Visceral leishmaniasis (Kala-Azar) in a 3-year-old German infant (author's transl)]

The article reports on a case of visceral leishmaniasis in a 3-year-old child of German residents in Rome who had passed two vacations on the isle of Ischia. Initial signs were intermittent temperatures, marked anorexia, hepatosplenomegaly and pancytopenia, with spontaneous recovery after three weeks. At that time, leishmania serology was already positive, whereas no leishmania were found in several bone marrow preparations despite a most thorough search. During the following eight weeks, the patient had chickenpox and mumps. During the mumps, relapse of the visceral leishmaniasis occurred, associated with a dramatic increase of the hepatosplenomegaly and recurring pancytopenia. It was only now that we could discover multiple leishmania infection of the bone marrow. Subsequent therapy with sodium stibogluconate (Pentostam) was effective without any complications, and eventually cured the patient.     

2004~2018年全国流行性腮腺炎发病特征及重点防控人群分析

目的 分析2004~2018年我国流行性腮腺炎（简称流腮）的流行病学特征,为确定流腮防控重点人群提供数据支持。方法 通过国家人口与健康科学数据共享服务平台和国家卫生健康委员会疾病预防控制局报告的2004~2018年全国流腮报告发病数据,采用描述性流行病学方法,分析流腮的发病特征。结果 2004~2018年全国共报告流腮4 272 368例,年平均报告发病率为21.44/10万。2008年起单剂含腮腺炎成份的疫苗加入国家计划免疫,但各年发病率范围仍在12.84/10万~35.59/10万之间。北京、天津和上海实施第2剂麻疹-腮腺炎-风疹联合减毒活疫苗（MMR）常规免疫后,三地区的流腮报告发病率均降至10/10万左右。2004~2016年间3~14岁人群流腮发病占比81.16%。2004~2013各年份多以6岁儿童流腮发病率最高。结论 单剂含有腮腺炎成份的疫苗接种对流腮发病率无明显影响。从各年龄组流腮发病率看,6岁儿童最高。建议在学龄前儿童开展第2剂次含腮腺炎成分疫苗接种。     

Epidemiologic Studies on mumps. II. Prospective, Periodic Surveillance on Mumps in Three Different Areas

Prospective, periodical sero-epidemiological surveillance on mumps was carried out in three different populations in Aichi prefecture. 1) In a newly developed residental quarter full of big apartment buildings, where heavy population density burst has been occurring, mumps has been observed as an endemic disease. Serologically, almost all the children under six years old has experienced mumps infection in such an area. 2) In an old city with stable population dynamics, mumps outbreaks have been taken place pediodically. The results of serosurvey suggested that the periodic outbreaks occurred when more than 60–70% of the children became susceptible, regardless of seasons. 3) In a relatively isolated small town, mumps epidemics has not been observed for many years and when the disease is introduced into the community however, large outbreak develops in the town.     

Measles and mumps antibody concentrations in newborns and their mothers--follow up first year of life

BACKGROUND: During the last twenty years the incidence of measles and mumps decreased after introduction of vaccinations in the industrial nations. The vaccination rate of the population in Germany lies currently under the required elimination rate. The epidemiological situation has changed altogether. The illness age has on the one hand moved up, teenager and adult suffer more frequent these so-called children's diseases with an increased complication rate. On the other hand illness cases in infancy seeming to increase. It was aim of this study to examinate the current serological situation for measles and mumps antibody status in women in childbed and their healthy newborns at birth time and during the first seven to nine life months. PATIENTS AND METHOD: 237 healthy newborns, born in 1999 in Bochum, West-Germany and their mothers were included. The mothers were asked if and when they did suffer from measles and mumps or were questioned to active vaccinations against these diseases. Immediately antepartal from all mothers was taken a venous blood sample. Immediately postpartal from all newborn childs umbilical cord blood was taken and again a blood sample in the age of six to eight months. In the serum tests the measle and mumps IgG antibody concentrations were examined quantitatively with ELISA methods. In cases with negative or borderline positive values the plaque neutralization test was also used for measuring of the measle antibodies. CONCLUSIONS: Between the maternal and neonatal titers results the knownly positive correlation. Maternal lending immunity against measle and mumps lasts more less into infancy as generally suspected. An earlier first active immunization against measles and mumps could be discussed. The strict realisation of the present vaccinating recommendations should be operated as a matter of priority to lead to the desired measles and mumps eradication.     

Local immunity in mumps meningitis

Titers of antibodies to mumps and measles virus and interferon activity were measured in sera and CSF obtained from 15 children with mumps meningitis. Antibody to mumps virus was found in 11 of 15 CSF samples. Evaluation of the CSF-serum ratio for antibodies to both viruses showed a substantially higher ratio for antibody to mumps virus. The ratio of IgG/IgM antibody activity to mumps virus was greater in CSF than in sera. These results could be attributed to antibody synthesis, particularly IgG, in the CNS. Titers of antibodies to mumps virus in CSF increased rapidly, reaching a peak four to ten days from onset of meningitis, and swiftly decreased thereafter. During the acute phase, interferon activity was found in almost all cases ranging from 16 to 128 IU/mL in sera, and 4 to 16 IU/mL in CSF. In cases of mumps meningitis that followed the usual clinical course, interferon disappeared within a week, whereas it persisted in the CSF in cases of persistent pleocytosis.     

Incidence of type 1 diabetes mellitus in the 0- to 17-yr-old Israel population, 1997-2003

BACKGROUND: Recent reports from different countries have shown an increased incidence of type 1 diabetes mellitus (T1DM). A national juvenile diabetes register was established by the Israel Pediatric Endocrine Society and the Israel Center for Disease Control (ICDC) in 1997. OBJECTIVE: This article reports the epidemiology of T1DM in children in the age-group 0-17 yr in Israel during 1997-2003. METHODS: The Israel juvenile diabetes register is a population-based anonymous registry. Newly diagnosed cases of all types of diabetes in children and adolescents are reported to the ICDC by all the endocrinologists in all the pediatric diabetes centers. Overall incidence rates and rates by sex, age, and population group are presented. Comparisons are made by year, sex, age, and population group. RESULTS: During 1997-2003, 1485 children and adolescents with T1DM were reported in the age-group 0-17 yr. The annual incidence rate of T1DM increased by 34% during 1997-2003, from 8.0 per 100 000 [95% confidence interval (CI) 6.8-9.3] to 10.7 per 100 000 (95% CI 9.4-12.1). Incidence rates were higher for Jews than for Arabs. Among Jews, children of Yemenite origin had the highest incidence rate (26.1 per 100 000; 95% CI 13.3-38.9). Incidence peaked at an earlier age in girls. A first-degree family history of T1DM was found in 9.1% of the cases. CONCLUSIONS: The incidence of T1DM is increasing in the Israeli population, particularly in the Arab population. The culturally varied composition of the Israeli population provides important areas for future studies based on data collected in this national register.     

Hematuria with mumps infection

Two cases with macroscopic hematuria as complication of acute mumps infection is reported. The patients have neither been vaccinated against mumps nor had mumps infection earlier. Macroscopic hematuria resolved spontaneously and renal functions did not deteriorate in both the patients. Although mumps has a benign course, mild and rarely severe renal involvement may occur. Therefore, renal functions in patients with hematuria and mumps should be followed closely     

Aseptic meningitis after vaccination against measles and mumps

This retrospective study (1979 to 1986) investigated the possible etiologic relationship between vaccination and aseptic meningitis in 115 hospitalized children who became ill within 30 days of vaccination with the Leningrad 3 strain of mumps virus and the Edmonston-Zagreb strain of measles virus. The etiologic viral diagnosis was based on serologic tests and the isolation of virus from cell cultures which distinguished between attenuated and "virulent" mumps virus. The incidence of mumps vaccine-associated meningitis was 1/1000 vaccine recipients. In 92% of children the incubation period was 11 to 25 days and 28% had associated swelling of the salivary glands. Sixteen cases (13.9%) had a positive cerebrospinal fluid culture (attenuated mumps virus, 6 cases; "virulent" mumps virus, 7 cases; echoviruses, 3 cases). Clustering of cases, seasonal occurrence and age of the patients suggested causal relationship with the vaccination in the majority of children. In 4 patients with attenuated virus isolation from cerebrospinal fluid the incubation period ranged from 17 to 20 days. Clinical findings did not differ from natural mumps meningitis. The course was uncomplicated and at discharge the patients had no sequelae. Measles virus was never found as a cause of the meningitis. The mumps vaccine virus should be recognized as one of the causative agents of aseptic meningitis in countries where less attenuated mumps vaccine is used.     

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.     

Increased Serum Levels of Anti-Mumps and Rubella Viruses Antibodies in Children with Kawasaki Disease

Serum IgM and IgG antibodies against mumps virus and rubella virus were quantitated serially by enzyme-linked immunosorbent assays in 15 children with Kawasaki disease. IgM antibody against mumps virus and IgG antibody against rubella virus were increased significantly in children with Kawasaki disease who had no previous history of mumps virus or rubella virus infection. Booster-like effect in IgG antibody levels against mumps virus was observed in children with Kawasaki disease who had a previous history of exposure to mumps virus. Since none of the patients manifested clinical symptoms of mumps or rubella, the increased antibody levels against mumps and rubella may represent a part of the nonspecific increase in serum immunoglobulins in children with Kawasaki disease.     

Intussusception in children in Southern Israel: disparity between 2 populations

BACKGROUND: Intussusception has been associated with 1 rotavirus vaccine. Our objective was to determine intussusception rates in children in southern Israel during a 15-year period before the introduction of new rotavirus vaccines. METHODS: All children born at the Soroka Medical Center are hospitalized in that center, enabling population-based studies. Two populations reside in Southern Israel: the Jewish population (comparable to a Western population) and the Bedouin population (comparable to a developing population). Retrospectively, all children <5 years of age admitted with ICD-9 code for intussusception were recorded as well as their demographic and clinical data. RESULTS: During 1990-2004, 316 patients with intussusception [241 (76%) Jewish children and 75 (24%) Bedouin children] were recorded. None died. The mean annual rates for children <5 years (per 100,000) were 49.3 +/- 17.4 and 18.9 +/- 9.6 for Jewish and Bedouin children, respectively (P < 0.001), with a significant increase in intussusception rates during the study period in Bedouin (P = 0.022), but not in Jewish children (P = 0.38). Mean annual intussusception rates per 100,000 for children <12 months were 199.6 +/- 5.2 and 66.8 +/- 44.1 for Jews and Bedouin infants, respectively (P < 0.001). In Bedouin children, a significantly higher number of cases were observed from March to May, whereas no seasonality pattern was noted in Jewish children. Negative correlation between intussusception and gastroenteritis was found in Bedouin infants during the summer months, whereas no such correlation was found in Jewish infants. CONCLUSIONS: Pre-rotavirus vaccination intussusception rate is high especially among Jewish infants in Southern Israel. Intussusception rates increased significantly during the study period in Bedouin infants.     

A benefit-cost analysis of mumps vaccine

Applying benefit-cost analysis, we determined the savings in morbidity, mortality, and costs of mumps vaccination in the United States. Using reported mumps incidence rates in a model cohort of 1 million persons followed up for 30 years, mumps vaccination would prevent more than 74,000 cases of mumps and three deaths. Approximating the actual incidence rate of mumps, by assuming that 90% of people are infected by age 30 and 60% of these have had clinical illness, mumps vaccination would prevent more than 540,000 cases of mumps and 23 deaths. A mumps vaccination program, in which mumps was given as part of a measles-mumps-rubella combination, would reduce costs associated with mumps by more than 86%, with a benefit-cost ratio of 7.4:1, using reported incidence rates. The program has a benefit-cost ratio of 39:1 when approximations of actual mumps incidence are used in the analysis. Mumps vaccination is highly cost beneficial.     

Mumps-associated acute cerebellar ataxia.

During a mumps outbreak between 1987 and 1988, six children presented with symptoms of acute cerebellar involvement as the sole neurologic complication. The neurologic symptoms followed parotitis and lasted for up to 3 weeks. Serologic evidence was suggestive of recent mumps infection. Symptoms spontaneously resolved in all patients without any residual signs or symptoms during 2- to 2.5-year follow-up.     

Two Doses of Measles Mumps Rubella (MMR) Vaccine

A schedule of two doses of measles mumps rubella vaccine (MMR) at an interval of six weeks was tried in children aged between 12 and 48 months. One hundred percent seroconversion was attained in the measles HI (hemagglutinin inhibition) test, rubella HI test, and mumps ELISA test in both groups of children who received NIH (National Institute of Health, Japan) MMR lot B-30 and Kitasato MMR lot TV-1. The possibility of vaccine failure with one dose of measles vaccine is not negligible [1], and the frequency of vaccine failure increases if three vaccines are combined in the form of MMR. Our observations revealed that a few of the children who had received one dose of MMR remained seronegative with regard to measles HI antibody and rubella HI antibody, and that some of the children remained seronegative with regard to mumps ELISA antibody. A schedule of two doses of MMR was shown to be helpful in reinforcing immunity in children who did not respond satisfactorily to one dose of MMR. We concluded that two doses of MMR are preferable to control measles, mumps and rubella infections.     

Rapid Serological Diagnosis of Mumops Virus Infection by an Enzyme-Linked Immunosorbent Assay of Mumps IgG and IgM Antibodies

A simple and sensitive ELISA of mumps IgM and IgG antibodies was described. This assay served as a useful means of rapid diagnosis of mumps virus infection. Coolection of parired serum specimens before day 2 and during the second week of the disease was recommended. A great increase in mumps ELISA IgG in combination with the presence of significant elevation of mumps ELISA IgM level was one of the best proffs of quite recent mumps virus infection. Infulences of false negative reaations and false positive reactions on mumps ELISA IgM were not great. We concluded that the measurement of ELISA IgM antibody along with that of IgG antibody was useful for rapid serological diagnosis of recent mumps infection.     

Changing epidemiology of mumps and its impact on university campuses

The reported incidence of mumps has declined dramatically since licensure of the live attenuated mumps vaccine in the United States in 1967, particularly in young children. Because administration of the vaccine was not widely practiced during the first decade it was available, there is now a cohort of teenagers and young adults who are relatively underimmunized. Reported mumps cases in this cohort increased substantially during 1986 to 1987. Mumps outbreaks at three Illinois universities, from which 123 clinical cases were reported between September 1986 and May 1987, were investigated. Meningeal involvement was reported in 17% of case-patients, orchitis occurred in 19% of 64 men, 6% of patients were hospitalized, and direct health care costs were estimated at $264 per case and more than $32,000 for the three outbreaks combined. The risk of mumps illness was greater for students less than 20 years of age (relative risk [RR] = 2.1, 95% confidence interval [CI] = 1.4, 3.1); students residing in dormitories (RR = 2.7, 95% CI = 1.6, 4.6); and out-of-state students (RR = 1.8, 95% CI = 1.0, 3.0). Because the available data suggest that mumps in college-aged persons is due chiefly to a failure to vaccinate susceptible persons, colleges and universities should become one major focus of mumps prevention activities to reduce susceptibility in this high-risk population.     

Effectiveness of mumps vaccine in a school outbreak

An outbreak of mumps in a middle school (grades 6 through 8) in Ohio during 1981 was investigated to determine the effectiveness of mumps vaccine. Of the 481 middle school students on whom questionnaires were completed, 62 (12.4%) exhibited clinical mumps. The overall vaccine efficacy was 81.2% when children with a history of mumps disease are excluded from the analysis. Using a logistic regression model with the presence or absence of clinical mumps as the dependent variable, three factors were found to be significant: mumps vaccine, a history of mumps disease, and sex. Factors that did not significantly affect the rate of disease among vaccinated pupils included whether the mumps vaccine was administered singly or in combination with rubella and/or measles vaccine, age at vaccination, year of vaccination, and month of vaccination.     

Mumps outbreak in a highly vaccinated population

From October 1988 to April 1989, a large mumps outbreak occurred in Douglas County, Kansas. Of the 269 cases, 208 (77.3%) occurred among primary and secondary school students, of whom 203 (97.6%) had documentation of mumps vaccination. Attack rates were highest for students attending junior high school (8.0%), followed by high school (2.0%) and elementary school (0.7%). A retrospective cohort study conducted at one junior high school with an attack rate of 12.9% did not find age at vaccination or type of vaccine received (single or combined antigen) to be risk factors for vaccine failure. Students vaccinated more than 4 years before the outbreak appeared to have a higher attack rate than those vaccinated more recently (relative risk (RR) = 4.3; 95% confidence interval (CI) = 0.6, 30.0); however, this association did not exist when risk was evaluated based on number of vaccine doses received. Students who had documentation of receiving only one dose of vaccine were at greater risk than those who had received two doses (RR = 5.2; 95% CI = 1.0, 206.2). Overall, vaccine effectiveness among Douglas County junior high school students was estimated to be 83% (95% CI = 57%, 94%). These data suggest that mumps vaccine failure and the failure to vaccinate have contributed to the relative resurgence of mumps observed in the United States since 1986. The recent change in immunization policy to recommend a two-dose schedule of measles-mumps-rubella vaccine should help reduce the occurrence of mumps outbreaks in highly vaccinated populations.     

Combined vaccine against measles, mumps, rubella, and varicella

A combined measles, mumps, rubella, and varicella vaccine produced seroconversions for all four components similar to that found if measles, mumps, and rubella vaccine or live varicella vaccine were given separately. In addition, those exposed to varicella were completely protected or had only a mild rash. Moreover, the reaction rates were not increased if the vaccines were combined. The somewhat lower and delayed serologic response to live varicella vaccine as compared with the combined measles, mumps, rubella, and varicella may have been due to the small amount of varicella vaccine virus used or to its degree of attenuation. Persistence of antibody was observed 1 year postimmunization.     

Mumps as a cause of admission to hospital: an estimate for Western Australia 1981

Close to 40% of children admitted to Princess Margaret Hospital with mumps over the period 1979 to 1982 were diagnosed retrospectively as a result of virological tests and their illness was not coded as being due to mumps. This clinical underestimate of the incidence of mumps is due to the frequent absence of salivary gland enlargement, especially in preschool children. In such cases there is usually evidence of inflammation of the upper respiratory tract. The main clinical features leading to admission were neck stiffness, fits and high fever. An appropriate adjustment was made to the figures obtained from the computerised data on discharges with the diagnosis of mumps from Western Australian hospitals in 1981. This led to the estimate that 104 patients suffering from mumps were discharged from hospital during that year. It was also estimated that mumps was responsible for 379 in-patient days. Our findings show that the benefit cost ratios for mumps immunization of others are underestimates.