BMJ  2005;330:1119-1120 (14 May), doi:10.1136/bmj.330.7500.1119

Paper

Mumps outbreaks across England and Wales in 2004: observational study

¹ Immunisation Department, Communicable Disease Surveillance Centre, Health Protection Agency, Centre for Infections, London NW9 5EQ, ² Enteric Respiratory and Neurological Virus Laboratory, Health Protection Agency, Centre for Infections

Introduction

In October 1988, routine immunisation against mumps was introduced in the United Kingdom as a combined measles, mumps, and rubella (MMR) vaccine for children aged 12-15 months. Although the incidence of mumps declined quickly, mathematical modelling supported the introduction of a second dose of MMR in 1996.¹ In 1999, numbers of cases of mumps in teenagers in England and Wales began to rise. We report a further increase in the incidence of mumps in 2004.

Participants, methods, and results

Notifications of clinically diagnosed and laboratory confirmed mumps cases are collated for England and Wales by the Health Protection Agency Centre for Infections. Confirmed cases include those obtained by routine follow-up of all notified cases where IgM is detected in oral fluid.

In 2004, the number of mumps notifications in England and Wales increased to 16 436 from 4204 in 2003. A total of 8104 cases of mumps were confirmed in 2004, compared with a total of 3907 cases in the previous five years. All regions reported more cases in 2004 than in 2003. Cases were predominantly in older teenagers and young adults born before 1987 (figure), and most were in those born between 1983 and 1986. Many of this group are currently at tertiary level education institutions and are associated with outbreaks in universities and colleges across England and Wales. Outbreaks in the same birth cohorts have also been reported in military establishments and prisons.² Only 2.4% (197/8104) of confirmed cases in 2004 occurred in children who would have been offered two doses routinely—that is, those born between 1993 and 1999 (figure); only 29 of these had documented receipt of two doses of MMR. Only 62 cases (0.8%) have been confirmed in children born after 1999.

View larger version (38K): [in this window] [in a new window]   Confirmed cases of mumps in 2004 by year of birth (1970-2001) per 100 000 population and opportunity for MMR vaccination (excludes 105 cases of unknown birth year, 351 born in 1914-69, and 30 born after 2001)

 

Comment

During 2004, numbers of notifications and confirmed cases of mumps increased dramatically in all regions across England and Wales, after several years of moderately increased incidence. Most cases are in young adults born before 1988, who would not have been routinely scheduled for MMR during childhood. The highest attack rate was in those born between 1983 and 1986, who were too old to be offered MMR vaccination routinely when it was introduced in 1988, although some may have received one dose of MMR as part of a catch-up programme offered at school entry.³ These individuals would have missed the opportunity for mumps exposure during childhood because high coverage in younger children had reduced circulation of mumps in the UK. Older individuals are more likely to have had mumps when it was still a common childhood infection. The absence of cases in children in younger cohorts, including those affected by the fall in MMR coverage since 1995,⁴ confirms the effectiveness of the current vaccination policy.

What is already known about this topic The incidence of mumps fell after the MMR was introduced in 1988 The number of confirmed mumps cases in 2004 has risen across England and Wales, with a number of reported outbreaks in universities What this study adds The current mumps outbreak has been predominantly in older teenagers and young adults, who would not have been offered two doses of MMR This confirms the effectiveness of the current vaccination policy

The mumps component of the MMR vaccine used in the UK is believed to offer around 90% protection for one dose, although recent reports indicate that this could be as low as 64%.⁵ This outbreak confirms that the current, two dose MMR schedule is effective in preventing mumps. In addition to improving routine coverage of MMR, reviewing the vaccination status of all school leavers is recommended, to ensure that they have received two doses of MMR. Other opportunities to offer MMR vaccine to the age group at highest risk, such as when entering university or other institutions, should also be considered.

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See also p 1120, and Clinical review p 1132

Contributors: ES, MR, and JW conceived and designed the study. ES conducted the epidemiological analyses. SB, HL, RH, and DB interpreted laboratory data. All authors critically reviewed and contributed to the final draft of the paper. MR is guarantor.

Funding: None.

Competing interests: DB's laboratory has received funding from vaccine manufacturers for specific projects. He has acted as an unpaid expert witness in MMR litigation for vaccine companies. All other authors have nothing to declare.

References

1. Gay NJ, Miller E, Hesketh L, Morgan-Capner P, Ramsay M, Cohen B, et al. Mumps surveillance in England and Wales supports introduction of two dose vaccination schedule. Commun Dis Rep CDR Rev 1997;7(2): R21-6.[Medline]
2. Communicable Disease Surveillance Centre. Laboratory confirmed cases of measles, mumps and rubella, England and Wales: July to September 2002. Commun Dis Rep CDR Wkly 2002;12(48).
3. Gay NJ, Valambia S, Galasko D, Miller E. Selective rubella vaccination programmes: a survey of districts in England and Wales. Commun Dis Rep CDR Rev 1994;4(7): R77-9.[Medline]
4. Communicable Disease Surveillance Centre. Fall in MMR vaccine coverage reported as further evidence of vaccine safety is published. Commun Dis Rep CDR Wkly 1999;9(26): 227, 230.
5. Harling R, White JM, Ramsay ME, MacSween K, van den Bosch C. The effectiveness of the mumps component of the MMR vaccine: a case control study. Vaccine 2005 (in press).

(Accepted 14 April 2005)

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