Gaynor Watson-Creed, Andrea Saunders, Jeffrey Scott, Luis Lowe, Janice Pettipas, and Todd F. Hatchette. Two Successive Outbreaks Of mumps In Nova Scotia Among Vaccinated Adolescents And Young Adults. CMAJ. 2006 August 29; 175(5): 483488.

Two recent outbreaks in Nova Scotia were investigated by public health officials. Cases were defined by laboratory confirmation of infection (i.e., isolation of mumps virus by culture) or clinical diagnosis in people epidemiologically linked to a laboratory-confirmed case. The people infected were interviewed to determine possible links and to identify contacts. Mumps virus was cultured from urine and throat specimens, identified via reverse-transcriptase polymerase chain reaction (RT-PCR) and subjected to phylogenetic analysis to identify the origin of the strain.

Results. The first outbreak involved 13 high-school students (median age 14 yr): 9 who had previously received 2 doses of measlesmumpsrubella vaccine (MMR) and 4 who received a single dose. The second outbreak comprised 19 cases of mumps among students and some staff at a local university (median age 23 yr), of whom 18 had received only 1 dose of MMR (the other received a second dose). The viruses identified in the outbreaks were phylogenetically similar and belonged to a genotype commonly reported in the UK. The virus from the second outbreak is identical to the strain currently circulating in the UK and United States.

Interpretation. The predominance in these outbreaks of infected people of university age not only highlights an environment with potential for increased transmission but also raises questions about the efficacy of the MMR vaccine. The people affected may represent a lost cohort who do not have immunity from natural mumps infection and were not offered a 2-dose schedule. Given the current level of mumps activity around the world, clinicians should remain vigilant for symptoms of mumps.