Tag: mumps

Mumps on the USS Fort McHenry

Like measles, we are seeing more mumps these days.

“Beginning in 1991, the military services implemented universal recruit immunization with a single dose of MMR vaccine, regardless of prior vaccination history. Shortly thereafter, and informed by the results of population serosurveys, the Air Force transitioned to a policy of targeted MMR vaccination, limiting the administration of MMR vaccine to recruits lacking serologic evidence of immunity to measles or rubella. With recent outbreaks of mumps, concerns have arisen that the practice of not specifically screening for mumps immunity in determining the need for MMR vaccine could lead to a relative increase in mumps risk among military recruits subject to screening. “

Eick et al on Incidence of mumps and immunity to measles, mumps and rubella among US military recruits, 2000–2004

Unlike measles, the MMR vaccine provides good, but not great protection against mumps.

And although military recruits are screened to see if they have low titers for measles and rubella, they still aren’t screened for mumps. The theory is that if their measles and rubella titers are low, then their mumps titer will be low too and they will get an MMR vaccine. Of course, this misses some who just have a low mumps titer, possibly an effect of waning immunity.

Mumps on the USS Fort McHenry

And that’s why we have been seeing mumps outbreaks on college campuses and most recently, on a Navy ship, although that isn’t a reason for everyone to go out and check their titers.

A tiny handful of measles outbreaks? There have been over 700 cases in the US during the past two years! There were only 37 cases in 2004.

Robert F. Kennedy, Jr has a lot to say about mumps…

He says that mumps outbreaks have devastated fully vaccinated populations at Harvard, Temple, Syracuse, Louisiana State, IU, and the U of Missouri…

And that mumps “epidemics” haven’t been covered by the media, because they don’t want to embarrass Merck…

Why won’t the media cover the mumps outbreaks! Oh, wait…

He also seems to think that these mumps cases have caused a national security threat

Is any of this true?

The simple fact that you can find a ton of stories in the media about the mumps outbreaks (they are not epidemics) gives you a good clue that they aren’t.

What about the quarantined sailors on the USS Fort McHenry?

That is true, but consider that only 27 of 700 of them have gotten parotitis, presumed to have been caused by mumps.

While you would expect that no one would get mumps or any other vaccine-preventable disease these days, that is just under 4% of those on board the ship.

What would have happened in the pre-vaccine era?

Although deaths were rare, mumps caused a lot of considerable loss of service and sick time in the military in the pre-vaccine era.
Although deaths were rare, mumps caused a lot of considerable loss of service and sick time in the military in the pre-vaccine era.

A whole lot more people would have gotten sick!

In the pre-vaccine era, although mumps was supposed to be a common childhood illness, about 1/3 to 1/2 of military recruits had never had mumps.

That meant big outbreaks of mumps that were hard to control, unlike what we see today.

“This article reports a recent public health response to 3 imported mumps cases occurring at Fort Campbell, Kentucky, that resulted in a contact investigation for 109 close contacts across varied settings. No secondary mumps cases were identified.”

Public Health Response to Imported Mumps Cases – Fort Campbell, Kentucky, 2018

Instead, not only do fewer people get sick during mumps outbreaks these days, but fortunately, they have fewer complications.

What kind of complications?

Mumps causes kids to have fever, puffy cheeks, and a painful, swollen jaw.
Mumps causes kids to have fever, puffy cheeks, and a painful, swollen jaw.

In addition to a swollen jaw, mumps is known to cause orchitis, aseptic meningitis, oophoritis, pancreatitis, and encephalitis.

“Risk was reduced for hospitalization, mumps orchitis and mumps meningitis when patient had received 1 dose of measles, mumps, and rubella vaccine. The protective effect of vaccination on disease severity is critical in assessing the total effects of current and future mumps control strategies.”

Young et al on Mumps Complications and Effects of Mumps Vaccination, England and Wales, 2002–2006

Fortunately, those complications are reduced when you get vaccinated. And so are your risks of actually getting mumps in the first place!

“This study demonstrates a significant preventive effect of two-dose vaccination against mumps complications (orchitis, meningitis, or encephalitis) and hospitalization for mumps.”

Orlíkováet al on Protective effect of vaccination against mumps complications, Czech Republic, 2007-2012.

Kennedy doesn’t mention a protective effect of the MMR vaccine, does he?

Remember, vaccines aren’t perfect, but even those that don’t work as well as the others still protect you from many of the worst complications and are much better than getting the disease naturally.

Mumps was often described as one of the top diseases that incapacitated soldiers in the prevaccine era.
Mumps was often described as one of the top diseases that incapacitated soldiers in the prevaccine era.

Vaccines are safe, with few risks, and are obviously necessary.

Is the mumps vaccine a national security threat? The only threat are the folks who continue to push anti-vaccine misinformation.

More on Mumps on the USS Fort McHenry

Does Japan have the Lowest Infant Mortality Rate Following a Ban on Mandatory Vaccinations?

Vaccines don’t affect infant mortality rates as much as you would expect, because there are many other things that kill infants besides vaccine-preventable diseases. Things like birth defects, prematurity, injuries and complications during pregnancy.

Unfortunately, that gives anti-vaccine folks lots of opportunities to misuse statistics about infant mortality rates.

Does Japan have the Lowest Infant Mortality Rate Following a Ban on Mandatory Vaccinations?

The latest propaganda about vaccines and infant mortality rates relates to Japan.

“It may come as no surprise to many that the Japanese Government banned a number of vaccines that are currently mandatory in the United States and has strict regulations in place for other Big Pharma drugs and vaccines in general.”

Jay Greenberg on Anti-Vaccine Japan Has World’s Lowest Child Death Rate, Highest Life Expectancy

Most folks will understand why this is simply propaganda.

Japan never banned any vaccines.

The 2016 routine and voluntary immunization schedule in Japan.
The 2016 routine (Hib, Prevnar, hepB, DTaP, IPV, BCG, MR, Varicella, Japanese Encephalitis, DT, and HPV) and voluntary (mumps, rotavirus, hepA, meningococcal) immunization schedule in Japan.

Japan is not anti-vaccine. Although their immunization schedule is certainly a lot more complicated than ours, they give many of the same vaccines as every other developed country.

“Following a record number of children developing adverse reactions, including meningitis, loss of limbs, and even sudden death, the Japanese government banned the measles, mumps, and rubella (MMR) vaccine from its vaccination program, despite facing serious opposition from Big Pharma.”

Was the MMR vaccine banned in Japan?

The MMR vaccine was introduced in Japan in 1989, and four years later, the government withdrew its recommendation for the vaccine.

Why? Reports of aseptic meningitis. This was likely due to the Urabe strain of the mumps component in their MMR vaccine, which was not used in the United States.

“The data up to now have revealed low rates of aseptic meningitis and no cases of virologically proven meningitis following the use of Jeryl–Lynn and RIT 4385 strains.”

WHO on Safety of mumps vaccine strains

They didn’t ban the vaccine or vaccination though.

They returned to giving children separate measles, rubella, and mumps (optional) vaccines. Tragically, because many kids didn’t get vaccinated against mumps, the rate of aseptic meningitis from people who actually got mumps was 25 times higher than the rate from the MMR vaccine!

When comparing risks vs benefits, it clearly favored getting vaccinated.

“Due directly to these gaps in ‘herd’ immunization resulting from politicized transitions in vaccination policy by the government, there were outbreaks of rubella with 17,050 cases reported between the years of 2012 and 2014, and 45 cases of congenital rubella syndrome reported to the National Epidemiological Surveillance of Infectious Diseases from week 1, 2012 to week 40, 2014.”

Yusuke Tanaka on History repeats itself in Japan: Failure to learn from rubella epidemic leads to failure to provide the HPV vaccine

The switch over also lead to outbreaks of rubella and increased cases of congenital rubella syndrome.

That’s no surprise to those who remember what happened in 1975, when routine pertussis vaccinations were halted in Japan following the deaths of two children. That eventually lead to epidemic cases of whooping cough in the country and at least 41 deaths in children (in 1979) before the vaccine was restarted.

Unfortunately, once they moved to DTaP vaccines, they started to see an increase in allergic reactions after kids got their MMR vaccine. Why? Their version of the DTaP vaccine contained poorly hydrolyzed bovine gelatin, which likely sensitized infants, who then developed an allergic reaction after getting an MMR vaccine with gelatin. While gelatin was removed from their DTaP vaccines, these extra side effects likely scared some folks in Japan.

Japan’s Vaccine Problem

Japan has more vaccine-preventable diseases than many other industrial countries.

Is it because Japan is anti-vaccine?

Of course not.

By impulsively halting and withdrawing vaccines, the Japanese government has done a good job of scaring folks though. They have also been very slow to introduce new vaccines, although they are catching up, as hepatitis, B, rotavirus, Hib, pneumococcal, meningococcal, HPV, and the chicken pox vaccine are all now available in Japan.

Have there been any benefits?

Nope.

They might have lower infant mortality rates, but that has nothing to do with vaccines.

There is no correlation between the number of vaccines that a country gives and their infant mortality rate.

If infant mortality rates are linked to vaccines, how do you explain Finland?
If infant mortality rates are linked to vaccines, how do you explain Finland?

Just look at the immunization schedules in Finland, Portugal, and other countries.

What about autism?

Rates of autism have increased in Japan, just as they have in other countries. So much for the idea that the MMR vaccine is associated with autism, right?

It should be obvious now that if anti-vaccine folks did any research at all, they wouldn’t use Japan as an example when they talk about vaccines.

With higher rates of vaccine-preventable disease and deaths from vaccine-preventable diseases, especially right after they impulsively halt a vaccine, Japan’s vaccine history simply demonstrates that vaccines work and that they are still very necessary.

One thing is true though. Japan’s infant mortality rate has been dropping, but then so has the infant mortality rate in almost all other countries, including the United States, which is at record low levels.

It certainly isn’t true that Japan’s infant mortality rate started to drop following a ban on mandatory vaccinations. How do we know that? Like many other countries, Japan has never had mandatory vaccinations. And not surprisingly, their infant mortality rate has continued to drop as they have added more vaccines and improved their immunization rates.

More on Vaccines and Infant Mortality Rates

Is Mutating Mumps More Than the MMR Can Manage?

It is not news that we have been seeing more cases of mumps in recent years.

It is also isn’t news that many of these folks are vaccinated.

“Long Beach has been hit with a mumps outbreak that is vaccine-resistant. According to health officials in the Long Island town, almost two dozen individuals are believed to have contracted the virus, with four confirmed cases and at least 14 suspected ones.”

Natural News

That sites like Natural News is putting out misinformation about vaccine-resistant strains of mumps also shouldn’t be news to anyone.

Why Do Folks Think That Vaccine-Resistant Viruses Are Causing Mumps Outbreaks?

So are vaccine-resistant mumps viruses causing outbreaks?

There is no good evidence of that and plenty of evidence that our current vaccines, even though they aren’t perfect, do cover all wild strains of mumps.

Unfortunately, it might not be surprising that some folks are confused about vaccine-resistant mumps viruses, when we have health officials saying things like:

“Sometimes nature throws a strain at us that might have mutated a little bit, and coverage of the vaccine is not 100 percent.”

Dr. Lawrence Eisenstein, Nassau County Health Commissioner

Dr. Eisenstein’s “might have mutated a little bit” comment got twisted into “the outbreak is most likely attributable to a new strain of the virus that is resistant to vaccines” by health reporters

And out of Arkansas, where there have also been large mumps outbreaks:

“We are actually to the point that we are worried that this vaccine may indeed not be protecting against the strain of mumps that is circulating as well as it could.”

Dr. Dirk Haselow, Arkansas State Epidemiologist

Of course, to say that the vaccine may not be protecting folks “as well as it could” doesn’t mean it doesn’t work because the wild type mumps virus has evolved or mutated enough to surmount our current MMR vaccine.

Is Mutating Mumps More Than the MMR Can Manage?

Although anything is possible, we fortunately have plenty of research that says that the mumps virus hasn’t mutated and that the MMR still works.

During an outbreak, universities make sure students are up-to-date with their MMR vaccines.
During an outbreak of mumps, some kids are getting a third dose of the MMR vaccine.

In fact, although the MMR vaccine is made from the A strain or genotype of mumps, it provides good protection against all 12 known strains of wild mumps viruses, including genotype G that has been causing most of the recent outbreaks.

But how can it cover a different strain of virus that isn’t in the vaccine?

Because not all viruses and vaccines are like influenza.

“The genotyping of the mumps virus is based on the Small Hydrophobic (SH) protein, a nonstructural protein and genetically the most variable one. Based on the SH-protein 12 different mumps viruses were detected up to now. In recent epidemics in Western countries the genotype G was mainly detected, while the mumps viruses used in the live attenuated mumps vaccines belong to genotype A (Jeryl Lynn) and to a lesser extent to genotype B (Urabe). However, antibodies against the SH protein have not yet been observed in human serum. It is, therefore, unlikely that antibodies against the SH protein play an important role in antibody-mediated virus neutralization.”

Sabbe et al. on The resurgence of mumps and pertussis

It is well known that you need a very specific match of the flu vaccine to the wild flu virus that is going around to get good protection, but for many other viruses, the differences that determine the strain or genotype have nothing to do with how antibodies will recognize the virus.

“Since mumps virus is monotypic, vaccine from any strain should provide lifelong protection against subsequent infection.”

Palacios et al. on Molecular Identification of Mumps Virus Genotypes from Clinical Samples: Standardized Method of Analysis

Like measles, mumps is a monotypic virus.

“Studies have demonstrated that blood sera from vaccinated persons cross-neutralizes currently circulating mumps strains.”

CDC on Mumps for Healthcare Providers

And like measles, the mumps vaccine (MMR), protects against all strains of wild mumps viruses.

“Compared with attack rates of 31.8%–42.9% among unvaccinated individuals, attack rates among recipients of 1 dose and 2 doses of the Jeryl Lynn vaccine strain were 4%–13.6% and 2.2%–3.6%, respectively.”

Dayan et al. on Mumps Outbreaks in Vaccinated Populations: Are Available Mumps Vaccines Effective Enough to Prevent Outbreaks?

And like other vaccines, the mumps vaccine (MMR) works.

Waning immunity may be an issue, but that certainly isn’t a reason to skip or delay this vaccine and put your kids, and everyone else, at risk to get mumps.

What to Know About Mumps Strains and Outbreaks

The MMR vaccines covers all strains of mumps and getting fully vaccinated is the best way to make sure your kids don’t get mumps.

More on Mumps Strains and Outbreaks

Does Your Child with Parotitis Have Mumps?

Even though they might never have had or seen a kid with mumps, most people know the tell-tale signs and symptoms.

Classically, mumps is associated with parotitis, with swelling of the salivary glands.
Classically, mumps is associated with parotitis, with swelling of the salivary glands.

But mumps isn’t the only thing that causes parotitis, especially in the post-vaccine era.

Does Your Child with Parotitis Have Mumps?

So having parotitis doesn’t automatically mean that you have mumps.

“Mumps is diagnosed by a combination of symptoms and physical signs and laboratory confirmation of the virus, as not all cases develop characteristic parotitis and not all cases of parotitis are caused by mumps.”

Mumps Questions and Answers

What else can cause parotitis?

  • bacterial infections, including Staphylococcus aureus, especially when the swelling is just on one side of the child’s face
  • blockage of the salivary gland because of a stone in the duct that drains the glands (sialadenitis), again, would be more common on just one side of the child’s face
  • viral infections, including adenovirus, Epstein-Barr virus (EBV), CMV, coxsackie A virus, HHV-6, influenza A, parainfluenza virus types 1, 2 and 3, and echovirus
  • less common causes in children might include medications, benign and malignant tumors, and immunologic diseases

So how do you know if your child with parotitis has the mumps or some other infection or condition?

“Mumps infection is most often confused with swelling of the lymph nodes of the neck. Lymph node swelling can be differentiated by the well-defined borders of the lymph nodes, their location behind the angle of the jawbone, and lack of the ear protrusion or obscuring of the angle of the jaw, which are characteristics of mumps.”

Mumps for Healthcare Providers

There are an increasing number of mumps outbreaks being reported these days and many cases are in vaccinated teens, so it might be easy to just say it is the mumps and recommend that you wait it out, as there is no treatment for the mumps or most other viral infections.

The only problem with that strategy is that if your child has a bacterial infection that is causing their parotitis, then they will likely need antibiotics. Some even go on to develop abscesses that need to be drained. Getting diagnosed with mumps might delay their treatment. And kids with mumps get quarantined far longer than kids with other viral infections.

Fortunately, testing is available, either a real-time RT-PCR (rRT-PCR) or mumps virus culture from a parotid duct swab. You can also do titer testing, although testing for the mumps virus is considered to be more accurate.

So does your child with parotitis have mumps?

They likely do if they have acute parotitis lasting at least 2 days, and either:

  • a positive test for serum anti-mumps immunoglobulin M (IgM) antibody,
  • a positive test for mumps virus with  the reverse transcription polymerase chain reaction (RT-PCR) test or culture
  • a link or exposure to someone else with mumps

Of course, there are other signs and symptoms of mumps besides parotitis. In fact, instead of the parotid gland, your child with mumps could have swelling of other salivary glands, like their sublingual or submandibular gland.

Confusing things, some kids with mumps do have parotitis on just one side of their face, or one side swells before the other. So you can’t say it isn’t mumps just because it is one side. And some kids with mumps never even develop parotitis, but may still have other symptoms and go on to develop complications of mumps.

“CDC recommends that a buccal or oral swab specimen and a blood specimen be collected from all patients with clinical features compatible with mumps.”

CDC on Collecting and Shipping Specimens for Suspected Mumps Cases

Still, many recent studies have confirmed few actual cases of mumps among kids with parotitis, especially among sporadic, non-outbreak cases. That makes it important to actually confirm that a child has mumps if you are going to diagnosis them with mumps.

And get your kids vaccinated and protected. The mumps vaccine isn’t perfect, but you are still much more likely to get mumps if you are unvaccinated.

What to Know About Mumps and Parotitis

While most kids with mumps have parotitis, not everyone with parotitis will have mumps, as there are many other things that cause pain and swelling of the parotid glands.

More on Mumps and Parotitis