Mumps

      The Mumps vaccine was developed for the protection of adult males who may not have acquired mumps in childhood and gained natural immunity. In the pre-vaccine era, and for more than 10 years after the recommended Mumps vaccine, children typically caught Mumps between 5-9 years of age. The shift in incidence from childhood to adolescents was seen in 1985 to 1988. Then in 1992, there was another shift as Mumps was increasing and occurring in adolescents and young adults (10-19 years old) and exceeded all other age groups. The exact opposite of what the vaccine was intended for has been occurring; despite large vaccine coverage rates in childhood.  It should also be noted that the seasonal pattern of Mumps from 1988-1993 was consistent with the pre-vaccine era.

 

     During the 2005-2006 outbreaks, 51% had received 2 doses of Mumps vaccine, yet the incident rate was highest in those aged 18-24 years. Even after the ACIP made new recommendations in the 1980’s, adolescents and adults in 1982, 1986, and 1987 had the highest infection rates. During the 1989-1991 outbreaks amongst children in primary and secondary school, the majority were vaccinated. From 1988-1993, 75% of Mumps cases were seen in adolescents over 15 years of age and young adults. This trend has continued.

      “The shift in higher risk for mumps to these other age groups (i.e., from younger children of school ages to older children, adolescents, and young adults) — which occurred after the routine use of mumps vaccine was initiated — has persisted despite minimal fluctuations in disease incidence that occurred in recent years among the various age groups.” ( The resurgence of Mumps in Young Adults and Adolescents. John D. Shanley, M.D. Shanley_07 [1] pdf, pg. 1-4.)

 

     Young adults in high school and colleges were the primary target of the 2006 Mumps outbreak, even though most (84%) had received 2 doses of MMR. The ACIP then recommended yet another Mumps ‘booster’ vaccine, and for CSTE to update its case definition.  2010 was the goal set for elimination of Mumps in the United States. That year appears to be no longer attainable.

          “Despite a high coverage rate with two doses of Mumps-containing vaccine, a large Mumps outbreak occurred, characterized by 2-dose vaccine failure, particularly among Midwestern college adults who probably received the second dose as school children.  A more effective Mumps vaccine or changes in vaccine policy may be needed…” 

      The Mumps vaccine program has essentially put all adult males at a greater risk, since it can be cause more complications in adulthood.  If the vaccine had only been offered to susceptible males and females after puberty, who had not acquired a natural case in childhood, we might very well see a different picture than we see today.  

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