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Seroepidemiology of mumps in Europe (1996–2008): why do outbreaks occur in highly vaccinated populations?

  • J. ERIKSEN (a1) (a2), I. DAVIDKIN (a3), G. KAFATOS (a2), N. ANDREWS (a2), C. BARBARA (a4), D. COHEN (a5), A. DUKS (a6), A. GRISKEVICIUS (a7), K. JOHANSEN (a8), K. BARTHA (a9), B. KRIZ (a10), G. MITIS (a11), J. MOSSONG (a12), A. NARDONE (a2), D. O'FLANAGAN (a13), F. DE ORY (a14), A. PISTOL (a15), H. THEETEN (a16), K. PROSENC (a17), M. SLACIKOVA (a18) and R. PEBODY (a2)...

Mumps outbreaks have recently been recorded in a number of highly vaccinated populations. We related seroprevalence, epidemiological and vaccination data from 18 European countries participating in The European Sero-Epidemiology Network (ESEN) to their risk of mumps outbreaks in order to inform vaccination strategies. Samples from national population serum banks were collected, tested for mumps IgG antibodies and standardized for international comparisons. A comparative analysis between countries was undertaken using age-specific mumps seroprevalence data and information on reported mumps incidence, vaccine strains, vaccination programmes and vaccine coverage 5–12 years after sera collection. Mean geometric mumps antibody titres were lower in mumps outbreak countries [odds ratio (OR) 0·09, 95% confidence interval (CI) 0·01–0·71)]. MMR1 vaccine coverage ⩾95% remained protective in a multivariable model (P < 0·001), as did an interval of 4–8 years between doses (OR 0·08, 95% CI 0·01–0·85). Preventing outbreaks and controlling mumps probably requires several elements, including high-coverage vaccination programmes with MMR vaccine with 4–8 years between doses.

Corresponding author
*Author for correspondence: Dr R. G. Pebody, HPA Health Protection Services, 61 Colindale Avenue, London NW9 5EQ, UK. (Email:
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1.Mumps virus vaccines. Weekly Epidemiological Record 2007; 82: 5160.
2.Peltola H, et al. Mumps and rubella eliminated from Finland. Journal of the American Medical Association 2000; 284: 26432647.
3.Johnson CD, Goodpasture EW. An investigation of the etiology of mumps. Journal of Experimental Medicine 1934; 59: 119.
4.Galazka AM, Robertson SE, Kraigher A. Mumps and mumps vaccine: a global review. Bulletin of the World Health Organization 1999; 77: 314. MMR vaccination overview in European countries., Copenhagen, 2010.
6.Bart KJ, Orenstein WA, Hinman AR. The virtual elimination of rubella and mumps from the United States and the use of combined measles, mumps and rubella vaccines (MMR) to eliminate measles. Developments in Biological Standardization 1986; 65: 4552.
7.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.
8.Vandermeulen C, Leroux-Roels G, Hoppenbrouwers K. Mumps outbreaks in highly vaccinated populations: What makes good even better? Human Vaccines 2009; 5: 494496.
9.Castilla J, et al. Effectiveness of Jeryl Lynn-containing vaccine in Spanish children. Vaccine 2009; 27: 20892093.
10.Cohen C, et al. Vaccine effectiveness estimates, 2004–2005 mumps outbreak, England. Emerging Infectious Diseases 2007; 13: 1217.
11.Dayan GH, Rubin S. Mumps outbreaks in vaccinated populations: are available mumps vaccines effective enough to prevent outbreaks? Clinical Infectious Diseases 2008; 47: 14581467.
12.Gupta RK, Best J, MacMahon E. Mumps and the UK epidemic 2005. British Medical Journal 2005; 330: 11321135.
13.Dayan GH, et al. Recent resurgence of mumps in the United States. New England Journal of Medicine 2008; 358: 15801589.
14.Ferson MJ, Konecny P. Recent increases in mumps incidence in Australia: the ‘forgotten’ age group in the 1998 Australian Measles Control Campaign. Medical Journal of Australia 2009; 190: 283284.
15.Brockhoff HJ, et al. Mumps outbreak in a highly vaccinated student population, The Netherlands, 2004. Vaccine 2010; 28: 29322936.
16.Kaaijk P, et al. Increased mumps incidence in the Netherlands: review on the possible role of vaccine strain and genotype. Eurosurveillance 2008; 13.
17.Schwarz NG, et al. Mumps outbreak in the Republic of Moldova, 2007–2008. Pediatric Infectious Diseases Journal 2010; 29: 703706.
18.Pebody RG, et al. Immunogenicity of second dose measles-mumps-rubella (MMR) vaccine and implications for serosurveillance. Vaccine 2002; 20: 11341140.
19.LeBaron CW, et al. Persistence of mumps antibodies after 2 doses of measles-mumps-rubella vaccine. Journal of Infectious Diseases 2009; 199: 552560.
20.Davidkin I, et al. Persistence of measles, mumps, and rubella antibodies in an MMR-vaccinated cohort: a 20-year follow-up. Journal of Infectious Diseases 2008; 197: 950956.
21.Mauldin J, et al. Mumps virus-specific antibody titers from pre-vaccine era sera: comparison of the plaque reduction neutralization assay and enzyme immunoassays. Journal of Clinical Microbiology 2005; 43: 48474851.
22.Vyse AJ, et al. Interpreting serological surveys using mixture models: the seroepidemiology of measles, mumps and rubella in England and Wales at the beginning of the 21st century. Epidemiology and Infection 2006; 134: 13031312.
23.Nardone A, et al. Sero-epidemiology of mumps in western Europe. Epidemiology and Infection 2003; 131: 691701.
24.Kelly H, et al. A random cluster survey and a convenience sample give comparable estimates of immunity to vaccine preventable diseases in children of school age in Victoria, Australia. Vaccine 2002; 20: 31303136.
25.Osborne K, et al. Ten years of serological surveillance in England and Wales: methods, results, implications and action. International Journal of Epidemiology 2000; 29: 362368.
26.Tischer A, et al. Standardization of measles, mumps and rubella assays to enable comparisons of seroprevalence data across 21 European countries and Australia. Epidemiology and Infection 2007; 135: 787797.
27.Kafatos G, Andrews N, Nardone A. Model selection methodology for inter-laboratory standardisation of antibody titres. Vaccine 2005; 23: 50225027.
28.Andrews N, et al. The European Sero-Epidemiology Network: standardizing the enzyme immunoassay results for measles, mumps and rubella. Epidemiology and Infection 2000; 125: 127141.
29.Mossong J, et al. Mumps outbreak among the military in Luxembourg in 2008: epidemiology and evaluation of control measures. Eurosurveillance 2009; 14.
30.Cortese MM, et al. Mumps vaccine performance among university students during a mumps outbreak. Clinical Infectious Diseases 2008; 46: 11721180.
31.Vandermeulen C, et al. Outbreak of mumps in a vaccinated child population: a question of vaccine failure? Vaccine 2004; 22: 27132716.
32.Hersh BS, et al. Mumps outbreak in a highly vaccinated population. Journal of Pediatrics 1991; 119: 187193.
33.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.
34.Schaffzin JK, et al. Effectiveness of previous mumps vaccination during a summer camp outbreak. Pediatrics 2007; 120: e862868.
35.Mossong J, et al. Social contacts and mixing patterns relevant to the spread of infectious diseases. PLoS Medicine 2008; 5: e74.
36.Hanna-Wakim R, et al. Immune responses to mumps vaccine in adults who were vaccinated in childhood. Journal of Infectious Diseases 2008; 197: 16691675.
37.Ilonen J, et al. Immune responses to live attenuated and inactivated mumps virus vaccines in seronegative and seropositive young adult males. Journal of Medical Virololgy 1984; 13: 331338.
38.Hyoty H, et al. Cell-mediated and humoral immunity to mumps virus antigen. Acta Pathologica, Microbiologica et Immunologica Scandinavica C 1986; 94: 201206.
39.Nardone A, et al. Comparison of rubella seroepidemiology in 17 countries: progress towards international disease control targets. Bulletin of the World Health Organization 2008; 86: 118125.
40.Andrews N, et al. Towards elimination: measles susceptibility in Australia and 17 European countries. Bulletin of the World Health Organization 2008; 86: 197204.
41.Masseria C, Mladovsky P, Hernandez-Quevedo C. The socio-economic determinants of the health status of Roma in comparison with non-Roma in Bulgaria, Hungary and Romania. European Journal of Public Health 20: 549554.
42.Toscani L, et al. Comparison of the efficacy of various strains of mumps vaccine: a school survey [in German]. Sozial- und Präventivmedizin 1996; 41: 341347.
43.Richard JL, et al. Comparison of the effectiveness of two mumps vaccines during an outbreak in Switzerland in 1999 and 2000: a case-cohort study. European Journal of Epidemiology 2003; 18: 569577.
44.Chamot E, et al. Estimation of the efficacy of three strains of mumps vaccines during an epidemic of mumps in the Geneva canton (Switzerland) [in French]. Revue d'épidémiologie et de santé publique 1998; 46: 100107.
45.Hahne S, et al. Mumps vaccine effectiveness against orchitis. Emerging Infectious Diseases 2012; 18: 191193.
46.Cortese MM, et al. Mumps antibody levels among students before a mumps outbreak: in search of a correlate of immunity. Journal of Infectious Diseases 2011; 204: 14131422.
47.Davidkin I, Valle M, Julkunen I. Persistence of anti-mumps virus antibodies after a two-dose MMR vaccination. A nine-year follow-up. Vaccine 1995; 13: 16171622.
48.Kuno-Sakai H, Ozaki K, Kimura M. Two doses of measles mumps rubella (MMR) vaccine. Acta Paediatrica Japonica 1989; 31: 690697.
49.Davidkin I, et al. MMR vaccination and disease elimination: the Finnish experience. Expert Review of Vaccines 2010; 9: 10451053.
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Epidemiology & Infection
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