Preventive measures
Fivefold rise in mumps in young adults
Mumps notifications: by age, England & Wales
Over 16,000 new cases of mumps were notified in 2004, a fourfold rise compared with 2003. This followed a doubling in the number of cases over the previous year. The substantial rise in mumps mostly occurred in adults, with a more than fivefold rise between 2003 and 2004, to over 13,000 cases. Over 11,000 of these cases (84 per cent) were among young people aged 15 to 24. The rise for children under 15 was more gradual, nearly doubling over the same period to reach 2,800 cases, the highest level since 1990.
The increase largely reflects lower immunity among older teenagers and young adults in their early 20s, particularly those born between 1983 and 1986 immediately before the introduction of routine vaccination in 1988. These young people would not have been exposed to mumps in childhood because of the swift success of the MMR (measles, mumps, rubella) vaccine in controlling the disease. Older adults were more likely to have had mumps when it was still a common childhood infection.
The introduction of the MMR vaccine in 1988 had an almost immediate effect on the incidence of mumps. Consultations with general practitioners for the illness fell from 2.2 per thousand in that year to 0.6 per thousand in 1990 in England and Wales. There was also a steep decline in notified cases from nearly 21,000 in 1989 to about 2,400 in 1992, as the vaccine became established, with coverage in England, for example, reaching 92 per cent in 1992/93.
The number of cases remained low during the 1990s for all ages. However there was an increase in notified cases for children under 15 at the turn of the century. Although 2002 showed some remission, the number of cases for this age group had risen to over 2,800 by 2004, the greatest number since 1990.
Mumps is an acute viral illness spread through coughing or sneezing and through direct contact with saliva. Symptoms include fever, headache, and painful swollen glands, and in more severe cases complications such as swelling of the testes or ovaries, deafness, or meningitis may occur.
Completed diphtheria and MMR immunisations, UK
By 1996/97 MMR coverage at 24 months of age reached 92 per cent. In 1997/98, however, uptake of MMR began to fall, declining to 81 per cent in 2003/04. There has since been a slight improvement, to 82 per cent in 2004/05. MMR coverage fell dramatically, unlike diphtheria where levels of coverage dipped slightly from 96 per cent to 94 per cent. There is substantial variation between countries. In 2004/05 MMR coverage was lower in England (81 per cent) and Wales (82 per cent) than in Scotland and Northern Ireland (88 per cent). The World Health Organisation (WHO) recommends immunity levels of around 95 per cent to prevent outbreaks of disease.
Sources: Health Protection Agency
Notes: Vaccination courses completed by age 24 months.
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