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Editorials

Measles: neither gone nor forgotten

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3976 (Published 25 September 2018) Cite this as: BMJ 2018;362:k3976

Rapid Response:

Mumps the word

Dear Editors

While not trying to wade into the vaccine discussion and its associated lobbying and ideological standoff, I do take issue when Dr Anand wrote in his rapid response (Ref 1 ) that:

"Sixthly, as recently as 1985, the BRITISH NATIONAL FORMULARY stated (page 385, column 2, para 1): Since mumps and its complications are very rarely serious there is little indication for the routine use of mumps vaccine."

Casual readers should be made aware of the following complications relating to mumps (ref 2,3):

1. Orchitis affects 1 in 10 to 1 in 4 males post puberty, of which half "notice some shrinkage of their testicles and an estimated 1 in 10 men experience a drop in their sperm count (the amount of healthy sperm their body can produce). However, this is very rarely large enough to cause infertility."
2. Viral meningitis "occurs in about 1 in 7 cases of mumps" which is "milder, flu-like symptoms, and the risk of serious complications is low"
3. Of those people who develop viral meningitis from mumps, 1 in 1,000 develops encephalitis which is potentially fatal
4. Acute pancreatitis occurs in "1 in 20 cases", most are self resolving
5. Acute hearing loss occurs in 1 in 20 people with mumps, most are temporary, but permanent loss of hearing is rare at around 1 in 20,000 cases of mumps
6. Mastitis rates have been ≤1%
7. Oophoritis rates have been ≤1%
8. 1 in 25 mumps suffers has ECG-changing myocarditis (adults, males more common) (ref 4)

Unless one only considers conditions which are fatal or permanently disabling as "serious", most people should be made aware that mumps can cause significant burden on the healthcare system, particularly when it is preventable.

It was noted that rural conscripts are more likely to be mumps-naive than urban recruits during the First World War (ref 5), some 50 years before the first mumps vaccine, and any uncontrolled outbreak of mumps in the barracks could have had a significantly deleterious effect on the battle readiness of the troops in aid of the European allies. That too would have been "serious".

Increasing numbers of unvaccinated military recruits are again causing concerns in the US military services (ref 6) and would likely be reflected in other dormitory-type living arrangements--for example, university college houses.

References
1. https://www.bmj.com/content/362/bmj.k3976/rr-0
2. https://www.cdc.gov/mumps/hcp.html#complications
3. https://www.nhs.uk/conditions/mumps/complications/
4. Kabakus N et al. Fatal Mumps Nephritis and Myocarditis. J Tropical Paediatrics. Vol 45 Dec 1999 358-60.
5. Barskey AE, Glasser JW, LeBaron CW. Mumps resurgences in the United States: a historical perspective on unexpected elements. Vaccine 2009; 27:6186–95.
6. Lewis P.E., Burnett D.G., Costello A.A., Olsen C.H., Tchandja J.N., Webber B.J. Measles, mumps, and rubella titers in air force recruits: Below herd immunity thresholds? Am. J. Prev. Med. 2015;49:757–760. doi: 10.1016/j.amepre.2015.04.019

Competing interests: No competing interests

26 October 2018
Shyan Goh
Orthopaedic Surgeon
Sydney, Australia