title: Risk factors for transmission of mumps in a highly vaccinated population in Orange County, NY, 2009-2010.
abstract: BACKGROUND
  In 2009-2010, we investigated a mumps outbreak among a highly vaccinated Orthodox Jewish population in a village in Orange County, NY, to identify risk factors associated with mumps transmission among persons with 2 doses of mumps-containing vaccine.
  
  
  METHODS
  Demographic and epidemiologic characteristics were collected on students in grades 6-12 in 3 schools. A mumps case was defined as a student, who self-reported parotitis, orchitis, jaw swelling and/or a mumps-related complication or whose mumps illness was reported to the Orange County Health Department during September 1, 2009, to January 18, 2010. Log-binomial regression analyses were conducted separately for boys and girls as they attended different schools and had different hours of study.
  
  
  RESULTS
  Of the 2503 students with 2 documented doses of mumps-containing vaccine, 320 (13%) developed mumps. Risk of mumps increased with increasing number of mumps cases in the class [≥8 vs. ≤3 cases: boys aRR = 3.1; 95% confidence interval (CI): 2.0-5.0; girls aRR = 2.6; 95% CI: 1.6-4.1] and household (>1 vs. 0 cases: boys aRR = 4.3 95% CI: 3.7-5.6; girls aRR = 10.1 95% CI: 7.1-14.3). Age at first dose, time since last dose, time between first and second dose, school, class size, number of hours at school per week and household size were not significantly associated with having mumps.
  
  
  CONCLUSIONS
  Two doses of mumps-containing vaccine may not be as effective in outbreak settings with multiple, prolonged and intense exposure. Additional studies are required to understand why such mumps outbreaks occur and how they can be prevented in the future.
authors.affiliation: From the *Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA; †Marshfield Clinic Research Foundation, Marshfield, Wisconsin; ‡Orange County Health Department, Goshen; and §Bureau of Immunization, New York State Department of Health, Albany, NY.
authors.forename: Preeta K
authors.initials: PK
authors.lastname: Kutty
authors.forename: Huong Q
authors.initials: HQ
authors.lastname: McLean
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Lawler
authors.forename: Cynthia
authors.initials: C
authors.lastname: Schulte
authors.forename: Jean M
authors.initials: JM
authors.lastname: Hudson
authors.forename: Debra
authors.initials: D
authors.lastname: Blog
authors.forename: Gregory
authors.initials: G
authors.lastname: Wallace
mesh_terms: D000293:Adolescent; D002648:Child; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007585:Jews / Q000706:statistics & numerical data*; D008297:Male; D015999:Multivariate Analysis; D009107:Mumps / Q000453:epidemiology* / Q000208:ethnology / Q000517:prevention & control / Q000635:transmission*; D009108:Mumps Vaccine / Q000008:administration & dosage*; D009518:New York / Q000453:epidemiology; D012307:Risk Factors; D013334:Students
chemical_list: D009108:Mumps Vaccine