Abstract
After routine mumps immunization programs were implemented in Manitoba in the 1980s, incidence was low, with 0-9 cases of disease annually. In September 2016, a mumps outbreak began in fully vaccinated university students in Winnipeg, Manitoba. We describe the investigation of this province-wide mumps outbreak, which lasted between September 2016 and December 2018. We present the details of public health measures implemented and challenges encountered. Possible contributing factors to the sustained transmission are also provided. Probable and confirmed cases of mumps were investigated by public health departments using the investigation form developed for this outbreak. Confirmed mumps cases were linked to the provincial immunization registry. An outbreak response team planned and implemented control measures across the province. The outbreak began in vaccinated university students in September 2016 and spread across the province. Activity was high and prolonged in the northern remote areas. By the end of 2018, 2,223 cases had been confirmed. All age groups were affected, and incidence was highest among people aged 18-29 years. Two-dose coverage of mumps-containing vaccine in confirmed cases was close to 70%. This prolonged outbreak revealed a large vulnerable population likely resulting from under-vaccination and waning vaccine-induced immunity in the absence of natural boosting from exposure to mumps virus. It is important to maintain high two-dose coverage with mumps-containing vaccines. A third dose of mumps-containing vaccine in future outbreaks may be considered.
Highlights
Mumps is an illness caused by the mumps virus, of the Paramyxoviridae family
We describe the investigation of this province-wide mumps outbreak, which lasted between September 2016 and December 2018
6 Department of Community Health Sciences, University of Manitoba, Winnipeg, MB. This prolonged outbreak revealed a large vulnerable population likely resulting from under-vaccination and waning vaccine-induced immunity in the absence of natural boosting from exposure to mumps virus
Summary
Mumps is an illness caused by the mumps virus, of the Paramyxoviridae family. Symptoms of mumps infection include fever, headache and the characteristic swelling and tenderness of the parotid or other salivary glands. The MMR vaccine, for children aged 4–6 years, was added to the routine schedule in 1996 [5]. This is consistent with the most recent recommendation of 2007, from the National Advisory Committee on Immunization (NACI) for mumps-containing vaccine. After reviewing mumps outbreaks in Canada and internationally, NACI recommended two-dose routine mumps immunization in infants and children as well as in certain high-risk adult groups including secondary and postsecondary students, military personnel and health care workers [6]. After routine mumps immunization programs were implemented in Manitoba in the 1980s, incidence was low, with 0–9 cases of disease annually. In September 2016, a mumps outbreak began in fully vaccinated university students in Winnipeg, Manitoba
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