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The mumps outbreak that wasn't

The mumps outbreak that wasn't Communicable Diseases Section, Public Health Division, Department of Human Ser vices, Victoria, and Masters of Applied Epidemiology Program, National Centre for Epidemiology and Population Health, Australian National University, ACT Jennie Leydon Victorian Infectious Diseases Reference Labor atory, Victoria Ross Andrews Communicable Diseases Section, Public Health Division, Department of Human Ser vices, Victoria Stephen Lambert Murdoch Children’s Research Institute, Royal Children’s Hospital, Victoria Since the introduction of an effective vaccine, mumps has become a rare disease. While parotitis is the most common and recognised clinical presentation of mumps, aseptic meningitis can occur in 1-10% of cases.1 In July 2001, the Victorian Department of Human Services (DHS) received 16 notifications of mumps, over three times more than expected for this time period (see Figure 1). Two notif ications were from laboratories (mumps IgM positive) and 14 were notif ied on clinical grounds. As of 1 July 2001, DHS had been conducting enhanced mumps surveillance, in conjunction with the Victorian Infectious Disease Reference Laboratory (VIDRL). Based on the Victorian model for measles surveillance,2 mumps surveillance included interview and attempted laborator y conf irmation of each case. Serum specimens were tested by VIDRL using Dade Behring’s Enzygnost Anti-Parotitis-Virus IgM [manuf acturer quoted sensitivity 95% and specificity 99.8%] and IgG [sensitivity 95.4% and specificity 93.7%] enzyme immunoassay kits. All 16 cases presented with parotitis. The other laborator y notification, aged eight years, had received a MMR vaccination five weeks prior to onset of parotitis; the detection of mumps IgM is likely to be vaccine related. We obtained serum specimens from the 14 clinical notifications 6-23 days after onset of parotitis, all were mumps IgM negative. One case, an unvaccinated adult aged 24 years, was IgM and IgG negative on paired convalescent sera taken 14 days apart. The other 13 cases were all mumps IgG positive, indicating that they had immunity to mumps. Of these 13, 10 were children aged 1-10 y ears who had received at least one MMR vaccination and three were adults aged 40-55 years who had not been vaccinated. Although all cases presented with parotitis, laborator y testing demonstrated that none of the 14 clinically diagnosed cases were mumps and that the increase in notifications during July was not an outbreak. We have not established a differential diagnosis for these cases but other infectious causes of parotitis include EpsteinBarr, parainfluenza, coxsackie, and influenza A viruses.1,3 Similar results have been found in the United Kingdom (only 3% of mumps notifications laboratory confirmed)4 and Texas (14% of mumps notifications laboratory confirmed).5 The critical point is that, in the vaccine era, parotitis may not be a good clinical indicator of mumps infection. This reinforces the importance of laboratory confirmation whenever a mumps diagnosis is suspected. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australian and New Zealand Journal of Public Health Wiley

The mumps outbreak that wasn't

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References (10)

Publisher
Wiley
Copyright
Copyright © 2002 Wiley Subscription Services
ISSN
1326-0200
eISSN
1753-6405
DOI
10.1111/j.1467-842X.2002.tb00914.x
Publisher site
See Article on Publisher Site

Abstract

Communicable Diseases Section, Public Health Division, Department of Human Ser vices, Victoria, and Masters of Applied Epidemiology Program, National Centre for Epidemiology and Population Health, Australian National University, ACT Jennie Leydon Victorian Infectious Diseases Reference Labor atory, Victoria Ross Andrews Communicable Diseases Section, Public Health Division, Department of Human Ser vices, Victoria Stephen Lambert Murdoch Children’s Research Institute, Royal Children’s Hospital, Victoria Since the introduction of an effective vaccine, mumps has become a rare disease. While parotitis is the most common and recognised clinical presentation of mumps, aseptic meningitis can occur in 1-10% of cases.1 In July 2001, the Victorian Department of Human Services (DHS) received 16 notifications of mumps, over three times more than expected for this time period (see Figure 1). Two notif ications were from laboratories (mumps IgM positive) and 14 were notif ied on clinical grounds. As of 1 July 2001, DHS had been conducting enhanced mumps surveillance, in conjunction with the Victorian Infectious Disease Reference Laboratory (VIDRL). Based on the Victorian model for measles surveillance,2 mumps surveillance included interview and attempted laborator y conf irmation of each case. Serum specimens were tested by VIDRL using Dade Behring’s Enzygnost Anti-Parotitis-Virus IgM [manuf acturer quoted sensitivity 95% and specificity 99.8%] and IgG [sensitivity 95.4% and specificity 93.7%] enzyme immunoassay kits. All 16 cases presented with parotitis. The other laborator y notification, aged eight years, had received a MMR vaccination five weeks prior to onset of parotitis; the detection of mumps IgM is likely to be vaccine related. We obtained serum specimens from the 14 clinical notifications 6-23 days after onset of parotitis, all were mumps IgM negative. One case, an unvaccinated adult aged 24 years, was IgM and IgG negative on paired convalescent sera taken 14 days apart. The other 13 cases were all mumps IgG positive, indicating that they had immunity to mumps. Of these 13, 10 were children aged 1-10 y ears who had received at least one MMR vaccination and three were adults aged 40-55 years who had not been vaccinated. Although all cases presented with parotitis, laborator y testing demonstrated that none of the 14 clinically diagnosed cases were mumps and that the increase in notifications during July was not an outbreak. We have not established a differential diagnosis for these cases but other infectious causes of parotitis include EpsteinBarr, parainfluenza, coxsackie, and influenza A viruses.1,3 Similar results have been found in the United Kingdom (only 3% of mumps notifications laboratory confirmed)4 and Texas (14% of mumps notifications laboratory confirmed).5 The critical point is that, in the vaccine era, parotitis may not be a good clinical indicator of mumps infection. This reinforces the importance of laboratory confirmation whenever a mumps diagnosis is suspected.

Journal

Australian and New Zealand Journal of Public Health – Wiley

Published: Jan 1, 2002

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