Effectiveness of Mumps Vaccine in a School Outbreak

Sullivan, Kevin M.; Halpin, Thomas J.; Marks, James S.; Kim-Farley, Robert

doi:10.1001/archpedi.1985.02140110063030

Cited by 22 publications

(13 citation statements)

References 12 publications

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“…Although some studies did not find an association between time since vaccination and increased risk of disease [11,12,14,16], other studies conducted in the United States [15,17,19] found persons vaccinated 15 years before the outbreak to be at higher risk of developing disease than persons vaccinated р5 years before the outbreak, suggestive of waning immunity. In a recent study conducted at a university in Kansas during an outbreak in 2006, case patients were more likely than their roommates without mumps to have been last vaccinated with the second dose у10 years earlier [10].…”

Section: Resultsmentioning

confidence: 99%

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

2008

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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.

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Section: Resultsmentioning

confidence: 99%

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

2008

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“…Experience obtained from outbreaks (figure 1) suggests that vaccine effectiveness is lower than one would expect from the findings of serological studies (which are unreliable) or controlled efficacy trials (of which there are only a few). Waning immunity has not been deemed to be important [14,15,85,86], but outbreaks in highly vaccinated populations [1,2,[14][15][16][18][19][20] warrant some rethinking. Also, modeling of the serological information [19,27] supports the view that waning immunity is an issue.…”

Section: Discussionmentioning

confidence: 99%

Mumps Outbreaks in Canada and the United States: Time for New Thinking on Mumps Vaccines

Peltola

Kulkarni

Kapre

et al. 2007

Clinical Infectious Diseases

133

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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 approximately 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.

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“…While mumps vaccination attempts to emulate immune responses to natural infection without producing the serious consequences of wild-type disease, occasionally problems have arisen with inadequate induction of antibody directed against neutralizing epitopes (primary vaccine failure) and/or waning immunity (secondary vaccine failure) (2,4,5,9,25,33). Accordingly, studies have shown that immunization results in lower levels of neutralizing antibody than can be seen following natural mumps virus infection (1,6,26,29,32). Notably, most mumps serological evaluations utilizing the EIA technique have been performed subsequent to the institution of widespread mumps vaccination; thus, little is known about the performance of EIA-measured mumps serology in the setting of wild-type infection and serological response and about the correlation of EIA mumps serology titers and protection from mumps.…”

mentioning

confidence: 99%

Mumps Virus-Specific Antibody Titers from Pre-Vaccine Era Sera: Comparison of the Plaque Reduction Neutralization Assay and Enzyme Immunoassays

et al. 2005

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Mumps virus-neutralizing antibodies are believed to be the most predictable surrogate marker of protective immunity. However, assays used to detect neutralizing antibodies, such as the plaque reduction neutralization (PRN) assay, are labor-and time-intensive and consequently are often supplanted by the more rapid and inexpensive enzyme immunoassay (EIA) technique. For virus infections for which international antibody standards exist and are bridged to clinical studies of protection (e.g., measles and rubella), the EIA has been successfully used to determine immune surrogate endpoints, yet no such international reference exists for mumps serology. Since both virus-neutralizing and nonneutralizing antibodies are measured in the EIA, in the absence of a mumps serological standard, the EIA may be prone to yielding false-positive results when utilized for assessing surrogate markers of protective immunity. Moreover, since mumps virus-specific antibody titers are generally low in comparison to antibody levels induced by other viruses and EIA procedures often employ relatively high serum dilution factors, the EIA may be prone to yielding false-negative results. To examine these issues, a PRN assay and two commercially available EIA kits were used to evaluate wild-type mumps virus serological responses in human serum samples from the pre-mumps vaccine era. Our results indicate that the PRN assay is a more sensitive and specific method of measuring serological responses to wild-type mumps virus.Protective efficacy field studies have shown that mumps virus-neutralizing antibody titers as low as 1:2 provide protection against mumps (10, 30-32). Accordingly, virus neutralization assays, such as the plaque reduction neutralization (PRN) assay, have long been the "gold standard" in determining the presence of protective immunity against mumps virus infection (3, 24, 32). The PRN assay measures the serum dilution (titer) capable of preventing 50% of plaque formation by mumps virus in cell cultures. Although virus neutralization assays may be the most predictive technique for assessing protective immunity, these assays are often not standardized and are extremely skilled labor-and time-intensive, making examining large numbers of human sera by PRN assay difficult. In contrast, the enzyme immunoassay (EIA) technique is simpler to perform and provides rapid, quantitative results and, thus, is the most widely used technique in clinical serology testing. However, since the EIA does not distinguish neutralizing from nonneutralizing antibodies, this assay may be prone to yielding false-positive results in the context of assessing protective immunity. In many cases, e.g., measles and rubella serology, an international standard referenced to a protective serum titer is used within the context of the EIA to provide a reasonable immune surrogate marker of protection. No such mumps standard exists. Further, since mumps virus-neutralizing antibody titers are often low (less than or equal to 1:8) and EIA procedures require initial serum dil...

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Effectiveness of Mumps Vaccine in a School Outbreak

Cited by 22 publications

References 12 publications

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

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

Mumps Outbreaks in Canada and the United States: Time for New Thinking on Mumps Vaccines

Mumps Virus-Specific Antibody Titers from Pre-Vaccine Era Sera: Comparison of the Plaque Reduction Neutralization Assay and Enzyme Immunoassays

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