Mylène Maillet1, Eric Bouvat2, Nicole Robert2, Monique Baccard-Longère3, Christine Morel-Baccard4, Patrice Morand5, Astrid Vabret6, Jean-Paul Stahl7. 1. Infectious Diseases Department, Grenoble University Hospital, France. Electronic address: mmaillet@chu-grenoble.fr. 2. Inter-University Health Center, Grenoble, France. 3. Virology Department, Grenoble University Hospital, France. Electronic address: mbaccard@chu-grenoble.fr. 4. Virology Department, Grenoble University Hospital, France. Electronic address: cmorel-baccard@chu-grenoble.fr. 5. Virology Department, Grenoble University Hospital, France; Unit of Virus Host Cell Interactions UMI 3265 UJF-EMBL-CNRS, Grenoble, France. Electronic address: pmorand@chu-grenoble.fr. 6. National Reference Centre for Paramyxoviridae, Caen University Hospital, France. Electronic address: vabret-a@chu-caen.fr. 7. Infectious Diseases Department, Grenoble University Hospital, France. Electronic address: jpstahl@chu-grenoble.fr.
Abstract
BACKGROUND: Several mumps outbreaks have been reported in Europe and in the United States among highly vaccinated populations. Biological diagnosis is classically based on the detection of mumps-specific IgM, but the ability of serological tests to confirm mumps infection seems to be limited among vaccinated patients. OBJECTIVES: We aim to report a mumps outbreak in an engineering school in Grenoble, France, from February to June 2013 and results of the biological testing. STUDY DESIGN: WHO definitions were used to define cases. Mumps--specific IgM and IgG were assessed by a commercially available EIA. Mumps RNA detection by real time reverse transcriptase polymerase chain reaction tests (RT-PCR) and mumps genotyping were performed by the French National Reference Centre for Paramyxoviridae. RESULTS: Sixty two mumps patient-cases were identified using WHO case definitions, 20 being biologically explored, of which 17 were confirmed by biological tests. Vaccination status was documented for 27 patients/62: 4 (14.8%) patients had received one dose of MMR vaccine, and 23 (85.2) two doses of MMR vaccine. Among the biologically explored patients, 83% had a positive RT PCR at the first sampling whereas only 45% had positive or equivocal IgM. All the genotyped strains were genotype G. CONCLUSIONS: Mumps laboratory diagnosis in a highly vaccinated population is challenging. Serological tests among vaccinated patients should be interpreted cautiously and confirmed by RT-PCR tests at the beginning of a mumps outbreak.
BACKGROUND: Several mumps outbreaks have been reported in Europe and in the United States among highly vaccinated populations. Biological diagnosis is classically based on the detection of mumps-specific IgM, but the ability of serological tests to confirm mumps infection seems to be limited among vaccinated patients. OBJECTIVES: We aim to report a mumps outbreak in an engineering school in Grenoble, France, from February to June 2013 and results of the biological testing. STUDY DESIGN: WHO definitions were used to define cases. Mumps--specific IgM and IgG were assessed by a commercially available EIA. Mumps RNA detection by real time reverse transcriptase polymerase chain reaction tests (RT-PCR) and mumps genotyping were performed by the French National Reference Centre for Paramyxoviridae. RESULTS: Sixty two mumps patient-cases were identified using WHO case definitions, 20 being biologically explored, of which 17 were confirmed by biological tests. Vaccination status was documented for 27 patients/62: 4 (14.8%) patients had received one dose of MMR vaccine, and 23 (85.2) two doses of MMR vaccine. Among the biologically explored patients, 83% had a positive RT PCR at the first sampling whereas only 45% had positive or equivocal IgM. All the genotyped strains were genotype G. CONCLUSIONS: Mumps laboratory diagnosis in a highly vaccinated population is challenging. Serological tests among vaccinated patients should be interpreted cautiously and confirmed by RT-PCR tests at the beginning of a mumps outbreak.
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