Epidemiology and Infection

Original Papers

Vaccination

Seroepidemiology of mumps in Europe (1996–2008): why do outbreaks occur in highly vaccinated populations?

J. ERIKSENa1a2, I. DAVIDKINa3, G. KAFATOSa2, N. ANDREWSa2, C. BARBARAa4, D. COHENa5, A. DUKSa6, A. GRISKEVICIUSa7, K. JOHANSENa8, K. BARTHAa9, B. KRIZa10, G. MITISa11, J. MOSSONGa12, A. NARDONEa2, D. O'FLANAGANa13, F. DE ORYa14, A. PISTOLa15, H. THEETENa16, K. PROSENCa17, M. SLACIKOVAa18 and R. PEBODYa2 c1

a1 European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden

a2 Health Protection Agency Health Protection Services Colindale, London, UK

a3 National Institute for Health and Welfare (THL), Helsinki, Finland

a4 Mater Dei Hospital, Malta

a5 School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel

a6 Laboratory of the State Agency Infection Centre, Virology Unit, Riga, Latvia

a7 National Public Health Surveillance Laboratory, Vilnius, Lithuania

a8 Swedish Institute for Infectious Disease Control, Stockholm, Sweden

a9 National Centre for Epidemiology, Budapest, Hungary

a10 National Institute of Public Health (SZU), Prague, Czech Republic

a11 Nicosia Hospital, Nicosia, Cyprus

a12 Surveillance & Epidemiology of Infectious Diseases, Laboratoire National de Santé, Luxembourg

a13 Health Protection Surveillance Centre, Dublin, Ireland

a14 Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain

a15 National Centre for Communicable Diseases Surveillance and Control, National Institute of Public Health, Romania

a16 Center for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute (Vaxinfectio), University of Antwerp, Belgium

a17 Laboratory for Virology, NPHI, Slovenia

a18 Public Health Authority of the Slovak Republic, Bratislava, Slovak Republic

SUMMARY

Mumps outbreaks have recently been recorded in a number of highly vaccinated populations. We related seroprevalence, epidemiological and vaccination data from 18 European countries participating in The European Sero-Epidemiology Network (ESEN) to their risk of mumps outbreaks in order to inform vaccination strategies. Samples from national population serum banks were collected, tested for mumps IgG antibodies and standardized for international comparisons. A comparative analysis between countries was undertaken using age-specific mumps seroprevalence data and information on reported mumps incidence, vaccine strains, vaccination programmes and vaccine coverage 5–12 years after sera collection. Mean geometric mumps antibody titres were lower in mumps outbreak countries [odds ratio (OR) 0·09, 95% confidence interval (CI) 0·01–0·71)]. MMR1 vaccine coverage ⩾95% remained protective in a multivariable model (P < 0·001), as did an interval of 4–8 years between doses (OR 0·08, 95% CI 0·01–0·85). Preventing outbreaks and controlling mumps probably requires several elements, including high-coverage vaccination programmes with MMR vaccine with 4–8 years between doses.

(Received December 14 2011)

(Revised May 14 2012)

(Accepted May 15 2012)

(Online publication June 12 2012)

Key words

  • Epidemiology;
  • mumps;
  • outbreaks;
  • serology;
  • vaccination (immunization)

Correspondence:

c1 Author for correspondence: Dr R. G. Pebody, HPA Health Protection Services, 61 Colindale Avenue, London NW9 5EQ, UK. (Email: Richard.pebody@hpa.org.uk)

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