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## Complete Summary

#### GUIDELINE TITLE

Notice to readers: updated recommendations of the Advisory Committee on
Immunization Practices (ACIP) for the control and elimination of mumps.

#### BIBLIOGRAPHIC SOURCE(S)

Centers for Disease Control and Prevention (CDC). Notice to readers:
updated recommendations of the Advisory Committee on Immunization
Practices (ACIP) for the control and elimination of mumps. MMWR Morb
Mortal Wkly Rep 2006 Jun 9;55(22):629-30.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16761359)

#### GUIDELINE STATUS

This is the current release of the guideline.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Mumps

#### GUIDELINE CATEGORY

Prevention

#### CLINICAL SPECIALTY

Family Practice\
Infectious Diseases\
Internal Medicine\
Pediatrics\
Preventive Medicine

#### INTENDED USERS

Advanced Practice Nurses\
Allied Health Personnel\
Health Care Providers\
Health Plans\
Hospitals\
Managed Care Organizations\
Nurses\
Patients\
Physician Assistants\
Physicians\
Public Health Departments

#### GUIDELINE OBJECTIVE(S)

To update the 1998 Advisory Committee on Immunization Practices (ACIP)
recommendations for mumps vaccination

#### TARGET POPULATION

**Routine vaccination**:

One (1) dose of live mumps virus vaccine:

-   Preschool-aged children

-   Adults not at high risk

Two (2) doses of live mumps virus vaccine:

-   School-aged children (i.e., grades K-12)

-   Adults at high risk (i.e., persons who work in health-care
    facilities, international travelers, and students at post-high
    school educational institutions)

**In a mumps outbreak setting**:

-   Children aged 1 to 4 years and adults at low risk if affected by the
    outbreak

-   Health-care workers born before 1957 without other evidence of
    immunity

#### INTERVENTIONS AND PRACTICES CONSIDERED

Vaccination with live mumps virus vaccine (e.g., mumps, measles, rubella
\[MMR\] vaccine)

#### MAJOR OUTCOMES CONSIDERED

-   Effectiveness of 1 dose mumps, measles, rubella (MMR) vaccine in
    preventing mumps

-   Effectiveness of 2 dose MMR vaccine in preventing mumps

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

Not stated

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Not stated

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

**Note from the National Guideline Clearinghouse (NGC) and the Centers
for Disease Control and Prevention (CDC)**: On May 17, 2006, the
Advisory Committee on Immunization Practices (ACIP) updated criteria for
mumps immunity and mumps vaccination recommendations. According to the
1998 ACIP recommendations for measles, mumps, and rubella (MMR) vaccine,
for routine vaccination, a first dose of MMR vaccine is recommended at
ages 12 to 15 months and a second dose at ages 4 to 6 years. Two doses
of MMR vaccine also are recommended for students attending colleges and
other post-high school institutions. However, documentation of mumps
immunity through vaccination has consisted of only 1 dose of mumps
containing vaccine for all designated groups, including health-care
workers.

During January 1-May 2, 2006, the current outbreak in the United States
has resulted in reports of 2,597 cases of mumps in 11 states. The
outbreak has underscored certain limitations in the 1998 recommendations
relating to prevention of mumps transmission in health-care and other
settings with high risk for mumps transmission. After reviewing data
from the current outbreak and previous evidence on mumps vaccine
effectiveness and transmission, ACIP issued updated recommendations for
mumps vaccination (see box below).

+-----------------------------------------------------------------------+
| **Key changes to 1998 ACIP recommendations on mumps \-- May 17,       |
| 2006**                                                                |
+=======================================================================+
| *Acceptable Presumptive Evidence of Immunity*                         |
|                                                                       |
| -   Documentation of adequate vaccination is now 2 doses of a live    |
|     mumps virus vaccine instead of 1 dose for                         |
|                                                                       |
|     -   School-aged children (i.e., grades K-12).                     |
|                                                                       |
|     -   Adults at high risk (i.e., persons who work in health-care    |
|         facilities, international travelers, and students at          |
|         post-high school educational institutions).                   |
+-----------------------------------------------------------------------+
| *Routine Vaccination for Health-Care Workers*                         |
|                                                                       |
| -   Persons born during or after 1957 without other evidence of       |
|     immunity: 2 doses of a live mumps virus vaccine.                  |
|                                                                       |
| -   Persons born before 1957 without other evidence of immunity:      |
|     consider recommending 1 dose of a live mumps virus vaccine.       |
+-----------------------------------------------------------------------+
| *For Outbreak Settings*                                               |
|                                                                       |
| -   Children aged 1 to 4 years and adults at low risk: if affected by |
|     the outbreak, consider a second dose\* of live mumps virus        |
|     vaccine.                                                          |
|                                                                       |
| -   Health-care workers born before 1957 without other evidence of    |
|     immunity: strongly consider recommending 2 doses of live mumps    |
|     virus vaccine.                                                    |
|                                                                       |
| \*Minimum interval between doses = 28 days.                           |
+-----------------------------------------------------------------------+

**Acceptable Presumptive Evidence of Immunity to Mumps**

Acceptable presumptive evidence of immunity to mumps includes one of the
following: 1) documentation of adequate vaccination, 2) laboratory
evidence of immunity, 3) birth before 1957, or 4) documentation of
physician-diagnosed mumps. Evidence of immunity through documentation of
adequate vaccination is now defined as 1 dose of a live mumps virus
vaccine for preschool-aged children and adults not at high risk and 2
doses for school-aged children (i.e., grades K-12) and for adults at
high risk (i.e., health-care workers,\* international travelers, and
students at post-high school educational institutions).\*\*

\*Health-care workers include persons who provide health care to
patients or work in institutions that provide patient care (e.g.,
physicians, nurses, emergency medical personnel, dental professionals
and students, medical and nursing students, laboratory technicians,
hospital volunteers, or administrative and support staff in health-care
institutions).

\*\* The first dose of mumps-containing vaccine should be administered
on or after the first birthday; the second dose should be administered
no earlier than 1 month (i.e., at a minimum of 28 days) after the first
dose. MMR vaccine generally should be used whenever any of its component
vaccines are indicated. For children aged 12 months-12 years, combined
measles, mumps, rubella, and varicella (MMRV) vaccine can be considered
if varicella vaccination is also indicated.

**Routine Vaccination for Health-Care Workers**

All persons who work in health-care facilities should be immune to
mumps. Adequate mumps vaccination for health-care workers born during or
after 1957 consists of 2 doses of a live mumps virus vaccine.
Health-care workers with no history of mumps vaccination and no other
evidence of immunity should receive 2 doses (at a minimum interval of 28
days between doses). Health-care workers who have received only 1 dose
previously should receive a second dose. Because birth before 1957 is
only presumptive evidence of immunity, health-care facilities should
consider recommending 1 dose of a live mumps virus vaccine for
unvaccinated workers born before 1957 who do not have a history of
physician-diagnosed mumps or laboratory evidence of mumps immunity.

**Mumps Outbreak Control**

Depending on the epidemiology of the outbreak (e.g., the age groups
and/or institutions involved), a second dose of mumps vaccine should be
considered for children aged 1 to 4 years and adults who have received 1
dose. In health-care settings, an effective routine MMR vaccination
program for health-care workers is the best approach to prevent
nosocomial transmission. During an outbreak, health-care facilities
should strongly consider recommending 2 doses of a live mumps virus
vaccine to unvaccinated workers born before 1957 who do not have
evidence of mumps immunity.

These new recommendations for health-care workers are intended to offer
increased protection during a recognized outbreak of mumps. However,
reviewing health-care worker immune status for mumps and providing
vaccine during an outbreak might be impractical or inefficient.
Therefore, facilities might consider reviewing the immune status of
health-care workers routinely and providing appropriate vaccinations,
including a second dose of mumps vaccine, in conjunction with routine
annual disease-prevention measures such as influenza vaccination or
tuberculin testing.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence supporting the recommendations is not specifically
stated.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

These new recommendations for health-care workers are intended to offer
increased protection during a recognized outbreak of mumps.

#### POTENTIAL HARMS

Not stated

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

Use of trade names and commercial sources is for identification only and
does not imply endorsement by the U.S. Department of Health and Human
Services.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

#### IMPLEMENTATION TOOLS

Foreign Language Translations\
Resources\
Slide Presentation

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Staying Healthy

#### IOM DOMAIN

Effectiveness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Centers for Disease Control and Prevention (CDC). Notice to readers:
updated recommendations of the Advisory Committee on Immunization
Practices (ACIP) for the control and elimination of mumps. MMWR Morb
Mortal Wkly Rep 2006 Jun 9;55(22):629-30.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16761359)

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2006 Jun 1

#### GUIDELINE DEVELOPER(S)

Centers for Disease Control and Prevention - Federal Government Agency
\[U.S.\]

#### SOURCE(S) OF FUNDING

United States Government

#### GUIDELINE COMMITTEE

Advisory Committee on Immunization Practices (ACIP)

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Not stated

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

The Centers for Disease Control and Prevention (CDC), their planners,
and content experts wish to disclose they have no financial interests or
other relationships with the manufacturers of commercial products,
suppliers of commercial services, or commercial supporters.
Presentations do not include any discussion of the unlabeled use of a
product or a product under investigational use.

#### GUIDELINE STATUS

This is the current release of the guideline.

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [Centers for Disease Control and
Prevention (CDC) Web
site](http://www.cdc.gov/mmwr/preview/mmwrhtml/mm55e601a1.htm).

Print copies: Available from the Centers for Disease Control and
Prevention, MMWR, Atlanta, GA 30333. Additional copies can be purchased
from the Superintendent of Documents, U.S. Government Printing Office,
Washington, DC 20402-9325; (202) 783-3238.

#### AVAILABILITY OF COMPANION DOCUMENTS

Additional resources are available from the [CDC Web
site](http://www.cdc.gov/nip/vaccine/MMR/default.htm), including
multilingual translations.

#### PATIENT RESOURCES

None available

#### NGC STATUS

This NGC summary was completed by ECRI on June 2, 2006.

#### COPYRIGHT STATEMENT

No copyright restrictions apply.

### DISCLAIMER

#### NGC DISCLAIMER

The National Guideline Clearinghouse™ (NGC) does not develop, produce,
approve, or endorse the guidelines represented on this site.

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Guidelines represented on the NGC Web site are submitted by guideline
developers, and are screened solely to determine that they meet the NGC
Inclusion Criteria which may be found at
<http://www.guideline.gov/about/inclusion.aspx> .

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Readers with questions regarding guideline content are directed to
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© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008