It's déjà vu all over again.
|The first chapter in Arthur Allen's book "Vaccine" describes the history of smallpox vaccination in the United States. In 1721, in Boston, the prevailing belief was that to get vaccinated was to intervene with "divine providence." If you tried to protect yourself, it meant that you lacked faith in God.
Today, I read that a mumps outbreak is happening in Vancouver, Canada. So far 116 cases have been confirmed.
Why is mumps, a preventable and serious disease, causing problems in Canada?
|photo of a child with mumps by by Barbara Rice, from the Public Health Image Library|
Quoting from CBCnews.ca:
Two people from Alberta carried the mumps to a religious community near Agassiz that has a low rate of vaccinations, said Dr. Elizabeth Brodkin of the Fraser Health Authority.
"My understanding is their interpretation of scripture is that to immunize would be to show a lack of faith in God's ability to protect them, and therefore they choose not to do that," said Brodkin.
It's seems odd that anyone would consider it appropriate to test their faith by risking the lives of others. Still, as Orac has written so eloquently, there is a small group of parents in U.S. who are also willing risk the lives of their kids and members of the community. This group contributed to a large outbreak of mumps in 2006 where 6584 cases were found and 85 people, hospitalized (1).
What is mumps? What does it do? and why is it a problem?
Mumps is the name of a virus and the disease caused by the mumps virus. The most notable symptom is that it causes the salivary glands to swell, as you can see in the picture. When you get mumps, to quote Gisela Enders' chapter from Medical Microbiology:
meningitis is common; and pancreatitis, encephalitis, and hearing loss may occur. In young adults, orchitis or oophoritis is not uncommon
In English, meningitis is an inflammation of the meninges, the tissues surrounding the brain. Pancreatitis refers to an inflamed pancreas. Hearing loss, is clear enough. Orchitis means that if you're male, your testicles can be inflamed. Oophoritis is an inflammation of the ovaries. The CDC mumps page adds that mumps can make you feel achy, lose your appetite, and feel tired (myalgia, anorexia, malaise, headache, and low-grade fever).
Mumps is an RNA virus, composed of 15,384 nucleotides. Its genome is a single strand of RNA. If we look at the mumps genome at the NCBI, we can see that it codes for eight proteins. If we follow the link to the proteins, we can see something about each one.
The names aren't very informative, though. We have to select the GeneID to get more useful information and even then, we may have to read an abstract or a paper to see more about the function of the protein.
This is one of my favorite ways to learn about something new. I go to the genome map and look around to see what kinds of genes are there.
It's interesting to see that the mumps virus has a gene that acts as a hemagglutinin and neuraminidase. In influenza, it takes two proteins to provide those functions. Hemagglutinin helps the virus stick to cells with certain sugars on the surface and neuraminidase helps the virus escape after new particles are made.
What happens to people who get the mumps/ Learn more about the consequences here.
- Dayan, G. et. al. 2008. Recent Resurgence of Mumps in the United States. NEJM Volume 358:1580-1589.
The problem is not so much anti-vaccination feelings in Canada as much as it was the end of the in-school immunization programs, that the kids parents benefited from. Once it was by-the-numbers, and everybody left booster shots in the hands of the needle squads that went from school to school.
The end of these programs, coupled with the difficulty many Canadian parents are having finding a family doctor has led to a situation where many young people are overdue and are not being followed. I suspect that this is at the root of this outbreak.
I remember getting vaccinated in elementary school. We all lined up and got shots in the arm and then punched each other afterwards.
It may be that some of the people who got sick in Vancouver missed getting vaccinated for those kinds of reasons. But, people who brought the mumps to Vancouver had a different rationale.
I remember the mumps. The older women in my family came in to see me one by one, each with a different cure involving some combination of potients and talismans. I can still recollect the smell of one of them. The Dr. came with his black bag and his stethoscope. None of it helped much.
My brother and I had the mumps for Christmas one year as kids. We were moved down to the living room so we could see the Christmas tree. Mumps for adults is often more severe and can cause sterility in men.
My daughter is scheduled to get a mumps booster shot before I finish typing this. She will be entering university next week at a location only half an hour's drive away from the source of the infection in BC.
She was in the window where they had not yet decided that booster shots were worthwhile when she was at that age.
What was interesting going through our records was finding the notices that required parental authorisation before Hep B was given to Grade 6 students. I'd rather they had made it opt out, rather than opt in.
Don't know where DV8 lives. Here in BC school age shots are given by the school nurse. It's a Provincial responsibility, so I wouldn't be surprised if there are variations.
One problem I see is that there is no central registry. They will arrange to transfer records when a child moves, but there is not much incentive to prevent the occasional shot from getting missed.
I have been vaccinated with MMR (measles, mumps, and rubella)about 3 times as much as most people, because subsequent blood tests always showed as negative for antibodies. The last time I got it, I broke out in a horrible rash, but when I looked up photos the measles online, it showed rashes WAY worse than what I had. I can't imagine anyone willingly allowing their child to endure what I only had a taste of.
I got mumps over 45 years ago, in first grade, and I still remember crying because of how badly my head and neck hurt. It's a pretty miserable experience. As someone who also experienced severe Mittelschmerz for years, I don't even want to think of what mumps oophoritis might feel like.
I also managed to transmit mumps to my cousin's year-old son, even though I'd had only minimal contact with the baby during the week or two before I got symptoms of my own. That disease is one contagious sucker. Ick.
So can anyone tell me whether I, as a 35-year-old man who has been immunized as a child, should worry about this current outbreak?
Steve: Getting vaccinated again might be a good idea, but I think it would best to consult your doctor.
Am a 27yrs old lady. I woke up 4 days ago and discover dis painful swelling below my ear around my jaw. I visited a local hospital and d doc said i have mumps. I didnt ask any further questions for fear of being told more scary things. I looked up the disease on the internet and was mortified with every information given there. Pls what do i do, especialy in preventing hearing loss.
If you have mumps, you need to see a doctor. They can give you advice on what to do.
If you want to learn more about mumps before seeing your doctor, the CDC has a good information page here: http://www.cdc.gov/mumps/