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April 27, 2020updated 24 Apr 2020 9:56am

Another bump in the road for mumps treatment

In 2019, the number of mumps cases in England reached heights not seen since 2009, despite the availability of the MMR vaccine on the NHS. This peak follows similar trends in the US and has sparked concerns about the spread of anti-vaccination fervour, and its impact on the decline of vaccination rates. Allie Nawrat charts the history of mumps and vaccines throughout history.

By Allie Nawrat

Mumps are caused by a highly contagious viral disease, usually characterised by inflammation and swelling of the salivary glands – young adults can experience similar inflammation in their testes, possibly causing infertility. Also, in rare cases, mumps can cause meningitis, which is associated with life-threatening septicaemia, as well as brain swelling and deafness, particularly when contracted younger children. 

Last year, the number of mumps cases in England reached the highest in a decade, and this trend shows no sign of slowing down in 2020s. 

This growth can be attributed to anti-vaccination sentiment, resulting from the incorrect linking of the measles, mumps and rubella (MMR) vaccine with autism. 

UK Secretary of State for Health and Social Care Matt Hancock said: “The rise in mumps cases is alarming and yet another example of the long-term damage caused by anti-vax information.

“Science proves that vaccines are the best form of defence against a host of potentially deadly diseases and are safer and more effective than ever before. Those who claim otherwise are risking people’s lives.” 

The return of mumps is a significant step backward from progress made to combat this childhood disease. Although it has never been classified as eradicated in the UK or US, routine immunisation of children has managed to drastically reduce the incidence of mumps to benefit of all. 

400 BC – First mention of gland inflammation in Hippocrates’ Of the Epidemics 

Greek physician Hippocrates of Kos is often considered to be the father of medicine. He is credited with writing or influencing around 60 works, known collectively as the Hippocratic Corpus. One of these is Of the Epidemics, in which he identified painful swelling of the parotid glands (now known as the salivary glands). This is believed to be the first mention of mumps in medical history.

1700s – First detailed description of mumps

Although there were local outbreaks of the disease through the centuries, it took until 1790 for the first description of the disease. In this year, British physician Robert Hamilton wrote about the disease in his paper for the Transactions of the Royal Society of Edinburgh, titled ‘An Account of a Distemper, by the common People in England vulgarly called the mumps’. 

1934 – Contagious nature of mumps proven

Following its characterisation by Hamilton and further research into the disease, in the 1910s scientists began to investigate the contagious nature of the disease, particularly as it became a serious health threat to armies fighting in the First World War. 

However, it took until 1934 for a breakthrough when US researchers Claude Johnson and Ernest William obtained a filterable cytotropic virus from M. rhesus monkeys’ parotid glands, which had been inoculated with six specimens of saliva from six cases of the mumps. They concluded this virus was the same as the causative agent of mumps.

1940s – First mumps vaccine produced  

John Franklin Enders, known for his supportive work on the polio vaccine, medically advised the US War Department during the Second World War on infectious diseases, including the mumps. Using a similar production method to the polio vaccine, Enders developed a vaccine against mumps leveraging a killed virus, however, the immunity it conferred was only short lived.

1967 – Merck’s Mumpsvax inactivated vaccine developed

In 1957, US microbiologist Maurice Hilleman started working at Merck. Six years later his daughter, Jeryl Lynn, contracted the mumps, so he cultivated some material from her throat to develop the first live, attenuated vaccine for mumps, which was known as MumpsVax. Until it was discontinued in 2004, an inactivated so-called Jeryl Lynn strain of mumps was still used in the vaccine.  

It was approved by the US Food and Drug Administration in 1967. However, Mumpsvax was never available in the UK, nor was any other vaccine aimed purely at the mumps.

1971 – Development of the triple-virus MMR vaccine 

Hilleman then focused on creating vaccines against other infectious, potentially life-threatening viral diseases – measles in 1963 and rubella, or German measles, in 1969. He brought all this work together to develop the measles, mumps, rubella (MMR) live, attenuated vaccine in 1971. 

This one-of-a-kind, trivalent vaccine combines Merck’s Mumpsvax, Attentuvax for measles based on Enders’ attenuated Edmonston strain of measles and Meruvax II for rubella. Although Hilleman had created his own rubella vaccine, the version used in the MMR product was created by Stanley Plotkin at the Wistar Institute because it was sourced from humans. 

Combination vaccines were, and continue to be, deemed important for public health since they allow for quicker and wider vaccination coverage, and therefore population herd immunity.

1980s-90s – NHS recommends routine MMR vaccine use 

In the UK, the MMR vaccine was recommended as part of the routine immunisation programme for children aged 13 to 15 months in 1988. The government also announced a catch-up vaccination for children of pre-school age. 

Seven years later, in 1996, the government introduced a second dose to children before they went to pre-school.  Further research into the MMR vaccine had revealed that it was most effective after two doses of the vaccine spread out over time. The second dose helps to produce immunity in those who, for some reason, did not gain immunity from the initial dose – a single dose brought immunity to mumps to 78% of recipients, but the second dose successfully conferred immunity in 88% of patients.

1998 – The birth of the anti-vaxxer movement  

In 1998, former British doctor Andrew Wakefield and 12 of his colleagues published a study in The Lancet, which implied a link between the MMR vaccine and autism. The research was only carried conducted on 12 patients and had a very uncontrolled design. Wakefield subsequently called for the abandonment of the trivalent and the use of single jabs for the three individual viruses. 

This work received huge media coverage all over the world and caused MMR coverage to fall by 80% across the UK in the late 1990s and early 2000s. 2003 had the lowest recorded MMR vaccine coverage of 79%, threatening herd immunity, putting immunocompromised populations who cannot receive the vaccine at risk.

2000s – Wakefield’s conclusions begin to be disproved

Almost immediately after the research was published, other scientists began to investigate these claims and concluded there was no link between MMR vaccines and autism – further studies continue to be carried out disproving Wakefield’s claims, the most recent, and largest, was published in 2019

In addition, very quickly after publication, ten10 of the 12 co-authors of the paper retracted the interpretation data stating there was “no causal link” and “the data was insufficient”. It was also later revealed that Wakefield had failed to disclose that he had been funded by lawyers supporting parents in lawsuits against vaccine producers.

2010s – Continued discrediting of Wakefield’s claims

The Lancet retracted the paper in 2010,; this is the same year Wakefield was stripped of his medical license by the General Medical Council. 

In 2014, Public Health England (PHE) officially discredited the claims that single vaccines for mumps, measles and rubella would be safer, noting it would “leave children vulnerable to dangerous diseases for longer. Giving 3 separate doses at spaced out intervals would mean that, after the first injection, the child still has no immunity to the other 2 diseases.” 

This discrediting of Wakefield’s claims were clearly successful as the UK saw a peak in MMR vaccination rates in 2013 where 94% of five-year-olds had received the first dose and 90% given both doses.

2018 – Research suggests need for a third dose  

Although it would be easy to blame anti-vaxxer sentiment for the rise in mumps cases, researchers at Harvard University – Joseph Lewnard and Yonatan Gard – noticed that US outbreaks in 2016 also occurred among those who were vaccinated against the disease. 

They published a study in Science Translational Medicine showing that the mumps vaccine only protected people for an average of 27 years. Therefore, recommending there should be a third dose of the vaccine at 18 years of age or later during adulthood; however, this idea would need to be validated in clinical trials.

2019-20 – Government responds to peak in UK cases 

PHE found that there were 5,042 lab-confirmed cases of mumps in 2019, marking a fourfold jump from 1,066 in 2018. This troubling trend is expected to continue in 2020 since 546 cases had already been confirmed in January this year, compared to 191 in January 2019.  

In response, PHE consultant epidemiologist Dr Vanessa Saliba called for anyone who “may have missed out on their MMR vaccine in the past to contact their GP practice and get up to date as soon as possible.” 

Hancock emphasised that the government would respond with a Vaccination Strategy to be launched in spring 2020. This strategy centres around world-leading immunisation programme. The medium term aim of the programme is to reach 95% uptake of childhood vaccinations, particularly for the second dose of the MMR vaccine, so it equals the successful roll-out of the first dose. 

Since the entire world is now pre-occupied with controlling the spread of the Covid-19 pandemic, it is highly unlikely the UK’s vaccination strategy will come into force this spring. But, could the pandemic, solutions for which focus on finding a vaccine as quickly as possible for vulnerable populations, actually help to temper general anti-vaxxer sentiment to the benefit of general public health?

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