title: Mumps outbreak in Orthodox Jewish communities in the United States.
abstract: By 2005, vaccination had reduced the annual incidence of mumps in the United States by more than 99%, with few outbreaks reported. However, in 2006, a large outbreak occurred among highly vaccinated populations in the United States, and similar outbreaks have been reported worldwide. The outbreak described in this report occurred among U.S. Orthodox Jewish communities during 2009 and 2010.
  
  
  
  Cases of salivary-gland swelling and other symptoms clinically compatible with mumps were investigated, and demographic, clinical, laboratory, and vaccination data were evaluated.
  
  
  
  From June 28, 2009, through June 27, 2010, a total of 3502 outbreak-related cases of mumps were reported in New York City, two upstate New York counties, and one New Jersey county. Of the 1648 cases for which clinical specimens were available, 50% were laboratory-confirmed. Orthodox Jewish persons accounted for 97% of case patients. Adolescents 13 to 17 years of age (27% of all patients) and males (78% of patients in that age group) were disproportionately affected. Among case patients 13 to 17 years of age with documented vaccination status, 89% had previously received two doses of a mumps-containing vaccine, and 8% had received one dose. Transmission was focused within Jewish schools for boys, where students spend many hours daily in intense, face-to-face interaction. Orchitis was the most common complication (120 cases, 7% of male patients ≥12 years of age), with rates significantly higher among unvaccinated persons than among persons who had received two doses of vaccine.
  
  
  
  The epidemiologic features of this outbreak suggest that intense exposures, particularly among boys in schools, facilitated transmission and overcame vaccine-induced protection in these patients. High rates of two-dose coverage reduced the severity of the disease and the transmission to persons in settings of less intense exposure.
authors.affiliation: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. abarskey@cdc.gov
authors.forename: Albert E
authors.initials: AE
authors.lastname: Barskey
authors.forename: Cynthia
authors.initials: C
authors.lastname: Schulte
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Rosen
authors.forename: Elizabeth F
authors.initials: EF
authors.lastname: Handschur
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rausch-Phung
authors.forename: Margaret K
authors.initials: MK
authors.lastname: Doll
authors.forename: Kisha P
authors.initials: KP
authors.lastname: Cummings
authors.forename: E Oscar
authors.initials: EO
authors.lastname: Alleyne
authors.forename: Patricia
authors.initials: P
authors.lastname: High
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Lawler
authors.forename: Andria
authors.initials: A
authors.lastname: Apostolou
authors.forename: Debra
authors.initials: D
authors.lastname: Blog
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Zimmerman
authors.forename: Barbara
authors.initials: B
authors.lastname: Montana
authors.forename: Rafael
authors.initials: R
authors.lastname: Harpaz
authors.forename: Carole J
authors.initials: CJ
authors.lastname: Hickman
authors.forename: Paul A
authors.initials: PA
authors.lastname: Rota
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Rota
authors.forename: William J
authors.initials: WJ
authors.lastname: Bellini
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Gallagher
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D018562:Disease Transmission, Infectious; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D007117:Immunization, Secondary; D007223:Infant; D007585:Jews; D008297:Male; D008875:Middle Aged; D009107:Mumps / Q000150:complications / Q000208:ethnology* / Q000635:transmission; D009108:Mumps Vaccine / Q000008:administration & dosage / Q000276:immunology; D009515:New Jersey / Q000453:epidemiology; D009518:New York / Q000453:epidemiology; D009920:Orchitis / Q000209:etiology; D012574:Schools; D017678:Sex Distribution; D055815:Young Adult
chemical_list: D009108:Mumps Vaccine