title: The risk of aseptic meningitis associated with the Leningrad-Zagreb mumps vaccine strain following mass vaccination with measles-mumps-rubella vaccine, Rio Grande do Sul, Brazil, 1997.
abstract: BACKGROUND
  Few data are available on the risk of aseptic meningitis following vaccination with the Leningrad-Zagreb (L-Z) strain of mumps vaccine. In 1997 the mumps vaccine was introduced into the state of Rio Grande do Sul in Brazil through mass vaccination with mumps-measles-rubella (MMR), targeting children aged 1-11 years. Five municipalities used exclusively MMR vaccine containing the L-Z strain of mumps. An outbreak of aseptic meningitis was observed shortly after the mass campaign.
  
  
  METHODS
  To estimate the risk of aseptic meningitis associated with this strain, we analysed vaccination and meningitis case surveillance data from the selected municipalities. A case of vaccine-associated aseptic meningitis was defined as one with a pleocytosis of 10-1,500 leukocytes/ml and occurring within 15-35 days after vaccine receipt.
  
  
  RESULTS
  We estimated a risk of 2.9 cases per 10,000 doses of L-Z administered, equivalent to 1 case per 3,390 doses administered. The overall risk of aseptic meningitis following the campaign was increased 12.2-fold (95% CI: 6.0-24.7) compared with the same period in 1995-1996. Following the mass campaign, the incidence of mumps declined 93% during 1998-2000.
  
  
  CONCLUSIONS
  Vaccination with the L-Z strain of mumps vaccine as part of a mass campaign was associated with a significantly increased risk of aseptic meningitis. Decisions about type of mumps vaccine and mumps vaccination strategies must consider vaccine safety issues in addition to other criteria.
authors.affiliation: Rio Grande do Sul Health Department, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Claudio Marcos
authors.initials: CM
authors.lastname: da Silveira
authors.forename: Claudete Iris
authors.initials: CI
authors.lastname: Kmetzsch
authors.forename: Renate
authors.initials: R
authors.lastname: Mohrdieck
authors.forename: Alethea Fagundes
authors.initials: AF
authors.lastname: Sperb
authors.forename: D Rebecca
authors.initials: DR
authors.lastname: Prevots
mesh_terms: D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D006801:Humans; D015994:Incidence; D007223:Infant; D032541:Mass Vaccination / Q000009:adverse effects*; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage*; D008582:Meningitis, Aseptic / Q000453:epidemiology / Q000209:etiology*; D009107:Mumps / Q000453:epidemiology; D009108:Mumps Vaccine / Q000009:adverse effects*; D018570:Risk Assessment
chemical_list: D022542:Measles-Mumps-Rubella Vaccine; D009108:Mumps Vaccine