Skip to content

Tag: mumps

Published on Leave a comment on Adventures in My Rabbit Hole

By my rough estimate, I've been in my private rabbit hole of infectious diseases and microbiology for over 50 years. Certainly covid has prolonged my stay. This past week I saw a number of new publications that are worth mentioning, I'll try to be succinct!

Tripledemic Tracking

After pausing for data entry to somewhat catch up after the holiday lull, let's look at the landscape.

Influenza

According to FLUVIEW, the country as a whole is seeing continued decline in flu cases. Remember I'm showing you just the hospitalizations confirmed to be flu, as a most accurate tally. Note that the dashed line is to call attention to the lag in reporting the past few weeks. Let's hope we don't see a rebound.

COVID-19

Percent positivity continues to rise, but a little tougher to determine accurate infection rates given all the nuances we've discussed recently.

The XBB.1.5 variant continues to hold the lion's share of the variant proportion in the US. I was interested to see that, at least so far, this variant is not a big deal in the UK. I expect that to change.

RSV

RSV-NET shows a continued decline in RSV infections, with the caveat that we might still be experiencing delayed reporting from the holidays. I don't expect RSV to trouble us any more this winter.

More on Long Covid

A new analysis from Israel suggests that most symptoms of long covid tend to resolve at 1 year follow-up for those individuals who had mild covid illness originally. This is an analysis from a large database which can have its own misleading reporting issues, but in the past this same database has had a good track record for being correct.

Bivalent Covid Vaccine Boosters No Better Than Monovalent?

Two small studies (here and here) in last week's NEJM suggest this is the case, from comparisons of antibody responses. I first commented on these studies last October when they were only in preprint form. Note these studies did not include children, so we could see some different results when those analyses are performed. The accompanying editorial by Paul Offit is a good read. It is essentially an "I told you so" discussion. Some may recall that he was the only member of the FDA VRBPAC panel last summer who voted against moving forward with the bivalent boosters. His main argument was that we didn't know if they were any better than monovalent boosters against the emerging variants, and these small studies appear to confirm his suspicions.

Please be aware this doesn't mean that bivalent boosters are worse, just that they may be no better than boosting with the monovalent vaccine, at least for now. Stay tuned for what should be a very stimulating discussion of future vaccine plans at the next FDA VRBPAC meeting on January 26.

A Clue to Myocarditis Mechanism Following Covid Vaccine?

Researchers in Boston reported results from 61 adolescents and young adults (16 who developed myocarditis and 45 who did not) who had received either the Pfizer or Moderna mRNA vaccines. They found an association of circulating spike protein in blood samples with the myocarditis group. They also looked at immune and cytokine patterns in the subjects. The discussion portion of the article brings up many possible explanations for how intact spike protein might be involved in the pathogenesis of myocarditis, but this is all very preliminary. Now we need more studies to confirm this association and further explore the immunologic phenomena accompanying it.

Note that nothing in this study changes the bottom line for vaccine advice: benefits of covid vaccination outweigh risks when we are considering myocarditis or any other endpoint for COVID-19.

Everything Old is New Again

No one seems to know definitely who first coined this phrase, but I mention it here to remind all healthcare providers to be on the lookout for those "old" vaccine-preventable diseases such as measles, mumps, rubella, and even diphtheria. This week the CDC gave us figures for vaccination rates in kindergarteners during the 2021-22 school year: not encouraging, but also not surprising. Another publication provided some some explanation for why we see problems with mumps outbreaks even in fully vaccinated adolescents and young adults. (Spoiler alert, it is waning immunity.) If any healthcare provider is a little fuzzy on diagnosis and management of these diseases, please review!

Speaking of old, I found that Alice's Adventures in Wonderland was published in 1865, and Down the Rabbit-Hole is the title of the first chapter. Maybe I'll reread it one of these years.

Published on Leave a comment on Why Do We Vaccinate Against Mumps?

At the Montgomery County Pediatric Society meeting on December 4, 2017, Dr. Stuart Taylor asked me a very thought-provoking question. During a discussion of the numerous mumps outbreaks on college campuses and elsewhere recently, he wondered whether the effort and expense of tracking cases and immunizing in special situations was worthwhile, considering that mumps is a relatively mild illness. He recalled being told some decades ago that the mumps vaccine was included with the measles and rubella vaccines, both of which protect against infections with very serious complications, more out of convenience than for a compelling public health benefit. That question sent me back to the medical literature, and I learned (or maybe re-learned) some interesting points. Bottom line: mumps isn't as mild as most pediatricians think.

I wanted to first find recent information on mumps in more industrialized countries, but that isn't as easy as it sounds. However, studies on mumps outbreaks primarily in adolescents in England in 2004-5 offer some sobering statistics. In the United Kingdom, MMR vaccine was introduced in 1988 as a single dose for children 12-15 months of age, followed by a recommendation in 1996 to add a second dose to the routine immunization schedule. The 2004-5 epidemic largely affected individuals who were born too early to be offered the initial vaccine, but also protected somewhat during their childhood by a high vaccination rate in younger children, such that they weren't as likely to be exposed to the wild virus. Yung et al mined various databases in England and Wales from 2002-2006 and estimated that mumps infection resulted in 2647 case-patients being hospitalized, or about 6% of all mumps cases. That alone certainly would justify universal mumps immunization programs. These investigators also estimated hospitalization rates for some of the mumps complications: 4.4% for orchitis, 0.35% for meningitis (note aseptic meningitis is very common in mumps, about 50%, but is very mild usually), and 0.33% for mumps pancreatitis.

Mumps also is a cause of hearing loss, sometimes severe. A recent Japanese study was able to locate and confirm 67 cases of mumps hearing loss. Only 15 of them had obvious clinical mumps infection by history, and over 90% of these cases had severe hearing loss, though this latter figure may be inflated due to ascertainment bias. It is important to note that Japan is an outlier among developed countries in how they immunize for measles, mumps, and rubella.

A few interesting references:
Hviid A, et al. Mumps. Lancet 2008; 371:932-44.
IASR. Mumps (infectious parotitis) in Japan, as of September 2016. IASR 2016; 37:185-6. Online at https://www.niid.go.jp/niid/en/index-e/865-iasr/6843-440te.html.
Morita S, et al. The clinical features and prognosis of mumps-associated hearing loss: a retrospective, multi-institutional investigation in Japan. Acta Oto-laryngol 2017; 137 (Suppl 565):S44-7.
Yung C, Ramsay M. Estimating true hospital morbidity of complications associated with mumps outbreak, England, 2004/5. Euro Surveill 2016; 21, online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998425/.
Yung C-F, et al. Mumps complications and effects of mumps vaccination, England and Wales, 2002-2006. Emerg Infect Dis 2011; 17:661-7.

Unless otherwise indicated, the content and opinions expressed on this web site are those of the author(s). They are not endorsed by and do not necessarily reflect the views of the George Washington University.
Viewing Message: 1 of 1.
 Notice

This site uses cookies to offer you a better browsing experience. Visit GW’s Website Privacy Notice to learn more about how GW uses cookies.