Prevention Of Mumps Research Articles

Prevention of mumps.

Prevention of mumps.

Prevention of mumps

Prevention of mumps

Prevention of mumps.

Prevention of mumps.

Surveillance of Mumps in the United States as Background for Use of Vaccine

MUMPS is a common infectious disease, particularly among children. Although the illness is not usually severe, considerable morbidity and loss of time from school occur because of the large numbers affected. In addition, a number of complications may ensue. Meningeal involvement is the most common complication, but central nervous system disease with residua is rare. However, orchitis, which occurs in approximately 20 percent of postpubertal males with clinical mumps, is a significant complication. The symptomatic ininvolvement of other organs occurs less frequently. The loss of productive time because of uncomplicated mumps as well as the morbidity associated with meningitis and orchitis are reasonable justification for mumps prevention. In the past, the use of hyperimmune globulin and inactivated vaccines has proved to be less than optimal in both effectiveness and duration of protection. A live attenuated mumps virus vaccine, developed recently, appears to be both safe and effective (1-3). No adverse reactions, including fever, have been observed among the more than 6,000 susceptible persons who have received this mumps vaccine. Although antibodies have developed in more than 95 percent of the vaccinees, knowledge regarding the duration of immunity is not yet available. Currently, studies of natural challenge and antibody levels indicate a durable immunity beyond 1 year. The availability of the live attenuated mumps virus vaccine demands a rationale for its use. Since recommendations for the use of a vaccine must relate to the epidemiologic characteristics of the disease, this paper presents a review of the available surveillance data for mumps in the United States.

Studies on the Prevention of Mumps

Summary Efforts were made to establish suitable dosage schedules for formalin-inactivated mumps virus vaccines. Susceptible children between one and eight years of age were selected on the basis of negative complement fixation (V antigen) and neutralization tests, as well as absence of “booster-type” responses following the first dose of vaccine. These were immunized by the subcutaneous route with 1-ml doses of vaccine at various time intervals. The results were evaluated in terms of anti-V and neutralizing antibody responses and, in one institution, by prevention of illness during an intercurrent outbreak of mumps. A primary course of two doses, one to four weeks apart, following 6–12 months later by a booster dose, gave most satisfactory results. Many of the susceptible children formed some neutralizing antibodies within one to two weeks after the first dose, and nearly all after the second. A third injection at one- to four-week intervals was of little added value. Most of these children failed to reveal detectable antibodies three to six months after the initial dose. A primary course of two or more doses, nevertheless, protected five out of six children against disease during an outbreak of mumps three to eight months later. Subclinical infections were not prevented. The incidence of parotitis in children who had received only one dose corresponded to that in unvaccinated controls. Booster doses 6 or 12 months after the initial course rapidly recalled antibodies and to higher titers than those seen following primary vaccination. Neutralizing antibodies remained detectable in the sera of the majority of the children for 6–12 months thereafter. A second booster after a half year interval did not yield higher titers than elicited by the first. The booster responses in the vaccinated groups failed to match those observed in naturally immunized children following injection of vaccine. The implications of these findings have been discussed.

Studies on the Prevention of Mumps

Summary Studies have been reported which led to the development of a reliable and reproducible neutralization test for mumps in the chick embryo, employing serial dilutions of inactivated serum and constant amounts of virus. Slight variations in the concentration of test agent fail to influence significantly the results in that a 1000-fold increase in mumps virus reduces the serum titer by only 10-fold. Convalescent sera showed a wide variation in neutralizing titers, ranging from 1:8 to greater than 1:2000. Analysis of serial sera from individual patients revealed that maximal levels were ordinarily attained within 3 weeks, and remained at this level for several months before a gradual decline was detected. Subclinical cases exhibited similar titers. Exceptional patients may develop only low levels of neutralizing antibodies. A comparison of neutralizing, complement-fixing (V and S antigens) and hemagglutination inhibiting titers failed to reveal correlations. The ratios of neutralizing and complement fixing titers varied over a 1000-fold range, those of neutralizing and hemagglutination inhibiting titers over a 40-fold range. These variations were of an order far greater than could be accounted for on technical grounds and the suggestion has been offered that the various technics measure different antibodies. The fact that one or the other antibody may fail to appear in the serum of convalescents from mumps, offers a practical diagnostic problem which has been discussed.

Studies on the Prevention of Mumps

Summary Vaccination procedures for the prevention of mumps have been evaluated in the light of results obtained with neutralization tests in chick embryos. Only 25% of individuals judged susceptible responded with neutralizing antibodies following the subcutaneous inoculation of inactivated mumps virus in contrast to the development of complement-fixing antibodies to the V antigen in 70 to 100% of the vaccinees. Production of neutralizing antibodies appeared to be closely related to immunity to mumps in an epidemic which occurred 8–11 months after vaccination while many cases were recorded in those who failed to reveal a measurable response. These data indicate that the vaccine or the method of vaccination requires improvement. The oral spraying of active attenuated virus failed to yield better responses in neutralizing antibodies as compared to subcutaneous vaccination with inactivated virus. The neutralization test did not appear superior to the complement-fixation reaction or the skin test as a method of determining susceptibility when related to the history of past mumps or subsequent incidence of mumps. On behalf of greater simplicity and speed the complement-fixation reaction and the skin test will remain useful tools in evaluating the state of immunity. A correlation of the titers in all types of sera obtained by the neutralization test, the complement fixation with the virus antigen and the hemagglutination inhibition, indicated that these three technics measured different antibodies.

STUDIES ON THE PREVENTION OF MUMPS

THE development of satisfactory procedures for the propagation of mumps virus in the chick embryo has brought within reach the possibility of immunization against the disease. Before discussing the various approaches to prevention of mumps, it is well to define clearly the need for such vaccines and who should be vaccinated. Mumps on the whole is a childhood disease and usually mild when restricted to the salivary glands. In the adult the disease may be more severe, particularly on account of socalled complications such as the involvement of the reproductive glands in the male. In view of this experience vaccination of children should be attempted only if (a) a prolonged immunity can be attained or (b) if certain other clinical conditions in the child render an attack of mumps undesirable at a particular time. In the latter case as well as in adults vaccination may he considered of value even if only a short term immunity can be induced. Vaccines appear desirable for susceptible parents, for instance, who have been exposed by their children, for hospital staffs in contact with mumps patients, and for college students or military personnel, where outbreaks of the disease may interrupt the normal course of training. A second point to be considered concerns the question of susceptibility. It has been well established, particularly since the advent of specific immunologic procedures, that mumps virus causes overt disease in about two thirds of human beings; in the other third the infection remains inapparent but nevertheless induces permanent immunity.

Studies on the Prevention of Mumps

Summary Studies have been reported on the serological response of human beings to subcutaneous vaccination with inactivated mumps virus, as measured by complement fixation and hemagglutination inhibition tests. Emphasis has been placed upon the results obtained in individuals judged susceptible to mumps by negative histories and serological tests prior to vaccination. Maximal complement-fixing antibody response was obtained 2–3 weeks after vaccination. A single injection of vaccine resulted in antibody responses indistinguishable from those recorded after 2 injections 2 weeks apart. The frequency of response, as well as the height of titers attained, depended upon the amount of vaccine injected. Only with 4 ml of vaccine, representing approximately a 20-fold concentrate of virus from allantoic fluid, did all susceptible individuals show some antibody response. A correlation between the serum titers obtained by the complement-fixation test with the virus antigen, and by the hemagglutination-inhibition reaction, indicated that the two technics very likely measure different antibodies. Although, in general, a high titer by one test was matched by a high antibody level in the other, the ratios of hemagglutination-inhibition to complement-fixation titers varied over a range far greater than could be ascribed to the variations inherent in the technics. An epidemic of mumps occurred 9–12 months after vaccination. The incidence of infection among the controls (63 cases in 193 individuals) was almost twice that encountered in the immunized group (46 cases in 250 individuals). This result gained in significance when the antibody levels attained 4–5 weeks after vaccination were correlated to the incidence of mumps. The incidence was highest in those who failed to respond with measurable antibodies to vaccination, and decreased markedly with the increase in the antibody level attained after immunization. Although there were discrepancies between the clinical diagnosis and serological tests performed after the epidemic had subsided, the general interpretation is not altered by inclusion of the doubtful cases. No serologically confirmed case was noted in the 33 individuals who had reached a complement-fixing titer of 1:16 or greater after vaccination. The data indicate that transitory immunity may be induced by subcutaneous vaccination with inactivated mumps virus and that its duration appears to be related to the height of antibody levels attained.

Studies on the Prevention of Mumps

Summary The effect of intradermal injection of mumps skin test antigen on stimulation of antibody formation and on immunity to mumps has been studied. Although development of antibodies as measured mainly by the complement-fixation technic, and in some instances also by hemagglutination inhibition tests, is not infrequent in individuals who had negative reactions prior to the skin test, it is suggested that these responses nevertheless must be termed in many instances a recall phenomenon and not de novo antibody formation. This suggestion is based particularly on the inverse relationship between age of the individual and height and frequency of antibody response to skin test. Whereas in the adult group more than 75% of the originally negative reactors responded, in children of 5 years of age of less, this figure decreased to 23%. Attempts to interrupt the course of mumps outbreaks in several institutions by application of skin tests did not conclusively demonstrate significant protective effects. The incidence of mumps in skin tested and control groups of children of the combined institutions was practically the same.

Studies on the Prevention of Mumps

Summary Experiments have been reported on the response of human beings to oral spraying of attenuated active mumps virus. Among 410 children judged susceptible by negative histories and serological tests, 6 developed mild signs of infection. Up to 93% of the children in the individual groups responded with antibodies as measured by complement fixation technic. The frequency of response depended on the concentration of virus used. The preparations contained originally between 107.5 to 108.9 ID50 for chick embryos. When diluted 10- or 100-fold before spraying, the incidence of response fell to about 50% and less than 10%, respectively. Antibodies to the soluble antigen, as a rule, exceeded those against the virus antigen. Hemagglutination-inhibition tests in a small number of cases revealed formation of antibodies in 60%. In most instances the serological tests were negative one year after the spraying. However, following skin testing at that time, the antibody response was greater in these children than in comparable control subjects. Experimental exposure of 4 children to mumps virus 3 months after immunization failed to elicit the disease, whereas 4 out of 6 controls developed clinical evidence of mumps. Of the larger groups treated by this procedure only those in one institution had been definitely exposed to mumps 8 months later. Eight cases occurred among the non-immunized children, mainly new admissions to the school. Although these data permit no conclusion they justify further exploration of this method of active immunization.

Studies on the Prevention of Mumps

Summary The results of over 1800 skin tests and over 1500 complement fixation tests have been analyzed in terms of past mumps infection, age of the individual and geographical area. Correlation between past known infection and positive complement fixation or skin tests was of the order of 70 to 80%. With the skin test it was somewhat higher in the adult than in individuals less than 18 years of age, whereas the reverse was noted with the complement fixation test. Neither a positive complement fixation reaction nor a positive skin response affords absolute assurance of resistance to mumps but the incidence of infection among such individuals was found to be less than 2%, whereas it was many times that in those giving negative reactions. Since discrepancies between the results of the 2 tests, when performed simultaneously, were not infrequent, it is obvious that both technics should be employed to attain maximal accuracy in determining the immune status of an individual.

OBSERVATIONS ON IMMUNITY IN MUMPS

Excerpt The importance of the problems of the control and prevention of mumps among military personnel was illuminated by the events of the last war when nearly four million man days were lost from...

An evaluation of convalescent serum in the prevention of mumps

Summary An experience with convalescent mumps serum is presented, in which there were eleven failures to prevent the disease after treating eighty-six exposed susceptible persons. Six of the failures occurred in children who had been re-exposed to the disease after having attained an apparent immunity to the first exposure. While this is too small a group of cases from which to draw many conclusions, it may add to the experience of others in evaluating this form of therapy. These data indicate that 10 c.c. of convalescent mumps serum gives a passive immunity of very short duration in a high percentage of cases, and that it seems necessary to repeat the injection of serum after each exposure to the disease. Our experience suggests that previous reports on this subject have been too encouraging and that, while serum is of definite value, it should not be depended upon too strongly for the control of institutional epidemics.

Convalescent serum in the prevention of mumps

Summary Forty-four boys ranging in age from ten to eighteen years, who according to their history had never had mumps, were injected with 5 c.c. of convalescent's serum seven days after exposure to the disease. None developed mumps. It would appear from the above report and from the data in the literature that convalescent's serum is of definite value in the prevention of mumps in exposed persons if employed early and in sufficient dosage.