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• From August 2016 through July 2017, nearly 3,000 cases of mumps were reported to ADH. • Second largest US mumps outbreak in over 30 years. • Over 50% of cases were in the Arkansas Marshallese community, a close-knit community. • Costs reflect the response strategies tailored to the affected populations. • Total public health response costs were over $2.1 million, approximately $725 per case. On August 8, 2016, a confirmed case of mumps was reported to the Arkansas Department of Health (ADH) in an adult resident of Springdale, Arkansas. By July 2017, nearly 3,000 cases of mumps were reported to ADH from 37 of the 75 counties in Arkansas. Over 50% of cases were in the Arkansas Marshallese community, a close-knit community characterized by large, and extended families sharing the same living space and communal activities. In a statewide effort, ADH collaborated with CDC, the Republic of the Marshall Island's (RMI) Ministry of Health, and the Arkansas Department of Education (ADE) to rapidly respond to and contain the outbreak. We assessed the economic burden to ADH of the outbreak response in terms of containment and vaccination costs, as well as response costs incurred by CDC, RMI, and ADE. The 2016–2017 Arkansas mumps outbreak was the second largest US mumps outbreak in over 30 years and was unique in size, spread, and population affected. Total public health response costs as a result of the outbreak were over $2.1 million, approximately $725 per case. The costs incurred to control this outbreak reflect the response strategies tailored to the affected populations, including consideration of social, cultural, and political factors in controlling transmission and requirements of distinctive strategies for public health outreach. Aside from the burden these outbreaks have on the affected population, we demonstrate the potential for high economic burden of these outbreaks to public health. [ABSTRACT FROM AUTHOR]

Background Ships destined for, or departing from, U.S. ports of entry must report certain signs and symptoms of potentially communicable diseases of public health interest among travelers to the Division of Global Migration and Quarantine (DGMQ) at the Centers for Disease Control and Prevention. Methods We reviewed ships' varicella case and outbreak reports from January 2010 through December 2015. Results DGMQ received 967 reports of varicella and 13 reports of herpes zoster. Most varicella case-patients were 20–49 years of age (84.7%, 472/557) and were cruise ship crew members (78.4%, 758/967). Most often, cruise ship crew member case-patients were born in or held passports from Indonesia (21.7%, 80/369), Philippines (17.6%, 65/369), or India (17.3%, 64/369). Ninety-nine varicella outbreaks were reported, including 439 varicella cases and one herpes zoster case; 97 (98.0%) outbreaks occurred on cruise ships, and 90.2% of associated cases were among crew members (397/440). Most varicella cases were in crew members, who are adults often from tropical regions where varicella immunity is acquired later in childhood or young adulthood or without varicella vaccination programs. Conclusion Varicella vaccination as appropriate for susceptible travelers, particularly crew members, before maritime travel may decrease risk of varicella infection and prevent outbreaks on ships. [ABSTRACT FROM AUTHOR]

Abstract: Following implementation of a routine childhood two-dose measles–mumps–rubella vaccination strategy, mumps disease levels dropped dramatically in the US and an elimination goal was set for 2010. However, a 2006 epidemic involved >5700 cases nationwide, with many reported among fully vaccinated college students. In an outbreak in two Iowa colleges, we investigated: (1) vaccination coverage using electronic records verified by provider records and (2) vaccine effectiveness assessed by comparison of dose-specific attack rates. Mumps was classified as typical (parotitis/orchitis) or atypical (parotid tenderness or submandibular/sublingual adenitis). Two-dose mumps vaccination coverage was 90% both for the student population (2128/2363) and case-students (97/108). Two-dose vaccine effectiveness was 76–88% with no significant difference for attack rates between one and two doses. Among two-dose vaccine recipients, 74% of the population (1482/2009) and 79% of the case-students (75/95) had received the second dose >10 years before. A large mumps outbreak occurred despite high two-dose vaccination coverage in a population most of whom had received the second dose >10 years before. Two-dose vaccine effectiveness was similar to previous one-dose estimates. Further studies are needed to examine the persistence of two-dose mumps vaccine-induced immunity and to determine whether US mumps elimination can be achieved with the current vaccination strategy. [Copyright &y& Elsevier]

Children may receive measles-mumps-rubella (MMR) and varicella (VAR) vaccines separately or as measles-mumps-rubella-varicella (MMRV). We examined whether pediatric herpes zoster (HZ) incidence varied by pattern of varicella vaccine administration. In six integrated health systems, we examined HZ incidence among children turning 12 months old during 2003–2008. All received varicella and MMR vaccines on recommended schedules. Cases were identified through 2014 using ICD-9 codes. Incidence was examined by number of varicella vaccine doses and same-day MMR. Among 199,797 children, overall HZ incidence was 18.6/100,000 person-years in the first-dose MMR + VAR group, 17.9/100,000 person-years in the MMRV group, and 7.5/100,000 person-years in the VAR-alone group. HZ incidence was lower following the second dose than before the second dose in all first-dose groups. HZ incidence was not meaningfully different between the MMRV and MMR + VAR first-dose groups. Overall and within first-dose groups, HZ incidence was lower among children receiving two varicella vaccine doses. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Measles–mumps–rubella–varicella (MMRV) vaccine is associated with increased febrile seizure risk compared with measles–mumps–rubella and varicella vaccine given separately (MMR+V) in children 12–15-month old. We assessed knowledge regarding MMRV and febrile seizures, intended practices, and factors influencing the decision to recommend MMRV. Methods: National survey administered 10/2008–1/2009 of US pediatricians (Peds) and family physicians (FP). Results: Response rate was 73% (620/849). Twenty-nine percent of Peds and 74% of FP (p <0.001) were unaware of increased febrile seizure risk after MMRV. After reading an informational statement, 20% of Peds and 7% of FP (p <0.001) would recommend MMRV to a healthy 12–15-month-old child. The factor most frequently reported as “very important” in the decision to recommend MMRV or MMR+V was ACIP/AAFP/AAP recommendations (pediatricians, 77%, family physicians, 73%, p =0.08). Conclusions: After receiving data regarding febrile seizure risk after MMRV, few physicians report they would recommend MMRV to a healthy 12–15-month-old child. [Copyright &y& Elsevier]

Background Two-dose varicella vaccination has been available in Beijing since 2012 in the private sector. We investigated a varicella outbreak in a highly vaccinated elementary school population. Methods A cohort study was carried out and a varicella case was defined as an acute onset of generalized maculopapulovesicular rash without other apparent cause in a student attending the school from March 29 through May 17, 2015. Breakthrough varicella was defined as varicella >42 days after the last vaccine dose among both 1- or 2-dose varicella vaccine recipients. Vaccination information was collected from immunization records; information on prior varicella and clinical presentations was collected by surveying students’ parents. Results Of the 1056 students in the school, 1027 (97.3%) reported no history of varicella. Prior to the outbreak, 98.6% of students had received ≥1 dose of varicella vaccine, and most (63.2%) students received two doses. Twenty varicella cases were identified for an overall attack rate of 2.0%. Half of the cases occurred in the classroom of the index case-patient, a two-dose recipient who was not isolated after symptom onset. Breakthrough varicella accounted for 95% of cases (19/20) with attack rates of 14.3% (1/7), 1.6% (6/362) and 2.0% (13/649) among unvaccinated, one-dose, and two-dose students, respectively. Most case-patients (18/20, 90%) had <50 lesions. No difference in clinical presentations was found between one-dose and two-dose recipients with breakthrough varicella. Conclusion Moderate two-dose varicella vaccine coverage was insufficient to prevent a varicella outbreak. Two-dose recipients with breakthrough varicella are contagious. High two-dose varicella vaccine coverage and timely isolation of cases may be needed for varicella outbreak prevention in the two-dose era. [ABSTRACT FROM AUTHOR]