Correspondence

Mumps in the United States

N Engl J Med 2008; 359:654-655August 7, 2008

Article

To the Editor:

The article by Dayan et al. (April 10 issue)1 on the resurgence of mumps in 2006 raises a number of issues. First, the resurgence may be partly explained by the switch in 1992 in the United States from the Urabe vaccine strain to the Jeryl Lynn strain. The former is more immunogenic and efficacious than the latter but causes more aseptic meningitis.2 Second, the high proportion of cases in the postpubertal population highlights the need to expand the case definition of mumps, for which parotitis is currently mandatory.1 In up to 30% of symptomatic cases of mumps, parotitis is not present3; therefore, the number of cases in this outbreak would have been underestimated. The easiest modification to the case definition would be the addition of “postpubertal males with orchitis and laboratory evidence of mumps.” Finally, natural infection does not necessarily confer lifelong immunity to mumps; therefore, the issue of vaccinating all patients in the post-acute setting should be considered.

Sanjaya N. Senanayake, M.B., B.S.
Canberra Hospital, Woden, ACT 2606, Australia
sanjaya.senanayake@act.gov.au

3 References

1. 1

   Dayan GH, Quinlisk MP, Parker AA, et al. Recent resurgence of mumps in the United States. N Engl J Med 2008;358:1580-1589
   Full Text | Web of Science | Medline

2. 2

   Bonnet MC, Dutta A, Weinberger C, Plotkin SA. Mumps vaccine virus strains and aseptic meningitis. Vaccine 2006;24:7037-7045
   CrossRef | Web of Science | Medline

3. 3

   Singh R, Mostafid H, Hindley RG. Measles, mumps and rubella -- the urologist's perspective. Int J Clin Pract 2006;60:335-339
   CrossRef | Web of Science | Medline

Author/Editor Response

Mumps and the combined measles–mumps–rubella (MMR) vaccines in the United States have included only the Jeryl Lynn strain. By contrast, mumps-containing vaccines in the United Kingdom included the Urabe strain until 1992 and subsequently have included either the Jeryl Lynn strain or the RIT 4385 strain.1

We agree that symptomatic mumps infections without parotitis probably occurred in 2006, but surveillance for these nonspecific presentations would have been challenging and of limited usefulness. However, we did capture mumps complications with or without parotitis in our detailed analysis of mumps cases reported from the eight highly affected states. In 2007, the national mumps case definition was revised to include complications without parotitis, provided there is an epidemiologic link to a case with parotitis.2

There are rare case reports of second mumps infections. However, on a population basis, there has not been a significant occurrence of second infections. The duration of immunity after two doses of MMR vaccine and the potential benefit of a third dose are currently being evaluated.

Amy A. Parker, M.S.N., M.P.H.
Centers for Disease Control and Prevention, Atlanta, GA 30333

Gustavo H. Dayan, M.D.
Sanofi Pasteur, Swiftwater, PA 18370

Jane F. Seward, M.B., B.S., M.P.H.
Centers for Disease Control and Prevention, Atlanta, GA 30333

2 References

1. 1

   Miller E, Andrews N, Stowe J, Grant A, Waight P, Taylor B. Risks of convulsion and aseptic meningitis following measles-mumps-rubella vaccination in the United Kingdom. Am J Epidemiol 2007;165:704-709
   CrossRef | Web of Science | Medline

2. 2

   Council of State and Territorial Epidemiologists. CSTE position statement 2007-ID-02: revision of the surveillance case definition for mumps. (Accessed July 8, 2008, at http://www.cste.org/dnn/AnnualConference/PositionStatements/tabid/191/Default.aspx.)