Medical treatment and prevention of mumps

Diseased patients receive symptomatic treatment like analgesic or antipyretic drugs. So far, there is no specific antiviral treatment against MuV available. Therefore, the prevention of MuV infection plays an important role. Some easy ways to prevent MuV transmission via droplets are washing hands, cleaning of often touched surfaces like door handles, and covering nose and mouth while coughing or sneezing.

Vaccination plays the most important role in the prevention of mumps. Mumps vaccines are available as monovalent vaccines or combined with measles, measles and rubella (MMR) or measles, rubella, and varicella (MMRV) vaccines. The Centers for Disease Control and Prevention (CDC) proposes to vaccinate children using MMR or MMRV vaccines at the age of 12 - 15 month with the first dose, followed by a second dose at the age of 4 - 6 years (CDC, 2012). Children between 13 and 18 years should be vaccinated by one dose of MMR vaccine.

The MMRV vaccine is not licensed for children older than 12 years or adults. Adults, who were born during or after 1957, should receive on dose of MMR vaccine. In general, adults born before 1957 do not need to be vaccinated. The mumps vaccines were routinely introduced in 1967 and MuV infections mainly occured during the age of 5-9 years, suggesting that most of the persons born before 1957 were infected with MuV and are protected by antibodies. Generally, natural MuV infection confers a longlife protection against mumps. Nevertheless, healthcare workers, who can get in contact with infected persons, should receive 2 doses of MMR vaccine within 4 weeks to receive immunity against MuV infection. Mumps vaccines can not prevent mumps if applied after exposure to virus.

Immunosuppressed people, pregnant women, and people showing allergy against components of mumps vaccines such as neomycin or gelatine should be excluded from vaccination (Recommendations of the Immunization Practises Advisory Committee, 1998; Galazka et al., 1999).

Since 2001, the STIKO (ständige Impfkomission) adviced to vaccinate German children by two doses of mumps vaccines: the first dose should be administered at an age of 11 - 14 months, the second dose at an age of 15 - 23 months. All licensed mumps vaccines used in Germany are derived from the Jeryl Lynn strain (Koch, 2013). Furthermore, since March 2013 mumps is a notifiable disease in Germany in accordance to §6, Abs. 1 Infektionsschutzgesetz (IFSG). Confirmed MuV infections and deaths, as well as the suspicion of disease have to be reported to the public health office.

The first MuV vaccine, which was developed in 1948, was used from 1950 to 1978 in the United States. This inactivated vaccine induced only short-term immunity and is therefore not used anymore. At the moment, all licensed mumps vaccines are live attenuated vaccines which are derived from different MuV strains. MuV is serologically monotypic: Mumps vaccines are able to neutralize other mumps strains, but their efficacy is lower compared to the strain used for developing the vaccine (Rubin and Beeler, 2013).

A live attenuated Jeryl Lynn strain MuV vaccine was developed by passaging the virus in embryonated hen´s eggs followed by passaging in chicken embryo cell culture (Buynak and Hilleman, 1966). This vaccine was licensed in 1967 and used in the United States for more than 30 years. The seroconversion rates of a single dose of Jeryl Lynn vaccine ranged between 80 - 100 % (Fahlgren, 1988); 63 - 96 % of vaccinated people were protected against clinical mumps. More than 135 million people worldwide received the Jeryl Lynn mumps vaccine (WHO, 1994).

Another vaccine, derived from the Leningrad-3 strain, was developed in the former Soviet Union in guinea pig kidney cells, followed by passaging in Japanese quail embryo cultures (Smorodintsev et al., 1970). Leningrad-3 vaccine was used in the former Soviet Union since 1974. The seroconversation in children aged 1 - 7 years ranged between 89 - 98 % and the protective efficacy against clinical mumps ranged between 92 - 99 % (Smorodintsev et al., 1970). The Leningrad-Zagreb vaccine was developed by further attenuation of Leningrad-3 strain by adaptation and passaging in chicken embryo fibroblast cells (Beck et al., 1989). It was used in Croatia, the former Yugoslavia, and India. The seroconversation and preotection against mumps was similar to the Leningrad-3 vaccine (Beck et al., 1989; Bhargava et al., 1995).

The Urabe Am9 vaccine, which was produced in embryonated hen´s eggs or chicken embryo cells, was first licensed in Japan and later in Belgium, France, and Italy (WHO, 1994).

Overall more than 60 million people worldwide received this vaccine. Seroconversation and clinical protection was similar to Jeryl Lynn vaccine or even a little bit higher (Vesikari et al., 1983; Boulianne et al., 1995; Miller et al., 1995). Canada, the United Kingdom, and Japan reported cases of aseptic meningitis associated with the administration of Urabe Am9 vaccine and therefore withdrew MMR vaccines containing the Urabe Am9 strain from the market (Furesz and Contreras, 1990; Sugiura and Yamada, 1991; Miller et al., 1993; Ueda et al., 1995; Brown et al., 1996).

The Rubini strain vaccine was licensed in Switzerland in 1985 and used for the vaccination of more than 4 million people worldwide (WHO, 1994). This strain was first passaged in human diploid cells and embryonated hen´s eggs before it was adapted to the MRC-5 human diploid cell line (Gluck et al., 1986). Several studies in Switzerland and Italy showed that the seroconversion and efficacy of Rubini vaccine was lower compared to Jeryl Lynn and Urabe Am9 mumps vaccines and suggested that this vaccine should not be used for immunization programs any more (Paccaud et al., 1995; Chamot et al., 1998; Unknown, 1998).

In December 2005 the WHO reported that 110 (57 %) of the 193 WHO member states are using mumps vaccines in national immunization programs (WHO, 2007). In contrast to this, in most regions of Africa and regions of Southeast Asia MuV vaccines are not part of national immunization programs (Galazka et al., 1999). Fig. 8 gives an overview of countries using mumps vaccines in national immunization programs in 2012.

Fig. 8: Mumps vaccination in national immunization programs worldwide, 2012

Adapted from WHO, 2013 (Retrieved 2013-12-05, from http://www.who.int/immunization/

monitoring_surveillance/burden/vpd/surveillance_type/passive/Mumps_map_schedule.JPG?u a=1)