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Mumps Outbreaks

Pre-Vaccine Era Mumps Outbreaks

In the pre-vaccine era, mumps was a common childhood infection that could cause orchitis, meningitis, pancreatitis, deafness, and even death.

There were about 212,000 cases a year in the early 1960s, before the first mumps vaccine was licensed in 1968.

Post-Vaccine Era Mumps Outbreaks

Tips to prevent getting sick with the mumps.
A large Ohio mumps outbreak prompted an education campaign to help protect everyone from getting sick.

As with other vaccine-preventable diseases, there was a big drop in cases of mumps once the mumps vaccine was introduced.

In 1968, there were just over 152,000 cases and 25 deaths  and just ten years later, in 1978, that was down to 16,817 cases and 3 deaths.

Once the recommendation for the second dose of MMR came in 1990, it looked like mumps was on it’s way out.

We went from 5,292 cases and one death that year, to just 906 cases and no deaths in 1995. When measles hit its low point of 37 cases in 2004, there were just 258 cases of mumps.

That wasn’t the end for mumps though, as we had some up and down years, including big outbreaks in:

  • 2006 – 6,584 cases among Midwest college students and one death
  • 2008 – only 454 cases, but one death
  • 2009 – 1,991 cases and two deaths
  • 2010 – 2,612 cases mostly among Orthodox Jewish communities and two deaths
  • 2011 – 370 cases
  • 2012 – 229 cases
  • 2013 – 584 cases
  • 2014 – 1,223 cases involving a large outbreak in Ohio and in the NHL
  • 2015 – 1,057 cases mostly among university students in Iowa and Illinois

Could this all be because of waning immunity?

2016 Mumps Outbreaks

So far in 2016, the CDC reports that there have been:

  • at least 4,619 cases of mumps
  • cases have been reported in all states except Delaware, Louisiana, Vermont, and Wyoming
  • seven states, AK, IA, IN, IL, MA, NY, and OK with more than 100 cases in 2016

The most recent, ongoing outbreaks are in:

  • Arkansas (at least 2,159 cases) – which may be fueled by a large community of Marshall Islanders living in close quarters, with low levels of vaccinations among adults in the community
  • Oklahoma (at least 324 cases)
  • Washington (93 cases)
  • Long Beach, New York (45 cases), and at State University of New York (SUNY) at New Paltz in New York (13 cases)
  • Harvard University (4 cases)
  • University of Missouri (31 cases)
  • Tufts University (9 cases)
  • Texas – with most of the cases in North Texas, including a large outbreak in Johnson County (72 cases) and two other outbreaks linked to four different cheerleading competitions.

At SUNY New Paltz, most of the cases were among the swim team. In addition, 20 unvaccinated students were sent home from school under quarantine until December 3.

In Arkansas, 42 workplaces, 39 schools in six school districts, six colleges and two private schools in Benton, Carroll, Conway, Faulkner, Madison, Pulaski, and Washington counties are seeing most of the cases. A quarantine is in effect, with unvaccinated children being kept out of school for 26 days from the date of exposure or for the duration of the outbreak, whichever is longer.

Many of these outbreaks occur despite many of the cases having had two doses of the MMR vaccine. A third dose is sometimes recommended during these outbreaks.

That doesn’t mean that the MMR vaccine doesn’t work. After all, just compare today’s rates of mumps, even if they are a little higher than we would like, to pre-vaccine levels…

Getting two doses of the MMR vaccine is still the best way to avoid mumps.

There is no general recommendations to get extra shots though.

Keep in mind that the MMR vaccine isn’t just for kids. Adults who didn’t have mumps when they were kids (or who were born before 1957, when most kids got mumps), should make sure they are vaccinated (at least one dose) and protected too.

For More Information on Mumps Outbreaks:

References on Mumps Outbreaks:
CDC. Reported Cases and Deaths from Vaccine Preventable Diseases, United States, 1950-2013.

Updated on December 24, 2016

Who is Tom Frieden?

CDC Director Tom Frieden in West Africa during the Ebola epidemic.
CDC Director Tom Frieden in West Africa during the Ebola epidemic.

Thomas Frieden, MD, MPH has had a long career in public health, working as Commissioner of the New York City Health Department and most recently as the Director of the Centers for Disease Control and Prevention.

Dr Frieden went to Oberlin College, Columbia University College of Physicians and Surgeons, and did his residency in internal medicine at Yale University.

The field of public health aims to improve the health of as many people as possible as rapidly as possible.

A responsive government can maintain that people are responsible for their own health while also taking public health action that changes default choices to make it easier for people to stay healthy.

Dr. Frieden on The Future of Public Health

During his career, he:

  • worked to reduce rates of cases of multidrug-resistant tuberculosis by 80 percent in New York City
  • assisted the national tuberculosis control program in India
  • directed efforts to reduce smoking, including teen smoking, in New York City
  • led the response to the 2009 H1N1 flu pandemic in the US
  • has pushed for more funding to help control and treat Zika, which he says will likely “become endemic in this hemisphere”

Perhaps most importantly, and despite some criticism, Dr. Frieden led the CDC during the Ebola epidemic in West Africa. An epidemic that spread to the US and other countries and for which the “CDC has undertaken the most intensive outbreak response in the agency’s history.”

Recently, he has also highlighted “two shortcomings of our health system,” that the upward trend in life expectancy that we have seen over the past 50 years (about 9 years), “is neither as  rapid  as  it  should  be  —  we  lag  behind  dozens  of  other  nations – nor is it uniformly experienced by people in the United States.” And that is because “life  expectancy  and  other  key health outcomes vary greatly by race, sex, socioeconomic status, and geographic location.”

And after working to eliminate trans fats from restaurants in New York City and have chain restaurants post calorie information on their menu boards, he has continued to confront many of the more modern era epidemics, like obesity, hypertension, and diabetes.

He resigned from the CDC on January 20, 2017 and was replaced by Anne Schuchat, MD, who became the  became Acting Director.

For More Information on Thomas Frieden

Updated January 22, 2017

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This Year’s Flu Season

The 2017 flu season has peaked and is finally winding down.
The 2017 flu season has peaked and is finally winding down.

Breaking News: Flu season has peaked, and is winding down. (see below)

While flu season typically peaks in February, it is very important to understand that there are few things that are typical about the flu.

Since 1982, while we have been twice as likely to see a flu activity peak in February than other winter months, we have been just as likely to get that peak in December, January, or March. That makes it important to get your flu vaccine as soon as you can.

You really never know if it is going to be an early, average, or late flu season.

Flu Facts

While there will likely be some surprises this flu season – there always are – there are some things that you can unfortunately count on.

Among these flu facts include that:

  • there have been 1,482 pediatric flu deaths since the 2003-04 flu season, including 89 flu deaths last year
  • about 113 kids die of the flu each year – most of them unvaccinated
  • antiviral flu medicines, such as Tamiflu, while recommended to treat high-risk people, including kids under 2 to 5 years of age, have very modest benefits at best (they don’t do all that much, are expensive, don’t taste good, and can have side effects, etc.)
  • a flu vaccine is the best way to decrease your child’s chances of getting the flu

And even in a mild flu season, a lot of kids get sick with the flu.

This Year’s Flu Season

When does flu season start?

In general, flu season starts when you begin to see people around you with signs and symptoms of the flu, including fever, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches, and fatigue, etc.

To be more accurate, you can also look at reports for flu activity in your area, especially the weekly reports from the CDC.

Those flu reports can also help you determine when flu season ends.

As of late-April, the CDC is reporting that “flu activity continues to decrease in the United States.”

The CDC has also recently reported that:

  • this year’s flu vaccine reduces “the risk for influenza-associated medical visits by approximately half”
  • influenza A (H3N2) viruses, a component of this year’s flu vaccine, predominated early in this year’s flu season, which could be a sign of a severe flu season. In general, “H3N2-predominant seasons have been associated with more severe illness and higher mortality, especially in older people and young children…”
  • Is it a match? – “…antigenic and/or genetic characterization shows that the majority of the tested viruses remain similar to the recommended components of the 2016-2017 Northern Hemisphere vaccines.”
  • As often happens on the downside of a flu season peak, we are starting to see more and more influenza B each week
  • There are reports of a new avian influenza A(H7N9) epidemic in China. Although deadly, there is fortunately no reports of sustained human-to-human transmission of this flu virus strain that is usually associated with poultry exposure.
  • Next year’s flu vaccine won’t be changing much, except that “The  A(H1N1)pdm09  virus  has  been  updated  compared  to  the  virus recommended  for  northern  hemisphere  2016-2017  influenza  season.”
  • only 3 states (down from 7), including Connecticut, New Hampshire, and New York, are still reporting widespread flu activity (the highest level)
  • only 8 states (down from 11), including Alaska, Arizona, Maine, Massachusetts, New Jersey, Ohio, Rhode Island, and South Carolina are still reporting regional flu activity
  • 20 states (up from 19), California, Delaware, Florida, Iowa, Kansas, Louisiana, Maryland, Michigan, Minnesota, Missouri, Montana, New Mexico, North Dakota, Oklahoma, Pennsylvania, Tennessee, Texas, Washington, West Virginia, and Wisconsin, and Puerto Rico are now reporting local flu activity
  • 19 states (up from 13), including Alabama, Arkansas, Colorado, Georgia, Hawaii, Idaho, Illinois, Indiana, Kentucky, Mississippi, Nebraska, Nevada, North Carolina, Oregon, South Dakota, Utah, Vermont, Virginia and Wyoming, are now reporting sporadic flu activity
  • there have been 89 pediatric deaths this flu season, including reports of 7 new deaths this week

Have you and your family gotten been vaccinated and protected against the flu yet?

“Anyone who has not gotten vaccinated yet this season should get vaccinated now.”

CDC Influenza Situation Update

If not, this is still a good time to get a flu vaccine.

Recent Flu Seasons

Are H3N2 predominant flu seasons really worse than others?

  • 2003-04 flu season – 152 pediatric flu deaths (H3N2-predominant)
  • 2004-05 flu season – 47 pediatric flu deaths
  • 2005-06 flu season – 46 pediatric flu deaths
  • 2006-07 flu season – 77 pediatric flu deaths
  • 2007-08 flu season – 88 pediatric flu deaths (H3N2-predominant)
  • 2008-09 flu season – 137 pediatric flu deaths
  • 2009-10 flu season – 289 pediatric flu deaths (swine flu pandemic)
  • 2010-11 flu season – 123 pediatric flu deaths
  • 2011-12 flu season – 37 pediatric flu deaths
  • 2012-13 flu season – 171 pediatric flu deaths (H3N2-predominant)
  • 2013-14 flu season – 111 pediatric flu deaths
  • 2014-15 flu season – 148 pediatric flu deaths (H3N2-predominant)
  • 2015-16 flu season – 92 pediatric flu deaths

In addition to high levels of pediatric flu deaths, the CDC reports that the four flu seasons that were H3N2-predominant in recent years were “the four seasons with the highest flu-associated mortality levels in the past decade.”

For More Information on the 2016-17 Flu Season

Updated May 6, 2017

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Doctors Facing Disciplinary Actions Over Vaccines

mendelsohn
Dr. Mendelsohn was the Dr. Bob of his day.

There are many doctors and other health professionals who do and recommend things that are far out of the mainstream. They may tell their patients to skip or delay vaccines, that vaccine-preventable diseases aren’t that bad, or even that vaccines don’t work, etc.

And yet, many are surprised when some of them face disciplinary actions from their state’s medical boards, such as:

Dr. Ming Te Lin, the board certified pediatrician in Illinois who:

  • was preparing alternative vaccinations for children for more than a decade
  • gave patients modified vaccinations containing cat saliva and vodka
  • was signing state forms certifying he had given pediatric patients their conventional shots
  • used a WaveFront 2000 device to detoxify vaccines of mercury

Dr. Lin’s medical license has been suspended and he  was supposed to have “a hearing before the Medical Disciplinary Board is set for Oct. 11 in Chicago.” That hearing didn’t happen though and he is now supposed to have a new hearing on November 21.

Dr. Bob Sears is also facing disciplinary action from his state’s medical board.

With a long history of recommending his own alternative immunization schedule to parents, Sears is accused of gross negligence for the way that he granted a medical exemption for vaccines to a child.

An anti-vaccine doctor in Arizona, Dr. Jack Wolfson, a holistic cardiologist, was also investigated by his state’s medical board following several complaints that were made during a recent measles outbreak.

Joseph Mercola, D.O. is another anti-vaccine doctor who has faced trouble in the past. A frequent guest on the Dr. Oz show, he has gotten several warnings from the FDA for marketing a thermal camera as a cancer screening device and making false and misleading claims about natural supplemental products he markets.

Even Dr. Oz has gotten into some trouble in recent years, testifying before Congress about weight loss scams.

For More Information On Doctors Facing Disciplinary Actions Over Vaccines:

Vaccine Recalls

comvax
Two lots of Comvax were recalled in 2007 because of contamination concerns.

Vaccines aren’t often recalled. There have been about 18 recalls of vaccines since 2006.

While that might seem like a lot, remember that at least 2.5 billion doses of vaccines have been given in that time .

When vaccines are recalled, it is typically because:

  • there is a loss of potency over time (typically flu vaccines near the middle or end of flu season)
  • there are minor production or manufacturing issues

Fortunately, these recalls don’t usually seem to involve major problems.

They are also a testament to just how closely vaccines are inspected after they are manufactured.

Vaccine Recalls

Recent vaccine recalls include:

  • Fluzone Quadrivalent – 3 lots had declined below the stability specification limit for 2 strains (2015)
  • Flulaval Quadrivalent – 13 lots of thimerosal-free pre-filled syringes were recalled because of loss of potency (2015)
  • Gardasil – one lot was recalled “due to the potential for a limited number of vials to contain glass particles” (2013)
  • Menveo – two lots were recalled “following observation of higher-than-specified levels of residual moisture within the lyophilized MenA component vial” (2013)
  • Recombivax HB – one lot was recalled “due to the potential for a limited number of cracked vials to be present in the lot.” (2013)
  • Typhim Vi – two lots of prefilled syringes and 20-dose vials because the “lots are at risk for lower antigen content” (2012)
  • MMR-II – one lot was recalled because it had not been shipped before being released. (2012)
  • Prevnar 13 – one lot was recalled because “the lot was formulated and filled with expired serotype 3 conjugate material.” (2012)
  • Fluvirin – one lot was recalled because “for a small number of vials, cracked vial necks leading to broken vials have been detected” (2010)
  • RabAvert Rabies Vaccine Kits – one lot was recalled because “as the stopper and the metal crimp dislodge from the vial completely when removing the protective cap.” (2010)
  • Prevnar 7 – 4 lots were recalled because “a potential exists for syringes to have been distributed with a rubber formulation in the syringe tip caps that was not approved for use with Prevnar.” (2010)
  • 2009 H1N1 intranasal vaccine – 13 lots were recalled because of a “slight decrease in the potency of the H1N1 component of the vaccine” (2009)
  • 2009 H1N1 vaccine – 4 lots were recalled because they were “intended for children 6 through 35 months of age” (2009)
  • Prevnar 7 – 1 lot was recalled because some of pre-filled syringes were “not intended for commercial use” (2009)
  • Fluvirin – 5 lots was recalled because of “a minor deviation in the potency of the A/Brisbane (H1N1) component of the vaccine” (2009)
  • PedvaxHib and Comvax – 13 lots were recalled because of a “lack of assurance of product sterility” (2007)
  • Fluvirin – 2 lots were recalled because they were shipped “in either a frozen state and/or below the required storage temperature” (2006)
  • Decavac – one carton (about 3000 Td shots) was recalled because it ” exceeded labeled temperature requirements during shipment” (2006)

These vaccine recalls shouldn’t scare you away from getting your kids vaccinated.

None led to “serious adverse events,” as some folks try to scare parents.

If anything, they should reassure you just how safe vaccines are. After all, from these vaccine recalls, you now know that ‘they’ are:

  • monitoring the potency of vaccines after they are manufactured
  • monitoring the temperatures of the vaccines while they are being shipped and stored
  • continuing to do quality testing, even after the vaccine is released

Remember, according to the CDC:

There have been only a few vaccine recalls or withdrawals due to concerns about either how well the vaccine was working or about its safety.  Several vaccine lots have been recalled in recent years because of a possible safety concern before anyone reported any injury.  Rather, the manufacturer’s quality testing noticed some irregularity in some vaccine vials.  In these cases, the safety of these vaccines was monitored continuously before and after they were in use.

Of these recalls, one of the largest was the 2007 recall of PedvaxHib and Comvax by Merck over concerns “about potential contamination with bacteria called B. cereus.” Fortunately, “no evidence of B. cereus infection was found in recipients of recalled Hib vaccines.”

If one of your child’s vaccines have been recalled, you will likely be notified by your pediatrician, who would have been notified by the manufacturer of the vaccine.

For More Information on Vaccine Recalls:

Discontinued Vaccines

tripedia
The Tripedia DTaP vaccine was discontinued in 2013.

Most people know that the RotaShield rotavirus vaccine was discontinued in 1999 because it was found to be linked to intussusception.

It took eight years for a new rotavirus vaccine to be licensed.

Lymerix, a Lyme disease vaccine was discontinued in 2002. Unfortunately, we still don’t have a new replacement Lyme disease vaccine.

Vaccines That Have Been Discontinued

More commonly, a vaccine gets discontinued with little notice, as there are other options to keep kids vaccinated and protected.

Other vaccines that are no longer made, include:

  • Cervarix – an HPV vaccine that was discontinued in the US in 2016
  • Comvax –  a Hib/Hepatitis B combination – discontinued in 2014
  • Tetanus toxoid – discontinued 2013
  • Tripedia – a DTaP vaccine – discontinued 2011
  • TriHIBit – a DTaP/Hib combination
  • JE-VAX – discontinued 2005
  • Attenuvax – measles vaccine
  • Mumpsvax – mumps vaccine
  • Meruvax II – rubella vaccine
  • M-R-Vax – measles and rubella combo
  • M-M-Vax – measles and mumps combo
  • Biavax II – rubella and mumps combo
  • Heptavax-B – the original hepatitis B vaccine
  • HIB-Vax – the original Hib vaccine
  • Plague vaccine
  • Poliovax
  • Dryvax – smallpox vaccine
  • Measles-Smallpox combination vaccine
  • Diptussis – a diphtheria/pertussis combination (1949-55)
  • Quadrigen – a DTP/Polio combination (1959-68)
  • Streptococcus vaccine (1952-88)
  • Serobacterin – a pertussis vaccine (1945-54)
  • Rocky mountain spotted fever vaccine (1942-78)
  • Typhus vaccine (1941-79)
  • smallpox vaccine (1917-1976)

Most of these vaccines were discontinued because they simply became obsolete.

Orig. Title: SPvac806.8a
A smallpox vaccination kit included the diluent, a vial of Dryvax smallpox vaccine, and a bifurcated needle.

The Hib-Vax and Heptavax-B vaccines, for example, both use older technology, so these vaccines were discontinued when newer Hib and hepatitis B vaccines were introduced.

And some vaccines are discontinued  or are phased out when they get an update:

  • MMR -> MMR-II (1978)
  • Prevnar 7 -> Prevnar 13 (2010)
  • Gardasil -> Gardasil 9 (2014)

Still other vaccines, like Tripedia and TriHIBit, seemed to get discontinued as a business decision. Through mergers, Sanofi Pasteur, Ltd. ended up with two DTaP vaccines. They had their own Daptacel, but also had Tripedia, a vaccine they acquired from Pasteur Merieux. They ended up discontinuing Tripedia.

Merck also stopped making Comvax not because of “any  product safety or manufacturing issues,” but rather “as part of its ongoing effort to focus company resources on opportunities that provide the greatest value for customers, patients, and public health…”

Cervarix was discontinued because of low market demand. The competing HPV vaccine, Gardasil, had the much larger market share.

Vaccine Manufacturers and Discontinued Vaccines

And of course, some vaccine manufacturers simply stopped making vaccines.

The Texas Department of Health Resources once had a license to make vaccines, including DTP, diphtheria, DT, pertussis, tetanus, Td, and typhoid vaccines since 1950. They completely exited the vaccine market in 1979.

In the 1970s and 80s, dozens of vaccines were discontinued as Miles Inc., Eli Lilly, Parke Davis, and other companies stopped making vaccines.

While that is often downplayed these days, it is important to realize that we used to have much more competition among vaccine manufacturers. For example, in the early 1970s, the DTP vaccine was made by at least 11 different companies! We now have just two that make DTaP. And in many other cases, like for Prevnar, MMR-II, polio, and the chicken pox vaccine, there is just one manufacturer.

For More Information on Discontinued Vaccines:

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HPV Vaccine Update

merck-hpv-vaccination-large-9
A new commercial is raising awareness about the importance of getting kids vaccinated against HPV.

How often does an update from the Advisory Committee for Immunization Practices (ACIP) mean that your kids will need fewer shots?

Not that often…

But at their October meeting, the ACIP did recommend that preteens needed only two rounds of HPV vaccine, instead of three.

This follows FDA approval for Gardasil 9 on a 2-dose regimen for individuals 9 through 14 years of age in early October.

Remember that children who are at least 9 years old (traditionally 11 or 12 year old boys and girls) have traditionally gotten three doses of Gardasil, with:

  • the second dose at least 1 to 2 months after the first dose, and
  • the third dose at least 6 months after the first dose

With the new recommendations, if your child is under 15 years old when getting the first dose, then he or she will need only two doses of HPV vaccine to complete the series, with the second dose 6 to 12 months after the first.

What if your child has already gotten three doses? Then your child is well protected against HPV.

If your child has already gotten a second dose 1 to 2 months after the first, then they will have to wait to get the third dose following the 3 dose original schedule. The same goes if your child is already at least 15 years old. Neither will benefit from the new recommendation.

In other news about the HPV vaccines:

And remember that it is no longer news that Gardasil, a vaccine that can prevent cancer, was approved by the FDA. That happened over ten years ago – June 2006.

It should also no longer be news that the HPV vaccines are well studied and in continuing studies have only been found to cause mild side effects, just like most other vaccines.

In other vaccine news, GSK will no longer sell its HPV vaccine Cervarix in the United States because of low market demand – i.e. competition from Gardasil.

For More Information On HPV Vaccines: