A protracted mumps outbreak in Western Australia despite high vaccine coverage: a population-based surveillance study

Darren W. Westphal, Ashley Eastwood, Avram Levy, Jane Davies, Clare Huppatz, Marisa Gilles, Heather Lyttle, Stephanie A. Williams, Gary K. Dowse

Research output: Contribution to journalArticle

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Abstract

Background: In 2007–08, a genotype J mumps outbreak occurred among Aboriginal people in northern Western Australia, despite high vaccine coverage. In March, 2015, a second protracted mumps outbreak occurred in northern Western Australia and spread widely across rural areas of the state. This time the outbreak was caused by a genotype G virus and again primarily affected Aboriginal people. We aimed to describe the epidemiology of this outbreak. Methods: In this population-based surveillance study, we analysed statutory notifications and public health case follow-up data from the Western Australia Notifiable Infectious Diseases Database and vaccination information from the Australian Childhood Immunisation Register. An outbreak case of mumps was notified if the affected person was living in or visiting a community in Western Australia where there was active mumps transmission, and if mumps infection was confirmed by laboratory diagnosis or by an epidemiological link. We analysed case demographics, vaccination status, and age-standardised attack rates in Aboriginal and non-Aboriginal people by region of notification. Laboratory diagnoses were made by real-time RT-PCR, serology, or both, and carried out by the sole public pathology provider in Western Australia. Findings: Between March 1, 2015, and December 31, 2016, 893 outbreak cases were notified. 798 (89%) of 893 outbreak cases were reported in Aboriginal people. 40 (4%) of 893 people were admitted to hospital, and 33 (7%) of 462 men reported orchitis. Mumps attack rates increased sharply with age, peaking in the 15–19 age group. 371 (89%) of 419 people aged 1–19 years were fully vaccinated and 29 (7%) were partly vaccinated. Of the 240 people who tested positive by real-time RT-PCR and had also been tested for mumps-specific IgG and IgM, 165 (69%) were positive for IgG but negative for IgM, indicating the importance of RT-PCR testing for diagnosis in vaccinated populations. None of the cases from the 2007–08 genotype J outbreak were re-notified. Interpretation: The number of mumps outbreaks reported in recent years among highly vaccinated populations, including Indigenous populations, has been growing. More widespread and pre-emptive use of the third dose of measles, mumps, and rubella vaccine might be required to control and prevent future outbreaks in high-risk populations. Research should explore the benefit of increasing the intervals between vaccine doses to strengthen the durability of vaccine protection. Funding: None.

Original languageEnglish
Pages (from-to)177-184
Number of pages8
JournalThe Lancet Infectious Diseases
Volume19
Issue number2
DOIs
Publication statusPublished - 1 Feb 2019

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Population Surveillance
Mumps
Western Australia
Disease Outbreaks
Vaccines
Clinical Laboratory Techniques
Genotype
Immunoglobulin M
Real-Time Polymerase Chain Reaction
Vaccination
Immunoglobulin G
Measles-Mumps-Rubella Vaccine
Orchitis
Population
Infectious Disease Transmission
Serology
Population Groups
Communicable Diseases
Immunization
Epidemiology

Cite this

Westphal, Darren W. ; Eastwood, Ashley ; Levy, Avram ; Davies, Jane ; Huppatz, Clare ; Gilles, Marisa ; Lyttle, Heather ; Williams, Stephanie A. ; Dowse, Gary K. / A protracted mumps outbreak in Western Australia despite high vaccine coverage : a population-based surveillance study. In: The Lancet Infectious Diseases. 2019 ; Vol. 19, No. 2. pp. 177-184.
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abstract = "Background: In 2007–08, a genotype J mumps outbreak occurred among Aboriginal people in northern Western Australia, despite high vaccine coverage. In March, 2015, a second protracted mumps outbreak occurred in northern Western Australia and spread widely across rural areas of the state. This time the outbreak was caused by a genotype G virus and again primarily affected Aboriginal people. We aimed to describe the epidemiology of this outbreak. Methods: In this population-based surveillance study, we analysed statutory notifications and public health case follow-up data from the Western Australia Notifiable Infectious Diseases Database and vaccination information from the Australian Childhood Immunisation Register. An outbreak case of mumps was notified if the affected person was living in or visiting a community in Western Australia where there was active mumps transmission, and if mumps infection was confirmed by laboratory diagnosis or by an epidemiological link. We analysed case demographics, vaccination status, and age-standardised attack rates in Aboriginal and non-Aboriginal people by region of notification. Laboratory diagnoses were made by real-time RT-PCR, serology, or both, and carried out by the sole public pathology provider in Western Australia. Findings: Between March 1, 2015, and December 31, 2016, 893 outbreak cases were notified. 798 (89{\%}) of 893 outbreak cases were reported in Aboriginal people. 40 (4{\%}) of 893 people were admitted to hospital, and 33 (7{\%}) of 462 men reported orchitis. Mumps attack rates increased sharply with age, peaking in the 15–19 age group. 371 (89{\%}) of 419 people aged 1–19 years were fully vaccinated and 29 (7{\%}) were partly vaccinated. Of the 240 people who tested positive by real-time RT-PCR and had also been tested for mumps-specific IgG and IgM, 165 (69{\%}) were positive for IgG but negative for IgM, indicating the importance of RT-PCR testing for diagnosis in vaccinated populations. None of the cases from the 2007–08 genotype J outbreak were re-notified. Interpretation: The number of mumps outbreaks reported in recent years among highly vaccinated populations, including Indigenous populations, has been growing. More widespread and pre-emptive use of the third dose of measles, mumps, and rubella vaccine might be required to control and prevent future outbreaks in high-risk populations. Research should explore the benefit of increasing the intervals between vaccine doses to strengthen the durability of vaccine protection. Funding: None.",
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A protracted mumps outbreak in Western Australia despite high vaccine coverage : a population-based surveillance study. / Westphal, Darren W.; Eastwood, Ashley; Levy, Avram; Davies, Jane; Huppatz, Clare; Gilles, Marisa; Lyttle, Heather; Williams, Stephanie A.; Dowse, Gary K.

In: The Lancet Infectious Diseases, Vol. 19, No. 2, 01.02.2019, p. 177-184.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A protracted mumps outbreak in Western Australia despite high vaccine coverage

T2 - a population-based surveillance study

AU - Westphal, Darren W.

AU - Eastwood, Ashley

AU - Levy, Avram

AU - Davies, Jane

AU - Huppatz, Clare

AU - Gilles, Marisa

AU - Lyttle, Heather

AU - Williams, Stephanie A.

AU - Dowse, Gary K.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Background: In 2007–08, a genotype J mumps outbreak occurred among Aboriginal people in northern Western Australia, despite high vaccine coverage. In March, 2015, a second protracted mumps outbreak occurred in northern Western Australia and spread widely across rural areas of the state. This time the outbreak was caused by a genotype G virus and again primarily affected Aboriginal people. We aimed to describe the epidemiology of this outbreak. Methods: In this population-based surveillance study, we analysed statutory notifications and public health case follow-up data from the Western Australia Notifiable Infectious Diseases Database and vaccination information from the Australian Childhood Immunisation Register. An outbreak case of mumps was notified if the affected person was living in or visiting a community in Western Australia where there was active mumps transmission, and if mumps infection was confirmed by laboratory diagnosis or by an epidemiological link. We analysed case demographics, vaccination status, and age-standardised attack rates in Aboriginal and non-Aboriginal people by region of notification. Laboratory diagnoses were made by real-time RT-PCR, serology, or both, and carried out by the sole public pathology provider in Western Australia. Findings: Between March 1, 2015, and December 31, 2016, 893 outbreak cases were notified. 798 (89%) of 893 outbreak cases were reported in Aboriginal people. 40 (4%) of 893 people were admitted to hospital, and 33 (7%) of 462 men reported orchitis. Mumps attack rates increased sharply with age, peaking in the 15–19 age group. 371 (89%) of 419 people aged 1–19 years were fully vaccinated and 29 (7%) were partly vaccinated. Of the 240 people who tested positive by real-time RT-PCR and had also been tested for mumps-specific IgG and IgM, 165 (69%) were positive for IgG but negative for IgM, indicating the importance of RT-PCR testing for diagnosis in vaccinated populations. None of the cases from the 2007–08 genotype J outbreak were re-notified. Interpretation: The number of mumps outbreaks reported in recent years among highly vaccinated populations, including Indigenous populations, has been growing. More widespread and pre-emptive use of the third dose of measles, mumps, and rubella vaccine might be required to control and prevent future outbreaks in high-risk populations. Research should explore the benefit of increasing the intervals between vaccine doses to strengthen the durability of vaccine protection. Funding: None.

AB - Background: In 2007–08, a genotype J mumps outbreak occurred among Aboriginal people in northern Western Australia, despite high vaccine coverage. In March, 2015, a second protracted mumps outbreak occurred in northern Western Australia and spread widely across rural areas of the state. This time the outbreak was caused by a genotype G virus and again primarily affected Aboriginal people. We aimed to describe the epidemiology of this outbreak. Methods: In this population-based surveillance study, we analysed statutory notifications and public health case follow-up data from the Western Australia Notifiable Infectious Diseases Database and vaccination information from the Australian Childhood Immunisation Register. An outbreak case of mumps was notified if the affected person was living in or visiting a community in Western Australia where there was active mumps transmission, and if mumps infection was confirmed by laboratory diagnosis or by an epidemiological link. We analysed case demographics, vaccination status, and age-standardised attack rates in Aboriginal and non-Aboriginal people by region of notification. Laboratory diagnoses were made by real-time RT-PCR, serology, or both, and carried out by the sole public pathology provider in Western Australia. Findings: Between March 1, 2015, and December 31, 2016, 893 outbreak cases were notified. 798 (89%) of 893 outbreak cases were reported in Aboriginal people. 40 (4%) of 893 people were admitted to hospital, and 33 (7%) of 462 men reported orchitis. Mumps attack rates increased sharply with age, peaking in the 15–19 age group. 371 (89%) of 419 people aged 1–19 years were fully vaccinated and 29 (7%) were partly vaccinated. Of the 240 people who tested positive by real-time RT-PCR and had also been tested for mumps-specific IgG and IgM, 165 (69%) were positive for IgG but negative for IgM, indicating the importance of RT-PCR testing for diagnosis in vaccinated populations. None of the cases from the 2007–08 genotype J outbreak were re-notified. Interpretation: The number of mumps outbreaks reported in recent years among highly vaccinated populations, including Indigenous populations, has been growing. More widespread and pre-emptive use of the third dose of measles, mumps, and rubella vaccine might be required to control and prevent future outbreaks in high-risk populations. Research should explore the benefit of increasing the intervals between vaccine doses to strengthen the durability of vaccine protection. Funding: None.

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