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Volume 4 No 2; 15 January 2010

Laboratory confirmed number of mumps cases in England and Wales: update to end-November 2009


In the period between January and November 2009, 7,410 cases of mumps were confirmed in England and Wales from almost 19,000 notifications received (see table). The five weekly average of notified cases in 2009 (see figure) were lower than those seen during the epidemic of 2004 and 2005, but higher than the rates seen in 2007 and 2008. In 2009, notifications have been declining since the peak in week 23 (figure).

Of the 7,410 samples with onset between January and November 2009 where mumps was confirmed, 5% (389) had detectible viral RNA by PCR, 75% (5,249) IgM antibodies in oral fluid and in 15% (1,119 ) IgM was identified in serum. An additional 9% (653) of cases had samples with high IgG antibody levels and are believed to represent probable re-infection in individuals with some pre-existing immunity (either natural or vaccine acquired).

Since 2004, the majority of the confirmed cases have been linked with outbreaks in universities; the proportion of patients of university age remains high (table). Although it is recommended that new entrants to universities and colleges have had two doses of MMR before commencing their studies, many confirmed cases are still unvaccinated or have only received one dose (because these cohorts were included in the MMR catch-up campaign but were not part of the routine two-dose MMR schedule). The high proportion of confirmed cases who have received at least one dose of MMR is consistent with high vaccine coverage in individuals born after 1988. Analysis of the 2004-05 epidemic [1,2] and data from US [3] suggest that decline in protection with time (since vaccination) may also contribute to cases in university students.

Confirmed cases of mumps by age group and region, England and Wales:
January - November 2009
 
Age group

Region

Less than 1

1-4

5-9

10-14

15-19

20-24

25+

n/k

Total

East Mids

-

5

4

27

219

246

151

3

655

East of Engl'd

2

3

15

27

190

194

114

-

545

London

2

27

49

65

180

303

262

9

897

North East

-

3

3

7

100

138

85

2

338

North West

3

13

36

71

471

477

301

4

1376

South East

3

15

15

35

311

437

268

3

1087

South West

2

8

10

38

294

429

203

4

988

West Mids

4

5

11

17

150

210

103

4

504

Wales

-

5

11

21

103

136

81

2

359

Yorks & Humber

1

5

19

27

206

267

133

3

661

Total*

17

89

173

335

2224

2837

2582

34

7410

* Includes samples (oral fluid, serum and other) with detectible IgM, viral RNA or raised IgG levels.

 

Mumps notifications (five weekly moving averages) July-June, England and Wales

 


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. Cohen C, White JM, Savage EJ, Glynn JR, Choi Y, Andrews N, et al. Vaccine effectiveness estimates, 2004–2005 mumps outbreak, England. Emerg Infect Dis [serial online], 14 December 20006. Available from: http://www.cdc.gov/ncidod/EID/13/1/12.htm [accessed 15 January 2010].

3. Kyaw MH, Rue AM, Klahn J, Obrecht L, Krohn T, Rowland J, et al. Long-term persistence of mumps antibody after receipt of two measles-mumps-rubella (MMR) vaccinations and antibody response after a third MMR vaccination among a university population. J Infect Dis. 2008 June 15; 197(12):1662-8.