Abstract
In two recent nation-wide outbreaks of mumps in Switzerland two-thirds of young children with clinical mumps had a history of primary vaccination. On average, measles–mumps–rubella (MMR) vaccination coverage is 80%. Two types of vaccine are commonly used: Jeryl-Lynn and Rubini. The effectiveness of the latter has been questioned in several publications. The authors therefore compared Rubini to Jeryl-Lynn in a case–cohort study. The study included 111 young children with clinical mumps who had been reported to the Swiss Federal Office of Public Health (SFOPH) by primary care physicians of the Swiss Sentinel Surveillance Network (SSSN) between January 1999 and May 2000. Sentinel physicians also sampled 661 children from the same birth cohort as the cases. While we found no evidence for the effectiveness of the Rubini strain, vaccination with the Jeryl-Lynn strain was 70% effective against clinical mumps. Furthermore, children vaccinated with the Rubini strain attended primary health care more frequently with clinical mumps than those who had received Jeryl-Lynn (odds ratio: 2.4; 95% confidence interval (CI): 1.3, 4.7). Restricting the analysis to laboratory confirmed cases increased the odds ratio to 18.4 (95% CI: 2.5, 811.2). Our study confirms the low effectiveness of the Rubini strain vaccine in the field. This vaccine should therefore be considered inappropriate for the control and elimination of mumps and its use should be discontinued. As other vaccines with comparable quality and safety standards and a substantially higher effectiveness are available the MMR vaccination program in Switzerland will not be compromised if the use of Rubini is no longer recommended.
References
Matter HC, Cloetta J, Zimmermann H. Das Meldesystem Sentinella in der Schweiz am Beispiel des Pertussismonitorings von 1991 bis 1993. Schweizerische Rundschau für Medizin (PRAXIS) 1995; 84: 690–697.
Bundesamt für Gesundheit. Mumps 1995. Bulletin BAG/OFSP 1997; 16: 9–12.
Matter HC, Cloetta J, Zimmermann H, Sentinella Arbeitsgemeinschaft. Measles, mumps, and rubella: Monitoring in Switzerland through a sentinel network, 1986-1994. J Epidemiol Commun Health 1995; 49(Suppl 1): 4–8.
Bundesamt für Gesundheit. Erneute Zunahme der Mumpsfälle in der Schweiz. Bulletin BAG/OFSP 2000; 1: 4–7.
Somaini B. Ziele des Masern/Mumps/Rötelnimpfprogramms. Bulletin BAG/OFSP 1988; 3: 31–35.
Bundesamt für Gesundheit, Schweizerische Kommission für Impffragen. Impfplan für routinemässige Schutzimpfungen. In: Bundesamt für Gesundheit (ed.), Infektionskrankheiten: Diagnose und Bekämpfung. Bern: Bundesamt für Gesundheit, 1996; 1–5.
Bundesamt für Gesundheit, Schweizerische Kommission für Impffragen. Impfplan für routinemässige Schutzimpfungen. In: Bundesamt für Gesundheit (ed.), Infektionskrankheiten: Diagnose und Bekämpfung. Bern: Bundesamt für Gesundheit, 2001; 1–6.
Minder C, Steffen R. Kleinkinderimpfungen. Eine repräsentative Erhebung zur Durchimpfung in der Schweiz 1991. Bulletin BAG/OFSP 1992; 32: 504–507.
Bundesamt für Gesundheit. Kleinkinderimpfungen. Repräsentative Erhebung zur Durchimpfung in der Schweiz 1998. Bulletin BAG/OFSP 1999; 20: 356–361.
Paccaud MF, Hazeghi P, Bourquin M, et al. Rückblick auf zwei Mumpsausbrüche. Soz Praventivmed 1995; 40: 72–79.
Zimmermann HP, Matter HC, Kiener T, Sentinella Arbeitsgemeinschaft. Mumps-Epidemiologie in der Schweiz: Ergebnisse der Sentinella-Überwachung 1986-1993. Soz Praventivmed 1995; 40: 80–89.
Vaudaux B, Zimmermann HP, Bourquin C, Germann B. Effet protecteur du vaccin contre les oreillons (souche Rubini): étude du taux d'attaque secondaire. Présentation à la 88e Assemblée annuelle de la Société de Pédiatrie, Crans Montana, 22-24 juin 1995. Schweiz Med Wochenschr 1995; 125(Suppl 70): 6s.
Toscani L, Batou M, Bouvier P, Schlaepfer A. Comparaison de l'efficacité de différentes souches de vaccin ourlien: Une enquête en milieu scolaire. Soz Präventivmed 1996; 41: 341–347.
Chamot E, Toscani L, Egger P, Germann D, Bourquin C. Estimation de l'efficacité de trois souches vaccinales ourliennes au cours d'une épidémie d'oreillons dans le canton de Genève. Rev Epidemiol Sante Publ 1998; 46: 100–107.
Gonçalves G, de Araùjo A, Cardoso MLM. Outbreak of mumps associated with poor vaccine efficacy - Oporto, Portugal, 1996. Eurosurveillance 1998; 3: 119–121.
Schlegel M, Osterwalder JJ, Galeazzi RL, Vernazza PL. Comparative efficacy of three mumps vaccines during disease outbreak in eastern Switzerland: Cohort study. Brit Med J 1999; 319: 352–353.
Goh KT. Resurgence of mumps in Singapore caused by the Rubini mumps virus vaccine strain. The Lancet 1999; 354: 1355–1356.
Pons C, Pelayo T, Pachòn I, et al. Two outbreaks of mumps in children vaccinated with the Rubini strain in Spain indicate low vaccine efficacy. Eurosurveillance 2000; 5: 80–84.
Germann D, Strohle A, Eggenberger K, Steiner CA, Matter L. An outbreak of mumps in a population partially vaccinated with the Rubini strain. Scand J Infect Dis 1996; 28: 235–238.
The Benevento and Compobasso Pediatricians Network for the Control of Vaccine-Preventable Diseases. Field evaluation of the clinical effectiveness of vaccines against pertussis, measles, rubella and mumps. Vaccine 1998; 16: 818–822.
De los Rios Martin R, Garcia Marin N, Sanz Morena JC, Ballester Orcal E. Parotiditis en un área urbana de la Comunidad de Madrid. Estado vacunal, diagnóstico y medidas de intervención. Atención Primaria 2001; 28: 10–16.
Moulton LH, Wolff MC, Brenneman G, Santosham M. Case-cohort analysis of case-coverage studies of vaccine effectiveness. Am J Epidemiol 1995; 142: 1000–1006.
Rothman KJ, Greenland S. Case-control studies. In: Rothman KJ, Greenland S (eds), Modern Epidemiology. Philadelphia, PA: Pippincott-Raven Publishers, 1998; 93–114.
Orenstein WA, Bernier RH, Hinman AR. Assessing vaccine efficacy in the field. Further observations. Epidemiol Rev 1988; 10: 212–241.
Miettinen O. Design options in epidemiologic research. An update. Scand J Work Environ Health 1982; 8: 7–14.
Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance. Morb Mortal Wkly Rep 1997; 46: RR-10–55.
Cheek JE, Baron R, Atlas H, Wilson DL, Crider RD. Mumps outbreak in a highly vaccinated school population. Evidence for large-scale vaccination failure. Arch Pediatr Adolesc Med 1995; 149: 774–778.
World Health Organization. Mumps virus vaccines: WHO position paper. Wkly Epidemiol Record 2001; 76: 346–355.
Bundesamt für Gesundheit. Nationales Impfprogramm: Mumpsimpfung. Das Bundes-amt für Gesundheit empfiehlt, Impfstoffe, die den Rubini-Stamm enthalten, wegen dessen geringer Wirksamkeit nicht mehr zu verwenden. Bulletin BAG/OFSP 2002; 16: 300–302.
World Health Organization, Expanded programme on immunization (EPI). Recrudescence of measles. Switzerland. Wkly Epidemiol Record 1998; 73: 137–139.
Paget WJ, Zimmermann H, Vorkauf H, Sentinella Working Group. A national measles epidemic in Switzerland in 1997: Consequences for the elimination of measles by the year 1997. Eurosurveillance 2000; 5: 17–22.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Richard, JL., Zwahlen, M., Feuz, M. et al. Comparison of the effectiveness of two mumps vaccines during an outbreak in Switzerland in 1999 and 2000: A case–cohort study. Eur J Epidemiol 18, 569–577 (2003). https://doi.org/10.1023/A:1024698900332
Issue Date:
DOI: https://doi.org/10.1023/A:1024698900332