ACIP: Give 3rd mumps vaccine dose during outbreaks

People deemed to be at risk of mumps during an outbreak should receive a third dose of mumps vaccine, a Centers for Disease Control and Prevention (CDC) committee agreed Wednesday.

The CDC Advisory Committee on Immunization Practices (ACIP) said the recommendation would help health departments respond to outbreaks more quickly and increase access to the vaccine.

The CDC director will review ACIP’s recommendation. If approved, it will be published as an official recommendation in the Morbidity and Mortality Weekly Report. The Academy will review the CDC’s changes and make official policy recommendations of its own.

Two doses of measles-mumps-rubella (MMR) vaccine are highly effective in preventing mumps, but effectiveness decreases over time, according to the CDC. People in close contact settings are especially vulnerable, and there has been an increase in cases and outbreaks since 2006.

From January 2016 through June 2017, there were 150 mumps outbreaks consisting of 9,200 cases with a median age of 21, according to the CDC. Half of the outbreaks occurred in university settings, 32% in community groups or sports teams, 13% in schools other than universities and 5% in households.

Previously, the CDC provided guidance on using a third dose for outbreak control but did not make a recommendation for or against its use.

ACIP members on Wednesday reviewed data showing a third dose of MMR vaccine had an effectiveness of 61% to 88%. Among 14,368 recipients, there were no serious adverse events, and rates of mild reactions such as headache, joint pain, diarrhea and swollen glands were low.

In addition, survey data showed students and parents were concerned about mumps, and health departments that had used a third dose generally reported positive experiences.

ACIP members discussed whether recommending a third dose in an outbreak would place a burden on public health departments, but some said they believed it would provide more clarity and flexibility. Some also suggested a routine third dose for people entering college, but others said there is not enough evidence to support it.

The committee voted unanimously in favor of a recommendation that “persons previously vaccinated with two doses of a mumps-containing vaccine who are identified by public health as at increased risk for mumps because of an outbreak should receive a third dose of a mumps-containing vaccine to improve protection against mumps disease and related complications.”

Yvonne A. Maldonado, M.D., FAAP, representing the AAP Red Book Committee at Wednesday’s meeting, said ACIP’s recommendation is a “good compromise” as the group awaits additional research and pediatricians field questions from families of college-bound adolescents.

“For the time being, we actually thought this would be a reasonable way to approach vaccination for providers and to give them guidance in dealing with the unpredictable nature of what may happen (with mumps outbreaks),” said Dr. Maldonado, vice chair of the AAP Committee on Infectious Diseases.