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A third dose of MMR vaccine may result in decreased disease spread during a mumps outbreak
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Giving a third dose of measles-mumps-rubella (MMR) vaccine may have helped decrease the mumps attack rate by as much as 96% among adolescents in an outbreak situation, according to a study published online.
Ikechukwu U. Ogbuanu, MD, MPH, Epidemic Intelligence Service Officer, at the CDC, and colleagues reported on a mumps outbreak, which started around September 2009 and ended the following year, and involved 790 cases in an Orthodox Jewish community in New York State.
Health officials offered a third dose of MMR vaccine to 6th-12th graders at three of four schools in that community, and about 1,755 (80.6%) of the eligible students received the third dose.
The mumps attack rate decreased from 4.9% in the 21 days before the third dose was administered to 1.55% in the 22-42 days afterward.
Since the intervention occurred after the outbreak’s peak, it was “not possible to exclude the possibility that the rapid decline in incidence after the intervention was entirely unrelated to our intervention,” but the researchers said, their findings may merit further investigation.
Disclosure: The researchers report no relevant financial disclosures.Perspective
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Steven B. Black, MD
Perhaps it is time to reassess our current vaccine armamentarium. Ogbuanu and colleagues report on the impact of a third dose of MMR on a mumps outbreak that occurred in a population with high levels of two-dose MMR coverage prior to the outbreak. Although this could have occurred because of improper handling of MMR vaccine in recipients, the authors assume, logically I believe, that given the diverse number of providers, this is unlikely. Fortunately for those involved in the outbreak, a third dose was highly effective in reducing the risk of mumps in vaccinees.
However, it should give us pause that a third dose was required at all. The MMR vaccine is a combination vaccine containing measles, mumps and rubella viruses. However, the recommendation for a two dose measles schedule, which has been highly effective for measles control, has also been carried over for the two “tag along” diseases of mumps and rubella. Clearly, this approach has not been ideal for mumps, as this outbreak points out.
As a recent article by Nicola Klein, MD, points out for acellular pertussis (N Engl J Med 2012; 367:1012-1019), we cannot assume that the vaccines we have are optimal for disease prevention. Perhaps it is time for a systematic review of the effectiveness of currently available vaccines and consideration of a strategically targeted development program for improved vaccines.
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