Complementary findings in clinical and epidemiologic features of mumps and mumps meningoencephalitis in children without mumps vaccination

BACKGROUND: Mumps vaccine has not yet been included in the routine vaccination programme, for this reason mumps is still one of the most common infections for children in Turkey. One of the major complication of mumps is meningoencephalitis, which although usually heals spontaneously, it may cause neurologic complications. METHODS: This study was undertaken to investigate epidemiologic and demographic characteristics in children with mumps and mumps meningoencephalitis and clinical/laboratory findings in children with mumps meningoencephalitis diagnosed over a 11 year period. A total of 2422 mumps and 135 mumps meningoencephalitis cases were covered in this study which constitutes one of the largest series of mumps meningoencephalitis in the literature. The mean age of mumps and mumps meningoencephalitis cases were 6.6 +/- 2.7 and 7.6 +/- 2.6 years, respectively. RESULTS: There was a male predominance both among the cases of mumps and mumps meningoencephalitis. The age and seasonal distributions were similar in the mumps and mumps meningoencephalitis groups. The most common symptoms of mumps meningoencephalitis were fever (97%), vomiting (94%) and headache (88.8%). The mean cerebrospinal fluid (CSF) total cell count and lymphocyte count were 540 +/- 460/mm(3) and 300 +/- 330/mm(3), respectively. The mean CSF protein and glucose levels were found to be 56.97 +/- 27.94 mg/dL and 53.67 +/- 15.46 mg/dL, respectively. The mean of CSF/blood glucose ratio was 0.53 +/- 0.16. The mean duration of hospitalization in mumps meningoencephalitis cases was found to be 5.1 +/- 2.4 days and this was longer in boys (P < 0.05). CONCLUSION: In patients with mumps meningoencephalitis, higher CSF protein levels and lower CSF glucose/blood glucose ratio were associated with longer hospitalization periods. There was no death.     

43例流行性腮腺炎临床特征及并发症分析

目的分析流行性腮腺炎的临床特点和多器官并发症的特点,总结防治经验。方法回顾分析我院1991年4月～2005年5月间流行性腮腺炎病例,对其临床特点和并发症进行分析。结果共收集病例43例,其中出现并发症27例,分别为脑膜炎2例,面神经炎3例,睾丸炎13例,胰腺炎2例,颌下腺炎7例,颌下淋巴结炎5例,肝炎1例;其中发生两种及以上并发症5例。经抗病毒、抗感染、对症等综合治疗均临床痊愈。结论流行性腮腺炎容易导致多系统多器官并发症,但早期积极治疗一般预后良好。     

九江市健康人群风疹和流行性腮腺炎抗体水平检测

目的了解九江市健康人群风疹、流行性腮腺炎(腮腺炎)抗体水平和自然感染情况。方法采集九江市浔阳区1~≥70岁健康人群血清标本843人份,采用血球凝集抑制(HI)试验检测风疹和腮腺炎抗体。结果风疹抗体共检测血清843份,抗体阳性率83.51%,几何平均滴度(GMT)1∶93.96。腮腺炎抗体共检测血清834份,抗体阳性率71.46%,GMT1∶4.76。结论由于<5岁儿童风疹感染率为58.64%,腮腺炎感染率为38.58%,建议对≤5岁儿童接种风疹和腮腺炎疫苗。     

SARIMA-GRNN组合模型和SARIMA模型在流行性腮腺炎发病率预测中的应用

目的 探讨SARIMA-GRNN组合模型和SARIMA模型在流行性腮腺炎发病率预测中的应用,并对他们的预测效果进行比较。 方法 选取2004—2016年上海市流行性腮腺炎逐月发病率资料,基于2004年1月—2016年6月的数据建立SARIMA模型。利用2004—2015年流行性腮腺炎的SARIMA模型拟合值与实际值、时间因子训练SARIMA-GRNN组合模型,并运用2016年1—6月数据进行验证,筛选模型最优平滑因子(spread)。采用2016年7—12月数据进行回代验证模型的外推预测效果。评价指标包括平均绝对误差百分比(MAPE)、平均误差率(MER)、均方误差(MSE)和平均绝对误差(MAE)。 结果 SARIMA(0,0,2)(0,1,1)₁₂为最优SARIMA模型。SARIMA-GRNN组合模型spread 值为0.0037。SARIMA模型、SARIMA-GRNN组合模型拟合的MAPE、MER、MSE和MAE依次分别为16.19%、15.18%、0.14、0.25;2.93%、2.28%、0.01、0.04。SARIMA模型、SARIMA-GRNN组合模型预测的MAPE、MER、MSE和MAE依次分别为17.40%、17.26%、0.03、0.16;15.24%、15.50%、0.02、0.14。 结论 SARIMA-GRNN组合模型拟合及预测效果均优于SARIMA模型,但预测精度有待进一步提高。     

Cross-neutralization between vaccine and circulating wild-type mumps viruses in Korea

Mumps is a contagious disease caused by the mumps virus. It can be prevented using mumps vaccines, administered as a measles-mumps-rubella (MMR) vaccine. For first and second dose immunization, children aged 12–15 months and 4–6 years have been administered this vaccine since 1997 in Korea. Nevertheless, mumps outbreaks still occur in vaccinated populations worldwide. Hence, immunity against these diseases may be attenuated, or there are antigenic differences between currently available vaccine strains and circulating wild-type viruses. After the introduction of national immunization programs in Korea, mumps cases became sporadic. Viral genotypes F, H, and I have emerged since 1998 whereas the vaccine strains belong to genotype A. Here, we compared the amino acid sequences of the haemagglutinin-neuraminidase (HN) gene from wild-type viruses and the mumps vaccine and measured the cross-neutralization titers between them. We selected the F, H, and I wild-type mumps strains circulating in Korea from 1998 to 2016 and analyzed changes in the amino acid sequence of the protein encoded by the HN gene. We measured mumps virus-specific IgG and rapid focus reduction neutralization test (FRNT) titers in Korean isolates and sera obtained from 50 children aged 1–2 years who had been administered a single dose of MMR vaccine. Analysis of the HN protein sequences disclosed no changes in the glycosylation sites but did reveal 4–5 differences between the Korean isolates and the genotype A vaccine strain in terms of the neutralizing epitope sites on their HN proteins. Post-vaccination FRNT titers were significantly lower against genotypes F, H, and I than they were against genotype A. This finding highlights the possibility of a recurrence of mumps outbreaks in vaccinated populations depending on the degree of genetic conservation of the HN gene. Further research into this issue is needed to prevent the resurgence of mumps.     

Pediatric provider vaccine hesitancy: An under-recognized obstacle to immunizing children

ObjectiveTo describe vaccine attitudes among pediatric healthcare providers attending immunization conferences.Study designAttendees of 5 American Academy of Pediatrics (AAP)-sponsored vaccine conferences held between June and November 2013 anonymously completed a questionnaire assessing vaccine attitudes and practices prior to the opening of educational sessions. Pearson's chi-square tests and Fisher's exact tests were used to analyze associations between vaccine attitudes, vaccine practices and provider characteristics.Results680 providers attending AAP-sponsored vaccine conferences were included. 661/666 (99%) enrolled providers state they routinely recommend standard pediatric vaccines, yet, 30 (5%) state that they do not routinely recommend influenza and/or human papillomavirus (HPV) vaccines. These providers expressed vaccine safety (87/680 (13%)) and efficacy (21/680 (31%)) concerns and stated belief in vaccine misperceptions: vaccine causes autism (34/668, 5%), multiple vaccines at a single visit reduces vaccine efficacy (43/680, 6%) or overwhelms the immune system (63/680, 9%), and administering HPV vaccine will increase the likelihood of unprotected adolescent sexual activity (29/680, 4%). Six percent of providers who do not routinely recommend all pediatric vaccines correctly identified themselves as vaccine hesitant.ConclusionVaccine hesitancy is under-recognized among pediatric providers attending AAP-sponsored immunization conferences. Educational interventions tailored to address provider vaccine concerns are needed to improve provider vaccine confidence.     

Febrile seizures following measles and varicella vaccines in young children in Australia

BackgroundFebrile seizures (FS) are common in childhood with incidence peaking in the second year of life when measles and varicella-containing vaccines are administered. This study aimed to examine the vaccine-attributable risk of FS following separate administration of MMR and monovalent varicella vaccines (VV) prior to a planned change to MMRV as the second dose of measles-containing vaccine at 18 months of age.MethodsAll FS cases in children aged <5 years from 1st January 2012 to 30th April 2013 were identified from emergency department (ED) and inpatient databases at five Australian tertiary paediatric hospitals participating in PAEDS (Paediatric Active Enhanced Disease Surveillance). Immunization records were obtained from the Australian Childhood Immunization Register (ACIR). The relative incidence (RI) of FS following MMR dose 1 (MMR1) and VV in children aged 11–23 months was determined using the self-controlled case series (SCCS) method and used to calculate attributable risk.ResultsThere were 2013 FS episodes in 1761 children. The peak age at FS was 18 months. The risk of FS was significantly increased 5–12 days post receipt of MMR1 at 12 months (RI = 1.9 [95% CI: 1.3–2.9]), but not after VV at 18 months (RI = 0.6 [95% CI: 0.3–1.2]. The estimated excess annual number of FS post MMR1 was 24 per 100,000 vaccinated children aged 11–23 months (95% CI = 7–49 cases per 100,000) or 1 per 4167 doses.ConclusionsOur study detected the expected increased FS risk post MMR1 vaccine at 12 months, but monovalent varicella vaccine at age 18 months was not associated with increased risk of FS. This provides baseline data to assess the risk of FS post MMRV, introduced in Australia as the second dose of measles-containing vaccine at 18 months of age in July 2013.     

Vaccination against serogroup B Neisseria meningitidis: Perceptions and attitudes of parents

BackgroundA vaccine against serogroup B Neisseria meningitidis, major cause of bacterial meningitis in children and adults, has recently been developed. In a context of an increasing parental mistrust against vaccinations, understanding the reason for their choices is crucial in order to improve immunization coverage. Our study aimed at evaluating parental attitudes and perceptions towards serogroup B meningococcal invasive disease vaccination.MethodsA prospective observational study was conducted in different French independent-practice medical offices (general practitioners and paediatricians) and nurseries between May 1 and December 31, 2013, using a questionnaire distributed in electronic and paper forms to parents having at least one child between the ages of 2 months and 16 years old.Results1270 parents were included, of whom 671 (52.8%) spontaneously stated to be in favour of this vaccination. Their choice was mainly justified by the severity of the disease (63.8%) and the desire to protect their child (51.7%). In multivariate analysis, the young age of parents (OR 0.949 per additional year; p < 10⁻³), the history of vaccination against serogroup C meningococcal invasive diseases (OR 6.755; p < 10⁻³), and the prior knowledge of the vaccine (OR 2.081; p = 0.001) were associated with vaccination acceptance. The main reasons for refusal were the lack of hindsight on this new vaccine (50.6%) and the fear of side effects (45.5%). After objective information on the disease and the vaccine, only 6.3% of the entire responding population would refuse to consider vaccination.ConclusionsThe spontaneous acceptance rate of vaccination against serogroup B meningococcal invasive disease is insufficient. However, after objective information by their physician or public health authorities, only a few parents would in the end be completely resistant.     

Mumps encephalitis with akinesia and mutism

Measles‐rubella‐mumps vaccination is routine in many countries, but the mumps vaccine remains voluntary and is not covered by insurance in Japan. A 5‐year‐old Japanese boy who had not received the mumps vaccine was affected by mumps parotitis. Several days later, he presented with various neurological abnormalities, including akinesia, mutism, dysphagia, and uncontrolled respiratory disorder. Mumps encephalitis was diagnosed. Despite steroid pulse and immunoglobulin treatment, the disease progressed. Magnetic resonance imaging showed necrotic changes in bilateral basal ganglia, midbrain, and hypothalamus. At 1 year follow up, he was bedridden and required enteral feeding through a gastric fistula and tracheostomy. Mumps vaccination should be made routine as soon as possible in Japan, because mumps encephalitis carries the risk of severe sequelae.     

某区2008~2010年流行性腮腺炎流行病学研究

目的探讨南岸区2008~2010年流行性腮腺炎的发病情况和流行特征,为科学防治提出对策。方法采用描述性流行病学方法,对2008~2010年南岸区流行性腮腺炎疫情资料进行统计分析。结果 2008~2010年共发生流行性腮腺炎病例1 185例,年平均发病率68.47/100 000。各年发病率分别为31.34/100 000、62.78/100 000、119.26/100 000。全年均有发病,其中5~8月发病例数为591例,占总数的49.87%(591/1 185)。学生和幼托儿童两大群体病例数分别为719例和286例,占60.68%(719/1 185)和24.14%(286/1 185)。5~岁组病例486例,占41.01%(486/1 185)。男、女性比例为1.33∶1。结论流行性腮腺炎发病率呈增加趋势;发病时间集中在每年的5~8月,发病人群主要为学生和幼托儿童;发病年龄主要在5~岁组。