TY - JOUR T1 - Mumps increase in Flanders, Belgium, 2012-2013: results from temporary mandatory notification and a cohort study among university students. JF - Vaccine Y1 - 2014 A1 - Toon Braeye A1 - Linina, Indra A1 - De Roy, Rikka A1 - Veronik Hutse A1 - Wauters, Magali A1 - Cox, Pia A1 - Mak, Ruud KW - ADOLESCENT KW - Adult KW - Belgium KW - Cohort Studies KW - Disease Notification KW - Disease Outbreaks KW - Female KW - Genotype KW - Humans KW - incidence KW - Male KW - Mumps KW - Mumps Vaccine KW - Mumps virus KW - Retrospective Studies KW - Students KW - Surveys and Questionnaires KW - Treatment Outcome KW - Universities KW - Young adult AB -

INTRODUCTION: In 2012, an increase in mumps notifications occurred in Belgium, affecting young vaccinated adults. At the end of 2012, a mumps outbreak occurred at the Catholic University of Leuven KU Leuven in Flanders. We investigated the outbreak to estimate incidence, mumps vaccine effectiveness and to detect potential risk factors for the disease.

METHODS: In June 2012, we set up mandatory notification in Flanders and we collected information on circulating genotypes from the National Reference Centre. We conducted a cohort study among KU Leuven students. We defined a case as self-reported parotitis, between September 2012 and March 2013. We distributed web-based questionnaires to a random sample of students. We calculated vaccine effectiveness by comparing the risks in students vaccinated twice with those vaccinated once. We estimated risk ratios (RR) to identify risk factors.

RESULTS: From 16th June 2012 to 1st April 2013, 4061 mumps cases were notified to the regional public health office (30% were vaccinated once and 69% were vaccinated twice). All 16 samples collected at the KU Leuven were genotype G5. Of 717 participants of the cohort study, 38 (5%; 95%CI 4-8%) met the case-definition. All reported being vaccinated with at least one dose of mumps-containing vaccine. The incidence of mumps was 5% among those vaccinated twice and 16% among those vaccinated once (vaccine effectiveness of two doses compared to one: 68%, 95%CI -24% to 92%). The risk of mumps was lower among those vaccinated with two doses of mumps-containing vaccine ≤10 years before (RR: 0.33, 95%CI 0.10-1.02) and higher among students working in a bar (RR: 3.6, 95%CI 1.8-7.0).

CONCLUSIONS: Incomplete protection by two doses of mumps-containing vaccine, possible waning immunity and intense social contacts may have contributed to the occurrence of this outbreak in Flanders. Efforts to maintain high vaccination coverage with two doses remain essential. However, the reasons for low vaccine effectiveness must be further explored and additional immunological research for more immunogenic mumps vaccines is necessary.

VL - 32 CP - 35 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24973734?dopt=Abstract M3 - 10.1016/j.vaccine.2014.06.069 ER -