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N Engl J Med. Mumps Outbreak in Orthodox Jewish Communities in the United States
[Source: The New England Journal of Medicine, full text: (LINK). Abstract, edited.]
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Original Article
Mumps Outbreak in Orthodox Jewish Communities in the United States
Albert E. Barskey, M.P.H., Cynthia Schulte, R.N., B.S.N., Jennifer B. Rosen, M.D., Elizabeth F. Handschur, M.P.H., Elizabeth Rausch-Phung, M.D., M.P.H., Margaret K. Doll, M.P.H., Kisha P. Cummings, M.P.H., E. Oscar Alleyne, Dr.P.H., Patricia High, M.H.S., Jacqueline Lawler, M.P.H., Andria Apostolou, Ph.D., M.P.H., Debra Blog, M.D., M.P.H., Christopher M. Zimmerman, M.D., M.P.H., Barbara Montana, M.D., M.P.H., Rafael Harpaz, M.D., Carole J. Hickman, Ph.D., Paul A. Rota, Ph.D., Jennifer S. Rota, M.P.H., William J. Bellini, Ph.D., and Kathleen M. Gallagher, D.Sc., M.P.H.
N Engl J Med 2012; 367:1704-1713November 1, 2012DOI: 10.1056/NEJMoa1202865
Background
By 2005, vaccination had reduced the annual incidence of mumps in the United States by more than 99%, with few outbreaks reported. However, in 2006, a large outbreak occurred among highly vaccinated populations in the United States, and similar outbreaks have been reported worldwide. The outbreak described in this report occurred among U.S. Orthodox Jewish communities during 2009 and 2010.
Methods
Cases of salivary-gland swelling and other symptoms clinically compatible with mumps were investigated, and demographic, clinical, laboratory, and vaccination data were evaluated.
Results
From June 28, 2009, through June 27, 2010, a total of 3502 outbreak-related cases of mumps were reported in New York City, two upstate New York counties, and one New Jersey county. Of the 1648 cases for which clinical specimens were available, 50% were laboratory-confirmed. Orthodox Jewish persons accounted for 97% of case patients. Adolescents 13 to 17 years of age (27% of all patients) and males (78% of patients in that age group) were disproportionately affected. Among case patients 13 to 17 years of age with documented vaccination status, 89% had previously received two doses of a mumps-containing vaccine, and 8% had received one dose. Transmission was focused within Jewish schools for boys, where students spend many hours daily in intense, face-to-face interaction. Orchitis was the most common complication (120 cases, 7% of male patients ≥12 years of age), with rates significantly higher among unvaccinated persons than among persons who had received two doses of vaccine.
Conclusions
The epidemiologic features of this outbreak suggest that intense exposures, particularly among boys in schools, facilitated transmission and overcame vaccine-induced protection in these patients. High rates of two-dose coverage reduced the severity of the disease and the transmission to persons in settings of less intense exposure.
The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention, Department of Health and Human Services.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
Source Information
From the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases (A.E.B., R.H., C.J.H., P.A.R., J.S.R., W.J.B., K.M.G.), and the Epidemic Intelligence Service, Scientific Education and Professional Development Program Office (A.A.), Centers for Disease Control and Prevention, Atlanta; New York State Department of Health, Albany (C.S., E.R.-P., D.B.), New York City Department of Health and Mental Hygiene, New York (J.B.R., M.K.D., K.P.C., C.M.Z.), Rockland County Department of Health, Pomona (E.O.A.), and Orange County Health Department, Goshen (J.L.) ? all in New York; and New Jersey Department of Health and Senior Services, Trenton (E.F.H., B.M.), and Ocean County Health Department, Toms River (P.H.) ? both in New Jersey.
Address reprint requests to Mr. Barskey at the Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Mailstop A-34, Atlanta, GA 30333, or at abarskey@cdc.gov.
-Mumps Outbreak in Orthodox Jewish Communities in the United States
Albert E. Barskey, M.P.H., Cynthia Schulte, R.N., B.S.N., Jennifer B. Rosen, M.D., Elizabeth F. Handschur, M.P.H., Elizabeth Rausch-Phung, M.D., M.P.H., Margaret K. Doll, M.P.H., Kisha P. Cummings, M.P.H., E. Oscar Alleyne, Dr.P.H., Patricia High, M.H.S., Jacqueline Lawler, M.P.H., Andria Apostolou, Ph.D., M.P.H., Debra Blog, M.D., M.P.H., Christopher M. Zimmerman, M.D., M.P.H., Barbara Montana, M.D., M.P.H., Rafael Harpaz, M.D., Carole J. Hickman, Ph.D., Paul A. Rota, Ph.D., Jennifer S. Rota, M.P.H., William J. Bellini, Ph.D., and Kathleen M. Gallagher, D.Sc., M.P.H.
N Engl J Med 2012; 367:1704-1713November 1, 2012DOI: 10.1056/NEJMoa1202865
Background
By 2005, vaccination had reduced the annual incidence of mumps in the United States by more than 99%, with few outbreaks reported. However, in 2006, a large outbreak occurred among highly vaccinated populations in the United States, and similar outbreaks have been reported worldwide. The outbreak described in this report occurred among U.S. Orthodox Jewish communities during 2009 and 2010.
Methods
Cases of salivary-gland swelling and other symptoms clinically compatible with mumps were investigated, and demographic, clinical, laboratory, and vaccination data were evaluated.
Results
From June 28, 2009, through June 27, 2010, a total of 3502 outbreak-related cases of mumps were reported in New York City, two upstate New York counties, and one New Jersey county. Of the 1648 cases for which clinical specimens were available, 50% were laboratory-confirmed. Orthodox Jewish persons accounted for 97% of case patients. Adolescents 13 to 17 years of age (27% of all patients) and males (78% of patients in that age group) were disproportionately affected. Among case patients 13 to 17 years of age with documented vaccination status, 89% had previously received two doses of a mumps-containing vaccine, and 8% had received one dose. Transmission was focused within Jewish schools for boys, where students spend many hours daily in intense, face-to-face interaction. Orchitis was the most common complication (120 cases, 7% of male patients ≥12 years of age), with rates significantly higher among unvaccinated persons than among persons who had received two doses of vaccine.
Conclusions
The epidemiologic features of this outbreak suggest that intense exposures, particularly among boys in schools, facilitated transmission and overcame vaccine-induced protection in these patients. High rates of two-dose coverage reduced the severity of the disease and the transmission to persons in settings of less intense exposure.
The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention, Department of Health and Human Services.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
Source Information
From the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases (A.E.B., R.H., C.J.H., P.A.R., J.S.R., W.J.B., K.M.G.), and the Epidemic Intelligence Service, Scientific Education and Professional Development Program Office (A.A.), Centers for Disease Control and Prevention, Atlanta; New York State Department of Health, Albany (C.S., E.R.-P., D.B.), New York City Department of Health and Mental Hygiene, New York (J.B.R., M.K.D., K.P.C., C.M.Z.), Rockland County Department of Health, Pomona (E.O.A.), and Orange County Health Department, Goshen (J.L.) ? all in New York; and New Jersey Department of Health and Senior Services, Trenton (E.F.H., B.M.), and Ocean County Health Department, Toms River (P.H.) ? both in New Jersey.
Address reprint requests to Mr. Barskey at the Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Mailstop A-34, Atlanta, GA 30333, or at abarskey@cdc.gov.
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