Mumps outbreaks among fully vaccinated young adults have raised questions about potential waning of immunity over time and need for a third dose of the measles, mumps, rubella (MMR) vaccine. However, there are currently limited data on real-life effectiveness of the third-dose MMR vaccine in preventing mumps. Here, we used a deterministic compartmental model to infer the effectiveness of the third-dose MMR vaccine in preventing mumps cases by analyzing the mumps outbreak that occurred at the University of Iowa between August 24, 2015, and May 13, 2016. The modeling approach further allowed us to evaluate the population-level impact of vaccination by different timing in relation to the start of the outbreak and varied coverage levels, and to account for potential sources of bias in estimating vaccine effectiveness. We found large uncertainty in vaccine effectiveness estimates; however, our models showed that early introduction of a third dose of MMR vaccine during a mumps outbreak can be effective in preventing transmission. School holidays, such as the winter break, likely played important roles in preventing mumps transmission.

Objectives: The largest mumps outbreak in the United States since 2006 occurred in Arkansas during the 2016-17 school year. An additional dose (third dose) of measles-mumps-rubella vaccine (MMR3) was offered to school children. We evaluated the vaccine effectiveness (VE) of MMR3 compared with two doses of MMR for preventing mumps among school-aged children during the outbreak. Study design: A generalized linear mixed effects model was used to estimate the incremental vaccine effectiveness (VE) of a third dose of MMR compared with two doses of MMR for preventing mumps. Methods: We obtained school enrollment, immunization status and mumps case status from school registries, Arkansas's immunization registry, and Arkansas's mumps surveillance system, respectively. We included students who previously received 2 doses of MMR in schools with ≥1 mumps case after the MMR3 clinic. We used a generalized linear mixed model to estimate VE of MMR3 compared with two doses of MMR. Results: Sixteen schools with 9272 students were included in the analysis. Incremental VE of MMR3 versus a two-dose MMR regimen was 52.7% (95% confidence interval [CI]: -3.6%‒78.4%) overall and in 8 schools with high mumps transmission it was 64.0% (95% CI: 1.2%‒86.9%). MMR3 VE was higher among middle compared with elementary school students (68.5% [95% CI: -30.2%‒92.4%] vs 37.6% [95% CI: -62.5%‒76.1%]); these differences were not statistically significant. Conclusion: Our findings suggest MMR3 provided additional protection from mumps compared with two MMR doses in elementary and middle school settings during a mumps outbreak. © 2023

Recent mumps outbreaks among highly vaccinated populations, including college students, have called into question the vaccine effectiveness (VE) of routine two-dose measles, mumps, and rubella (MMR2) immunization. We aimed to estimate the VE required for a novel vaccination strategy (e.g., MMR booster dose, novel vaccine) to prevent large mumps outbreaks on college campuses. Using mumps college outbreak data reported to the U.S. Centers for Disease Control and Prevention during 2016-2017, we estimated current MMR2 VE using the screening method and implemented a compartmental model of mumps transmission. We performed 2000 outbreak simulations, following introduction of an infectious person to a population of 10,000, over ranges of MMR2 vaccine coverage (VC) and VE (30.0-99.0%). We compared the impact of varying VC and VE on mumps and mumps orchitis case counts and determined VE thresholds that ensured < 5.0% and < 2.0% of the outbreak simulations exceeded 20 and 100 mumps cases. Median estimated MMR2 VE in reported mumps outbreaks was 60.5% and median reported MMR2 VC was 97.5%. Simulated mumps case count was more sensitive to changes in VE than in VC. The opposite was true for simulated mumps orchitis case count, though orchitis case count was small (mean <10 cases across simulations for VE near 60.5% and VC near 97.5%). At 97.5% VC, 73.1% and 78.2% VE were required for < 5.0% and < 2.0% of outbreaks, respectively, to exceed 100 mumps cases. Maintaining 97.5% VC, 82.4% and 85.9% VE were required for < 5.0% and < 2.0% of outbreaks, respectively, to exceed 20 cases. We conclude that maintaining current levels of MMR2 VC, a novel vaccination strategy aimed at reducing mumps transmission must achieve at least 73.1-85.9% VE among young adults to prevent large mumps outbreaks on college campuses.

BACKGROUND: Despite a >99% reduction in US mumps cases after the introduction of mumps vaccine in 1967, outbreaks have occurred in schools and other settings involving vaccinated children and adolescents since 2006. METHODS: We analyzed mumps cases reported by US health departments to the National Notifiable Diseases Surveillance System. We present the incidence and vaccination status of pediatric cases (age <18 years) during 2007-2019 and describe demographic, clinical, and vaccination characteristics of pediatric cases reported during the most recent resurgence in 2015-2019. RESULTS: During 2007-2019, 9172 pediatric cases were reported, accounting for a median of 32% of all cases reported each year (range: 13%-59%). A median of 87% (range: 81%-94%) of pediatric patients each year had previously received ≥1 measles, mumps, and rubella (MMR) vaccine dose. During 2015-2019, of 5461 pediatric cases reported, only 2% of those with known import status (74%) were associated with international travel. One percent of patients had complications and 2% were hospitalized. Among patients aged ≥1 year with known vaccination status (72%), 74% of 1- to 4-year-olds had received ≥1 MMR dose and 86% of 5- to 17-year-olds had received ≥2 MMR doses. Since 2016, pediatric mumps cases have been reported in most US states each year (range: 38-45 states). CONCLUSIONS: Since 2007, one-third of US reported mumps cases occurred in children and adolescents, the majority of whom were vaccinated. Clinicians should suspect mumps in patients with parotitis or mumps complications, regardless of age, travel history, and vaccination status.

OBJECTIVES: To assess pediatricians' mumps knowledge and testing practices, to identify physician and practice characteristics associated with mumps testing practices, and to assess reporting and outbreak response knowledge and practices. STUDY DESIGN: From January-April 2020, we surveyed a nationally representative network of pediatricians. Descriptive statistics were generated for all items. Chi-square, t-tests, and Poisson regression were used to compare physician and practice characteristics between respondents who would rarely or never vs. sometimes or often/always test for mumps in a vaccinated 17-year-old with parotitis in a non-outbreak setting. RESULTS: The response rate was 67% (297/444). For knowledge, over half of pediatricians responded incorrectly or 'Don't know' for six of nine true/false statements about mumps epidemiology, diagnosis, and prevention; and over half reported they would need additional guidance on mumps buccal swab testing. For testing practices, 59% of respondents reported they would sometimes (35%) or often/always (24%) test for mumps in a vaccinated 17-year-old with parotitis in a non-outbreak setting; older physicians, rural physicians, and physicians from the Northeast or Midwest were more likely to test for mumps. Thirty-six percent of pediatricians reported they would often/always report a patient with suspected mumps to public health authorities. CONCLUSIONS: Pediatricians report mumps knowledge gaps and practices that do not align with public health recommendations. These gaps may lead to under-diagnosis and under-reporting of mumps cases, delaying public health response measures and contributing to ongoing disease transmission.

CONTEXT: In response to numerous mumps outbreaks reported throughout the United States in 2016 and 2017, the Advisory Committee on Immunization Practices (ACIP) recommended a third dose of measles, mumps, and rubella (MMR) vaccine for groups of persons determined by public health authorities to be at increased risk for acquiring mumps because of an outbreak. OBJECTIVE: To provide guidance for health departments when implementing the ACIP recommendation. DESIGN: Draft guidance was developed by Centers for Disease Control and Prevention subject matter experts based on technical consultations with health departments and review of published and unpublished data regarding mumps outbreaks. The guidance was finalized based on input from experts from the ACIP Mumps Work Group and local and state epidemiologists through the Council of State and Territorial Epidemiologists and the National Association of County and City Health Officials. RESULTS: We developed guidance to assist public health authorities when determining which groups are at increased risk for acquiring mumps and should receive a third dose of MMR vaccine. During outbreaks, public health authorities identify groups of persons with known or likely close contact exposure to a mumps patient. Then, evidence of transmission and likelihood of transmission in a group's setting can be used to determine whether these groups are at increased risk. Additional epidemiologic and implementation factors may also be considered. All persons in the group at increased risk for acquiring mumps should receive a dose of MMR vaccine, including those with unknown vaccination status or those who have evidence of presumptive immunity other than documented 2 doses of MMR vaccine; no additional dose is recommended for persons who had received 3 or more doses before the outbreak. CONCLUSION: This guidance provides a framework for public health authorities to use when considering a third dose of MMR in response to mumps outbreaks while maintaining flexibility to incorporate local factors related to individual outbreaks.

CONTEXT: During January 2016 to June 2017, US health departments (HDs) reported 150 mumps outbreaks. Most occurred among populations with high 2-dose measles, mumps, and rubella (MMR) vaccine coverage, prompting the Advisory Committee on Immunization Practices to examine the evidence for use of a third dose of MMR vaccine. OBJECTIVE: To evaluate HD experiences with mumps outbreak control and use of a third MMR dose during outbreaks. DESIGN: An online survey assessing mumps outbreak characteristics, outbreak response measures, challenges, and lessons learned from previous outbreaks was distributed to all 81 Council of State and Territorial Epidemiologists member HDs in August 2017. RESULTS: Sixty-one (75%) HDs responded; 46 (75%) had experience with >/=1 mumps outbreak(s) during January 2016 to August 2017. Twenty (43%) HDs recommended a third or outbreak MMR dose during mumps outbreaks; of these, 19 completed the section on use of a third dose and 8 (40%) rated the intervention "somewhat effective" or better. Health departments that used a third/outbreak dose suggested implementing the recommendation early and to a targeted group. Forty-three (73%) HDs reported having a policy for excluding persons without presumptive immunity from outbreak settings; of these, 37 (86%) had some degree of legal authority to implement this policy. Exclusion compliance improved with the use of personalized notification letters, focus groups of excluded persons and the community, and standardized messaging. Other outbreak control measures included cohorting of exposed or susceptible persons, mobile vaccination clinics and home visits, contact monitoring via text messaging, and facilitating student isolation with meal delivery and excused class absences. CONCLUSIONS: Our study revealed heterogeneity across HDs' mumps outbreak responses but also identified common challenges that will inform future Centers for Disease Control and Prevention guidance. These results were considered in the October 2017 Advisory Committee on Immunization Practices recommendation for use of a third dose of MMR vaccine for persons at increased risk for mumps during an outbreak and in the development of Centers for Disease Control and Prevention guidance for HDs when applying the Advisory Committee on Immunization Practices recommendation.

OBJECTIVES: To present the first update on the epidemiology of US foodborne correctional institution outbreaks in 20 years. METHODS: We analyzed data from the Centers for Disease Control and Prevention's Foodborne Disease Outbreak Surveillance System to describe correctional institution outbreaks from 1998 to 2014 and compare them with other foodborne outbreaks. RESULTS: Two hundred foodborne outbreaks in correctional institutions were reported, resulting in 20 625 illnesses, 204 hospitalizations, and 5 deaths. Median number of outbreak-associated illnesses per 100 000 population per year was 45 (range = 11-141) compared with 7 (range = 4-10) for other outbreaks. These outbreaks accounted for 6% (20 625 of 358 330) of outbreak-associated foodborne illnesses. Thirty-seven states reported at least 1 outbreak in a correctional institution. Clostridium perfringens (28%; 36 of 128) was the most frequently reported single etiology. The most frequently reported contributing factor was food remaining at room temperature (37%; 28 of 76). CONCLUSIONS: Incarcerated persons suffer a disproportionate number of outbreak-associated foodborne illnesses. Better food safety oversight and regulation in correctional food services could decrease outbreaks. Public Health Implications. Public health officials, correctional officials, and food suppliers can work together for food safety. Clearer jurisdiction over regulation of correctional food services is needed. (Am J Public Health. Published online ahead of print May 18, 2017: e1-e7. doi:10.2105/AJPH.2017.303816).

In January 2016, the Angola Ministry of Health reported an outbreak of yellow fever, a vaccine-preventable disease caused by a flavivirus transmitted through the bite of Aedes or Haemagogus species mosquitoes (1,2). Although endemic in rural areas of Angola, the last outbreak was in 1988 when 37 cases and 14 deaths were reported (3). Large yellow fever outbreaks occur when the virus is introduced by an infected person to an urban area with a high density of mosquitoes and a large, crowded population with little or no immunity (2). By May 8, a total of 2,267 suspected cases were reported nationally, of which 696 (31%) were laboratory confirmed; 293 (13%) persons died (4). Most (n = 445, 64%) confirmed cases lived in Luanda Province. As part of the public health response that included strengthened surveillance, vector control, case management, and social mobilization (1), mass vaccination campaigns were implemented in Luanda during February 2–April 16. Despite >90% administrative vaccination coverage (the number of vaccine doses administered divided by the most recent census estimates for the target population), the province continued to report cases (4). Field teams reported low numbers of men being vaccinated, which was a concern because of a preliminary analysis that indicated approximately 70% of confirmed yellow fever cases occurred in males. A rapid assessment to identify and address potential barriers to vaccination among men was designed, using a knowledge, attitudes, and practices survey. | During April 23–25, 2016, a knowledge, attitudes, and practices rapid assessment was administered to men at 10 sites in the four municipalities of Luanda with the greatest number of confirmed cases: Viana, Kilamba Kiaxi, Cacuaco, and Cazenga. The range for administrative vaccination coverage was 22%–137%. Survey sites included public transportation stops, public markets, main streets, and town squares. Interviewers consecutively sampled men of working age while walking in separate trajectories from the site center until the interviewers reached a target of 30 interviews. The questionnaire consisted of multiple choice and open-ended questions on demographics, disease knowledge, vaccination status, vaccination practices, and reasons for nonvaccination, as appropriate.

As post-doctoral fellow in 2013, I published an editorial based on my experience as a translator, called “Writing scientific articles like a native English speaker: top ten tips for Portuguese speakers” (available at http://dx.doi.org/10.6061/clinics/2014(03)(01) 1. It focused on the repeated “simple” mistakes I observed while revising manuscripts of Brazilian friends and colleagues. I did not predict the editorial would receive as much attention as it did on social media. It speaks to Brazilian researchers’ quest for representation on the international scientific platform and the ever-growing number of Brazilian publications in international journals. | When I finished my post-doctoral fellowship, I left academia for government, starting a position as an Epidemic Intelligence Service (EIS) officer at the Centers for Disease Control and Prevention. Over the course of the two-year program, EIS officers learn applied public health by investigating outbreaks, making public health recommendations, and communicating public health issues to the public. The latter experience greatly changed my writing style. In the first month, I took a training called “Plain Language” developed by the National Institutes of Health (NIH). After applying the training to my communications as a public health official, I recognized my academic training prepared me to communicate my scientific findings to a scientific audience. Now my audience is the scientific community and the public. I was suddenly back on level one at a game I thought I had tirelessly conquered. Nevertheless, as with any skill, becoming a good writer is a matter of practice and persistence.