Canadian Immunization Guide
Seventh Edition - 2006

[Previous] [Table of Contents] [Next]

Part 4
Active Immunizing Agents

Mumps Vaccine

Epidemiology Preparations approved for use in Canada Efficacy and immunogenicity Recommended usage Schedule and dosage Route of administration Booster doses and re-immunization

Serologic testing Storage requirements Simultaneous administration with other vaccines Adverse reactions Contraindications and precautions Selected references

Mumps is an acute infectious disease caused by mumps virus. About 40% of those infected develop acute parotitis, which is unilateral in about 25% of cases. Nonspecific or primarily respiratory symptoms occur in about half of those who acquire infection. Subclinical infection is common. Although complications are relatively frequent, permanent sequelae are rare. Before the widespread use of mumps vaccine, mumps was a major cause of viral meningitis. Mumps meningoencephalitis can, rarely, result in permanent neurologic sequelae, including paralysis, seizures, cranial nerve palsies and hydrocephalus. Transient but occasionally permanent deafness may occur, at an estimated rate of 0.5 to 5.0 per 100,000 reported mumps cases. Orchitis occurs in 20% to 30% of post-pubertal male cases and oophoritis in 5% of post-pubertal female cases. Involvement of the reproductive organs is commonly unilateral; therefore, sterility as a result of mumps is rare. Mumps infection in pregnancy has not been associated with congenital malformations, but mumps infection during the first trimester of pregnancy may increase the rate of spontaneous abortion.

Since the publication of the 2002 Canadian Immunization Guide there have been some changes in the preparations approved for use in Canada.

Epidemiology

Since the approval of vaccine in 1969, the number of reported mumps cases has decreased by greater than 99% from an average of 34,000 cases reported per year in the early 1950s to under 400 cases per year in the early 1990s. A further reduction in incidence was observed following the introduction of the routine second dose of MMR. The annual number of reported cases has continued to drop; during the period 2000-2004, an average of 87 cases were reported annually, ranging from 32 (2004) to 205 cases (2002).

In Canada, large outbreaks have been rare in recent years, but three localized outbreaks occurred between 2001 and 2005. The first outbreak, of 193 cases, occurred between September 2001 and March 2002 and involved an under-vaccinated community in northern Alberta following importation of the disease from Bolivia. Most members of the community were philosophically opposed to vaccination. Immunization rates in the affected community were greatly below the provincial average. The majority of cases (80%) occurred in unimmunized individuals, spreading through area schools and to a lesser extent the surrounding community. Two small outbreaks involving 13 and 19 cases occurred in Nova Scotia in the spring and fall of 2005 respectively. The cases ranged in age from 13 to 19 years (average age 14) for the former and 20 to 27 years in a university community (average age 23 years) for the latter. Four of the 13 cases in the first Nova Scotia outbreak and all of the cases in the second outbreak reported receiving only one dose of MMR. The latter outbreak resulted in three secondary cases in other provinces.

Globally there has been an ongoing outbreak in the United Kingdom from 2004 to 2006, which has involved > 70,000 cases. Most of the cases have occurred among unvaccinated young adults. The circulating genotype has been identified as genotype G. The G genotype is not an unusual or rare genotype and, like the rest of known genotypes of mumps, it has been circulating globally for decades or longer. In 2005-2006, multi-state outbreaks of mumps involving several hundred individuals, mostly young adults, many of whom had been vaccinated (with one dose of mumps vaccine), have occurred in the United States. These outbreaks have also been identified as associated with genotype G. Mumps remains endemic in many countries throughout the world, and mumps vaccine is used in only 57% of World Health Organization member countries, predominantly in countries with more developed economies.

Preparations approved for use in Canada

This chapter will deal only with vaccines that are currently marketed in Canada.

• M-M-R^® II (measles, mumps, and rubella vaccine, live, attenuated), Merck Frosst Canada Ltd.
• Priorix^® (measles, mumps, and rubella vaccine, live, attenuated), GlaxoSmithKline Inc.

Mumps virus vaccine is a live, attenuated virus vaccine and is only available in the combined form as measles, mumps and rubella (MMR) vaccine.

For a list of all approved products in Canada, please refer to Table 1 in the General Considerations chapter.

Efficacy and immunogenicity

A single dose of mumps vaccine produces an antibody response in over 95% of susceptible individuals. In controlled clinical trials, one dose of mumps vaccine was 95% efficacious in preventing mumps disease. However, field studies have demonstrated lower estimates of vaccine efficacy, usually around 80% with single-dose regimens. Antibody levels are lower than those that follow natural disease. The duration of vaccine-induced immunity is unknown, but serologic and epidemiologic data show the persistence of antibody, suggesting continuing protection against infection for at least 20 years. Although no data are currently available corre lating specific antibody titres with susceptibility to mumps, outbreaks have been reported in highly vaccinated populations. A two-dose measles, mumps, and rubella immunization schedule used in Finland resulted in higher mumps-specific antibody levels, a higher seropositivity rate and slower decay of antibody levels.

Recommended usage

Administration of live attenuated mumps vaccine in combination with measles and rubella vaccines (MMR) is recommended for all children 12 months of age. The combined vaccine should be used even in individuals who may have prior immunity to components of the vaccine, and it can be used to immunize susceptible adults against mumps.

Although mumps immunization after exposure to mumps may not prevent the disease, it is not harmful. Should the exposure not result in an infection, the vaccine should confer protection against future exposures.

Schedule and dosage

One dose of MMR vaccine should be administered for mumps protection, with the second dose given for measles protection. The first dose should be given on or after the first birthday and the second dose given at least 1 month after the first and before school entry. The standard dose is 0.5 mL. See the Measles Vaccine chapter for details of indications for a second dose.

For single vials, the entire contents of the vial should be injected promptly after reconstitution (0.5-0.7 mL).

Route of administration

MMR vaccine should be administered subcutaneously.

Booster doses and re-immunization

Re-immunization after the standard two-dose schedule is not thought to be necessary at this time.

Serologic testing

There is no indication to routinely check pre- or post-vaccination serology. Persons can generally be presumed to be immune to mumps if they have documented evidence of vaccination on or after their first birthday, laboratory evidence of immunity, a history of laboratory-confirmed mumps disease, or if they were born before 1970.

Storage requirements

MMR vaccine should be stored in the refrigerator at a temperature of +2° C to +8° C. Vaccine must be protected from light, which may inactivate the vaccine viruses. Once reconstituted, the vaccine should be administered promptly.

Simultaneous administration with other vaccines

MMR can be administered simultaneously with other vaccines, at separate anatomic sites and in separate syringes. When administered with other live vaccines, such as varicella vaccine, MMR should be given at the same time or separated by a minimum 4-week interval.

Adverse reactions

Serious adverse events are rare following immunization and, in most cases, data are insufficient to determine a causal association.

The most frequent reaction (approximately 5% of immunized children) is malaise and fever with or without rash lasting up to 3 days and occurring 7 to 12 days after MMR immunization. One in 3,000 children with fever may have associated febrile convulsions. Historically, parotitis has occasionally occurred after immunization. Thrombocytopenia has been reported within 2 months after vaccination and is thought to be associated with the measles component of MMR. Joint symptoms are associated with the rubella component of MMR. Refer to the Measles Vaccine chapter and the Rubella Vaccine chapter for additional details.

Contraindications and precautions

Since MMR vaccine contains trace amounts of neomycin and gelatin, people who have experienced anaphylactic reactions to neomycin or who have a documented gelatin allergy should not receive MMR vaccine. Anyone who has experienced anaphylaxis to a previous dose of MMR should not receive the vaccine again. Please refer to the Anaphylaxis: Initial Management in Non-Hospital Settings chapter for more information.

As with other live vaccines, mumps-containing vaccine should not be administered to people whose immune mechanism is impaired as a result of disease or therapy, except under special circumstances. The immune response in such individuals may be impaired. Please refer to the Immunization of Immunocompromised Persons chapter for more information

Infants infected with human immunodeficiency virus (HIV) who are asymptomatic should receive routine MMR vaccination. In addition, MMR is recommended for most symptomatic HIV-infected persons, including children who are symptomatic without evidence of severe immunosuppression. Please consult an infectious disease specialist/immunologist for more specific advice on MMR immunization for HIV-infected people.

Although there is no known risk from mumps vaccine administered during pregnancy, it should not be given to pregnant women.

The recommended interval between immune globulin-containing products and MMR immunization varies from 3 to 11 months. Please refer to Table 4 in the Recent Administration of Human Immune Globulin Products chapter for more information.

Convincing evidence supports the safety of routine administration of MMR vaccines to all children who have allergy to eggs. Fewer than 2 per 1,000 vaccinated egg-allergic children have been found to be at risk of anaphylactic reaction to MMR. Please refer to the Anaphylactic Hypersensitivity to Egg and Egg-Related Antigens chapter for more information.

Selected references

Boulianne N, De Serres G, Ratnam S et al. Measles, mumps and rubella antibodies in children 5-6 years after immunization: effect of vaccine type and age at vaccination. Vaccine 1995; 13(16):1611-16.

Buxton J, Craig C, Daly P et al. An outbreak of mumps among young adults in Vancouver, British Columbia, associated with "rave parties". Canadian Journal of Public Health 1999;90(3):160-63.

Caplan CE. Mumps in the era of vaccines. Canadian Medical Association Journal 1999;160(6):865-66.

Cheek JE, Baron R, Atlas H et al. Mumps outbreak in a highly vaccinated school population. Archives of Pediatrics and Adolescent Medicine 1995;149(7):774-78.

Cooney MK, Fox JP, Hall CE. The Seattle Virus Watch, VI. Observations of infections with and illness due to parainfluenza, mumps, and respiratory syncytial viruses and Mycoplasma pneumoniae. American Journal of Epidemiology 1975;101(6):532-51.

Davidkin I, Valle M, Julkunen I. Persistence of anti-mumps virus antibodies after a two-dose MMR vaccination at nine-year follow-up. Vaccine 1995;13(16):1617-22.

Duclos P, Ward BJ. Measles vaccines: a review of adverse events. Drug Safety 1998;19(6):435-54.

Falk WA, Buchan K, Dow M et al. The epidemiology of mumps in Southern Alberta, 19801982. American Journal of Epidemiology 1989;130(4):736-49.

Griffin MR, Ray WA, Mortimer EA et al. Risk of seizures after measles-mumps-rubella immu nization. Pediatrics 1991;88(5):881-85.

Health Protection Agency, U.K. Confirmed cases of mumps by age and region: 1996-2005. URL:<www.hpa.org.uk/infections/topics_az/mumps/data_reg_age.htm>.

Jadavji T, Scheifele D, Halperin S. Thrombocytopenia after immunization of Canadian children, 1992 to 2001. Pediatric Infectious Disease Journal 2003;22(2):119-22.

James JM, Burks AW, Roberson PK et al. Safe administration of the measles vaccine to children allergic to eggs. New England Journal of Medicine 1995;332(19):1262-66.

Miller E, Goldacre M, Pugh S et al. Risk of aseptic meningitis after measles, mumps and rubella vaccine in U.K. children. Lancet 1993;341(8851):979-82.

Peltola H, Heinonen OP, Valle M et al. The elimination of indigenous measles, mumps and rubella from Finland by a 12 year two-dose vaccination program. New England Journal of Medicine 1994;331(21):1397-1402.

West R, Roberts PM. Measles, mumps and rubella vaccine: current safety issues. BioDrugs 1999;12(6):423-29.

[Previous] [Table of Contents] [Next]