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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*

The Pediatric Infectious Disease Journal: April 2013 - Volume 32 - Issue 4 - p 374–380
doi: 10.1097/INF.0b013e318279f593
Vaccine Reports

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.

From the *National Center for Immunization and Respiratory Diseases; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA; Guam Department of Public Health and Social Services; §Guam Memorial Hospital; Guam Department of Education, Guam; Division of Global Migration and Quarantine; and **Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA.

Accepted for publication October 17, 2012.

The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Amy Parker Fiebelkorn, MSN, MPH, CDC/NCIRD, 1600 Clifton Rd, MS A-34, Atlanta, GA 30333. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.