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Mumps outbreak in Israel's highly vaccinated society: are two doses enough?

  • E. ANIS (a1) (a2), I. GROTTO (a1) (a3), L. MOERMAN (a1), B. WARSHAVSKY (a1), P. E. SLATER (a1) (a2) and B. LEV (a1)...

Mumps outbreaks in recent years have given rise to questions about the effectiveness of the mumps vaccine. This study examined the epidemiological data from a recent mumps outbreak in Israel and from outbreaks in other countries with high vaccination coverage, and considered whether long-established vaccination policies designed to protect against mumps are in need of revision. Of over 5000 case patients in the Israeli outbreak, half of whom were in the Jerusalem health district, nearly 40% were aged ⩾15 years and, of those whose vaccination status was known, 78% had been fully vaccinated for their age – features similar to those in recent mumps outbreaks in Europe and North America. The epidemiological and laboratory evidence suggests that many previously vaccinated adolescents and young adults are now susceptible to mumps because their vaccine-based immunity has waned. Booster vaccination programmes for those at high risk of infection during mumps outbreaks – particularly those in congregate living environments – merit priority consideration.

Corresponding author
*Author for correspondence: E. Anis, MD, MPH, Director, Division of Epidemiology, Ministry of Health, Israel. (Email:
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1.Galazka AM, Robertson SE, Kraigher A. Mumps and mumps vaccine: a global view. Bulletin of the World Health Organization 1999; 77, Table 2 ( Accessed 20 February 2011.
2.Slater PE, Anis E, Leventhal A. The control of mumps in Israel. European Journal of Epidemiology 1999; 15: 765787.
3.Anis E, et al. Measles in a highly vaccinated society: the 2007–2008 outbreak in Israel. Journal of Infection 2009; 59: 252258.
4.Dayan GH, Rubin S. Mumps Outbreaks in vaccinated populations: are available mumps vaccines effective enough to prevent outbreaks? Clinical Infectious Diseases 2008; 47: 14581467.
5.Conly JM, Johnston BL. Is mumps making a comeback? Canadian Journal of Infectious Diseases & Medical Microbiology 2007; 18: 79.
6.Barskey AE, Glasser JW, LeBaron CW. Mumps resurgences in the United States: a historical perspective on unexpected elements. Vaccine 2009; 27: 61866195.
7.Whelan J, et al. Ongoing mumps outbreak in a student population with high vaccination coverage, Netherlands, 2010. Eurosurveillance 2010; 15(17).
8.Savage E, et al. Mumps outbreaks across England and Wales in 2004: observational study. British Medical Journal 2005; 330: 11191120.
9.Stein-Zamir C, et al. Mumps outbreak in Jerusalem affecting mainly male adolescents. Eurosurveillance 2009; 14(50): pii=19440.
10.Centers for Disease Control and Prevention. Update: mumps outbreak – New York and New Jersey, June 2009–January 2010. Morbidity and Mortality Weekly Report 2010; 59(5): 125129.
11.Anon.Mumps outbreak hits N.Y. Jewish Community. Vaccine News, 22 December 2009 ( Accessed 20 February 2011.
12.Memorandum. From Chen Stein-Zamir MD, Ministry of Health, Jerusalem, Israel, to Raphael Harpaz MD, Centers for Disease Control and Prevention, Atlanta, Georgia, United States, 24 November 2009.
13.Shanley JD. The resurgence of mumps in young adults and adolescents. Cleveland Clinic Journal of Medicine 2007; 74: 4248.
14.WHO.Weekly Epidemiological Record, no. 7, 16 February 2007. ( Accessed 20 February 2011.
15.WHO. WHO-recommended surveillance standard of mumps ( Accessed 20 February 2011.
16.McBryde ES. Network structure can play a role in vaccination thresholds and herd immunity: a simulation using a network mathematical model. Clinical Infectious Diseases 2009; 48: 685686.
17.Cohen C, et al. Vaccine effectiveness estimates, 2004–2005 mumps outbreak, England. Emerging Infectious Diseases 2007: 13(1).
18.Centers for Disease Control and Prevention.Mumps epidemic – United Kingdom, 2004–2005. Morbidity and Mortality Weekly Report 2006; 55(07): 173175.
19.Health Protection Agency, UK. Health Protection Report, Vol. 4, No. 2, 15 January 2010 ( Accessed 20 February 2011.
20.Schmid D, et al. Mumps outbreak affecting adolescents and young adults in Austria, 2006. Eurosurveillance 2006; 11(24).
21.Dayan GH, et al. Recent resurgence of mumps in the United States. New England Journal of Medicine 2008; 358: 15801589.
22.Watson-Creed G, et al. Two successive outbreaks of mumps in Nova Scotia among vaccinated adolescents and young adults. Canadian Medical Association Journal 2006; 175: 483488.
23.Kancherla VS, Hanson IC. Mumps resurgence in the United States. Journal of Allergy and Clinical Immunology 2006; 118: 938941.
24.Anderson LJ, Seward JF. Mumps epidemiology and immunity: the anatomy of a modern epidemic. Pediatric Infectious Disease Journal 2008; 27 (10 Suppl.): S75S79.
25.Briss PA, et al. Sustained transmission of mumps in a highly vaccinated population: assessment of primary vaccine failure and waning vaccine-induced immunity. Journal of Infectious Diseases 1994; 169: 7782.
26.Peltola H, et al. Mumps outbreaks in Canada and the United States: time for new thinking on mumps vaccines. Clinical Infectious Diseases 2007; 45: 459466.
27.Kaaijk P, et al. Increased mumps incidence in the Netherlands: review on the possible role of vaccine strain and genotype. Eurosurveillance 2008; 13(46).
28.Cortese MM, et al. Mumps vaccine performance among university students during a mumps outbreak. Clinical Infectious Diseases 2008; 46: 11721180.
29.Rubin SA, et al. Antibody induced by immunization with the Jeryl Lynn mumps vaccine strain effectively neutralizes a heterologous wild-type mumps virus associated with a large outbreak. Journal of Infectious Diseases 2008; 198: 505515.
30.Choi KM. Reemergence of mumps. Korean Journal of Pediatrics 2010; 54: 623628.
31.Date AA, et al. Long-term persistence of mumps antibody after receipt of 2 measles-mumps-rubella (MMR) vaccinations and antibody response after a third MMR vaccination among a university population. Journal of Infectious Diseases 2008; 197: 16621668.
32.Kutty PK, et al. Seroprevalence of antibody to mumps virus in the US population, 1999–2004. Journal of Infectious Diseases 2010; 202: 667674.
33.Park DW, et al. Mumps outbreak in a highly vaccinated school population: assessment of secondary vaccine failure using IgG avidity measurements. Vaccine 2007; 25: 46654670.
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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
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