Sex: F
Vaccine: MMR
Symptoms: Otitis externa, Otitis media acute, Parotitis, Pneumonia, Polymerase chain reaction
Clinical narrative: Information has been received on 18-APR-2017 as a part of media monitoring and as a literature article, titled as stated below. During July 2015 to May 2016, a mumps outbreak occurred at the University diagnosed among students. To characterize the outbreak, an investigation was conducted through telephone interviews, medical chart abstractions, and review of immunization records. Among 287 (95%) students with mumps for whom clinical information was available, 20 (7%) patients with complications were identified (16 self-reported and four clinician diagnosed). The 20 cases included 15 (5%) cases of orchitis, three (1%) of transient hearing loss, two of mastitis, and one of meningitis (one patient had both orchitis and transient hearing loss). All 20 patients had documentation of receipt of at least 2 doses of measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (manufacturer unknown). Because data were limited regarding the presentation and clinical course of mumps complications in persons who have received 2 doses of measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (manufacturer unknown) three illustrative cases of complications (orchitis, transient hearing loss, and meningitis) in students with mumps were presented. This case pertains to a 21 year old female patient who on unknown dates received vaccination with two doses of doses of measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (manufacturer unknown) (route and site of administration, lot # and expiry date were not reported). On 13-OCT-2015, the patient developed progressive right ear pain, cough, and shortness of breath. Two days later, she was treated in a hospital emergency department where she received a diagnosis of right otitis externa and left otitis media, for which she was prescribed amoxicillin and analgesics. Later that day, she went to the University Student Health Center because of worsening respiratory symptoms. During that encounter, she was also noted to have right bullous myringitis (purulent inflammation of the tympanic membrane), right parotitis suspected to be mumps, and suspected pneumonia. Azithromycin was prescribed empirically to treat both the bullous myringitis and atypical pulmonary pathogens. A polymerase chain reaction (PCR) test for mumps was performed on a buccal swab specimen and was negative. However, her symptoms and epidemiologic link to the outbreak met the Council of State and Territorial Epidemiologists case definition for a probable case of mumps. One day later, she noticed tinnitus and diminished hearing in her right ear; on day 8, she had audiology testing and was evaluated by an otolaryngologist, at which time she received a diagnosis of moderate right sensorineural hearing loss, attributed to mumps, and conductive hearing loss, attributed to otitis media and myringitis. She was treated for 1 week with prednisone, and all her symptoms resolved by 24-OCT-2015, reported as the thirteenth day after onset of parotitis. No repeat audiology testing was performed. The case studies underscore that complications occur even within vaccinated populations and could present at varying times throughout the course of illness and even when parotitis ended. Upon internal review, the event of hearing loss was considered to be medically significant. This case has been received from the same literature article (linked reports MARRS# 1608USA004560 and 1704USA013977). Additional information has been requested.  Sender's Comments: US-009507513-1608USA004560: US-009507513-1704USA013977: