Academic journal article Bulletin of the World Health Organization

Mumps and Mumps Vaccine: A Global Review

Academic journal article Bulletin of the World Health Organization

Mumps and Mumps Vaccine: A Global Review

Article excerpt

Introduction

Mumps is an acute infectious disease caused by a paramyxovirus closely related to parainfluenza virus. Although the disease is usually mild, its burden should not be underestimated. Up to 10% of mumps patients developed aseptic meningitis; a less common but more serious complication is encephalitis, which can result in death or disability; and permanent deafness, orchitis and pancreatitis are other untoward effects that can be prevented by vaccination. As of mid- 1998, mumps vaccine was routinely used by national childhood immunization programmes in 82 countries. Where high coverage has been achieved, countries have shown a rapid decline in mumps morbidity. Furthermore, in many countries encephalitis associated with mumps has almost totally vanished.

In this article we review the disease burden caused by mumps; summarize studies on the immunogenicity, efficacy, and safety of different strains of mumps vaccine; and highlight lessons learned about implementing mumps immunization from countries in different regions of the world. Guidance is provided for countries contemplating the introduction of mumps vaccine and for countries already using this vaccine.

Disease burden due to mumps

Humans are the only natural hosts for mumps virus, which is usually spread by respiratory droplets. The incubation period of mumps averages 16-18 days, with a range of about 2-4 weeks (1). Infection with mumps virus is asymptomatic in one-third of cases. Nonspecific prodromal symptoms include low-grade fever, anorexia, malaise, and headache. The disease can vary from a mild upper respiratory illness to viraemia with widespread systemic involvement (Table 1). Classic mumps is characterized by enlargement of the parotid and other salivary glands; parotitis is bilateral in three-quarters of cases; and other salivary glands are involved in 10% of cases (1).

Table 1. Major manifestations of mumps(a)

Manifestation                       Frequency (%)

Glandular
Parotitis                            60-70
Submandibular and/or sublingual         10
  adenitis
Epididymo-orchitis                      25 (postpubertal men)
Oophoritis                               5 (postpubertal women)
Pancreatitis                             4

Neurological
Asymptomatic pleocytosis of CSF         50
Aseptic meningitis                    1-10
Encephalitis                        0.02-0.3
Deafness (usually transient)             4

Other
Mild renal function abnormalities    30-60
Electrocardiogram abnormalities       5-15

(a) Modified from ref. 1.

Epididymo-orchitis occurs in about 25% of postpubertal men who contract mumps. In one large cohort study the median age for mumps orchitis was 29 years (range, 11-64 years) (2). Testicular atrophy occurs in about one-third of patients with mumps orchitis, but sterility is rare. Mumps orchitis appears to be a risk factor for testicular cancer, though not a major one (3). In postpubertal women, mastitis and oophoritis can occur; one study found mastitis in 31% of women over 14 years of age (4). Among women who acquire mumps during the first 12 weeks of pregnancy, more than a quarter suffer spontaneous abortion; in a large cohort study, the rate of spontaneous abortion in the first trimester due to mumps infection was higher than that due to rubella infection (5). An increased incidence of congenital malformations following maternal mumps infection during pregnancy has not been found (6).

Pancreatitis is seen in about 4% of patients with mumps (7). There is evidence suggesting that mumps virus can infect human pancreatic beta cells, and may trigger the onset of insulin-dependent diabetes mellitus in some individuals (8).

In mumps cases the central nervous system is frequently infected and about 50% of asymptomatic patients exhibit pleocytosis in the cerebrospinal fluid (CSF) (9). Aseptic meningitis occurs in up to 10% of all mumps patients, more often in males. …

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