Sex: M
Vaccine: MMR
Symptoms: Blood immunoglobulin G increased, Blood immunoglobulin M decreased, Enterovirus test positive, Influenza virus test positive, Mumps antibody test negative
Clinical narrative: These results suggest that symptomatic cases do not have protective levels of antibodies to JL and genotype G prior to mumps infection; This literature marketed report had been received from the authors of a published article, titled as stated above, and refers to a male patient of unknown age. The article aimed that in 2017, a mumps outbreak occurred, so serum collected at service entry was used to compare pre-exposure with presumptive vaccine-induced antibody levels from persons who developed mumps (cases) and potentially exposed persons who did not develop mumps (non-cases).  Information regarding the patient's pertinent medical history, concurrent conditions, concomitant therapies and previous drug reactions or allergies was not provided.  On an unknown date, the patient was vaccinated with 2 dose childhood regimen of measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (manufacturer unknown) as prophylaxis (dose, route of administration, vaccination scheme frequency, anatomical location, lot number and expiration date were not reported).   On 22-NOV-2016, a sample was collected and showed Jeryl Lynn (JL) titer at 33.9 (units not provided) and genotype G titer at 6.8 (units not provided), CDC IgM was negative (-), Zeus IgG was positive (+) (Zeus Index value: 2.50 (units not provided)), avidity was 20 percent (low). The low avidity result indicates that this patient was undergoing a primary immune response at the time of the repository collection due to an earlier mumps virus infection. It was reported that results suggested that symptomatic cases do not have protective levels of antibodies to JL and genotype G prior to mumps infection (mumps antibody test negative).  In February 2017, the patient (reported as index case) at the base transferred into Advanced Training after completing Basic Training in another state. On 25-FEB-2017, the patient was symptomatic and exhibited typical mumps symptoms like bilateral mandibular and parotid swelling, was hospitalized, and tested indeterminate for mumps immunoglobulin M (IgM). The index case recalled a trainee with whom he had been housed in his previous Basic Training class, who had been diagnosed with pharyngitis with facial swelling in January prior to his transfer to Advanced Training. Neither of these trainees was tested for mumps at the Basic Training site, according to personal correspondence with medical staff.   On 01-MAR-2017, CDC laboratory classification report probable case (P) of mumps. Also, sample collected show JL titer at 539.5 (units not provided) and genotype G titer at 163.7 (units not provided), serum from the patient was retested by the CDC capture assay and was mumps IgM positive (+), Zeus IgG was positive (+) (Zeus Index value: 5.47 (units not provided)), avidity was 60 percent (high). The outbreak sample was collected 4 days after symptom onset and 3.5 months after the repository sample, indicating IgG maturation. A buccal specimen for positive reverse-transcription polymerase chain reaction (RT-PCR) was not collected since the patient was identified later through public health contact tracing (also reported as PCR no result (NR)). The patient did not receive an measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (manufacturer unknown) dose prior to this collection. Other testing and alternative diagnosis were positive enterovirus (entero) and flu.  The outcome of the event mumps antibody test negative was not provided. The causal relationship between the event mumps antibody test negative and the suspect measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (manufacturer unknown) was considered as related.  Lot # is being requested and will be submitted if received.  This is one of several reports received from the literature.  A copy of the published article is attached as further documentation of the patient's experience.  Sender's Comments:  US-009507513-2408USA003353: US-009507513-2408USA003357: US-009507513-2408USA003358: US-009507513-2408USA003360: US-009507513-2408USA003361: US-009507513-2408USA003362: US-009507513-2408USA003363: US-009507513-2408USA003356: US-009507513-2408USA003355: US-009507513-2408USA003354: US-009507513-2408USA003359: