Mumps and Mumps Vaccine

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• Mumps and Mumps Vaccine

Epidemiology and Prevention of Vaccine-Preventable
Diseases National Immunization Program Centers
for Disease Control and Prevention
Revised January 2006 Update January 2007
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Note to presenters Images of vaccine-preventable
diseases are available from the Immunization
Action Coalition website at http//www.vaccineinfo
rmation.org/photos/index.asp
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Mumps

• Acute viral illness
• Parotitis and orchitis described by Hippocrates
  in 5th century BCE
• Viral etiology described by Johnson and
  Goodpasture in 1934
• Frequent cause of outbreaks among military
  personnel in prevaccine era

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Mumps Virus

• Paramyxovirus
• RNA virus
• One antigenic type
• Rapidly inactivated by chemical agents, heat, and
  ultraviolet light

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Mumps Pathogenesis

• Respiratory transmission of virus
• Replication in nasopharynx and regional lymph
  nodes
• Viremia 12-25 days after exposure with spread to
  tissues
• Multiple tissues infected during viremia

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Mumps Clinical Features

• Incubation period 14-18 days
• Nonspecific prodrome of myalgia, malaise,
  headache, low-grade fever
• Parotitis in 30-40
• Up to 20 of infections asymptomatic

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Mumps Complications
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Mumps Laboratory Diagnosis

• Isolation of mumps virus
• Detection of mumps antigen by PCR
• Serologic testing
• positive IgM antibody
• significant increase in IgG antibody between
  acute and convalescent specimens

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Mumps Epidemiology

• Reservoir Human Asymptomatic
  infections may transmit
• Transmission Respiratory drop nuclei
• Temporal pattern Peak in late winter and spring
• Communicability Three days before to four
  days after onset of active disease

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• MumpsUnited States, 1968-2005

Year
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• MumpsUnited States, 1980-2005

Year
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• MumpsUnited States, 1980-2003
• Age Distribution of Reported Cases

5-14 yrs
15-39 yrs
lt5 yrs
gt40 yrs
Year
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Mumps Clinical Case Definition

• Acute onset of unilateral or bilateral tender,
  self-limited swelling of the parotid or other
  salivary gland lasting gt2 days without other
  apparent cause

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Mumps Outbreak, 2006

• Source of the initial cases unknown
• Outbreak peaked in mid-April
• Median age of persons reported with mumps was 22
  years
• Highest incidence was among young adults 18-24
  years of age, many of whom were college students
• Transmission of mumps virus occurred in many
  settings, including college dormitories and
  healthcare facilities

MMWR 200655(42)1152-3
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MMWR 200655(42)1152-3
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Factors Contributing To Mumps Outbreak, 2006

• College campus environment
• Lack of a 2-dose MMR college entry requirement or
  lack of enforcement of a requirement
• Delayed recognition and diagnosis of mumps
• Mumps vaccine failure
• Vaccine might be less effective in preventing
  asymptomatic infection or atypical mumps than in
  preventing parotitis
• Waning immunity

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Mumps Diagnostic Testing

• Serum to test for mumps IgM antibody within 5
  days of illness onset
• A swab from the parotid duct or other affected
  salivary gland duct
• Parotid duct swab is the preferred viral sample

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Mumps Diagnostic Testing

• If the IgM antibody titer is negative, a second
  (convalescent) serum specimen for IgM antibodies
  should be obtained 2 to 3 weeks after onset of
  the illness
• Paired serum specimens also can be used to detect
  a significant rise in the level of mumps IgG

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Mumps Diagnostic Testing

• Negative laboratory tests, especially in
  vaccinated persons, should not be used to rule
  out a mumps diagnosis
• In the absence of another diagnosis, persons
  meeting the clinical case definition should be
  reported as a probable mumps case

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Mumps Vaccine

• Composition Live virus (Jeryl Lynn strain)
• Efficacy 95 (Range, 90-97)
• Duration ofImmunity Lifelong
• Schedule gt1 Dose
• Should be administered with measles and rubella
  (MMR) or with measles, rubella and varicella
  (MMRV)

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Mumps (MMR) Vaccine Indications

• One dose (as MMR) for preschool-age children 12
  months of age and older and persons born during
  or after 1957 not at high risk of mumps exposure
• Second dose (as MMR) for school-age children and
  adults at high risk of mumps exposure (i.e.,
  healthcare personnel, international travelers and
  students at post-high school educational
  institutions

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Mumps Immunity

• Born before 1957
• Serologic evidence of mumps immunity
• Documentation of physician- diagnosed mumps
• Documentation of adequate vaccination

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Presumptive Evidence of Mumps Immunity

• Documentation of adequate vaccination
• Laboratory evidence of immunity
• Birth before 1957
• Documentation of physician-diagnosed mumps

MMWR 200655(22)629-30
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Presumptive Evidence of Mumps Immunity

• Adequate vaccination
• 1 dose for preschool-aged children and adults not
  at high risk of exposure to mumps
• 2 doses school-aged children grades (K-12th
  grade) and for adults at high risk of exposure to
  mumps

MMWR 200655(22)629-30
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Mumps Vaccination ofHealthcare Personnel

• Born in 1957 or later
• documentation of 2 doses of live mumps virus
  vaccine (minimum interval between doses is 28
  days)
• Born before 1957 (without a history of
  physician-diagnosed mumps or laboratory evidence
  of mumps immunity)
• consider recommending 1 dose of a live mumps
  virus vaccine

MMWR 200655(22)629-30
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Mumps Vaccination ofHealthcare Personnel

• During a mumps outbreak healthcare facilities
  should strongly consider recommending 2 doses of
  mumps vaccine to unvaccinated personnel born
  before 1957 who do not have evidence of mumps
  immunity

MMWR 200655(22)629-30
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MMR Adverse Reactions

• Fever 5-15
• Rash 5
• Joint symptoms 25
• Thrombocytopenia lt1/30,000 doses
• Parotitis rare
• Deafness rare
• Encephalopathy lt1/1,000,000 doses

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MMR VaccineContraindications and Precautions

• Severe allergic reaction to vaccine component or
  following a prior dose
• Pregnancy
• Immunosuppression
• Moderate or severe acute illness
• Recent blood product

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Measles and Mumps Vaccines and Egg Allergy

• Measles and mumps viruses grown in chick embryo
  fibroblast culture
• Studies have demonstrated safety of MMR in egg
  allergic children
• Vaccinate without testing

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National Immunization ProgramContact Information

• Telephone 800.CDC.INFO
• Email nipinfo_at_cdc.gov
• Website www.cdc.gov/nip