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Journal of Clinical Microbiology, March 2009, p. 560-565, Vol. 47, No. 3
0095-1137/09/$08.00+0     doi:10.1128/JCM.01756-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

Characterization of Large Mumps Outbreak among Vaccinated Palestinian Refugees {triangledown}

Musa Y. Hindiyeh,1* Yair Aboudy,1 Mahmoud Wohoush,2 Lester M. Shulman,1,4 Daniela Ram,1 Tal Levin,1 Tamar Frank,1 Flavia Riccardo,3 Mohamad Khalili,2 Elias-Shlash Sawalha,2 Maysoun Obeidi,2 Guido Sabatinelli,3 Zehava Grossman,1,4 and Ella Mendelson1,5

Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Tel-Hashomer, Israel,1 UNRWA, Health Department West Bank Field Office UNRWA, West Bank,2 UNRWA, Health Department HQ Amman, Jordan,3 Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel,4 Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel5

Received 11 September 2008/ Returned for modification 18 November 2008/ Accepted 7 January 2009

During a large mumps virus (MuV) outbreak which occurred in the Palestinian refugee camps of the West Bank, 68.1% (2,636/3,871) of the cases were vaccinated with one dose of trivalent measles, mumps, and rubella (MMR) vaccine. Attack rates by camp ranged from less than 1 case per 1,000 people in the population to 43/1,000 (overall, 11/1,000). The outbreak lasted from December 2003 to June 2005, with two peaks, one from April to May 2004 and the other from March to April 2005. To control the outbreak, a mass MMR vaccination campaign was conducted in May 2005. Evaluation of the immune status of cases (n = 59) and healthy controls (n = 51) revealed high levels of mumps immunoglobulin G (IgG) and a low MuV-specific IgM in clinical cases indicative of a booster immune response. This suggested a secondary rather than a primary infection due to the insufficient protection conferred by the single vaccine dose included in the vaccination program. This prediction was further confirmed by the low seroprevalence (68.6%) found in the healthy control group, which was below the threshold level required for MuV herd immunity. Mumps diagnosis was established mainly by reverse transcription-PCR in clinical samples obtained within 48 h from the onset of disease. Of the parotid fluids and nasopharyngeal aspirates analyzed, 92% were positive for MuV RNA, while only 33% of the urine samples were positive. Phylogenetic analysis of the MuV SH gene identified the outbreak strain as the H genotype, which has been in circulation worldwide at least since 1989.

* Corresponding author. Mailing address: Viral Real-Time PCR Diagnosis, Central Virology Laboratory, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel. Phone: 972-3-530-2066. Fax: 972-3-530-2457. E-mail: hindiyeh{at}yahoo.com

{triangledown} Published ahead of print on 14 January 2009.

Journal of Clinical Microbiology, March 2009, p. 560-565, Vol. 47, No. 3
0095-1137/09/$08.00+0     doi:10.1128/JCM.01756-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.





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