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Does Temple University Mumps Outbreak Highlight Vaccination 'Values'?: Public Health Watch

The latest case cluster in the United States has led a university to change policy regarding the MMR vaccine.

Those of us of a certain age remember an episode of “The Flintstones” in which Barney Rubble fakes a case of the mumps.

However, the disease is no laughing matter for the community at Philadelphia’s Temple University, where media reports note that more than 100 students have been sickened (18 confirmed cases of the viral infection, 98 probable as of Wednesday, April 3). According to The Philadelphia Inquirer, the school is now requiring all incoming students to be vaccinated with the measles-mumps-rubella (MMR) vaccine, something not previously mandated.

Which is, of course, where the rubber always meets the road in stories such as this. The aforementioned animated sitcom aired that particular episode in 1966 (to be fair, we saw it in reruns), when standalone vaccines for the mumps were just coming to market. In 1971, the US Food and Drug Administration first approved the MMR vaccine, and now, the US Centers for Disease Control and Prevention (CDC) recommends that children get 2 doses: the first at 12 to 15 months old and the second at 4 to 6 years old.

Research suggests that the vaccine is 88% effective after 2 doses. These days, however, particularly in contained community settings such as a university, a third dose may be necessary to maintain immunity, experts say.

“Declining MMR vaccine uptake has been associated with measles outbreaks,” Jennifer Whitaker, MD, assistant professor of molecular virology and microbiology/medicine, in the Section of Infectious Disease at Baylor College of Medicine, told Contagion®. “In contrast, the majority of persons with mumps infection during outbreaks did previously receive two doses of MMR vaccine. Mumps outbreaks are the result of waning immunity in young adults. Increasing number of years since the last or second MMR vaccine dose is associated with a greater risk for infection.”

That’s why the Advisory Committee on Immunization Practices (ACIP) has recommended a third dose of MMR vaccine “for groups that public health authorities determine are at increased risk for mumps infection due to an outbreak,” according to Dr. Whitaker.

“Health care providers should be aware of the possibility of mumps infection and consider it in their differential diagnoses when appropriate,” she continued. “All mumps cases should be reported to the public health department. Persons at risk for mumps during an outbreak are those who may be exposed to mumps virus through close contact with a mumps patient. Infectious disease providers should educate their colleagues about the ACIP MMR vaccine recommendations, [and] all health care providers should assess immunization status and make sure immunizations are up to date.”

Notably, Whitaker added, mumps outbreaks in the US have been increasing since 2006, and “between January 2016 and June 2017, half of all outbreaks and 40% of all mumps cases occurred in university settings. Outbreaks also occur in other settings where young adults have close contact such as sports teams, secondary schools, and other close-knit communities.”

The challenge remains getting members of these communities to opt-in for vaccination in general and the third dose of the MMR shot specifically—and this may not be simply a matter of convincing “anti-vaxxers” about the legitimacy of science. As essayist Meghan O’Rourke wrote recently in The Guardian, “Given rising levels of distrust across political parties, it is no surprise that we also can’t agree on the social value of immunity, in which my child’s vaccination will help your grandfather live, or my own vaccination will help your infant survive before she is eligible for her own vaccinations.”

She continued, “In this sense, the debate over vaccination isn’t just about distrust of medicine or a false nostalgia for our ‘natural’ past. It’s also an expression of the limits of American individualism: a natural (if you will) manifestation of a culture that believes realizing one’s own destiny is the apogee of freedom.”

In other words, to return to our silly sitcom, had Barney really been sick, he would have had a choice: to think only of his own health or that of all of Bedrock, the fictitious town in which the show was set.

Unfortunately, when presented with the same options in the real world, it seems, if outbreaks such as the one at Temple are any indication, too many people are choosing the wrong one.