lunes, 28 de marzo de 2011

Mumps Complications and Vaccination, CME Activity | CDC EID

EID Journal Home > Volume 17, Number 4–April 2011

Volume 17, Number 4–April 2011
Mumps Complications and Effects of Mumps Vaccination, England and Wales, 2002–2006

Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit.

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.

Medscape, LLC designates this Journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test and/or complete the evaluation at; (4) view/print certificate.

Release date: March 23, 2011; Expiration date: March 23, 2012

Learning Objectives
Upon completion of this activity, participants will be able to:

•Describe the clinical presentation and short- and long-term complications associated with mumps infection
•Describe the attack rate of mumps in the United Kingdom epidemic of 2004–2005
•Identify the most common mumps complications seen in hospitalized children in the mumps epidemic
•Compare hospitalization and complication rates for mumps among MMR-vaccinated and unvaccinated children.

Medscape CME Editor
Carol Snarey, Technical Writer/Editor, Emerging Infectious Diseases. Disclosure: Carol Snarey has disclosed no relevant financial relationships.

Medscape CME Author
Désirée Lie, MD, MSEd, Clinical Professor; Director of Research and Faculty Development, Department of Family Medicine, University of California, Irvine at Orange, Orange, California. Disclosure: Désirée Lie, MD, MSEd, has disclosed the following relevant financial relationship: served as a nonproduct speaker for "Topics in Health" for Merck Speaker Services.

Chee-Fu Yung, MD; Nick Andrews, MSc; Antoaneta Bukasa; and Kevin E. Brown, MD, have disclosed no relevant financial relationships. Mary Ramsay, MD, has disclosed the following relevant financial relationship: received grants for clinical research from GlaxoSmithKline.

Mumps Complications and Vaccination, CME Activity | CDC EID

EID Journal Home > Volume 17, Number 4–April 2011
Volume 17, Number 4–April 2011
Mumps Complications and Effects of Mumps Vaccination, England and Wales, 2002–2006

Chee-Fu Yung, Nick Andrews, Antoaneta Bukasa, Kevin E. Brown, and Mary Ramsay

Authors affiliation: Health Protection Agency Centre for Infections, London, UK

Suggested citation for this article

We analyzed data from hospital admissions and enhanced mumps surveillance to assess mumps complications during the largest mumps outbreak in England and Wales, 2004–2005, and their association with mumps vaccination. When compared with nonoutbreak periods, the outbreak was associated with a clear increase in hospitalized patients with orchitis, meningitis, and pancreatitis. Routine mumps surveillance and hospital data showed that 6.1% of estimated mumps patients were hospitalized, 4.4% had orchitis, 0.35% meningitis, and 0.33% pancreatitis. Enhanced surveillance data showed 2.9% of mumps patients were hospitalized, 6.1% had orchitis, 0.3% had meningitis, and 0.25% had pancreatitis. Risk was reduced for hospitalization (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.43–0.68), mumps orchitis (OR 0.72, 95% CI 0.56–0.93) and mumps meningitis (OR 0.28, 95% CI 0.14–0.56) when patient had received 1 dose of measles, mumps, and rubella vaccine. The protective effect of vaccination on disease severity is critical in assessing the total effects of current and future mumps control strategies.

Mumps is an acute viral infection that is asymptomatic in ≈30% of children (1). Symptoms and signs include fever, headache, and swelling of the parotid glands, which may be unilateral or bilateral. Complications of mumps include orchitis, aseptic meningitis, oophoritis, pancreatitis, and encephalitis (2–4). Long-term complications include unilateral sensorineural deafness in children (5). To date, reported data on mumps complications are based on studies conducted mainly during the prevaccine era. Mumps vaccination was introduced into the UK immunization program as a single-dose mumps, measles, and rubella vaccine (MMR) for children 12 to 15 months of age in October 1988. The first vaccines contained the Urabe strain but this was changed to the Jeryl-Lynn strain in 1992 because of an unacceptable risk for aseptic meningitis (1). In 1996, to provide additional protection against all 3 infections, a second dose was added to the schedule. In the first decade after the MMR was introduced, rates of reported and confirmed mumps virus infection fell to extremely low levels in the United Kingdom. For persons born in the first 10 years of the program (1988–1998), vaccination coverage reached >90% for the first dose and ≈75% for the second dose of MMR by 5 years of age (6). Vaccine effectiveness in the UK has been estimated to be 87.8% for 1 dose and 94.6% for 2 doses of vaccine (7).

Since 1998, however, several mumps outbreaks have occurred in adolescents and young adults; these culminated in a national epidemic, mainly affecting university students, in 2004 and 2005. Clinical notifications of mumps increased from 4,203 in 2003 to 16,436 in 2004. The attack rate by birth rate was highest in those born between 1983 and 1986, with a rate of infection ranging from 140 to 170 per 100,000 population (8). Persons in this cohort were not offered routine childhood MMR and avoided mumps exposure because of high coverage in younger children. The rate of infection in persons born after 1988, and eligible to receive MMR, was substantially lower, and only 2.4% occurred in age groups eligible for 2 doses of MMR (8). Recent mumps surveillance data in England and Wales are showing an increase in the proportion of mumps cases in cohorts who should have received the 2-dose MMR (9). Two-dose MMR coverage in these cohorts has been estimated as ≈75% (10). Resurgences of mumps in vaccinated populations (including those who received 2-dose MMR) have been described in educational settings in other countries (11–15). Declining protection over time, and possible antigenic differences between the vaccine and outbreak strains, have been suggested as contributory factors (7,16,17). In the absence of natural boosting, therefore, future mumps epidemics may be unavoidable in vaccinated populations living in crowded, semiclosed settings such as colleges (18).

Because mumps is more severe in adults, increasing numbers of mumps cases in young adults in the postvaccine era could be expected to lead to a high rate of complications. A better understanding of mumps complication in vaccinated persons will therefore be essential in developing appropriate strategies to control mumps. We investigated hospitalizations associated with the mumps epidemic in England and Wales in 2004–2005 and used enhanced surveillance to compare the rate of complications among patients with confirmed mumps cases by age and vaccination status.

Mumps Complications and Vaccination | CDC EID

Suggested Citation for this Article
Yung CF, Andrews N, Bukasa A, Kevin E. Brown KE, Ramsay M. Mumps complications and effects of mumps vaccination, England and Wales, 2002–2006. Emerg Infect Dis [serial on the Internet]. 2011 Apr [date cited].

DOI: 10.3201/eid1704.101461

Comments to the Authors
Please use the form below to submit correspondence to the authors or contact them at the following address:

Chee-Fu Yung, Immunisation, Hepatitis and Blood Safety Department, Health Protection Agency, Centre for Infections, 61 Colindale Ave, London NW9 5EQ; email:

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