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Mumps outbreak and laboratory diagnosis
Mylène Maillet1, Eric Bouvat2, Nicole Robert2
1Infectious Diseases Department, Grenoble University Hospital, France.
Background:
Several mumps outbreaks have been reported in Europe and in the United States among highly vaccinated populations. Biological diagnosis is classically based on the detection of mumps-specific IgM, but the ability of serological tests to confirm mumps infection seems to be limited among vaccinated patients.
Objectives:
We aim to report a mumps outbreak in an engineering school in Grenoble, France, from February to June 2013 and results of the biological testing.
Study Design:
WHO definitions were used to define cases. Mumps--specific IgM and IgG were assessed by a commercially available EIA. Mumps RNA detection by real time reverse transcriptase polymerase chain reaction tests (RT-PCR) and mumps genotyping were performed by the French National Reference Centre for Paramyxoviridae.
Results:
Sixty two mumps patient-cases were identified using WHO case definitions, 20 being biologically explored, of which 17 were confirmed by biological tests. Vaccination status was documented for 27 patients/62: 4 (14.8%) patients had received one dose of MMR vaccine, and 23 (85.2) two doses of MMR vaccine. Among the biologically explored patients, 83% had a positive RT PCR at the first sampling whereas only 45% had positive or equivocal IgM. All the genotyped strains were genotype G.
Conclusions:
Mumps laboratory diagnosis in a highly vaccinated population is challenging. Serological tests among vaccinated patients should be interpreted cautiously and confirmed by RT-PCR tests at the beginning of a mumps outbreak.
Insights
Mumps diagnosis in vaccinated individuals is difficult. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) is more reliable than serological tests for confirming mumps infection during outbreaks.
Area of Science:
- Virology
- Epidemiology
- Public Health
Background:
- Mumps outbreaks occur in highly vaccinated populations.
- Serological tests for mumps may be less reliable in vaccinated individuals.
- Challenges in diagnosing mumps in vaccinated patients necessitate improved diagnostic strategies.
Purpose of the Study:
- To investigate a mumps outbreak in an engineering school in Grenoble, France.
- To evaluate the effectiveness of biological testing for mumps diagnosis.
- To analyze mumps virus genotype during the outbreak.
Main Methods:
- Case definitions were based on World Health Organization (WHO) criteria.
- Mumps-specific IgM and IgG were detected using commercially available enzyme immunoassays (EIA).
- Mumps RNA was detected using real-time reverse transcriptase polymerase chain reaction (RT-PCR), and genotyping was performed.
Main Results:
- Sixty-two mumps cases were identified; 20 were biologically explored, with 17 confirmed.
- A high proportion of patients (85.2%) had received two doses of the measles, mumps, and rubella (MMR) vaccine.
- RT-PCR confirmed mumps in 83% of cases, while IgM tests were positive or equivocal in only 45%.
Conclusions:
- Laboratory diagnosis of mumps in highly vaccinated populations presents significant challenges.
- Serological test results in vaccinated patients require cautious interpretation.
- RT-PCR testing is recommended for confirming mumps infection, especially early in an outbreak.
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