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Mumps in the U.S.: Elimination by 2010?

The largest outbreak of mumps in 2 decades has made us reexamine vaccination strategies.

One objective of the Healthy People 2010 initiative is eliminating indigenous cases of mumps in the U.S. Until 2006, this goal appeared to be achievable: Fewer than 350 cases were reported annually from 2000 through 2005. Unfortunately, an outbreak that began on college campuses in Iowa in January 2006 heralded a resurgence of the illness (Journal Watch Infectious Diseases Apr 21 2006).

In part to determine whether elimination of mumps is possible with the current two-dose childhood-vaccination strategy, researchers examined the epidemiology of the 2006 mumps outbreak. The analysis included all cases that were reported to the National Notifiable Diseases Surveillance System and met the standard case definition for the illness. Vaccine-coverage data were derived from nationwide surveys.

A total of 6584 cases of mumps were reported in 2006, with no mumps-related deaths. By April, the outbreak had peaked. Eighty-five percent of the cases occurred in eight contiguous midwestern states. No large outbreaks were reported in primary or secondary schools. Among patients for whom data were available, 29% were aged 18 to 24. (In this age group, mumps incidence was 3.7 times as high as the rate for all other age groups combined.) Eighty-three percent were currently attending college, and 63% had received two or more doses of mumps vaccine.

Comment: Numerous factors may have contributed to this resurgence, including increased exposure in crowded college dormitories, waning immunity, or partial immunity to wild-type virus. We now have startling evidence that immunity to mumps is not optimal in the U.S. This situation, coupled with the fact that 43% of the world’s countries do not vaccinate against mumps, makes me wonder whether eliminating mumps in this country by 2010 is a realistic goal. Vaccination policy must be based on many factors and, once established, must remain modifiable.

— Larry M. Baddour, MD

Published in Journal Watch Infectious Diseases April 9, 2008

Citation(s):

Dayan GH et al. Recent resurgence of mumps in the United States. N Engl J Med 2008 Apr 10; 358:1580.

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