Mumps Outbreaks in the United Kingdom

Health Editor’s Note: Outbreaks of mumps have been occurring at universities in the U.K. In the U.S., in January of this year, a U.S. Immigration and Customs Enforcement (ICE) Processing Center had mumps outbreaks and resultant isolations.  Anywhere large groups of people congregate, dorms, classrooms, clubs, etc. are prime areas for the spread of viruses and infections.

Just like measles, mumps is a viral infection. Mumps is a swelling of the salivary glands under the ears and may be on both or only one side.  This swelling (parotitis/the salivary gland is called the parotid) can be quite severe and painful.  Other symptoms of mumps are head and muscle aches, fever, loss of appetite, and feeling tired.

Not everyone develops these symptoms, but if they are infected with the virus, they can still spread the virus. You may think, swelling of the salivary glands…no big thing.  Most people, mainly children, will recover within about two weeks.  But as with most other diseases there can be complications.  These complications can be inflammation of the brain (encephalitis), inflammation of the pancreas (pancreatitis), inflammation of the ovaries (oophoritis), inflammation of the breast tissue (mastitis), or inflammation of the testicles (orchitis) in males who have reached puberty and this inflammation may lead to decrease in the size of the testicles (testicular atrophy), and last but not least, deafness. Pregnant women may miscarry if they contract mumps in the first trimester of pregnancy.

Let’s talk about inflammation of the testicles.  There is a chance that a male may become less fertile or rarely infertile.  Sperm counts may drop in one out of 10 men and half will notice shrinkage of the testicles. Permanent infertility is rare but has been noted. These complications are totally preventable if the male had been vaccinated against mumps.

The increase in mumps infections is caused by two issues.  The first is that possibly mumps vaccines needs to be given a third time, as a booster, because immunity may wear off. Secondly, the person that has never been vaccinated as a small child is exposed to more people who have never been vaccinated and also those whose immunity has worn off. With enough people who are not immune to the mumps virus, the herd effect is gone and individuals are not protected by those around them who will not get the virus.

Why take the chance that your male child may have fertility problems as an adult?  How about giving either sex child a chance at encephalitis, pancreatitis?  Does that sound like a good future to place before an unvaccinated child?  I think not!…Carol

Why are University Students Catching Mumps?

By BBC East Midlands UK

Mumps – a contagious viral infection that causes swelling of the glands – has been in the news this week following a confirmed outbreak at two universities.

A total of 223 suspected cases were reported, with 40 confirmed, across Nottingham Trent University and the University of Nottingham.

That has now risen to 241 suspected cases with 51 confirmed by Public Health England (PHE).

BBC News has taken a look at why this is and whether university students are still at risk.

Where else is this happening?

The numbers seem particularly high in Nottingham.

PHE said latest figures showed cases of mumps in England had decreased in 2018, with 1,024 confirmed cases compared with 1,796 in 2017.

There have also been a handful of reported cases at the universities of Bath, Hull and Liverpool and in the US – specifically Temple University, in Philadelphia, which has recorded about 100 people with signs of the infection.

There does not appear to be any reason as to why the Nottingham numbers are much higher, though experts have said it could be that there are more in the city who are not immune.

Professor Jonathan Ball, from the University of Nottingham – an expert in viruses and viral vaccines and treatments – said it was affecting students because they gathered in “close proximity for fairly large periods of time”.

This would include in halls of residence, lecture theatres or even at nightclubs, which hold specific nights aimed at students.

“The virus [could] spread fairly easy, especially if there are relatively large numbers of people who have not been vaccinated,” he said.

A marine biology student at the University of Hull, who did not want to give his name, said he started feeling ill while on a field trip to the Isle of Cumbrae in Scotland.

He said a local doctor diagnosed mumps but also sent away a swab for it to be confirmed, as mumps is a notifiable disease in England and Wales.

The 19-year-old, who said he knew at least two others who had the symptoms, had to be isolated and driven home, avoiding public transport because of the risk of others being infected.

Can you catch it if you have been vaccinated?

Yes. Dr Vanessa MacGregor, from PHE, said it had seen a rise in figures recently, with teenagers and young adults who have not had two doses of the MMR vaccine “particularly vulnerable”.

The NHS says the vaccine is part of the routine childhood immunisation schedule, in which a child is given one dose when they are 12 to 13 months old, and a second at three years and four months.

Dr MacGregor urged those who have not had the MMR vaccine – or only received one dose – to ensure they took up the offer of MMR (measles, mumps and rubella) vaccination.

The University of Hull student also said it was “strange” he had contracted the infection because he had received both doses and this had been confirmed by his father.

According to Prof Ball, the mumps part of the vaccine is the “least effective”.

He said: “For the mumps vaccine, we expect about 88% of people vaccinated to be protected, whereas for the measles vaccine this is as high as 98%.

“If you then add unvaccinated people into the mix, it is easy to see how a relatively contagious virus as mumps can spread so easily.”

He said this was further complicated, because some people who are infected show little or no symptoms at all.

However, if the majority were vaccinated, those susceptible to the infection would benefit from “herd immunity”, the level considered by experts to protect a population from a disease.

But, as Prof Ball states: “If you start to reduce the numbers of people being vaccinated, then that herd protection just isn’t there.”

Why is uptake of the MMR vaccine declining?

According to BBC Health Editor Hugh Pym, the reason for uptake declining in many countries was not clear.

The “damaging” work of discredited scientist and struck-off medic Andrew Wakefield in the 1990s “helped fuel the fire of the anti-vaccine movement,” according to Prof Ball.

In 1998, the doctor led a study that linked the MMR vaccine to autism, impacting on the coverage of the vaccine, with rates dropping to about 80% in the late 1990s and a low of 79% in 2003.

Rates partially recovered after the research was disproved but the volume of anti-vaccine sentiment on social media has increased in recent years.

This led Health and Social Care Secretary Matt Hancock to call for new laws to force social media companies to remove content that promoted false information about vaccines.

Prof Ball said there were rarely “side effects” with vaccines and even if there was, the benefits outweighed these.

“Because we have lived through a golden age of vaccination, we have forgotten just how harmful, and sometimes even fatal, these virus infections can be,” he said.

Are students and others still at risk?

Dr Natalie Riddell, a lecturer in immunology and ageing at the University of Surrey, said a reduced amount of people being vaccinated against any contagious disease was dangerous.

“Babies and immuno-compromised people [such as the elderly or those receiving chemotherapy] rely on the rest of us to be vaccinated to prevent the spread of disease,” she said.

“It is totally unnecessary for people to risk their friends and family becoming ill, or even dying, from measles or mumps, as there is a safe and effective vaccine to protect against both.”

Prof Ball said poor vaccine uptake worldwide had led to an increase in outbreaks of mumps and measles and we should “expect things to get worse” before they get better.

Carol Duff, MSN, BA, RN

Carol graduated from Riverside White Cross School of Nursing in Columbus, Ohio and received her diploma as a registered nurse. She attended Bowling Green State University where she received a Bachelor of Arts Degree in History and Literature. She attended the University of Toledo, College of Nursing, and received a Master’s of Nursing Science Degree as an Educator.

She has traveled extensively, is a photographer, and writes on medical issues. Carol has three children RJ, Katherine, and Stephen – one daughter-in-law; Katie – two granddaughters; Isabella Marianna and Zoe Olivia – and one grandson, Alexander Paul. She also shares her life with her husband Gordon Duff, many cats, and two rescues.

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