Mumps

What

Mumps is an acute viral illness. Symptomatic disease can range from mild upper respiratory symptoms to widespread systemic involvement.

Who

Mumps-containing vaccine is recommended for:

• children ≥12 months of age
• adolescents and adults born during or since 1966 who have not received 2 doses of mumps-containing vaccine

How

Mumps-containing vaccine is recommended for children at 12  months of age as MMR (measles-mumps-rubella) vaccine, and at 18 months of age as MMRV (measles-mumps-rubella-varicella) vaccine.

All adolescents and adults born during or since 1966 should have either:

• documented evidence of 2 doses of mumps-containing vaccine given at least 4 weeks apart and with both doses given ≥12 months of age, or
• serological evidence of immunity to measles, mumps and rubella

Why

Mumps occurs worldwide. Complications from mumps can include meningeal symptoms and deafness.

Mumps vaccines available in Australia

The Therapeutic Goods Administration website provides product information for each vaccine.

See also Vaccine information and Variations from product information for more details.

Dose and route 

The dose of Priorix and M-M-R II (MMR) vaccine for both children and adults is 0.5 mL given by either subcutaneous or intramuscular injection.

The dose of ProQuad and Priorix-tetra (MMRV) vaccine for children <14 years of age is 0.5 mL given by subcutaneous or intramuscular injection.² 

Co-administration with other vaccines

People can receive MMR or MMRV vaccine at the same time as other live attenuated parenteral vaccines or other inactivated vaccines,³ using separate syringes and injection sites. If a person does not receive MMR or MMRV vaccine at the same time as other live attenuated parenteral vaccines, wait at least 4 weeks between vaccinations.^4,5 

Measles, mumps and rubella vaccines are not available separately as an alternative to MMR vaccine. However, a monovalent varicella vaccine is available (see Varicella).

If a person receives MMR vaccine at the same time as monovalent varicella vaccine, use separate syringes and injection sites. Do not mix MMR vaccine and monovalent varicella vaccine together before injection.

Interchangeability of MMR-containing vaccines

The 2 brands of MMR vaccine are interchangeable, so the 2nd MMR vaccine dose does not have to be the same brand as the 1st. 

The same principle applies to the 2 MMRV vaccines,³ although they are not routinely recommended in a 2-dose schedule.

Contraindications

Anaphylaxis to vaccine components

MMR and MMRV vaccines are contraindicated in people who have had:

• anaphylaxis after a previous dose of any MMR-containing vaccine
• anaphylaxis after any component of an MMR-containing vaccine

See Anaphylaxis in Adverse events for more details about MMR vaccination for people with a known egg allergy.

Pregnant women 

MMR-containing vaccines are contraindicated in pregnant women.

Vaccinated women should avoid pregnancy for 28 days after vaccination.⁶

There is no risk to pregnant women from contact with people who have recently been vaccinated. The vaccine viruses is not transmitted from vaccinated people to susceptible contacts.⁷

See also Rubella, Varicella, Vaccination for women who are planning pregnancy, pregnant or breastfeeding and Table. Vaccines that are contraindicated in pregnancy: live attenuated vaccines for more details.

Breastfeeding women can receive MMR vaccines. See also Rubella.

People who are immunocompromised 

MMR-containing vaccines contain live attenuated viruses and are contraindicated in people who are immunocompromised. This means that MMR-containing vaccines are contraindicated in:

• people who are significantly immunocompromised because of a medical condition(s)
• people receiving high-dose systemic immunosuppressive therapy, such as chemotherapy, radiation therapy or oral corticosteroids

See Vaccination for people who are immunocompromised for more details.

For more details on using live attenuated vaccines in people receiving corticosteroid therapy, see Table. Recommended timing of live vaccines in adults and children taking corticosteroids in Vaccination for people who are immunocompromised.

Precautions

Vaccination after receiving immunoglobulin or a blood product

A recent blood transfusion with washed red blood cells is not a contraindication to MMR or MMRV vaccines.

People who have received an immunoglobulin-containing blood product should wait 3–11 months before receiving a mumps-containing vaccine. This is because the immunoglobulin may impair the expected immune response to the vaccine.^5,8

The interval between receiving the blood product and the vaccine depends on the amount of immunoglobulin in each product.⁵ See Table. Recommended intervals between immunoglobulins or blood products, and measles-mumps-rubella, measles-mumps-rubella-varicella or varicella vaccination and Vaccination for people who have recently received normal human immunoglobulin and other blood products.

People may receive MMR vaccine at the same time as anti-D immunoglobulin, but at different injection sites. They can also receive MMR vaccine at any time after anti-D immunoglobulin. Anti-D immunoglobulin does not interfere with the antibody response to the vaccine.

Immunoglobulin or blood product administration after vaccination 

People who have received a mumps-containing vaccine should not receive immunoglobulin-containing products for 3 weeks after vaccination, unless the benefits of receiving the blood product outweigh the benefits of vaccination. If the person receives an immunoglobulin-containing product within 3 weeks after a mumps-containing vaccine, the vaccinated person should be either:

• revaccinated later at the appropriate time, as indicated in Table. Recommended intervals between immunoglobulins or blood products, and measles-mumps-rubella, measles-mumps-rubella-varicella or varicella vaccination, or
• tested for immunity 6 months later and then revaccinated if seronegative

People may receive anti-D immunoglobulin at any time after receiving MMR vaccine.

People with HIV

The following people with HIV may receive MMR vaccine:^6,9-13

• asymptomatic children >12 months of age with an age-specific CD4⁺ count of ≥15%
• adults with a CD4⁺ cell count ≥200 cells per μL ⁴⁶

See People with HIV in Vaccination for people who are immunocompromised.

There have been no studies on combination MMRV vaccines in asymptomatic people with HIV or people with an age-specific CD4⁺ count of ≥15%. Therefore, it is recommended that these groups receive only MMR vaccine (and monovalent varicella vaccine — see Varicella).^11,13,14

No data are available on the safety, immunogenicity or efficacy of MMRV vaccines in children with HIV. These children should receive MMR vaccine and monovalent varicella vaccine, not MMRV vaccine.^6,8

People receiving corticosteroid therapy

People on low-dose systemic corticosteroids can receive MMR-containing vaccines. Low-dose systemic corticosteroid therapy includes:

• children on doses of ≤2 mg per kg per day for less than 1 week
• people on doses of 1 mg per kg per day or alternate-day regimens for longer periods

People receiving high-dose corticosteroids can receive MMR-containing vaccines after they have stopped corticosteroid therapy for at least 1 month (see Contraindications).¹⁵

Some experts suggest temporarily stopping lower doses of steroids 2–3 weeks before vaccination with live viral vaccines, if possible.^8,15

See also Vaccination for people who are immunocompromised.

Household contacts of people who are immunocompromised

Household contacts of people who are immunocompromised should ensure that they are age-appropriately vaccinated against, or are immune to, measles, mumps, rubella and varicella.

Household contacts of people who are immunocompromised can safely receive mumps-containing vaccines, because the vaccine viruses are not transmissible from vaccinated people to others.⁶

If using MMRV vaccine, see Varicella for details about varicella vaccine virus transmission.

People receiving long-term aspirin or salicylate therapy

There is no need to avoid salicylates before or after receiving MMR or MMRV vaccine.

People taking long-term salicylate therapy (aspirin) can receive MMRV vaccine if needed. The benefit is likely to outweigh any possible risk of Reye syndrome after vaccination with a varicella-containing vaccine (see Varicella).

People with a history of thrombocytopenia

Thrombocytopenia is a rare adverse event associated with MMR vaccination (see Adverse events).^16-18

In children who have had an episode(s) of idiopathic thrombocytopenia purpura (ITP), the risk of vaccine-associated thrombocytopenia after a dose of MMR vaccine is uncertain.^6,18 However, a systematic review concluded that MMR vaccination, either a 1st or 2nd dose, did not lead to a recurrence of ITP.¹⁹ In children due for their 2nd dose, serological testing can be used to determine whether the child needs the extra dose of MMR or MMRV vaccine.

People with possible IFNAR1 deficiency

IFNAR1 deficiency is a rare inherited condition affecting some people of Western Polynesian heritage including Tongan, Samoan and Niuean. It is associated with severe illness and death from certain viral infections and also potentially from some live attenuated viral vaccines including the measles, mumps and rubella (MMR) vaccine.²⁰ Currently, diagnosis of IFNAR1 deficiency prior to vaccination is challenging and there is no established treatment.

Healthcare providers need to be aware that children of Western Polynesian heritage who present for medical attention and are very unwell in the 1-2 weeks following MMR vaccine may need further investigation by an immunologist to assess for an immune deficiency. Any suspected adverse event following immunisation should be reported. Family members of individuals who have had a severe reaction to a live attenuated viral vaccine, or are related to someone with known IFNAR1 deficiency, should be referred to an immunologist before having the MMR vaccine. Children who have safely received a first dose of MMR vaccine are highly unlikely to have IFNAR1 deficiency.²⁰

Advice on vaccination of children or adults who have been diagnosed with IFNAR1 or any other specific immune deficiency should be sought from their immunologist, noting that disease from wild-type measles and mumps is probably more severe than from the vaccine-strain viruses.²⁰

Personal or close family history of seizures or convulsions

Children with a personal or close family history of seizures or convulsions can receive MMR or MMRV vaccine.

Ensure that the parents or carers understand that the child may develop a fever 6–14 days after vaccination.⁶ Advise parents or carers about how to manage the fever with paracetamol and other measures (see Adverse events following immunisation in After vaccination).

MMRV vaccines are only recommended for use as the 2nd dose of mumps-containing vaccine. This is because the risk of fever and febrile convulsions is higher if children receive MMRV vaccine as their 1st dose. See Recommendations and Adverse events.

Tuberculin skin testing after MMR vaccination

The measles virus inhibits the response to tuberculin. Tuberculin-positive people may become tuberculin-negative for 4–6 weeks after measles infection, and measles-containing vaccines have a similar effect.^6,21 Because of this, a tuberculin skin test (TST; Mantoux) may be unreliable for at least 4–6 weeks in people who have received MMR vaccine.

There are no studies on if and how MMR or MMRV vaccination affects the results of interferon-gamma release assays used for testing for M. tuberculosis infection.²²

Adverse events after receiving a mumps-containing vaccines are generally mild and well tolerated.¹ Adverse events are much less common after the 2nd dose of MMR or MMRV vaccine than after the 1st dose.

Fever and febrile convulsions

MMR vaccines

People who receive MMR vaccine may develop a fever 7–10 days (range 5–12 days) after vaccination. This can last 2–3 days. The fever may be associated with malaise and/or a non-infectious rash. Up to 15% of young children receiving MMR vaccine develop a high fever (>39.4°C).^6,23

An increased risk of febrile seizures of about 1 case per 3000–4000 doses occurs during the same time period.⁶

This time frame coincides with the period of peak measles vaccine virus replication.

Inform vaccine recipients, or their parents or carers, about:

• possible symptoms occurring 5–12 days after vaccination
• how to manage the symptoms, including using paracetamol for fever 

See Adverse events following immunisation in After vaccination. 

MMRV vaccines

In clinical trials, people who received MMRV vaccine had higher rates of fever than people who received MMR vaccine and monovalent varicella vaccine at the same time but at separate sites.^24-27 Rates of fever were highest in young children who received MMRV vaccine as their 1st dose.

Post-marketing studies in the United States identified an approximately 2-fold increased risk of fever and febrile convulsions 7–10 days²⁸ (or 5–12 days)²⁹ after vaccination in children who received MMRV vaccine as a 1st dose. MMRV recipients were compared with recipients of separate MMR and varicella vaccines. MMRV vaccination resulted in 1 additional febrile seizure for every 2300 doses compared with separate MMR and varicella vaccination.²⁸ Children in these studies were mostly 12–23 months of age.

In the United States, post-marketing studies did not find an increase in fever or febrile convulsions after children received the 2nd dose of ProQuad (MMRV) vaccine. However, most 2nd-dose recipients were aged 4–6 years, an age at which the incidence of febrile convulsions is low.³⁰ This side effect profile is expected to be similar in children who receive Priorix-tetra.

Rare adverse events

Anaphylaxis

Anaphylaxis after receiving an MMR vaccine is very rare (1.8–14.4 per million doses).⁶

Although no cases of anaphylaxis were reported in MMRV vaccine clinical trials, the incidence is likely to be similar to that of MMR vaccine.

Anaphylaxis after vaccination is probably due to anaphylactic sensitivity to gelatin or neomycin, not an egg allergy. Measles and mumps (not rubella or varicella) vaccine viruses are grown in chick embryo tissue cultures, but measles- and mumps-containing vaccines have negligible amounts of egg ovalbumin. See Variations from product information and Vaccination for people who have had an adverse event following immunisation.

People with an egg allergy can safely receive an MMR or MMRV vaccine.^16,31,32 Skin testing is not needed before vaccination.¹⁶

Thrombocytopenia 

Thrombocytopenia has been very rarely associated with the rubella or measles component of MMR vaccine. It is usually self-limiting and occurs in 3–5 per 100,000 doses of MMR vaccine.^16-18 This is considerably less frequent than after natural measles, mumps and rubella infections.¹⁸

Any association with MMRV vaccine is expected to be similar.

Encephalopathy 

It is uncertain whether people can develop encephalopathy after MMR vaccination. If they do, it is at least 1000 times less frequent than encephalopathy as a complication from natural infection.²³

Lymphadenopathy, arthralgia and parotitis

Other rare adverse events attributed to MMR vaccine include:⁶

• transient lymphadenopathy 
• arthralgia (see Rubella)
• parotitis

Parotitis can occur after mumps vaccination,¹ usually 10–14 days after vaccination. The incidence depends on the vaccine strain. 0.5–1.6% of people who received the Jeryl Lynn mumps strain had parotid or submandibular swelling.^1,33,34

An increased risk of aseptic meningitis after vaccination with the Urabe strain of mumps vaccine has been seen in some countries.¹ However, Australia does not use the Urabe strain. The MMR and MMRV vaccines available in Australia contain a Jeryl Lynn–derived strain of mumps, which is not associated with an increased risk of aseptic meningitis.^35,36

Conditions not linked to MMR vaccination

MMR vaccine is not associated with:

• autism
• autistic spectrum disorder 
• inflammatory bowel disease

No credible scientific evidence supports a link between MMR and these conditions. Most proponents of the link have retracted this claim.^37,38 There is a substantial body of evidence to refute these claims.^39-42

Mumps is caused by a paramyxovirus from the genus Rubulavirus. The mumps virus has a single-stranded RNA genome.

It is rapidly inactivated by:⁷

• heat
• formalin
• ether
• chloroform
• light

Pathogenesis

Mumps is an acute viral illness with an incubation period of 12–25 days.⁴³

Transmission

Mumps is transmitted by:⁴³

• respiratory secretions, including aerosol transmission
• direct contact with saliva or possibly urine

People may be infectious from 7 days before parotid swelling (see Symptoms of mumps in Clinical features) until 9 days after. Maximum infectiousness is between 2 days before onset of illness and 5 days afterwards.⁴³

Symptoms of mumps

Asymptomatic infection occurs in one-third of cases.⁴⁴

Symptomatic disease ranges from mild upper respiratory symptoms to widespread systemic involvement.⁴⁴

Many mumps infections involve non-specific symptoms, including:¹

• fever
• headache
• malaise
• myalgia
• anorexia

60–70% of clinical cases develop the characteristic bilateral or, occasionally, unilateral parotid swelling.^1,45

Orchitis (usually unilateral) occurs in about 15–30% of post-pubertal males who acquire mumps.^46,47

Other glands and organs are not commonly affected. Rarely, people develop:^1,7

• pancreatitis
• oophoritis
• hepatitis
• myocarditis
• thyroiditis
• mastitis

Complications of mumps

About 10% of people with mumps develop meningeal symptoms and signs, but permanent neurologic sequelae are rare.⁴³ About 0.01–0.02% of people with mumps develop mumps encephalitis, with a case-fatality rate of around 1.0%.⁴⁷

Deafness is relatively common in mumps meningoencephalitis, although permanent nerve deafness is rare (0.005%, or 1 in 20,000 infections).

Orchitis can lead to subfertility and, rarely, infertility.⁴⁷

Mumps infection during the 1st trimester of pregnancy may result in spontaneous abortion.^1,44 Maternal infection is not associated with an increased risk of congenital malformation.^1,44

Mumps in Australia

In Australia between 2009 and 2014, the national notification rate for mumps was <1 per 100,000 population. Peak incidence rates were reported in young and middle-aged adults.^48-51 These people may have missed mumps vaccinations as a child and were born at a time when circulating disease was low.

Since then, the rate has increased, from 2.7 per 100,000 population in 2015 to 3.4 per 100,000 population in 2017.⁵² This has been associated with a rise in the number of cases reported in adolescents.⁵³

Similar to Australia, the United States and Europe have had mumps outbreaks, where the peak rates of disease have been in the 18–24 years age group.^55-57

Mumps in Aboriginal and Torres Strait Islander communities

Despite high immunisation rates, multiple mumps outbreaks have occurred in Australia, mainly in Aboriginal and Torres Strait Islander communities.^58-60 For example, in 2016, the Northern Territory recorded 129 outbreak cases of mumps, with 91% of cases occurring in Aboriginal and Torres Strait Islander people in the Alice Springs, Barkly and Katherine regions. Of the outbreak cases with vaccination status recorded:⁶⁰

• 48.6% were fully vaccinated
• 38.1% were partially vaccinated 
• 13.3% were unvaccinated

Monovalent mumps vaccine is not available in Australia. People receive mumps vaccine as either MMR or MMRV vaccine.

Immunogenicity

Clinical trials of MMR vaccine indicate:¹

• 95% mumps seroconversion after a single dose
• up to 100% seroconversion after a 2nd dose

Clinical trials of MMR vaccine compared with MMRV vaccine were mainly done in children 12 months to 6 years of age. MMRV vaccines produce similar rates of seroconversion to all 4 vaccine components as MMR and monovalent varicella vaccines given at the same time at separate injection sites.^24-27

Vaccine effectiveness

Outbreak investigations and post-marketing studies have reported 1-dose MMR vaccine effectiveness of 60–90%.^55,61 A Cochrane review reported 1-dose vaccine effectiveness to be:⁶²

• 69–81% for the vaccine containing the Jeryl Lynn mumps strain
• 70–75% for the vaccine containing the Urabe strain

Although people who receive 2 doses of mumps-containing vaccine are better protected, recent outbreaks have reported mumps in people who have received 2 doses. This is particularly so for young adults who received the vaccination more than 10 years ago.^56,57,63,64

Transport according to National vaccine storage guidelines: Strive for 5.⁶⁵ Store at +2°C to +8°C. Do not freeze. Protect from light.

Both MMR and MMRV vaccines must be reconstituted. Add the entire contents of the diluent container to the vial containing the pellet. Shake until the pellet completely dissolves.

Use reconstituted Priorix (MMR), M-M-R II (MMR) and Priorix-tetra (MMRV) vaccines as soon as practicable. If reconstituted vaccine must be stored, hold at +2°C to +8°C for no more than 8 hours.

Use reconstituted ProQuad (MMRV) vaccine immediately. If it must be stored, hold at:

• +2°C to +8°C for no more than 2.5 hours, or
• +20°C to +25°C for no more than 1 hour

Mumps is a notifiable disease in all states and territories in Australia.

State and territory public health authorities can provide advice about the public health management of mumps, including management of cases and their contacts.

Mumps-containing vaccine does not protect people if they receive it after they have been exposed to mumps.^6,7

However, if the exposure did not result in infection, the vaccine will protect the person against future infection.

Normal human immunoglobulin is not useful for post-exposure prophylaxis for mumps.^6,7

People with egg allergy

The product information for Priorix, M-M-R II and Priorix-tetra states that people with a history of anaphylactic or anaphylactoid reactions to egg should not receive these vaccines.

The Australian Technical Advisory Group on Immunisation (ATAGI) recommends that these people can receive Priorix, M-M-R II, Priorix-tetra or ProQuad.⁶ 

Women planning pregnancy

The product information for M-M-R II and ProQuad recommends that women of child-bearing age should avoid pregnancy for 1 month after vaccination.

ATAGI recommends that these women should avoid pregnancy for 28 days after vaccination,⁶ as for Priorix and Priorix-tetra.

People taking salicylates

The product information for ProQuad and Priorix-tetra states that people should avoid taking salicylates for 6 weeks after vaccination. This is because Reye syndrome has been reported after using salicylates during natural varicella infection.

ATAGI recommends that non-immune people on long-term salicylate therapy can receive varicella-containing vaccines, because the benefit is likely to outweigh any possible risk of Reye syndrome after vaccination.

Recommended ages for MMR vaccines

The product information for M-M-R II and Priorix states vaccine is for use in children ≥12 months of age.

ATAGI recommends that children ≥9 months can receive both MMR vaccines in certain circumstances, including travel to highly endemic areas and during outbreaks

Recommended ages for MMRV vaccines

The product information for ProQuad states that this vaccine is for use in children 12 months to 12 years of age. The product information for Priorix-tetra states that children ≥9 months of age can receive this vaccine.

ATAGI recommends that children up to 14 years of age can receive both MMRV vaccines. ATAGI also recommends that MMRV vaccine should not be used routinely as the 1st dose of MMR-containing vaccine in children aged <4 years.

1. Rubin SA. Mumps vaccines. In: Plotkin SA, Orenstein WA, Offit PA, Edwards KM, eds. Plotkin's vaccines. 7th ed. Philadelphia, PA: Elsevier; 2018.
2. Knuf M, Zepp F, Meyer CU, et al. Safety, immunogenicity and immediate pain of intramuscular versus subcutaneous administration of a measles–mumps–rubella–varicella vaccine to children aged 11–21 months. European Journal of Pediatrics 2010;169:925-33.
3. Blatter MM, Klein NP, Shepard JS, et al. Immunogenicity and safety of two tetravalent (measles, mumps, rubella, varicella) vaccines coadministered with hepatitis A and pneumococcal conjugate vaccines to children twelve to fourteen months of age. Pediatric Infectious Disease Journal 2012;31:e133-40.
4. Verstraeten T, Jumaan AO, Mullooly JP, et al. A retrospective cohort study of the association of varicella vaccine failure with asthma, steroid use, age at vaccination, and measles-mumps-rubella vaccination. Pediatrics 2003;112:e98-103.
5. Kroger AT, Duchin J, Vázquez M. General best practice guidelines for immunization. Best practices guidance of the Advisory Committee on Immunization Practices (ACIP). Atlanta, GA: Centers for Disease Control and Prevention; 2017. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html
6. McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). [erratum appears in MMWR Morb Mortal Wkly Rep. 2015 Mar 13;64(9):259]. MMWR. Recommendations and Reports 2013;62(RR-4):1-34.
7. Centers for Disease Control and Prevention (CDC). Mumps. In: Hamborsky J, Kroger A, Wolfe C, eds. Epidemiology and prevention of vaccine-preventable diseases. 13th ed. Washington, DC: Public Health Foundation; 2015. https://www.cdc.gov/vaccines/pubs/pinkbook/index.html
8. Department of Health and Human Services, Centers for Disease Control and Prevention, National Immunization Program. Advisory Committee on Immunization Practices, June 29–30, 2006, Atlanta, Georgia. Record of the proceedings. Atlanta, GA: Centers for Disease Control and Prevention; 2006. http://www.cdc.gov/vaccines/acip/meetings/minutes-archive.html
9. Scott P, Moss WJ, Gilani Z, Low N. Measles vaccination in HIV-infected children: systematic review and meta-analysis of safety and immunogenicity. Journal of Infectious Diseases 2011;204 Suppl 1:S164-78.
10. World Health Organization (WHO). Global Advisory Committee on Vaccine Safety, report of meeting held 17–18 June 2009. Weekly Epidemiological Record 2009;84:325-32.
11. Menson EN, Mellado MJ, Bamford A, et al. Guidance on vaccination of HIV-infected children in Europe. HIV Medicine 2012;13:333-6.
12. Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Rockville, MD: AIDSinfo, US Department of Health and Human Services; 2018. https://aidsinfo.nih.gov/
13. Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and HIV-infected children: recommendations from the National Institutes of Health, Centers for Disease Control and Prevention, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics. Rockville, MD: AIDSinfo, US Department of Health and Human Services; 2018. https://aidsinfo.nih.gov/
14. Levin MJ, Gershon AA, Weinberg A, et al. Administration of live varicella vaccine to HIV-infected children with current or past significant depression of CD4+ T cells. Journal of Infectious Diseases 2006;194:247-55.
15. American Academy of Pediatrics. Immunization in immunocompromised children. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2015 report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2015.
16. Centers for Disease Control and Prevention (CDC). Measles. In: Hamborsky J, Kroger A, Wolfe C, eds. Epidemiology and prevention of vaccine-preventable diseases. 13th ed. Washington, DC: Public Health Foundation; 2015. https://www.cdc.gov/vaccines/pubs/pinkbook/index.html
17. Black C, Kaye JA, Jick H. MMR vaccine and idiopathic thrombocytopaenic purpura. British Journal of Clinical Pharmacology 2003;55:107-11.
18. Miller E, Waight P, Farrington P, et al. Idiopathic thrombocytopenic purpura and MMR vaccine. Archives of Disease in Childhood 2001;84:227-9.
19. Mantadakis E, Farmaki E, Buchanan GR. Thrombocytopenic purpura after measles-mumps-rubella vaccination: a systematic review of the literature and guidance for management. Journal of Pediatrics 2010;156:623-8.
20. Bastard P, Hsiao KC, Zhang Q, et al. A loss-of-function IFNAR1 allele in Polynesia underlies severe viral diseases in homozygotes. Journal of Experimental Medicine 2022;219.
21. Starr S, Berkovich S. Effects of measles, gamma-globulin-modified measles and vaccine measles on the tuberculin test. New England Journal of Medicine 1964;270:386-91.
22. Centers for Disease Control and Prevention (CDC). Fact sheet: Interferon-gamma release assays (IGRAs) – blood tests for TB infection. 2015. (Accessed Feb 2018). http://www.cdc.gov/tb/publications/factsheets/testing/IGRA.htm
23. Strebel PM, Papania MJ, Gastañaduy PA, Goodson JL. Measles vaccines. In: Plotkin SA, Orenstein WA, Offit PA, Edwards KM, eds. Plotkin's vaccines. 7th ed. Philadelphia, PA: Elsevier; 2018.
24. Kuter BJ, Hoffman Brown ML, Hartzel J, et al. Safety and immunogenicity of a combination measles, mumps, rubella and varicella vaccine (ProQuad®). Human Vaccines 2006;2:205-14.
25. Knuf M, Habermehl P, Zepp F, et al. Immunogenicity and safety of two doses of tetravalent measles-mumps-rubella-varicella vaccine in healthy children. Pediatric Infectious Disease Journal 2006;25:12-8.
26. Lieberman JM, Williams WR, Miller JM, et al. The safety and immunogenicity of a quadrivalent measles, mumps, rubella and varicella vaccine in healthy children: a study of manufacturing consistency and persistence of antibody. Pediatric Infectious Disease Journal 2006;25:615-22.
27. Schuster V, Otto W, Maurer L, et al. Immunogenicity and safety assessments after one and two doses of a refrigerator-stable tetravalent measles-mumps-rubella-varicella vaccine in healthy children during the second year of life. Pediatric Infectious Disease Journal 2008;27:724-30.
28. Klein NP, Fireman B, Yih WK, et al. Measles-mumps-rubella-varicella combination vaccine and the risk of febrile seizures. Pediatrics 2010;126:e1-8.
29. Jacobsen SJ, Ackerson BK, Sy LS, et al. Observational safety study of febrile convulsion following first dose MMRV vaccination in a managed care setting. Vaccine 2009;27:4656-61.
30. Klein NP, Lewis E, Baxter R, et al. Measles-containing vaccines and febrile seizures in children age 4 to 6 years. Pediatrics 2012;129:809-14.
31. Aickin R, Hill D, Kemp A. Measles immunisation in children with allergy to egg. BMJ 1994;309:223-5.
32. Australasian Society of Clinical Immunology and Allergy (ASCIA). Guidelines: vaccination of the egg-allergic individual. Sydney: ASCIA; 2017. https://www.allergy.org.au/health-professionals/papers/vaccination-of-the-egg-allergic-individual
33. dos Santos BA, Ranieri TS, Bercini M, et al. An evaluation of the adverse reaction potential of three measles-mumps-rubella combination vaccines. Pan American Journal of Public Health 2002;12:240-6.
34. Popow-Kraupp T, Kundi M, Ambrosch F, Vanura H, Kunz C. A controlled trial for evaluating two live attenuated mumps-measles vaccines (Urabe Am 9-Schwarz and Jeryl Lynn-Moraten) in young children. Journal of Medical Virology 1986;18:69-79.
35. Schlipköter U, Mühlberger N, von Kries R, Weil J. Surveillance of measles-mumps-rubella vaccine-associated aseptic meningitis in Germany. Infection 2002;30:351-5.
36. Mäkelä A, Nuorti JP, Peltola H. Neurologic disorders after measles-mumps-rubella vaccination. Pediatrics 2002;110:957-63.
37. Wakefield AJ, Murch SH, Anthony A, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. The Lancet 1998;351:637-41.
38. Murch SH, Anthony A, Casson DH, et al. Retraction of an interpretation. [retraction of Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, Berelowitz M, Dhillon AP, Thomson MA, Harvey P, Valentine A, Davies SE, Walker-Smith JA. Lancet. 1998 Feb 28;351(9103):637-41]. The Lancet 2004;363:750.
39. MacIntyre CR, McIntyre PB. MMR, autism and inflammatory bowel disease: responding to patient concerns using an evidence-based framework [editorial]. Medical Journal of Australia 2001;175:127-8.
40. Madsen KM, Hviid A, Vestergaard M, et al. A population-based study of measles, mumps, and rubella vaccination and autism. New England Journal of Medicine 2002;347:1477-82.
41. Taylor B, Miller E, Lingam R, et al. Measles, mumps, and rubella vaccination and bowel problems or developmental regression in children with autism: population study. BMJ 2002;324:393-6.
42. Peltola H, Patja A, Leinikki P, et al. No evidence for measles, mumps, and rubella vaccine-associated inflammatory bowel disease or autism in a 14-year prospective study. The Lancet 1998;351:1327-8.
43. Barskey A. Mumps. In: Heymann DL, ed. Control of communicable diseases manual. 20th ed. Washington, DC: APHA Press; 2015.
44. Galazka AM, Robertson SE, Kraigher A. Mumps and mumps vaccine: a global review. Bulletin of the World Health Organization 1999;77:3-14.
45. Centers for Disease Control and Prevention (CDC). Update: multistate outbreak of mumps – United States, January 1–May 2, 2006. MMWR. Morbidity and Mortality Weekly Report 2006;55:559-63.
46. Masarani M, Wazait H, Dinneen M. Mumps orchitis. Journal of the Royal Society of Medicine 2006;99:573-5.
47. Hviid A, Rubin S, Mühlemann K. Mumps. The Lancet 2008;371:932-44.
48. McIntyre P, Gidding H, Gilmour R, et al. Vaccine preventable diseases and vaccination coverage in Australia, 1999 to 2000. Communicable Diseases Intelligence 2002;26 Suppl:1-111.
49. Brotherton J, McIntyre P, Puech M, et al. Vaccine preventable diseases and vaccination coverage in Australia, 2001 to 2002. Communicable Diseases Intelligence 2004;28 Suppl 2:vii-S116.
50. Brotherton J, Wang H, Schaffer A, et al. Vaccine preventable diseases and vaccination coverage in Australia, 2003 to 2005. Communicable Diseases Intelligence 2007;31 Suppl:viii-S152.
51. Chiu C, Dey A, Wang H, et al. Vaccine preventable diseases in Australia, 2005 to 2007. Communicable Diseases Intelligence 2010;34 Suppl:ix-S167.
52. Australian Government Department of Health. National Notifiable Diseases Surveillance System: notification rate of mumps, received from state and territory health authorities. (Accessed May 2018). http://www9.health.gov.au/cda/source/rpt_4_sel.cfm
53. Australian Government Department of Health. National Notifiable Diseases Surveillance System: number of notifications of mumps, Australia, by age group and sex. (Accessed May 2018). http://www9.health.gov.au/cda/source/rpt_5_sel.cfm
54. Centers for Disease Control and Prevention (CDC). Mumps epidemic – Iowa, 2006. MMWR. Morbidity and Mortality Weekly Report 2006;55:366-8.
55. Gupta RK, Best J, MacMahon E. Mumps and the UK epidemic 2005. BMJ 2005;330:1132-5.
56. Dayan GH, Quinlisk MP, Parker AA, et al. Recent resurgence of mumps in the United States. New England Journal of Medicine 2008;358:1580-9.
57. Whelan J, van Binnendijk R, Greenland K, et al. Ongoing mumps outbreak in a student population with high vaccination coverage, Netherlands, 2010. Eurosurveillance 2010;15(17):pii=19554.
58. Queensland Health. Vaccine preventable and invasive diseases in Queensland. Brisbane: Queensland Health; 2018. https://www.health.qld.gov.au/__data/assets/pdf_file/0029/692507/vpd-quarterly-surveillance-2017.pdf
59. Westphal D, Giele C, Levy A, et al. A second prolonged mumps outbreak among highly vaccinated Aboriginal Western Australians. 15th National Immunisation Conference, June 2016, Brisbane. Canberra: Public Health Association Australia; 2016.
60. Greenwood-Smith B, Markey P, Burke J. Mumps outbreak in the Northern Territory 2015–2016. The Northern Territory Disease Control Bulletin 2016;23(4):9-14.
61. Deeks SL, Lim GH, Simpson MA, et al. An assessment of mumps vaccine effectiveness by dose during an outbreak in Canada. CMAJ Canadian Medical Association Journal 2011;183:1014-20.
62. Demicheli V, Rivetti A, Debalini MG, Di Pietrantonj C. Vaccines for measles, mumps and rubella in children. Cochrane Database of Systematic Reviews 2012;(2):CD004407. doi:10.1002/14651858.CD004407.pub3.
63. Marin M, Quinlisk P, Shimabukuro T, et al. Mumps vaccination coverage and vaccine effectiveness in a large outbreak among college students–Iowa, 2006. Vaccine 2008;26:3601-7.
64. Boxall N, Kubínyiová M, Príkazský V, Beneš C, Cástková J. An increase in the number of mumps cases in the Czech Republic, 2005–2006. Eurosurveillance 2008;13(16):pii=18842.
65. National vaccine storage guidelines: Strive for 5. 2nd ed. Canberra: Australian Government Department of Health and Ageing; 2013. https://www.health.gov.au/resources/publications/national-vaccine-storage-guidelines-strive-for-5