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Disentangling the causes of mumps reemergence in the United States
Deven V Gokhale1,2,3, Tobias S Brett1,2,3, Biao He4
1Odum School of Ecology, University of Georgia, Athens, GA 30602.
Abstract:
Over the past two decades, multiple countries with high vaccine coverage have experienced resurgent outbreaks of mumps. Worryingly, in these countries, a high proportion of cases have been among those who have completed the recommended vaccination schedule, raising alarm about the effectiveness of existing vaccines. Two putative mechanisms of vaccine failure have been proposed as driving observed trends: 1) gradual waning of vaccine-derived immunity (necessitating additional booster doses) and 2) the introduction of novel viral genotypes capable of evading vaccinal immunity. Focusing on the United States, we conduct statistical likelihood-based hypothesis testing using a mechanistic transmission model on age-structured epidemiological, demographic, and vaccine uptake time series data. We find that the data are most consistent with the waning hypothesis and estimate that 32.8% (32%, 33.5%) of individuals lose vaccine-derived immunity by age 18 y. Furthermore, we show using our transmission model how waning vaccine immunity reproduces qualitative and quantitatively consistent features of epidemiological data, namely 1) the shift in mumps incidence toward older individuals, 2) the recent recurrence of mumps outbreaks, and 3) the high proportion of mumps cases among previously vaccinated individuals.
Insights
Mumps outbreaks are resurging even in highly vaccinated populations. This study suggests waning vaccine immunity, not new viral strains, is the primary cause, with many losing protection by age 18.
Area of Science:
- Epidemiology
- Immunology
- Public Health
Background:
- Resurgent mumps outbreaks have occurred in highly vaccinated countries over the past two decades.
- A significant proportion of mumps cases are among individuals who have completed their vaccination schedules, questioning vaccine effectiveness.
- Two hypotheses for vaccine failure include waning immunity and novel, immune-evasive viral genotypes.
Purpose of the Study:
- To investigate the primary mechanism driving mumps resurgence in the United States.
- To differentiate between waning vaccine immunity and viral genotype evasion as causes of mumps outbreaks.
- To quantify the rate of vaccine-derived immunity loss over time.
Main Methods:
- Utilized statistical likelihood-based hypothesis testing.
- Employed a mechanistic transmission model incorporating age-structured epidemiological, demographic, and vaccine uptake data.
- Analyzed time series data from the United States.
Main Results:
- Epidemiological data strongly support the waning immunity hypothesis over viral evasion.
- Estimated that 32.8% of individuals lose vaccine-derived mumps immunity by age 18.
- The transmission model accurately reproduced key epidemiological trends, including shifts in incidence to older age groups, recent outbreak recurrence, and a high proportion of cases in vaccinated individuals.
Conclusions:
- Waning of vaccine-derived immunity is the most probable explanation for recent mumps outbreaks in the US.
- The findings highlight the need to consider booster vaccination strategies to address declining immunity.
- Understanding immunity duration is critical for effective mumps control in highly vaccinated populations.
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