Mumps outbreak in the Federation of Bosnia and Herzegovina with large cohorts of susceptibles and genetically diverse strains of genotype G, Bosnia and Herzegovina, December 2010 to September 2012

Abstract

A mumps outbreak reported from the Federation of Bosnia and Herzegovina involved 7,895 cases between December 2010 and September 2012. This was the largest outbreak in the country since the introduction of the measles, mumps and rubella vaccine in 1980. The highest disease incidence was found among 15 to 19 year-olds. About 39% (3,050/7,895) of cases reported to be unvaccinated; the vaccination status of 31% (2,426/7,895) was unknown. A seroprevalence study among 150 asymptomatic contacts to mumps cases showed that about one third (45/150) were susceptible to mumps. Among 105 clinically suspected mumps patients hospitalised at the Clinical Centre of the University of Sarajevo, orchitis (60% of all males: 51/85) and meningitis (9%: 9/105) were the most common complications. Among 57 outbreak sequences obtained for the small hydrophobic gene, eight different variants of genotype G viruses were identified. The outbreak affected mainly age groups comprising individuals who were not vaccinated during or after the Bosnian war, as well as cantons with single dose immunisation policies until 2001. In addition to issues related to vaccination of individuals, differential responses to vaccines and vaccine strains, waning of antibodies and potentially also the genetically diverse variants of genotype G may have compounded the size and duration of the outbreak. Our report emphasizes the need for supplementary immunisation programmes in particular for adolescents and young adults.

An ongoing measles outbreak in the Federation of Bosnia and Herzegovina, 2014 to 2015

“…However, this was not achieved in the EU [5], and, similarly, FB&H has accumulated [1992][1993][1994][1995] and in the post-war period (1996-1998) left a considerable number of children susceptible to measles, as well as mumps and rubella [7,8].…”

A Mumps Outbreak in Vojvodina, Serbia, in 2012 Underlines the Need for Additional Vaccination Opportunities for Young Adults

“…The outbreak started with two mumps cases registered in Novi Sad, Serbia on 16 th January 2012 among students who had spent the Christmas and New Year holidays in Bosnia and Herzegovina, where a large outbreak of mumps was ongoing at that time [ 7 , 8 ]. The week after, another 15 cases who had spent their holidays in Bosnia and Herzegovina were notified.…”

“…For MuV detection a Real-time PCR was done using a Qiagen one-step RT-PCR kit (Hilden, Germany) and primers and probes provided by the Statens Institute, Denmark (MP1- f: 5'- CATAGGRGAYATGTGGGGACCAACCATT-3’; MP2 –r: 5'- GTCTTCGCCAACGATGGTGATGATTG-3’; MP probe: 5'-FAM-CCATGCAGGCGGTCACATTCCRACAACTGC-TAMRA-3’, Nielsen LP, Department of Microbiological Diagnostics and Virology, 2009, unpublished). PCR amplification of the SH gene region, sequencing, genotype determination and phylogenetic analysis were done at the WHO European Regional Reference Laboratory for Measles and Rubella in Luxembourg as described before [ 7 ]. The sequences are available under European Nucleotide Archive (ENA) accession numbers LN680922-9.…”

Impact of immunization on epidemiology of vaccine-preventable diseases in the Federation of Bosnia and Herzegovina

“…The key issues to be considered before deciding to introduce a vaccine can be grouped into three areas: first area relates to the disease that the vaccine in question targets, second area to the vaccine, and third area to the capacity of the immunization program and underlying health system (16). Disease is considered to be serious for individual if: it can cause death, serious complications or permanent invalidity, and diagnosis and appropriate treatment do not provide adequate scope for control of disease (17).…”