Engl J Med 2012; 367:1704-13. [PMID: 23113481 DOI: 10.1056/nejmoa1202865] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND By 2005, vaccination had reduced the annual incidence of mumps in the United States by more than 99%, with few outbreaks reported. However, in 2006, a large outbreak occurred among highly vaccinated populations in the United States, and similar outbreaks have been reported worldwide. The outbreak described in this report occurred among U.S. Orthodox Jewish communities during 2009 and 2010. METHODS Cases of salivary-gland swelling and other symptoms clinically compatible with mumps were investigated, and demographic, clinical, laboratory, and vaccination data were evaluated. RESULTS From June 28, 2009, through June 27, 2010, a total of 3502 outbreak-related cases of mumps were reported in New York City, two upstate New York counties, and one New Jersey county. Of the 1648 cases for which clinical specimens were available, 50% were laboratory-confirmed. Orthodox Jewish persons accounted for 97% of case patients. Adolescents 13 to 17 years of age (27% of all patients) and males (78% of patients in that age group) were disproportionately affected. Among case patients 13 to 17 years of age with documented vaccination status, 89% had previously received two doses of a mumps-containing vaccine, and 8% had received one dose. Transmission was focused within Jewish schools for boys, where students spend many hours daily in intense, face-to-face interaction. Orchitis was the most common complication (120 cases, 7% of male patients ≥12 years of age), with rates significantly higher among unvaccinated persons than among persons who had received two doses of vaccine. CONCLUSIONS The epidemiologic features of this outbreak suggest that intense exposures, particularly among boys in schools, facilitated transmission and overcame vaccine-induced protection in these patients. High rates of two-dose coverage reduced the severity of the disease and the transmission to persons in settings of less intense exposure.
Collapse
Affiliation(s)
- Albert E Barskey
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Abstract
Recently, numerous large-scale mumps outbreaks have occurred in vaccinated populations. Clinical isolates sequenced from these outbreaks have invariably been of genotypes distinct from those of vaccine viruses, raising concern that certain mumps virus strains may escape vaccine-induced immunity. To investigate this concern, sera obtained from children 6 weeks after receipt of measles, mumps, and rubella (MMR) vaccine were tested for the ability to neutralize a carefully selected group of genetically diverse mumps virus strains. Although the geometric mean neutralizing antibody titer of the sera was lower against some virus strains than others, all viruses were readily neutralized, arguing against immune escape.
Collapse
|
12
|
Davidkin I, Kontio M, Paunio M, Peltola H. MMR vaccination and disease elimination: the Finnish experience. Expert Rev Vaccines 2010; 9:1045-53. [PMID: 20822347 DOI: 10.1586/erv.10.99] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Measles, mumps and rubella (MMR) vaccinations have been included in Finland's national vaccination program as a two-dose schedule since 1982. Owing to the high (>95%) coverage of vaccinations, indigenous MMR diseases were eliminated from Finland by the mid-1990s. In 1982, the incidence of measles, mumps and rubella was 105, 43 and 64 per 100,000 population, respectively, but declined to 0.1 per 100,000 population for all MMR diseases in 1995. Since then, the few cases of measles, mumps and rubella imported annually have not caused any outbreaks. Several research projects that started along with the vaccination campaign have provided important support throughout the program. The vaccine was proven to be safe, immunogenic and effective. Antibody follow-up has revealed that MMR vaccine-induced antibodies wane over time, and concerns have arisen about the continuation of this good situation. High vaccination coverage, enhanced surveillance and preparedness to administer additional doses when needed are key factors for future success. Here we present an overview of MMR vaccinations and the Finnish experience of the MMR disease elimination process, and we describe surveillance activities in the era following elimination in Finland.
Collapse
Affiliation(s)
- Irja Davidkin
- National Institute for Health and Welfare, Department of Vaccination and Immune Protection, Helsinki, Finland.
| | | | | | | |
Collapse
|
13
|
Barskey AE, Glasser JW, LeBaron CW. Mumps resurgences in the United States: A historical perspective on unexpected elements. Vaccine 2009; 27:6186-95. [PMID: 19815120 DOI: 10.1016/j.vaccine.2009.06.109] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Accepted: 06/22/2009] [Indexed: 11/27/2022]
Abstract
In 2006 the United States experienced the largest nationwide mumps epidemic in 20 years, primarily affecting college dormitory residents. Unexpected elements of the outbreak included very abrupt time course (75% of cases occurred within 90 days), geographic focality (85% of cases occurred in eight rural Midwestern states), rapid upward and downward shift in peak age-specific attack rate (5-9-year olds to 18-24-year olds, then back), and two-dose vaccine failure (63% of case-patients had received two doses). To construct a historical context in which to understand the recent outbreak, we reviewed US mumps surveillance data, vaccination coverage estimates, and relevant peer-reviewed literature for the period 1917-2008. Many of the unexpected features of the 2006 mumps outbreak had been reported several times previously in the US, e.g., the 1986-1987 mumps resurgence had extremely abrupt onset, rural geographic focality, and an upward-then-downward age shift. Evidence suggested recurrent mumps outbreak patterns were attributable to accumulation of susceptibles in dispersed situations where the risk of endemic disease exposure was low and were triggered when this susceptible population was brought together in crowded living conditions. The 2006 epidemic followed this pattern, with two unique variations: it was preceded by a period of very high vaccination rates and very low disease incidence and was characterized by two-dose failure rates among adults vaccinated in childhood. Data from the past 80 years suggest that preventing future mumps epidemics will depend on innovative measures to detect and eliminate build-up of susceptibles among highly vaccinated populations.
Collapse
Affiliation(s)
- Albert E Barskey
- Epidemiology Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, NE-MS A-47, Atlanta, GA 30333, United States.
| | | | | |
Collapse
|