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We analyzed data from hospital admissions and enhanced mumps surveillance to assess mumps complications during the largest mumps outbreak in England and Wales, 2004-2005, and their association with mumps vaccination. When compared with nonoutbreak periods, the outbreak was associated with a clear increase in hospitalized patients with orchitis, meningitis, and pancreatitis. Routine mumps surveillance and hospital data showed that 6.1% of estimated mumps patients were hospitalized, 4.4% had orchitis, 0.35% meningitis, and 0.33% pancreatitis. Enhanced surveillance data showed 2.9% of mumps patients were hospitalized, 6.1% had orchitis, 0.3% had meningitis, and 0.25% had pancreatitis. Risk was reduced for hospitalization (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.43-0.68), mumps orchitis (OR 0.72, 95% CI 0.56-0.93) and mumps meningitis (OR 0.28, 95% CI 0.14-0.56) when patient had received 1 dose of measles, mumps, and rubella vaccine. The protective effect of vaccination on disease severity is critical in assessing the total effects of current and future mumps control strategies.

State and local health departments, in collaboration with CDC, continue to investigate a mumps outbreak that began in New York in June 2009. The index case occurred in a boy aged 11 years who had returned on June 17 from a trip to the United Kingdom, where approximately 7,400 reports of laboratory-confirmed mumps were received by the Health Protection Agency in 2009. He then attended a New York summer camp for tradition-observant Jewish boys, where he became symptomatic on June 28. Subsequently, other camp attendees and a staff member were reported to have mumps, and transmission continued in multiple locations when the camp attendees returned home. As of January 29, 2010, a total of 1,521 cases had been reported, with onset dates from June 28, 2009, through January 29, 2010, a substantial increase from the 179 cases reported as of October 30, 2009. The outbreak has remained confined primarily to the tradition-observant Jewish community, with <3% of cases occurring among persons outside the community. The largest percentage of cases (61%) has occurred among persons aged 7-18 years, and 76% of the patients are male. Among the patients for whom vaccination status was reported, 88% had received at least 1 dose of mumps-containing vaccine, and 75% had received 2 doses. This is the largest mumps outbreak that has occurred in the United States since 2006. Although mumps vaccination alone was not sufficient to prevent this outbreak, maintaining high measles, mumps, and rubella (MMR) vaccination coverage remains the most effective way to prevent outbreaks and limit their size when they occur.

Information was obtained by postal questionnaire in 1663 cases of childhood diabetes of recent onset about other illnesses for which the family doctor was consulted in the six months before onset. Consultation rates in each of these six months were compared with each other and with rates reported in a concurrent study of morbidity in general practices. There was a significant excess of consultations for mumps in the six months before onset of diabetes (p < 0.001), the greatest excess being in the month before onset. These results support the suggestion that diabetes starting in childhood may result in a small proportion of cases from recent mumps infection.

A review of acute pancreatitis occurring over a 20-year period in the Bristol clinical area is reported. A total of 590 cases were available for analysis. The yearly incidence was 53-8 per million population at risk, with a mortality of 9-0 per million. This compares favourably with 11-4 deaths per million for England and Wales as a whole during the same period but the difference is not statistically significant. When the deaths occurring in the Bristol clinical area were expressed in terms of case mortality rate the figure was 17%. In contrast the mortality for recurrent acute pancreatitis was only 1-5%, and the benign nature of this second condition is confirmed. Aetiological factors and age and sex distribution were also analysed in relation to each other and to mortality. An increase in acute pancreatitis secondary to chronic alcoholism was confirmed and steroid pancreatitis also emerged as a definite entity in this survey. The pattern of recurrence in patients with idiopathic pancreatitis was studied in detail and is analysed on an actuarial basis.

A retrospective survey is described of 2,482 cases of mumps (1,513 males and 969 females) treated in a number of infectious disease units in England and Wales. About half the patients were under 15 years of age. Complications were recorded in 42 per cent of all cases (53 per cent of males and 25 per cent of females), the commonest complication in both sexes being involvement of the central nervous system. Three patients died, but in two of these there was serious underlying illness unrelated to mumps and in the remaining case a review of the records suggests, in retrospect, some doubt about the diagnosis of mumps. Deafness due to involvement of the eighth cranial nerve was the only permanent sequel recorded and occurred in five patients.From the results of this survey it is concluded that there is little need for general vaccination against mumps, although there might be an indication for vaccinating certain groups of the male population.

The possibility that some of the common childhood infections lead to unrecognized impairments of neurological function was examined in 43 820 Birmingham children whose intelligence was assessed in the 11-plus examination. Mean verbal reasoning scores were lower for children who had had measles or pertussis than for those who had had neither of these diseases. However, since attack rates and measured intelligence are related inversely to social class, the lower scores of children with measles and pertussis may be due to class differences which are not eliminated completely by standardization for maternal age and birth order. Mean scores were a little higher for children who had had rubella than for those who had not, and it is suggested that this difference may be due to more frequent reporting of the disease by the more intelligent mothers.