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Two successive outbreaks of mumps in Nova Scotia among vaccinated adolescents and young adults

From Nova Scotia Health Promotion and Protection (Watson-Creed, Saunders, Scott), the Departments of Community Health and Epidemiology (Watson-Creed, Scott), Pediatrics (Scott) and Pathology (Hatchette), Dalhousie University, and the Department of Pathology and Laboratory Medicine (Pettipas, Hatchette), QEII Health Science Centre, Halifax, NS; the Canadian Field Epidemiology Program (Saunders), Public Health Agency of Canada, Ottawa, Ont.; and the Respiratory and Enteric Virus Branch (Lowe), Centers for Disease Control and Prevention, Atlanta, Ga.

Correspondence to: Dr. Gaynor Barbara Watson-Creed, Public Health Services, 201 Brownlow Ave., Unit 4, Dartmouth NS B3B 1W2; fax 902 481-5803; gaynor.watson-creed{at}cdha.nshealth.ca

Background: Before the widespread use of vaccine, mumps was the most common cause of viral meningitis (up to 10% of mumps infections). Vaccination programs have resulted in a drop of more than 99% in the number of reported mumps cases in the United States and Canada. Although rare in Canada, outbreaks have recently occurred throughout the world, including a large outbreak in the United Kingdom, where more than 56 000 cases were reported in 2004–2005.

Methods: Two recent outbreaks in Nova Scotia were investigated by public health officials. Cases were defined by laboratory confirmation of infection (i.e., isolation of mumps virus by culture) or clinical diagnosis in people epidemiologically linked to a laboratory-confirmed case. The people infected were interviewed to determine possible links and to identify contacts. Mumps virus was cultured from urine and throat specimens, identified via reverse-transcriptase polymerase chain reaction (RT-PCR) and subjected to phylogenetic analysis to identify the origin of the strain.

Results: The first outbreak involved 13 high-school students (median age 14 yr): 9 who had previously received 2 doses of measles–mumps–rubella vaccine (MMR) and 4 who received a single dose. The second outbreak comprised 19 cases of mumps among students and some staff at a local university (median age 23 yr), of whom 18 had received only 1 dose of MMR (the other received a second dose). The viruses identified in the outbreaks were phylogenetically similar and belonged to a genotype commonly reported in the UK. The virus from the second outbreak is identical to the strain currently circulating in the UK and United States.

Interpretation: The predominance in these outbreaks of infected people of university age not only highlights an environment with potential for increased transmission but also raises questions about the efficacy of the MMR vaccine. The people affected may represent a "lost cohort" who do not have immunity from natural mumps infection and were not offered a 2-dose schedule. Given the current level of mumps activity around the world, clinicians should remain vigilant for symptoms of mumps.

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