Skip Navigation LinksHome > August 2010 - Volume 29 - Issue 8 > Mumps Outbreak in the Republic of Moldova, 2007–2008
Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e3181d743df
Original Studies

Mumps Outbreak in the Republic of Moldova, 2007–2008

Schwarz, Norbert G. MD, MSc, DTHM*†‡; Bernard, Helen MD§¶∥; Melnic, Anatolie MD**; Bucov, Victoria MD**; Caterinciuc, Natalia MD**; an der Heiden, Matthias PhD§; Andrews, Nick MSc††; Pebody, Richard MD, PhD††; Aidyralieva, Chinara MD, PhD‡‡; Hahné, Susan MD§§¶¶

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Abstract

Background: Moldova experienced a nationwide mumps outbreak between 2007 and 2008. Single-dose monovalent mumps vaccination at 15 to 18 months was introduced in 1983, replaced by a 2-dose MMR schedule at age 1 and 6 to 7 years in 2002. We investigated the outbreak to quantify its extent, explore the role of primary and secondary vaccine failure, and provide control recommendations.

Methods: We analyzed national mumps surveillance and vaccination coverage data to estimate vaccine effectiveness (VE) using the screening method. A retrospective cohort study in 5 educational institutions was conducted to determine age-specific attack rates (ARs) and VE. We compared vaccine strain-specific ARs. Isolation and genotyping of mumps virus strains were performed.

Results: Of 31,142 cases reported during October 2007 and July 2008, 80% were in 15- to 24-year-olds. Of cases with information (66%), 92% were vaccinated once, 4% twice. One-dose mumps VE estimates based on surveillance data over 1997–2001 declined from 91% (95% CI: 88%–92%) in 2-year-olds to 72% (70%–74%) in 15- to 19-year-olds. In the cohort study (n = 1589), VE was −40% (−120% to 20%) for 1 dose. For 2 doses it was 62% (−43% to 90%) in 13- to 15-year-olds. ARs were higher in individuals vaccinated with Urabe strains (43%) than with Leningrad-Zagreb strains (14%, P < 0.001). Mumps virus genotype G5 was identified.

Conclusions: Low effectiveness of single-dose mumps vaccination was the main cause of the outbreak. Waning immunity may have contributed to this. The risk of mumps in 2-dose vaccinees was low. Other countries in which large population groups have received <2 doses of mumps vaccine may face similar outbreaks.

© 2010 Lippincott Williams & Wilkins, Inc.

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