title: An outbreak of mumps in the metropolitan area of Walsall, UK.
abstract: OBJECTIVE
  To describe the epidemiology of excessive mumps cases during the year 2000, within the metropolitan area of Walsall, UK; to assess the impact of the mumps outbreak on morbidity; and to inform future communicable disease control strategy.
  
  
  METHODS
  Demographic records, school attendance, uptake of the measles-mumps-rubella (MMR) vaccine, and mumps-associated admission to hospital, were reviewed for all Walsall residents diagnosed and notified with mumps during the year 2000.
  
  
  RESULTS
  There were 200 mumps notifications in 2000 (76.6 per 100,000), representing the highest incidence in England. Only 91 of the notified cases were salivary antibody positive for mumps IgM, and 32 were negative, although 77 were not tested. Since 1990, annual totals have never previously exceeded 20. Over 90% of patients were <20 years old, with a peak age group of 10-14 years; 88% attended schools located within Walsall. The pattern of spread suggested that the outbreak proceeded through schools from north to south in the more deprived western half of the metropolitan area. Most cases (136, 68%) had received one (99, 49.5%) or two (37, 18.5%) doses of MMR vaccine; cases > or =20 years old had never received MMR. Six cases (aged 4-14 years) were admitted to hospital, all with a successful outcome, including one male with meningitis and one female with pancreatitis. Current uptake of the MMR vaccine at 24 months has dropped to below 90% in recent years, as in most parts of the UK.
  
  
  CONCLUSIONS
  Future mumps outbreaks in schools, and among older age groups, can be predicted, since most older children and young adults have received only one dose of MMR vaccine or no vaccination at all. Primary vaccine failure is well described in mumps, and cases during outbreaks can include recipients of two MMR vaccine doses. It was fortunate that no severe morbidity was associated with this outbreak (prior to MMR, two to four mumps deaths occurred annually in England and Wales). Measures to restore the uptake of MMR to the previous levels of above 90-95% will be necessary to reduce the risk of the mumps virus circulating within communities. Older children are susceptible, and it may be advisable to ensure second-dose MMR uptake while they are still at or when they leave school, or when they enter college, university or the military.
authors.affiliation: Directorate of Public Health Medicine, Walsall Health Authority, Walsall, UK. pughn@ha.walsall-ha.wmids.nhs.uk
authors.forename: R Nicholas
authors.initials: RN
authors.lastname: Pugh
authors.forename: Bolanle
authors.initials: B
authors.lastname: Akinosi
authors.forename: Shalini
authors.initials: S
authors.lastname: Pooransingh
authors.forename: Jagdish
authors.initials: J
authors.lastname: Kumar
authors.forename: Sharon
authors.initials: S
authors.lastname: Grant
authors.forename: Emma
authors.initials: E
authors.lastname: Livesley
authors.forename: John
authors.initials: J
authors.lastname: Linnane
authors.forename: Sam
authors.initials: S
authors.lastname: Ramaiah
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D018563:Disease Notification; D004196:Disease Outbreaks; D005260:Female; D006760:Hospitalization; D006801:Humans; D007114:Immunization; D015994:Incidence; D007223:Infant; D008297:Male; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage / Q000276:immunology; D009107:Mumps / Q000453:epidemiology* / Q000517:prevention & control; D009109:Mumps virus / Q000276:immunology; D012621:Seasons; D006113:United Kingdom / Q000453:epidemiology; D014505:Urban Population
chemical_list: D022542:Measles-Mumps-Rubella Vaccine