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Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e318279f593
Vaccine Reports

Epidemiology of a Mumps Outbreak in a Highly Vaccinated Island Population and Use of a Third Dose of Measles–Mumps–Rubella Vaccine for Outbreak Control—Guam 2009 to 2010

Nelson, George E. MD*†; Aguon, Annette; Valencia, Engracia; Oliva, Rita; Guerrero, Michele Leon; Reyes, Richard; Lizama, Anna; Diras, Daryl; Mathew, Annakutty MD, FACP‡§; Camacho, E. Jessica MEd; Monforte, Moryne-Nicole; Chen, Tai-Ho MD; Mahamud, Abdirahman MD*†; Kutty, Preeta K. MD, MPH*; Hickman, Carole PhD*; Bellini, William J. PhD*; Seward, Jane F. MBBS, MPH*; Gallagher, Kathleen MPH, DSc**; Fiebelkorn, Amy Parker MSN, MPH*

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Background: Despite high 2-dose measles-mumps-rubella (MMR) vaccine coverage, a large mumps outbreak occurred on the US Territory of Guam during 2009 to 2010, primarily in school-aged children.

Methods: We implemented active surveillance in April 2010 during the outbreak peak and characterized the outbreak epidemiology. We administered third doses of MMR vaccine to eligible students aged 9–14 years in 7 schools with the highest attack rates (ARs) between May 18, 2010, and May 21, 2010. Baseline surveys, follow-up surveys and case-reports were used to determine mumps ARs. Adverse events postvaccination were monitored.

Results: Between December 1, 2009, and December 31, 2010, 505 mumps cases were reported. Self-reported Pohnpeians and Chuukese had the highest relative risks (54.7 and 19.7, respectively) and highest crowding indices (mean: 3.1 and 3.0 persons/bedroom, respectively). Among 287 (57%) school-aged case-patients, 270 (93%) had ≥2 MMR doses. A third MMR dose was administered to 1068 (33%) eligible students. Three-dose vaccinated students had an AR of 0.9/1000 compared with 2.4/1000 among students vaccinated with ≤2 doses >1 incubation period postintervention, but the difference was not significant (P = 0.67). No serious adverse events were reported.

Conclusions: This mumps outbreak occurred in a highly vaccinated population. The highest ARs occurred in ethnic minority populations with the highest household crowding indices. After the third dose MMR intervention in highly affected schools, 3-dose recipients had an AR 60% lower than students with ≤2 doses, but the difference was not statistically significant and the intervention occurred after the outbreak peaked. This outbreak may have persisted due to crowding at home and high student contact rates.

© 2013 Lippincott Williams & Wilkins, Inc.


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