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Mumps Shots Didn't Fully Protect in 2006

Shiloh

Editor, Senior Moderator
Source: http://ap.google.com/article/ALeqM5i9zqPDN01X4grvcRvbsrvQG-qv6gD8VUJ0480

Mumps Shots Didn't Fully Protect in 2006

By LINDA A. JOHNSON ? 1 hour ago

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. The outbreak was the biggest in the U.S. since shortly before states began requiring a second shot for youngsters in 1990.

Nearly 6,600 people became sick with the mumps, mostly in eight Midwest 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 from outbreaks elsewhere the shots work well against the new strain.

The researchers, reporting in Thursday's New England Journal of Medicine, note the virus likely came from travelers or students from the United Kingdom, where mumps shots are voluntary and there was a much larger mumps outbreak of the same strain. Many countries don't vaccinate against mumps, so future cases brought from overseas are likely.

"If there's another outbreak, we would evaluate the potential benefit of a third dose to control the outbreak," said researcher Dr. Jane Seward, deputy director of the CDC's viral diseases division.

Mumps is spread by respiratory secretions and saliva among people in close contact, making college students particularly susceptible. Students' sharing of drinks and utensils, and sexual activity, probably increased their exposure.

Mumps causes fever and swollen salivary glands in the cheeks. Before the vaccine, complications such as deafness, viral meningitis and testicle inflammation, which can cause sterility, were common and there were a couple million U.S. cases a year.

The only U.S. vaccine, made by Whitehouse Station, N.J.-based Merck & Co., hasn't been changed since its introduction in 1967 and there are no plans to change it, said Barbara Kuter, Merck's executive director of pediatric affairs.

Over 500 million doses have been sold since the 1970s, when it was put in the combination measles-mumps-rubella shot.

Dr. John Bradley, a member of the American Academy of Pediatrics committee on infectious diseases, said his group is talking about possible changes to the vaccine recommendations schedule with CDC and other health agencies.

Now two shots are recommended, one at 12 to 15 months and the other at age 4 to 6.

It might not be cost effective to give everyone a third shot, but it should be considered for college students, said Dr. Stephen Marcella, an epidemiologist at University of Medicine and Dentistry of New Jersey's School of Public Health.

Dr. William Schaffner, head of preventive medicine at Vanderbilt University School of Medicine, said what's need is a longer-lasting shot.

"It's clear that over time, immunity wanes somewhat," he said. "We need a better vaccine."

Seward said other CDC studies on the 2006 outbreak found two mumps shots protected about 85 percent of people from the new strain ? not quite enough to prevent spread even with the nearly 90 percent vaccination rate at the time.

The outbreak was in Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, South Dakota and Wisconsin.
On the Net:

* American Academy of Pediatrics: http://www.aap.org
* CDC: http://www.cdc.gov/vaccines/default.htm
 
Re: Mumps Shots Didn't Fully Protect in 2006

Source: http://health.usnews.com/usnews/hea...outbreak-in-midwest-could-have-been-worse.htm

Mumps Outbreak in Midwest Could Have Been Worse
Study says high vaccination rates kept 2006 episode under control
By Steven Reinberg
Posted 4/9/08

WEDNESDAY, April 9 (HealthDay News) -- In 2006, the largest U.S. outbreak of mumps in 20 years swept across eight Midwestern states, but a new study claims things could have been much worse.

The scope of outbreak was limited, because the number of people in the United States who have been vaccinated against mumps is very high, explained study co-author Amy A. Parker, from the U.S. Centers for Disease Control and Prevention.

There were total of 6,584 cases scattered across Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, South Dakota and Wisconsin. Eighty-five people were hospitalized, but fortunately there were no deaths. However, 11 people lost their hearing and 22 developed meningitis, according to the report in the April 10 issue of the New England Journal of Medicine.

"The outbreak affected mostly college-age students who had two doses of the mumps vaccine," Parker said. "If that vaccination coverage drops, and a case of mumps is imported, then the spread can occur like wildfire."

Currently, mumps is not well-controlled around the world, Parker noted. "At the time of this outbreak, the United Kingdom was having an outbreak, and they saw over 70,000 cases of mumps," she said. "Most of these cases were among people who were not vaccinated."

In the United States, the mumps vaccine is part of the combination vaccine that includes mumps, measles and rubella (MMR). The vaccination rate against mumps in this country is robust: About 87 percent of adolescents have had two doses of the mumps vaccine, and more than 90 percent of 1-year-olds have had one dose.

"So, even though our outbreak was large, it wasn't of the same proportion as the one in the U.K.," Parker said.

She noted that the strain of mumps in the United Kingdom was identical to the one that spread across the United States. "It's likely this was the source, because the strains matched," she said.

Since the 2006 outbreak, there hasn't been another of the same proportion in the United States, Parker added.

However, the CDC has set a goal of eliminating mumps in the United States by 2010. Although the current vaccine was able to limit the scope of the outbreak, it is only 90 percent effective after two doses, Parker said. "So, even if you had a 100 percent vaccination rate, you would still have 10 out of every 100 people susceptible to mumps," she explained.

To protect people from future outbreaks and reach the 2010 goal, Parker thinks changes in the vaccine to make it more effective or booster shots to preserve immunity should be considered.

One expert thinks the having children vaccinated against mumps is the best way to prevent future outbreaks.

"Since the mumps vaccine was introduced in 1967, there was a dramatic decline in the incidence of mumps not only in our country but in many other countries," said Dr. Paul A. Offit, director of the Vaccine Education Center and chief of infectious diseases at Children's Hospital of Philadelphia.

Offit agrees that the high rate of vaccination kept the outbreak small, and he doesn't expect to see a similar outbreak anytime soon. But he recommends that children get the full two doses of the MMR vaccine.

However, Offit doesn't think the 2006 outbreak is reason enough to change the current two-shot vaccine policy. "It's been two years since the outbreak, and there hasn't been a similar outbreak. So, I don't think any changes in vaccine policy need to be made at this time, because it will be based on a single outbreak," he said.

But not getting vaccinated at all is taking a risk, Offit said. "The choice not to get vaccinated is not a risk-free choice. It's just a choice to take a different risk," he said. "I think the choice not to get a vaccine for a child is a bad one. Mumps is not a benign disease."

While mumps in children is usually mild, complications can include loss of hearing, meningitis and encephalitis, which can be fatal. In adult men, mumps can result in sterility.

More information

For more on mumps, visit the U.S. Centers for Disease Control and Prevention.
 
Re: Mumps Shots Didn't Fully Protect in 2006

"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 from outbreaks elsewhere the shots work well against the new strain."

The above statement is contradictory.

Furthermore, the 'startled' experts are about to have a rude awakening.

This is just one of many similar 'tried and true vaccine failures'.

1. Get used to them; you can expect them to occur frequently in the target subpopulation (teens/young adults).

2. Please disabuse yourselves of the notion that 'a foreign strain' that is "suddenly" vaccine resistant is being imported. Its already endemic.

3. More is NOT better, vaccine wise. Either the vaccine works, or it doesn't. You experts have seen this one coming for several years and that is why you began to recommend two doses over one. Now two won't 'do', so a third is needed.

Clue: the age bracket of those affected aren't the youngsters whose vaccine-paranoid parents have kept their kiddies from being vaccinated.
 
Re: Mumps Shots Didn't Fully Protect in 2006

Contradictory text indeed:

1./2. A new strain involved for which the vaccine is not matched, no matter how many doses - than the vaccination rate is not important

3./4. If the shot works well elsewhere targeting the new strain, than the vaccine from elsewhere is well matched, from US is not the same vaccine.
a) than the problem is not the right vaccine, or the numeric quantity of the vacc. doses
b) than the vaccination rate is important
c) the countries where vaccination is not mandatory, or not existent, are the bigger spreaders because of what the other countries must inserted an 100% mandatory vaccination policy to the hardest hitted groups.

Maybe to insert yellow passports with wroted immunizations of the airplain passengers coming from the countries with the illness ... (another Heat.2)

From the above text, if the strain is new, but the vaccine is well matched elsewhere, then must be aplicated that vaccine, instead of raising the number of "old" vaccine doses, and at the same time insert input airport med. screening for the teenager group, or their med. travel certificates.

Excerpts:
"1 - "the new strainnot quite enough to prevent spread even with the nearly 90 percent vaccination rate at the time"

2 - "The mumps virus involved was a relatively new strain in the U.S., not the one targeted by the vaccine",

3 - "although there's evidence from outbreaks elsewhere the shots work well against the new strain."

4 - "the United Kingdom, where mumps shots are voluntary and there was a much larger mumps outbreak of the same strain. Many countries don't vaccinate against mumps, so future cases brought from overseas are likely.""
 
Re: Mumps Shots Didn't Fully Protect in 2006

Mumps Outbreaks in Canada and the United States: Time for New Thinking on Mumps Vaccines. Clinical Infectious Diseases 2007;45:459–466.

Mumps epidemics in Canada and the United States prompted us to review evidence for the effectiveness of 5 different vaccine strains. Early trials with the Jeryl Lynn vaccine strain demonstrated an efficacy of 95%, but in epidemic conditions, the effectiveness has been as low as 62%; this is still considerably better than the effectiveness of another safe strain, Rubini (which has an effectiveness of close to 0% in epidemic conditions). The Urabe vaccine strain has an effectiveness of 54%–87% but is prone to cause aseptic meningitis. Little epidemiological information is available for other vaccines. The Leningrad-Zagreb vaccine strain, which is widely used in developing countries and costs a fraction of what vaccines cost in the developed world, seems to have encouraging results; in 1 study, the effectiveness of this vaccine exceeded 95%. Aseptic meningitis has also been reported in association with this vaccine, but the benign nature of the associated meningitis was shown recently in Croatia. Also, the Leningrad-3 strain seems to be effective but causes less-benign meningitis. No mumps vaccine equals the best vaccines in quality, but the virtually complete safety of some strains may not offset their low effectiveness. Epidemiological data are pivotal in mumps, because serological testing is subject to many interpretation problems.

http://www.journals.uchicago.edu/doi/abs/10.1086/520028


The Duration of Mumps Virus Shedding after the Onset of Symptoms.
Clinical Infectious Diseases 2008;46:1447–1449.

To determine how long people shed virus after the onset of mumps, we used logistic regression modeling to analyze data from the 2006 outbreak of mumps in Iowa. Our model establishes that the probability of mumps virus shedding decreases rapidly after the onset of symptoms. However, we estimate that 8%–15% of patients will still be shedding the virus 5 days after the onset of symptoms and, thus, may still be contagious during this period.
 
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