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Is a Third Dose of MMR Vaccine Needed for Mumps?
N Engl J Med; 2017 Sep 7; Cardemil, et al
There was a lower risk of mumps among university students who received a third dose of measles-mumps-rubella (MMR) vaccine compared to those who had received 2 doses, according to a recent study. The study included 20,496 University of Iowa students enrolled during the 2015-2016 academic year, a year in which there was a mumps outbreak at the school during which mumps was diagnosed in 259 students. The effectiveness of a third MMR dose for outbreak was evaluated and assessed for waning immunity. Researchers found:
- Before the outbreak, ∼98% of students had received at least 2 doses of MMR vaccine; during the outbreak, 4,783 students received a third dose.
- The attack rate was lower among students who had received 3 doses than among those who had received 2 doses (6.7 vs 14.5 cases per 1,000 population).
- Students who had received a second dose of MMR vaccine 13 years or more before the outbreak had nine times the risk of mumps.
- 28 days after vaccination, receipt of the third vaccine dose was associated with a 78% lower risk of mumps than receipt of a second dose (adjusted HR, 0.22).
Cardemil CV, Dahl RM, James L, et al. Effectiveness of a third dose of MMR vaccine for mumps outbreak control. N Engl J Med. 2017;377:947-956. doi:10.1056/NEJMoa1703309.
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Compared to the pre-vaccine era, in the US the 2-dose MMR series has led to a 99% decrease in the incidence of mumps. Nonetheless, thousands of cases of mumps still occur each year with periodic outbreaks, often on college campuses, which require documentation of students having received the 2-dose series, and where over 90% of students have had adequate vaccination. This raises the question of whether a booster dose of mumps vaccine would further reduce the incidence of mumps, particularly on college campuses and other institutional settings. In this study, a third mumps vaccine was offered to students at the University of Iowa during a year in which there was a mumps outbreak. The answer to whether a third dose of mumps vaccine is protective against the acquisition of mumps is an impressive yes, particularly among students who received mumps vaccine 13 or more years before. In this case, a third dose of mumps vaccine decreased the incidence of mumps by nine-fold. This is important, given that most college students have received MMR between 4-6 years of age, so for the cohort of individuals 18-21 years of age, the majority receive MMR 13 or more years prior to the outbreak. This study convincingly demonstrates that a third dose of MMR decreased acquisition of mumps in college-aged students during an outbreak. —Neil Skolnik, MD