Epidemiology and Infection

Measles, mumps, rubella and fifth disease

Mumps outbreak in Israel's highly vaccinated society: are two doses enough?

E. ANISa1a2 c1, I. GROTTOa1a3, L. MOERMANa1, B. WARSHAVSKYa1, P. E. SLATERa1a2 and B. LEVa1

a1 Ministry of Health, Jerusalem, Israel

a2 Braun School of Public Health, Hebrew University and Hadassah, Jerusalem, Israel

a3 Epidemiology Department, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel


Mumps outbreaks in recent years have given rise to questions about the effectiveness of the mumps vaccine. This study examined the epidemiological data from a recent mumps outbreak in Israel and from outbreaks in other countries with high vaccination coverage, and considered whether long-established vaccination policies designed to protect against mumps are in need of revision. Of over 5000 case patients in the Israeli outbreak, half of whom were in the Jerusalem health district, nearly 40% were aged ≥15 years and, of those whose vaccination status was known, 78% had been fully vaccinated for their age – features similar to those in recent mumps outbreaks in Europe and North America. The epidemiological and laboratory evidence suggests that many previously vaccinated adolescents and young adults are now susceptible to mumps because their vaccine-based immunity has waned. Booster vaccination programmes for those at high risk of infection during mumps outbreaks – particularly those in congregate living environments – merit priority consideration.

(Accepted March 16 2011)

(Online publication April 20 2011)


c1 Author for correspondence: E. Anis, MD, MPH, Director, Division of Epidemiology, Ministry of Health, Israel. (Email: emilia.anis@moh.health.gov.il)