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July 1995, Vol 149, No. 7 >
Article | July 1995

Mumps Outbreak in a Highly Vaccinated School Population:  Evidence for Large-scale Vaccination Failure FREE

James E. Cheek, MD, MPH; Roy Baron, MD, MPH; Holly Atlas, MD; D. L. Wilson; Robert D. Crider, MPA
Arch Pediatr Adolesc Med. 1995;149(7):774-778. doi:10.1001/archpedi.1995.02170200064010.
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Objectives:  To describe an outbreak and to identify risk factors for mumps occurring in a highly vaccinated high school population. (Note: Highly vaccinated means a population in which more than 95% have been vaccinated.)

Design and Participants:  Survey and cohort study of 307 (97%) of 318 students.

Outcome Measures:  Mumps was defined as an illness with 2 or more days of parotid swelling. Serologic confirmation of infection was obtained in eight cases, seven of which were evaluated for presence of IgM antibody using immunofluorescent antibodies. Vaccination records were verified for 297 (97%) students.

Results:  Between October 3 and November 23, 1990, clinical mumps developed in 54 students (attack rate, 18%), 53 of whom had been vaccinated. Most cases (40 [77%] of 52) occurred 12 to 20 days after a school-wide pep rally. Immunofluorescent antibody testing of all seven specimens demonstrated IgM antibody to mumps. Risk factors for clinical mumps identified in multivariate analyses included female gender (odds ratio, 3.0; 95% confidence interval, 1.6 to 5.7) and source of vaccination other than the local public health clinic (students vaccinated by private providers [odds ratio, 3.0; 95% confidence interval, 1.3 to 5.2] or in other districts [odds ratio, 2.4; 95% confidence interval, 1.1 to 5.3]).

Conclusions:  The overall attack rate is the highest reported to date (and to our knowledge) for a population demonstrating virtually complete mumps vaccine coverage. Even verified documentation of vaccination may not be an accurate indicator of an individual's protection against mumps. Vaccination failure may play an important role in contemporary mumps outbreaks. We found no evidence to indicate that waning immunity (secondary vaccine failure) contributed significantly to this outbreak. A second dose of mumps vaccine, as recommended using measles-mumps-rubella vaccine, could potentially prevent similar outbreaks in secondary school populations in the future.(Arch Pediatr Adolesc Med. 1995;149:774-778)

REFERENCES

1 +
Sullivan KM, Halpin TJ, Marks JS, Kim-Farley R.  Effectiveness of mumps vaccine in a school outbreak . AJDC . 1985;;139:909-912.
2 +
Chaiken BP, Williams NM, Preblud SR, Parkin W, Altman R.  The effect of a school entry law on mumps activity in a school district . JAMA . 1987;:257: 2455-2458.
3 +
Wharton M, Cochi SL, Hutcheson RH, Bistowish JM, Schaffner W.  A large outbreak of mumps in the postvaccine era . J Infect Dis . 1988;;158:1253-1260.
4 +
Hersh BS, Fine PEM, Kent WK, et al.  Mumps outbreak in a highly vaccinated population . J Pediatr . 1991;;119:187-193.
5 +
Briss PA, Fehrs LJ, Parker RA, et al.  Sustained transmission of mumps in a highly vaccinated population: assessment of primary vaccine failure and waning vaccine-induced immunity . J Infect Dis . 1994;;169:77-82.
6 +
Sosin DM, Cochi SL, Gunn RA, Jennings CE, Preblud SR.  Changing epidemiology of mumps and its impact on university campuses . Pediatrics . 1989;:84: 779-784.
7 +
Kaplan KM, Marder DC, Cochi SL, Preblud SR.  Mumps in the workplace: further evidence of the changing epidemiology of a childhood vaccine-preventable disease . JAMA . 1988;;260:1434-1438.
8 +
Cochi SL, Preblud SR, Orenstein WA.  Perspectives on the relative resurgence of mumps in the United States . AJDC . 1988;;142:499-507.
9 +
Hilleman MR, Weibel RE, Buynak EB, Stokes J, Whitman JE.  Live attenuated mumps-virus vaccine, IV: protective efficacy as measured in a field evaluation . N Engl J Med . 1967;;276:252-258.
10 +
Sugg WC, Finger JA, Levine RH, Pagano JS.  Field evaluation of live virus mumps vaccine . J Pediatr . 1968;;72:461-466.
11 +
Brunell PA, Brickman A, Steinberg S.  Evaluation of a live attenuated mumps vaccine (Jeryl Lynn) . AJDC . 1969;;118:435-440.
12 +
Brunell PA, Brickman A, Steinberg S, Allen E.  Parotitis in children who had previously received mumps vaccine . Pediatrics . 1972;;50:441-444.
13 +
Orenstein WA, Bernier RH, Dondero TJ, et al.  Field evaluation of vaccine efficacy . Bull World Health Organ . 1985;;63:1055-1068.
14 +
Fleiss JL. Statistical Methods for Rates and Proportions . 2nd ed. New York, NY: John Wiley & Sons Inc; 1981;:14-15.
15 +
Brunnell PA, Brickman A, O'Hare D, Steinberg S.  Ineffectiveness of isolation of patients as a method of preventing the spread of mumps . N Engl J Med . 1968;; 279:1357-1361.
16 +
Kleinbaum DG, Kupper LL. Morgenstern H. Epidemiologic Research . Belmont, Calif: Lifetime Learning Publications; 1982;:428-437.
17 +
Kim-Farley R, Bart S, Stetler H, et al.  Clinical mumps vaccine efficacy . Am J Epidemiol . 1985;;121:593-597.
18 +
Hull HF, Montes JM, Hayes PC, Lucero RL.  Risk factors for measles vaccine failure among immunized students . Pediatrics . 1985;;76:518-523.
19 +
Edmonson MB, Addiss DG, McPherson JT, Berg JL, Circo SR, Davis JP.  Mild measles and secondary vaccine failure during a sustained outbreak in a highly vaccinated population . JAMA . 1990;;263:2467-2471.
20 +
Markowitz LE, Preblud SR, Fine PEM, Orenstein WA.  Duration of live measles vaccine-induced immunity . Pediatr Infect Dis J . 1990;;9:101-110.
21 +
Weibel RE, Buynak EB, McLean AA, Hilleman MR.  Persistence of antibody after administration of monovalent and combined live attenuated measles, mumps, and rubella virus vaccines . Pediatrics . 1978;;16:5-11.
22 +
Immunization Practices Advisory Committee (ACIP).  Measles prevention: recommendations of the Immunization Practices Advisory Committee (ACIP) . MMWR Morb Mortal Wkly Rep . 1989;;38:1-13.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Sullivan KM, Halpin TJ, Marks JS, Kim-Farley R.  Effectiveness of mumps vaccine in a school outbreak . AJDC . 1985;;139:909-912.
2 +
Chaiken BP, Williams NM, Preblud SR, Parkin W, Altman R.  The effect of a school entry law on mumps activity in a school district . JAMA . 1987;:257: 2455-2458.
3 +
Wharton M, Cochi SL, Hutcheson RH, Bistowish JM, Schaffner W.  A large outbreak of mumps in the postvaccine era . J Infect Dis . 1988;;158:1253-1260.
4 +
Hersh BS, Fine PEM, Kent WK, et al.  Mumps outbreak in a highly vaccinated population . J Pediatr . 1991;;119:187-193.
5 +
Briss PA, Fehrs LJ, Parker RA, et al.  Sustained transmission of mumps in a highly vaccinated population: assessment of primary vaccine failure and waning vaccine-induced immunity . J Infect Dis . 1994;;169:77-82.
6 +
Sosin DM, Cochi SL, Gunn RA, Jennings CE, Preblud SR.  Changing epidemiology of mumps and its impact on university campuses . Pediatrics . 1989;:84: 779-784.
7 +
Kaplan KM, Marder DC, Cochi SL, Preblud SR.  Mumps in the workplace: further evidence of the changing epidemiology of a childhood vaccine-preventable disease . JAMA . 1988;;260:1434-1438.
8 +
Cochi SL, Preblud SR, Orenstein WA.  Perspectives on the relative resurgence of mumps in the United States . AJDC . 1988;;142:499-507.
9 +
Hilleman MR, Weibel RE, Buynak EB, Stokes J, Whitman JE.  Live attenuated mumps-virus vaccine, IV: protective efficacy as measured in a field evaluation . N Engl J Med . 1967;;276:252-258.
10 +
Sugg WC, Finger JA, Levine RH, Pagano JS.  Field evaluation of live virus mumps vaccine . J Pediatr . 1968;;72:461-466.
11 +
Brunell PA, Brickman A, Steinberg S.  Evaluation of a live attenuated mumps vaccine (Jeryl Lynn) . AJDC . 1969;;118:435-440.
12 +
Brunell PA, Brickman A, Steinberg S, Allen E.  Parotitis in children who had previously received mumps vaccine . Pediatrics . 1972;;50:441-444.
13 +
Orenstein WA, Bernier RH, Dondero TJ, et al.  Field evaluation of vaccine efficacy . Bull World Health Organ . 1985;;63:1055-1068.
14 +
Fleiss JL. Statistical Methods for Rates and Proportions . 2nd ed. New York, NY: John Wiley & Sons Inc; 1981;:14-15.
15 +
Brunnell PA, Brickman A, O'Hare D, Steinberg S.  Ineffectiveness of isolation of patients as a method of preventing the spread of mumps . N Engl J Med . 1968;; 279:1357-1361.
16 +
Kleinbaum DG, Kupper LL. Morgenstern H. Epidemiologic Research . Belmont, Calif: Lifetime Learning Publications; 1982;:428-437.
17 +
Kim-Farley R, Bart S, Stetler H, et al.  Clinical mumps vaccine efficacy . Am J Epidemiol . 1985;;121:593-597.
18 +
Hull HF, Montes JM, Hayes PC, Lucero RL.  Risk factors for measles vaccine failure among immunized students . Pediatrics . 1985;;76:518-523.
19 +
Edmonson MB, Addiss DG, McPherson JT, Berg JL, Circo SR, Davis JP.  Mild measles and secondary vaccine failure during a sustained outbreak in a highly vaccinated population . JAMA . 1990;;263:2467-2471.
20 +
Markowitz LE, Preblud SR, Fine PEM, Orenstein WA.  Duration of live measles vaccine-induced immunity . Pediatr Infect Dis J . 1990;;9:101-110.
21 +
Weibel RE, Buynak EB, McLean AA, Hilleman MR.  Persistence of antibody after administration of monovalent and combined live attenuated measles, mumps, and rubella virus vaccines . Pediatrics . 1978;;16:5-11.
22 +
Immunization Practices Advisory Committee (ACIP).  Measles prevention: recommendations of the Immunization Practices Advisory Committee (ACIP) . MMWR Morb Mortal Wkly Rep . 1989;;38:1-13.

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