Mumps vaccine

Mumps vaccines are vaccines which prevent mumps.[1] When given to a majority of the population they decrease complications at the population level.[1] Effectiveness when 90% of a population is vaccinated is estimated at 85%.[2] Two doses are required for long term prevention.[1] The initial dose is recommended between the age of 12 and 18 months of age.[1] The second dose is then typically given between two years and six years of age.[1] Usage after exposure in those not already immune may be useful.[3]

Mumps vaccine
Vaccine description
Target diseaseMumps
TypeAttenuated virus
Clinical data
MedlinePlusa601176
ATC code
Identifiers
ChemSpider
  • none
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Side effects are generally mild.[1][3] It may cause mild pain and swelling at the site of injection and mild fever.[1] More significant side effects are rare.[1] Evidence is insufficient to link the vaccine to complications such as neurological effects.[3] The vaccine should not be given to people who are pregnant or have very poor immune system function.[1] Poor outcomes among children of mothers who received the vaccine during pregnancy, however, have not been documented.[1][3] Even though the vaccine is developed in chicken cells, it is generally safe to give to those with egg allergies.[3]

Most of the developed world and many countries in the developing world include it in their immunization programs often in combination with measles and rubella vaccine known as MMR.[1] A formulation with the previous three and the varicella (chickenpox) vaccine known as MMRV is also available.[3] As of 2005 110 countries provided the vaccine as part of their immunization programs.[1] In areas where widespread vaccination is carried out it has resulted in a more than 90% decline in rates of disease.[1] Almost half a billion doses of one variety of the vaccine has been given.[1]

A mumps vaccine was first licensed in 1948; however, it only had short term effectiveness.[3] Improved vaccines became commercially available in the 1960s.[1] While the initial vaccine was Inactivated subsequent preparations are live virus that has been weakened.[1] It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system.[4] There are a number of different types in use as of 2007.[1] The wholesale cost in the developing world of the version that includes measles and rubella is 0.24 USD per dose as of 2014.[5]

Types

MMR vaccine
  • MMR vaccine (measles, mumps, rubella vaccine) is the most commonly used form of the vaccine, formulated in combination with vaccines for measles and rubella.[2][6]

Mumpsvax
  • Mumpsvax is Merck's brand of Jeryl Lynn strain vaccines[7][8] and is the mumps vaccine standard in the United States. The Jeryl Lynn strains have been in use since 1967, and were believed to be a single strain until 2002.

The vaccine is a component of Merck's three-virus MMR vaccine.[9] Mumpsvax is given by a subcutaneous injection of live virus reconstituted from freeze-dried (lyophilized) vaccine.[8]

The dosage of the mumps vaccine component in MMR is the same as of Mumpsvax, "Each 0.5 mL dose contains not less than 20,000 TCID50 (50% Tissue Culture Infective Dose) of mumps virus." The Merck product information recommends MMR as the secondary vaccination treatment with Mumpsvax.[8]

Mumpsvax is produced from the Jeryl Lynn[10] strain of mumps virus developed by Maurice Hilleman. When his daughter Jeryl Lynn Hilleman contracted Mumps (in 1963) Dr. Hilleman cultured the vaccine strain from her throat. The mumps virus strains were developed in embryonic hens' eggs and chick embryo cell cultures. The resulting strains of virus were less well-suited for human cells, and are thus said to be attenuated. They are sometimes referred to as neuroattenuated in the sense that these strains are less virulent to human neurons than the wild strains.[11][12]

The cells used in culture, virus stocks used, and animal fluids are all screened for extraneous material as part of the vaccine production. They are grown in Medium 199 (a solution containing buffered salt, vitamins, amino acids, fetal bovine serum) with SPGA (sucrose, phosphate, glutamate, human serum albumin) and neomycin. The human albumin processing uses the Cohn cold ethanol fractionation method.[8] Mumpsvax production as a stand-alone product ceased in 2009.[13][14]

Other
  • RIT 4385 is a newer strain derived from the Jeryl Lynn strain[2] by Maurice Hilleman, Jeryl Lynn's father.
  • Leningrad-3 strain was developed by Smrodintsev and Klyachko in guinea pig kidney cell culture and has been used since 1950 in former Soviet countries.[15] This vaccine is routinely used in Russia.
  • L-Zagreb strain used in Croatia and India was derived from the Leningrad-3 strain by further passaging.[15]
  • Urabe strain was introduced in Japan, and later licensed in Belgium, France and Italy. It has been associated with a higher incidence of meningitis (1/143 000 versus 1/227 000 for J-L),[16] and abandoned in several countries. It was formulated as MMR in the UK.
  • Rubini strain used mainly in Switzerland was attenuated by a higher number of passes through chicken embryos, and later proved to have low potency.[17] It was introduced in 1985.[15]

Illegal importation of ineffective version into the UK

Monovalent mumps vaccine (Mumpsvax) remained available in the U.S.A when MMR was introduced in the UK, replacing the MR (measles and rubella) mixed vaccine. No UK-licensed monovalent preparation was ever available.[18] Monovalent mumps vaccines were available before MMR, but only used on a limited scale.[19][20] This became the subject of considerable argument at the end of the 20th century, since some parents preferred to obtain individually the components of the MMR mixture. One mumps vaccine preparation imported into the United Kingdom and unlicensed, proved to be essentially ineffective.[21] Immunisation against mumps in the UK became routine in 1988, commencing with MMR. The Aventis-Pasteur "MMR-2" brand is usual in the UK in 2006.

Storage and stability

The cold chain is a major consideration in vaccination, particularly in less-developed countries. Mumps vaccines are normally refrigerated, but have a long half-life of 65 days at 23 degrees Celsius.[15]

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References
  1. World Health Organization (February 2007). "Mumps virus vaccines : WHO position paper". Weekly Epidemiological Record. 82 (7): 51–60. hdl:10665/240868. PMID 17304707.
  2. Hviid, A; Rubin, S; Mühlemann, K (March 2008). "Mumps". Lancet. 371 (9616): 932–44. doi:10.1016/S0140-6736(08)60419-5. PMID 18342688.
  3. Atkinson, William (May 2012). Mumps Epidemiology and Prevention of Vaccine-Preventable Diseases (12 ed.). Public Health Foundation. pp. Chapter 14. ISBN 9780983263135. Archived from the original on 2016-07-06.
  4. World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  5. "Vaccine, Measles-Mumps-rubella". International Drug Price Indicator Guide. Archived from the original on 16 January 2016. Retrieved 8 December 2015.
  6. Kowalzik, F; Faber, J; Knuf, M (August 2018). "MMR and MMRV vaccines". Vaccine. 36 (36): 5402–7. doi:10.1016/j.vaccine.2017.07.051. PMID 28757060.
  7. Hilleman MR, Buynak EB, Weibel RE, Stokes J (February 1968). "Live, attenuated mumps-virus vaccine". The New England Journal of Medicine. 278 (5): 227–32. doi:10.1056/NEJM196802012780501. PMID 4169706.
  8. Merck Co. (1999). "MUMPSVAX (Mumps Virus Vaccine Live) Jeryl Lynn Strain" (PDF). Merck Co. Archived from the original (PDF) on 2006-08-13.
  9. Merck Co. (1999). "M-M-R II (Measles, Mumps, and Rubella Virus Vaccine Live)" (PDF). Merck Co.
  10. Young ML; Dickstein B; Weibel RE; Stokes J Jr; Buynak EB; Hilleman MR. (1 November 1967). "Experiences with Jeryl Lynn strain live attenuated mumps virus vaccine in a pediatric outpatient clinic". Pediatrics. American Academy of Pediatrics. 40 (5): 798–803. PMID 6075651.
  11. "Immunization, Vaccines and Biologicals". World Health Organization. 2003. Archived from the original on 2006-04-15.
  12. Rubin, S. A.; Amexis, G; Pletnikov, M; Li, Z; Vanderzanden, J; Mauldin, J; Sauder, C; Malik, T; et al. (2003). "Changes in Mumps Virus Gene Sequence Associated with Variability in Neurovirulent Phenotype". Journal of Virology. 77 (21): 11616–24. doi:10.1128/JVI.77.21.11616-11624.2003. PMC 229304. PMID 14557647.
  13. https://www.cdc.gov/vaccines/vac-gen/shortages/mmr-faq-12-17-08.htm
  14. Smith, Rebecca (24 November 2009). "Single mumps vaccine production stops". The Telegraph. London: Telegraph Media Group Limited. Retrieved 14 February 2016.
  15. "Immunizations, Vaccines and Biologicals - The Mumps Vaccine". World Health Organization. Archived from the original on 2006-04-23.
  16. "MMR Vaccine". Pediatric Oncall. January 7, 2006. Archived from the original on April 30, 2007.
  17. Eurosurveillance report on Portugal outbreak. Archived September 7, 2005, at the Wayback Machine
  18. Smith, Rebecca (2009-11-24). "Single mumps vaccine production stops". Telegraph. Retrieved 2020-03-18.
  19. Donaldson, R. J. (2012-12-06). Essential Community Medicine: (including relevant social services). Springer Science & Business Media. ISBN 978-94-011-6249-4.
  20. Forsey, T. (1994). "Mumps vaccines—current status". Journal of Medical Microbiology. 41 (1): 1–2. doi:10.1099/00222615-41-1-1. ISSN 0022-2615. PMID 8006938.
  21. Pavivac ineffective. CMO's letter HSSMD33-02::Archived 2007-09-27 at the Wayback Machine Nov. 2002

Further reading
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