• George E Nelson, Annette Aguon, Engracia Valencia, Rita Oliva, Michele Leon Guerrero, Richard Reyes, Anna Lizama, Daryl Diras, Annakutty Mathew, E Jessica Camacho, Moryne-Nicole Monforte, Tai-Ho Chen, Abdirahman Mahamud, Preeta K Kutty, Carole Hickman, William J Bellini, Jane F Seward, Kathleen Gallagher, and Amy Parker Fiebelkorn.
• National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
• Pediatr. Infect. Dis. J. 2013 Apr 1; 32 (4): 374-80.

BackgroundDespite high 2-dose measles-mumps-rubella (MMR) vaccine coverage, a large mumps outbreak occurred on the US Territory of Guam during 2009 to 2010, primarily in school-aged children.MethodsWe implemented active surveillance in April 2010 during the outbreak peak and characterized the outbreak epidemiology. We administered third doses of MMR vaccine to eligible students aged 9-14 years in 7 schools with the highest attack rates (ARs) between May 18, 2010, and May 21, 2010. Baseline surveys, follow-up surveys and case-reports were used to determine mumps ARs. Adverse events postvaccination were monitored.ResultsBetween December 1, 2009, and December 31, 2010, 505 mumps cases were reported. Self-reported Pohnpeians and Chuukese had the highest relative risks (54.7 and 19.7, respectively) and highest crowding indices (mean: 3.1 and 3.0 persons/bedroom, respectively). Among 287 (57%) school-aged case-patients, 270 (93%) had ≥2 MMR doses. A third MMR dose was administered to 1068 (33%) eligible students. Three-dose vaccinated students had an AR of 0.9/1000 compared with 2.4/1000 among students vaccinated with ≤2 doses >1 incubation period postintervention, but the difference was not significant (P = 0.67). No serious adverse events were reported.ConclusionsThis mumps outbreak occurred in a highly vaccinated population. The highest ARs occurred in ethnic minority populations with the highest household crowding indices. After the third dose MMR intervention in highly affected schools, 3-dose recipients had an AR 60% lower than students with ≤2 doses, but the difference was not statistically significant and the intervention occurred after the outbreak peaked. This outbreak may have persisted due to crowding at home and high student contact rates.

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