title: Mumps increase in Flanders, Belgium, 2012-2013: results from temporary mandatory notification and a cohort study among university students.
abstract: BACKGROUND
  In 2012, an increase in mumps notifications occurred in Belgium, affecting young vaccinated adults. At the end of 2012, a mumps outbreak occurred at the Catholic University of Leuven KU Leuven in Flanders. We investigated the outbreak to estimate incidence, mumps vaccine effectiveness and to detect potential risk factors for the disease.
  
  
  METHODS
  In June 2012, we set up mandatory notification in Flanders and we collected information on circulating genotypes from the National Reference Centre. We conducted a cohort study among KU Leuven students. We defined a case as self-reported parotitis, between September 2012 and March 2013. We distributed web-based questionnaires to a random sample of students. We calculated vaccine effectiveness by comparing the risks in students vaccinated twice with those vaccinated once. We estimated risk ratios (RR) to identify risk factors.
  
  
  RESULTS
  From 16th June 2012 to 1st April 2013, 4061 mumps cases were notified to the regional public health office (30% were vaccinated once and 69% were vaccinated twice). All 16 samples collected at the KU Leuven were genotype G5. Of 717 participants of the cohort study, 38 (5%; 95%CI 4-8%) met the case-definition. All reported being vaccinated with at least one dose of mumps-containing vaccine. The incidence of mumps was 5% among those vaccinated twice and 16% among those vaccinated once (vaccine effectiveness of two doses compared to one: 68%, 95%CI -24% to 92%). The risk of mumps was lower among those vaccinated with two doses of mumps-containing vaccine ≤10 years before (RR: 0.33, 95%CI 0.10-1.02) and higher among students working in a bar (RR: 3.6, 95%CI 1.8-7.0).
  
  
  CONCLUSIONS
  Incomplete protection by two doses of mumps-containing vaccine, possible waning immunity and intense social contacts may have contributed to the occurrence of this outbreak in Flanders. Efforts to maintain high vaccination coverage with two doses remain essential. However, the reasons for low vaccine effectiveness must be further explored and additional immunological research for more immunogenic mumps vaccines is necessary.
authors: Epidemiology of Infectious Diseases, Operational Directorate Public Health and Surveillance, Scientific Institute of Public Health, Julliette Wytsmanstraat 14, 1050 Brussels, Belgium. Electronic address: Toon.Braeye@wiv-isp.be.
authors: Toon
authors: T
authors: Braeye
authors: Epidemiology of Infectious Diseases, Operational Directorate Public Health and Surveillance, Scientific Institute of Public Health, Julliette Wytsmanstraat 14, 1050 Brussels, Belgium; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden. Electronic address: indra.linina@gmail.com.
authors: Indra
authors: I
authors: Linina
authors: Student Medical Centre, KU Leuven, Catholic University of Leuven, Van Dalecollege, Naamsestraat 80 Bus 5415, 3000 Leuven, Belgium. Electronic address: Rikka.DeRoy@dsv.kuleuven.be.
authors: Rikka
authors: R
authors: De Roy
authors: Virology, Operational Directorate Communicable and Infectious Diseases, Scientific Institute of Public Health, Julliette Wytsmanstraat 14, 1050 Brussels, Belgium. Electronic address: Veronik.Hutse@wiv-isp.be.
authors: Veronik
authors: V
authors: Hutse
authors: Flemish Agency for Care and Health, Infectious Disease Control, Koning Albert II-laan 35 Bus 33, 1030 Brussels, Belgium. Electronic address: Magali.Wauters@wiv-isp.be.
authors: Magali
authors: M
authors: Wauters
authors: Flemish Agency for Care and Health, Infectious Disease Control, Koning Albert II-laan 35 Bus 33, 1030 Brussels, Belgium. Electronic address: pia.cox@wvg.vlaanderen.be.
authors: Pia
authors: P
authors: Cox
authors: Flemish Agency for Care and Health, Infectious Disease Control, Koning Albert II-laan 35 Bus 33, 1030 Brussels, Belgium. Electronic address: ruud.mak@wvg.vlaanderen.be.
authors: Ruud
authors: R
authors: Mak
mesh_terms: D000293:Adolescent; D000328:Adult; D001530:Belgium / Q000453:epidemiology; D015331:Cohort Studies; D018563:Disease Notification / Q000706:statistics & numerical data; D004196:Disease Outbreaks; D005260:Female; D005838:Genotype; D006801:Humans; D015994:Incidence; D008297:Male; D009107:Mumps / Q000453:epidemiology* / Q000276:immunology* / Q000517:prevention & control; D009108:Mumps Vaccine / Q000008:administration & dosage / Q000276:immunology; D009109:Mumps virus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D012189:Retrospective Studies; D013334:Students; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014495:Universities; D055815:Young Adult
chemical_list: D009108:Mumps Vaccine
keywords: Belgium; Cohort study; Epidemiology; Flanders; Mumps; Outbreak; Students; Vaccine effectiveness; Vaccine preventable disease