Mumps

Mumps

 

 Jeryl Lynn strain:

 

There are more than ten mumps vaccine strains have been used throughout the world, such as Jeryl Lynn, Urabe, Hoshino, Rubini, Leningrad-3, L-Zagreb, Miyahara, Torii, NK M-46, S-12 and RIT 4385. In Japan and Europe, some manufacturers produce a live mumps vaccine containing the Urabe Am9 virus strain. Due to concerns about vaccine-associated meningitis, several countries stopped using Urabe vaccine strain (WER 1992). Some vaccines have a more limited distribution. The mumps vaccines are cultured in various ways. The viruses can be cultured in chick embryo fibroblasts, such as the Jeryl Lynn and Urabe strain containing vaccines, or quail and human embryo fibroblasts are also used for some vaccines.

 

Vaccines:

  

MUMPSVAX® (MUMPS VIRUS VACCINE LIVE)

JERYL LYNN™ STRAIN 

Package Insert

 

M-M-R® II (MEASLES, MUMPS, and RUBELLA VIRUS VACCINE LIVE)

Jeryl Lynn** (B level) strain

Package insert

 

ProQuad® Measles, Mumps, Rubella and Varicella Virus Vaccine Live

MMRV(Measles, Mumps, Rubella, Varicella) 

Has been suspended.

 

ProQuad* is a combined attenuated live virus vaccine containing measles, mumps, rubella, and varicella viruses. ProQuad is a sterile lyophilized preparation of (1) the components of M-M-R*II (Measles, Mumps and Rubella Virus Vaccine Live): Measles Virus Vaccine Live, a more attenuated line of measles virus, derived from Enders’ attenuated Edmonston strain and propagated in chick embryo cell culture; Mumps Virus Vaccine Live, the Jeryl Lynn™ (B level) strain of mumps virus propagated in chick embryo

cell culture; Rubella Virus Vaccine Live, the Wistar RA 27/3 strain of live attenuated rubella virus propagated in WI-38 human diploid lung fibroblasts; and (2) Varicella Virus Vaccine Live (Oka/Merck), the Oka/Merck strain of varicella-zoster virus propagated in MRC-5 cells. The cells, virus pools, bovine serum, and human albumin used in manufacturing are all tested to provide assurance that the final product is free of potential adventitious agents.

ProQuad, when reconstituted as directed, is a sterile preparation for subcutaneous administration.

Each 0.5-mL dose contains not less than 3.00 log10 TCID50 (50% tissue culture infectious dose) of measles virus; 4.30 log10 TCID50 of mumps virus; 3.00 log10 TCID50 of rubella virus; and a minimum of 3.99 log10 PFU (plaque-forming units) of Oka/Merck varicella virus.

 

 WHO Position paper on Mumps vaccines

Feb 2007: Mumps vaccines; studies on immune responses, efficacy and effectiveness

 

Mumps virus strains used for vaccine

At least 10 strains of the mumps virus are in use throughout the world for live attenuated vaccine. The first vaccine strain to be developed, and that most often used, is the Jeryl Lynn strain which was named after the child from whom the virus was isolated. It was developed in the USA by passaging seven times in embryonated hen’s eggs and ten times in chick embryo cell cultures. At the initial level of attenuation, lower than that used in the final vaccine, the Jeryl Lynn strain produced parotid swelling in some vaccinees what was the indicating that the vaccine strain was not suffficiently attenuated. This parotid swelling was not seen after additional passages at the B level of attenuation. Since December 1967, a live attenuated Jeryl Lynn vaccine has been manufactured and distributed by an American company…

In the USSR in the 1950s, the Leningrad-3 strain was developed by Smrodintsev and Klyachko in guinea pig kidney cell culture, with further passages in Japanese quail embryo cultures. Vaccines based on this strain have been used in the former Soviet Union and other countries.

Leningrad-3 mumps virus was further attenuated in Croatia by adaptation and passages on chick embryo fibroblast cell culture. The new mumps strain has been designated L-Zagreb. This strain is used in Croatia and India.

The Urabe strain of live mumps vaccine was first licensed in Japan and thereafter in Belgium, France, and Italy. It is produced either in the amnion of embryonated hen’s eggs or in chick-embryo cell cultures and has been used successfully in Japan and other countries. Its immunogenic properties are similar to those of the Jeryl Lynn strain.

The other strains are used to produce vaccines on a limited local scale. Hoshino, Torii and NKM – 46 strains are said to have characteristics similar to those of the Urabe strain. Mumps vaccine strains have been attenuated on different cell-culture systems and it was originally thought that they are were equally capable of inducing high levels of immunity. Recent observations, however, suggest that some vaccines based on the Rubini strain, approved in 1985 in Switzerland, have lower efficacy than those based on the Jeryl Lynn or Urabe strains. One possible explanation for a low protective efficacy of the Rubini strain may be the high number (> 30) of passages attained during its attenuation process. Vaccines prepared from various strains may differ in their capacity to cause adverse events; meningitis associated with MMR vaccine containing Urabe strains has led to the withdrawal of Urabe-containing vaccine from several countries.

A killed mumps virus vaccine that was licensed in the United States in 1948 and used from 1950 to 1978, found little acceptance because it induced only short-term immunity of low protective efficacy. Since then, live, attenuated mumps virus vaccines have been developed in Japan, the Russian Federation, Switzerland and the United States. The vaccines are scheduled for either one or two doses, the first given at 12–15 months of age and the second at 9–12 years of age. They are available as monovalent, bivalent measles-mumps (MM) vaccines and trivalent measles-mumps-rubella (MMR) vaccines. WHO requirements do not specify the minimum amount of vaccine virus that one human dose should contain. Rather, this is determined by the national control authority of the country where the vaccine is produced. Most of these vaccines contain more than 1000 cell-culture infective doses of attenuated mumps virus per dose…

The incidence of vaccine-associated cases of aseptic meningitis ranges from 0.1–1 per 100 000 doses of the Jeryl Lynn mumps vaccine.The Leningrad-3 vaccine strain developed in the former Soviet Union is propagated in guinea-pig kidney cell culture and further passaged in Japanese quail embryo culture…

Passive surveillance and retrospective reviews indicate an incidence of 20–100 cases of aseptic meningitis per 100 000 doses of MM vaccine based on the Leningrad-3 strain. The Leningrad-3 strain has been further attenuated in Croatia by adaptation to chick embryo fibroblast cell culture. The new strain designated L-Zagreb is used in Croatia,India and Slovenia. Studies of L-Zagreb in Croatia revealed protective properties equivalent to those seen with the Leningrad-3 strain and also the incidence of vaccine associated aseptic meningitis remained largely the same (2–90 per 100 000 doses of MMR). 

Live mumps vaccine based on the Urabe strain was first licensed in Japan and then in France, Belgium and Italy. The Urabe strain is produced either in the amnion of embryonated hens’ eggs or in chick embryo cell cultures…

A possible association of the Urabe strain with vaccine-induced meningitis has resulted in its withdrawal from some countries. Studies up to 1993 identified an incidence of approximately 100 cases of aseptic meningitis per 100 000 doses of MMR containing the Urabe mumps strain. However, the rates differed by manufacturer. 

The Rubini strain was first licensed in Switzerland in 1985. It was developed by passage in a human diploid cell line, serial passaging in embryonated hens’ eggs and then adapted to the MRC-5 human diploid cell line. Recent observations with the vaccine based on the Rubini strain suggest that this vaccine has lower efficacy than those based on the Jeryl Lynn or Urabe strains. A three-year study in Switzerland showed that the Rubini strain conferred only 6.3% protection whereas the Urabe and Jeryl Lynn based vaccines achieved 73.1% and 61.6% efficacy respectively.In another study the corresponding figures were 12.4%, 75.8% and 64.7%.

An explanation for these poor results may be the high number of passages (>30) resulting in an overly attenuated vaccine strain. Furthermore, the manufacturer of the Rubini strain vaccine now recommends a second dose at four to six years of age. Data on the protective efficacy of this schedule are currently not available. Attenuated mumps virus strains that are used on a limited scale only include the Hoshino, Torii and NKM-46 strains. They are reported to possess immunogenic properties similar to the Urabe strain.

An Evaluation of the Rubini, Urabe AM9, and Jeryl-Lynn Mumps Vaccines, Specifically Concerning Efficacy and Association with Aseptic Meningitis

Comparison of the Neurovirulence of a Vaccine and a Wild-Type Mumps Virus Strain in the Developing Rat Brain   Journal of Virology, October 1998, p. 8037-8042, Vol. 72, No. 10

 

The risk of aseptic meningitis associated with the Leningrad-Zagreb mumps vaccine strain following mass vaccination with measles-mumps-rubella vaccine, Rio Grande do Sul, Brazil, 1997

Abstract

Background Few data are available on the risk of aseptic meningitis following vaccination with the Leningrad-Zagreb (L-Z) strain of mumps vaccine. In 1997 the mumps vaccine was introduced into the state of Rio Grande do Sul in Brazil through mass vaccination with mumps-measles-rubella (MMR), targeting children aged 1–11 years. Five municipalities used exclusively MMR vaccine containing the L-Z strain of mumps. An outbreak of aseptic meningitis was observed shortly after the mass campaign.

Methods To estimate the risk of aseptic meningitis associated with this strain, we analysed vaccination and meningitis case surveillance data from the selected municipalities. A case of vaccine-associated aseptic meningitis was defined as one with a pleocytosis of 10–1500 leukocytes/ml and occurring within 15–35 days after vaccine receipt.

Results We estimated a risk of 2.9 cases per 10 000 doses of L-Z administered, equivalent to 1 case per 3390 doses administered. The overall risk of aseptic meningitis following the campaign was increased 12.2-fold (95% CI: 6.0–24.7) compared with the same period in 1995–1996. Following the mass campaign, the incidence of mumps declined 93% during 1998–2000.

Conclusions Vaccination with the L-Z strain of mumps vaccine as part of a mass campaign was associated with a significantly increased risk of aseptic meningitis. Decisions about type of mumps vaccine and mumps vaccination strategies must consider vaccine safety issues in addition to other criteria.

Autism Explosion Followed Big Change in MMR Shot

(By Dan Olmsted January 13, 2009)

 

 

 

In 1990, Merck & Co., manufacturer of the mumps-measles-rubella vaccine known as the MMR, made a significant but little-noticed change: It quadrupled the amount of mumps virus in the combination shot, from 5,000 to 20,000 units. Then in 2007 it reversed course, reducing the amount to 12,500 units. Neither the measles nor the rubella (German measles) component of the MMR was changed at all — each remained at 1,000 units throughout.

Merck also makes the single-component mumps shot, and in 1990 it also increased the potency of that shot by the same amount, from 5,000 to 20,000 units. But unlike the MMR shot, the standalone mumps shot’s potency was not scaled back in 2007. It remains at 20,000 units…

 

Killed Mumps Vaccine:

 

Mumps virus vaccine. (Calif Med. 1969 November; 111(5): 413–414.)

 

 

 

 

Mumps Outbreaks in Vaccinated Populations

Mumps Outbreaks in Vaccinated Populations: Are Available Mumps Vaccines Effective Enough to Prevent Outbreaks?

Clinical Infectious Diseases 2008;47:1458–1467  2008

Increased reports of mumps in vaccinated populations prompted a review of the performance of mumps vaccines. The effectiveness of prior vaccination with 1 dose of vaccine ranged from 72.8% to 91% for the Jeryl Lynn strain, from 54.4% to 93% for the Urabe strain, and from 0% to 33% for the Rubini strain. Vaccine effectiveness after 2 doses of mumps vaccine was reported in 3 outbreaks and ranged from 91% to 94.6%. There was evidence of waning immunity, which is a likely factor in mumps outbreaks, aggravated by possible antigenic differences between the vaccine strain and outbreak strains. Inadequate vaccine coverage or use of the Rubini vaccine strain accounted for the majority of outbreaks reviewed; however, some outbreaks could not be prevented, despite high vaccination coverage with 2 doses of the Jeryl Lynn vaccine strain. Our findings indicate the need for more-effective mumps vaccines and/or for review of current vaccination policies to prevent future outbreaks.

*In the US-the Mumps strain we use is the Jeryl Lynn** (B level) strain.  

Mumps Epidemiology and Immunity: The Anatomy of a Modern Epidemic

Pediatric Infectious Disease Journal. 27(10) Supplement:S75-S79, October 2008.
Anderson, Larry J. MD; Seward, Jane F. MB, BS, MPH

Abstract:
The success of the measles, mumps, and rubella 2-dose vaccination program led public health officials in 1998 to set a goal to eliminate endemic transmission of mumps virus by 2010 in the United States. The large outbreak of mumps in the spring of 2006 has led public health officials to re-evaluate this goal and to recognize that the transmission and epidemiology of mumps in highly vaccinated populations may be different than anticipated. During 2006, a total of 6584 confirmed and probable cases of mumps were reported to the Centers for Disease Control and Prevention and most of these, 5865, occurred between January 1 and July 31. The peak of the outbreak was in April and seemed to be focused on college campuses in 9 midwestern states with Iowa having the highest attack rate. College campuses with mumps outbreaks included ones with 77% to 97% of students having had 2 doses of a mumps vaccine. Diagnosing mumps proved to be problematic in vaccinated persons (ie, laboratory tests seemed to be insensitive and some apparent mumps cases had mild nonclassic illness). The outbreak demonstrated that mumps can sometimes transmit efficiently in highly vaccinated populations and the clinical and laboratory diagnosis of mumps in vaccinated persons is more difficult than in naive persons. The reason for this mumps outbreak is not clear but probably results from multiple factors contributing to an overall increase in susceptibility and/or transmission.

(C) 2008 Lippincott Williams & Wilkins, Inc.

Mumps

The skinny on Mumps.

 

  Mumps Treatment

•  Warm or cool compresses can be applied to the swollen glands to help relieve pain/tenderness  
• A diet of soft foods and lots of fluids 
• Eliminate fatty foods  
• Beta-carotene(vitamin A) helps heal mucous membranes
• Vitamin C and bioflavonoid help stimulate immune system
• Zinc-promotes healing and stimulates immune system
• Arnica or Peppermint Oil used as a rub can relieve headache
• For restlessness- Chamomile tea
• Echinacea or goldenseal combination helps to fight viruses and boost immune system. Soothes mucous membranes
• Castor Oil-soothing to swollen glands (heat but not too hot)and soak clean cotton cloth in it and apply compresses as often as needed

 

 Mumps vaccine can become a risk to men. Young male adults are at risk of Orchitis because they did not catch mumps harmlessly when children. The MMR vaccination has not been effective in conferring full or lasting immunity across an entire population.  As a result, Mumps outbreaks have been pushed into older age groups.  Mumps now circulates in colleges and universities, not only in the U.S. but the U.K. and other countries that routinely vaccinate for Mumps.

  

Mumps in Iowa 2006

 

 Of the 219 cases reported in Iowa, the median patient age was 21 years (range: 3–85 years), with 48% of patients aged 17–25 years; 30% (34 of 114) were known to be college students. Of the 133 patients with investigated vaccine history, 87 (65%) had documentation of receiving 2 doses, 19 (14%) 1 dose, and eight (6%) no doses; vaccine status could not be documented in 19 (14%) patients. Among the 114 patients for whom symptomatic information was available, the most common symptoms were parotitis in 94 (83%) patients, submaxillary/sublingual gland swelling in 46 (40%), fever in 41 (36%), and sore throat in 36 (32%); average duration of illness was 5.1 days. Six (5%) patients reported complications (e.g., orchitis); one suspected case of encephalitis is being investigated. As of March 28, 2006, investigators had determined that only 36 (16%) of the 219 cases were linked epidemiologically (i.e., a source of infection was identified), suggesting frequent unapparent transmission. 

Despite control efforts and a highly vaccinated population, this epidemic has spread across Iowa and potentially to neighboring states.

 

Maine Outbreak 2007

The Mumps vaccine may need adjusting according to researchers. Scientists at the CDC investigated the Mumps cases and found that most of them were in people who had been vaccinated. College students were especially vulnerable during the outbreaks, even though they had received two doses of the vaccine as children. Immunity from the vaccine appears to wear off over time in some patients.

Summary of Maine Mumps Data 2007-2008

 

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.   (The Journal of Infectious Diseases 2008;197:1662–1668)

 

Conclusions.  Lower levels of NA observed among persons who received MMR2 15 years ago demonstrates antibody decay over time. MMR3 vaccination of most seronegative persons marked the capacity to mount an anamnestic response.

 Most of the college students who got the mumps in a big outbreak in 2006 had received the recommended two vaccine shots, according to a study that raises questions about whether a new vaccine or another booster shot is needed.

 

Mumps Cases Stun Experts

Most students sickened in 2006 had the recommended two vaccine shots, stirring debate on possible changes.

 Nearly 6,600 people became sick with the mumps, mostly in eight Midwestern states, and the hardest-hit group was college students ages 18 to 24. Of those in that group who knew whether they had been vaccinated, 84 percent had had two mumps shots, according to the study by the Centers for Disease Control and Prevention and state health departments.

That “two-dose vaccine failure” startled public health experts, who hadn’t expected immunity to wane so soon — if at all.

The mumps virus involved was a relatively new strain in the U.S., not the one targeted by the vaccine; although there’s evidence the shots work well against the new strain.