# Presentation: 751957

## 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**

## Note to presenters:

**Images of vaccine-preventable diseases are available from the Immunization Action Coalition website at ****http://www.vaccineinformation.org/photos/index.asp**

## 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**

**Notes:**
Only influenza and gonorrhea were more frequent among military personnel.

## Mumps Virus

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

## 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**

## 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**

## Mumps Complications

## 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**

## 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**

## Mumps—United States, 1968-2005

**Year**

## Mumps—United States, 1980-2005

**Year**

**Notes:**
Resurgence in 1986-1987 involved primarily states that did not have school entry requirements for mumps.  

## Mumps—United States, 1980-2003
Age Distribution of Reported Cases

- Mumps—United States, 1980-2003
- Age Distribution of Reported Cases

**5-14 yrs**

**15-39 yrs**

**<5 yrs**

_**>**_**40 yrs**

**Year**

## Mumps Clinical Case Definition

**Acute onset of unilateral or bilateral tender, self-limited swelling of the parotid or other salivary gland lasting >2 days without other apparent cause**

## 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***** 2006;55(42):1152-3**

## MMWR 2006;55(42):1152-3

***MMWR***** 2006;55(42):1152-3**

## 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 **

## 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  **

## 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  **

## 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**

## Mumps Vaccine

**Composition****	****	****Live virus (Jeryl Lynn strain)**** **
**Efficacy****	****	****	****95% (Range, 90%-97%)**** **
**Duration of****Immunity****	****	****Lifelong**** **
**Schedule****	****	**_**>**_**1 Dose**
**Should be administered with measles and rubella (MMR) or with measles, rubella and varicella (MMRV) **

## 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**

## Mumps Immunity

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

## Presumptive Evidence of Mumps Immunity

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

***MMWR***** 2006;55(22):629-30**

## 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-12****th**** grade) and for adults at high risk of exposure to mumps **

***MMWR***** 2006;55(22):629-30**

## Mumps Vaccination ofHealthcare 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***** 2006;55(22):629-30**

## Mumps Vaccination ofHealthcare 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***** 2006;55(22):629-30**

## MMR Adverse Reactions

**Fever****	****	****	****	****  5%-15%**
**Rash****	****	****	****	****  5%**
**Joint symptoms****	****  25%**
**Thrombocytopenia****	****  <1/30,000 doses**
**Parotitis****	****	****	****  rare**
**Deafness****	****	****	****  rare**
**Encephalopathy****	****  <1/1,000,000 doses**

## MMR VaccineContraindications and Precautions

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

## 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**

## National Immunization ProgramContact Information

**Telephone****	****	****800.CDC.INFO**** **
**Email****	****	****	****nipinfo@cdc.gov**** **
**Website****	****	****www.cdc.gov/nip**