News Archives |
Volume 3 No 10; 13 March 2009
Mumps increase in university students
The number of mumps cases notified in England and Wales has increased in the first part of 2009 (see figure), in association with outbreaks in several universities and colleges. This is the first such increase since the large epidemic of mumps that affected university students in academic years 2004/5 and 2005/6. Subsequently, numbers were lower - in 2006/7 and 2007/8 - but now appear to have increased slightly again in 2008/9 [1-4].
The provisional total of confirmed mumps cases in 2008 was 2440, higher than 2007 (1476) but much lower than the total for 2005 (43,378). Cases were reported from all English regions and Wales with the highest totals from the South East (670), the North West (395) and London (393). In line with the high number of notified cases, there was a provisional total of 265 laboratory confirmed cases of mumps in England and Wales with onset in January 2009.
The previous epidemic was attributed to a cohort of young adults, born between 1981 and 1990, who were at increased risk of mumps. These individuals were born before the implementation of the two-dose MMR programme and had therefore either received no MMR vaccine, or only one dose. As control of mumps was excellent after 1990, this group remained susceptible and once in the university or college setting, transmission of mumps was facilitated.
During 2008, 1542 (63%) of confirmed cases were in those born between 1981 and 1990, suggesting that the reason for the current increase is similar to those in the previous period. Only 309 (12%) of cases were in individuals born after 1990, suggesting that the current two dose schedule is effective in controlling mumps.
Figure: Five-week moving average of mumps notifications in England and Wales, 2008-2009
References
1. Savage E, Ramsay M, White J, Beard S, Lawson H, Hunjan R, et al. Mumps outbreaks across England and Wales in 2004: observational study. BMJ 2005; 330(7500):1119-20.
2. HPA. Changes in laboratory testing as the increase in mumps cases in England and Wales continues. Commun Dis Rep CDR Wkly [serial online] 2005 [cited 13 March 2009]; 15(5): news. Available at: http://www.hpa.org.uk/cdr/archives/archive05/News/news0505.htm#mumps.
3. HPA. Decrease in mumps notifications in England and Wales. Commun Dis Rep CDR Wkly [serial online] 2006 [cited 13 March 2009]; 16(51): news. Available at: http://www.hpa.org.uk/cdr/archives/archive06/News/news0806.htm.
4. Centers for Disease Control and Prevention. Mumps epidemic - United Kingdom, 2004-2005. MMWR Morb Mortal Wkly Rep [serial online] 2006; 55(7):173-5.
Investigation at Fat Duck Restaurant
The Health Protection Agency is leading the investigation into an outbreak of diarrhoea and vomiting associated with the Fat Duck restaurant in Berkshire. The Agency's Thames Valley Health Protection Unit (HPU) is working with the Royal Borough of Windsor and Maidenhead Environmental Health Department.
The aim is to establish the source of the illness and make recommendations to ensure any further risk is reduced as much as possible. The investigation has two elements:
- Examining samples of foodstuffs from the restaurant; samples taken from people who reported being ill after eating there; samples from all members of staff; and a risk assessment of all food storage, preparation and cooking processes. Experts from the HPA Centre for Infections are assisting by offering sensitive laboratory tests to look at possible contamination of foodstuffs by germs – either bacterial or viral – which could have occurred at any time from before supply to the restaurant to reaching the plate; and
- Investigating the characteristics of all the individuals affected: their symptoms and the food they ate. The Agency also plans to do further studies among all those who ate at the restaurant during this time, whether they reported being ill or not.
The restaurant's management is co-operating fully with the investigation and closed voluntarily after a number of people reported being ill soon after eating at the restaurant in Bray. The number of possible cases reported to the restaurant has risen since media coverage of the outbreak, to around 400 going back to late January and mostly through February.
The Agency advised managers of the restaurant that they could reopen on 12 March as they agreed to comply with recommendations made after a full risk assessment was carried out by Thames Valley HPU and environmental health officers.
Preliminary findings from the investigation have informed the advice given so far, although the investigation is ongoing. So far no one source has been identified. Results of some tests are still awaited and the detailed questioning of people who reported illness is likely to continue for some weeks in order to build a more complete picture.