The return of mumps: Why has the disease gained a hold in Ireland?

The origins of the word for the disease are lost in time, but most probably come from the “grimace” of the sufferer who finds swallowing painful. Mumps, like the word that describes it, should be lost in time, thanks to the introduction of vaccines and other modern improvements in health.

Instead, this highly contagious viral disease is back in the news, due to current outbreaks in colleges and schools across the country.

There have been 278 mumps cases in the first six weeks of the year, compared with 43 for the same time last year, according to the HSE’s Health Protection Surveillance Centre. Nine outbreaks were reported in school, university, community and private home settings, with the majority of cases occurring among teenagers and young adults.

One outbreak forced the cancellation of a schools rugby match in south Dublin, while Trinity College, DCU and schools in Co Louth have also been affected.

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Strikingly, scientists are suggesting that there may be more than seasonal factors and mere accident at play. Measles, mumps and rubella (MMR) vaccine immunisation rates dipped sharply in the years following Andrew Wakefield’s now discredited research in 1998 linking the vaccine with bowel disease and autism.

That means large numbers of today's late teens are unvaccinated. At the height of the Wakefield-fuelled controversy over the MMR jabs, the uptake of the vaccine in Ireland dropped to 70 per cent before slowly recovering.

These days, it has plateaued at about 92 per cent, still short of the 95 per cent target. The proportion of five-year-olds receiving the booster stands at 88 per cent.

"It could be better," Dr Suzanne Cotter of the Health Protection Surveillance Centre (HPSC) admits, "even if a majority of parents are availing of the vaccination."

Swollen testicles

Though rarely fatal, mumps is a nasty and contagious virus. Symptoms include headache, swollen glands and fever. Five per cent of sufferers get viral meningitis, and 40 per cent of men experience swollen testicles. Deafness and male infertility are, thankfully, rare outcomes.

The vaccine was introduced more than 30 years ago, in 1988, and the two-dose variation began in 1992. Most older people will have had mumps at some point in their earlier life and, because there is no lifelong immunity, could get it again.

But can you get mumps despite having been vaccinated? Dr Cotter says there have been reports in the US of small outbreaks among people who had had two doses of the vaccine.

In Ireland, mumps cases are more likely to occur among unvaccinated people or those who had received only one dose, she says. While some patients said they had received two doses, there was a “slight question” as to whether they were fully vaccinated.

Cases among vaccinated or under-vaccinated patients tend to be less severe, she adds.

The vaccine is 88 per cent effective against mumps, according to one study. Paradoxically, this means more people need to get the shot so that “herd immunity” can work.

So far this year, 15 mumps cases have required hospitalisation. The good news is that, for most patients, symptoms are mild and the treatment is to stay home, rest and ease the discomfort with paracetamol. There is nothing to be done to stem the progress of the disease.

Dr Cotter says the best way to prevent mumps is to be appropriately vaccinated according to your age. Parents of children need to be sure they have received both jabs, while older people should try to ascertain whether they have been vaccinated. If uncertain, they should get the MMR jab anyway.

Measles, the second M in MMR, is also on the rise, with a large outbreak in Limerick last year and a current one in Co Donegal. In Europe, the number of people infected last year was the highest this decade, and there were 72 fatalities.

More infectious than mumps, measles can be transmitted by a person breathing in air in a room in which a carrier coughed up to two hours previously.

The vaccine also protects against rubella, which can cause pregnant women to miscarry or suffer severe foetal abnormalities. Fortunately, Ireland has not seen a confirmed case of rubella since one was imported in 2004, according to Dr Cotter, though three unconfirmed cases have already been reported this year.

Clusters of opposition

The re-emergence of diseases we thought were largely consigned to history once again puts the focus on vaccines. For many scientists, the invention of vaccines is the single biggest health intervention, more significant even than antibiotics.

As science has developed, the number of vaccines available has increased, but so also have the clusters of opposition to them.

Effectively, scientists are the victims of their own success, because infectious diseases that were once common are now seldom seen, with their effects forgotten.

“The memory is quite short as to how devastating these diseases were,” Dr Cotter says. “Sometimes, people can be trite and say that living conditions have improved, but this is incorrect.”

Public health doctors are constantly challenged to maintain vaccination rates, particularly in the modern age of scepticism and social media.

"Wakefield's work was repeatedly and robustly refuted by research," says Dr Robert O'Connor of the Irish Cancer Society, "but then along came social media, with its unique ability to communicate fear."

As he sees it, the situation was accentuated by the controversy over the HPV vaccine, “driven by fundamentalist groups in the US who were concerned about chastity and who wrongly believed the vaccine promoted promiscuity”.

Dr O’Connor believes scientists are engaged in an asymmetric battle with forces that deliberately try to undermine vaccines, as well as some people who genuinely misunderstand the science. “All the bad guys have to do is sow the seeds of doubt, while the good guys have to communicate the benefits of something that involves a needle piercing the skin.”

"We essentially need 95 per cent of the population to be completely convinced of something and for them to make a conscious decision to have several needles stuck in their child," say public relations consultant Karl Brophy. "It's almost impossible to achieve that level of conformity among the general population on any issue in the modern age, never mind one that involves allowing something physical happen to your child."

Chickenpox vaccine

Brophy's interest in vaccines was provoked by an incident during a holiday when he had to inform two other families, from Australia and England, that his children had just broken out with chickenpox. "They just laughed and said their kids were vaccinated. I wasn't even aware there was a vaccine; [I] did some research and became increasingly annoyed that we were never informed there was one.

“You can only get shingles if you have had chickenpox (usually as a child) and getting chickenpox as an adult is very, very serious. Why would you not vaccinate against that? The Australians do it as a matter of course it seems. And it’s not expensive.”

Core elements of democracy, such as freedom of information and parliamentary questions, have been abused by those seeking to undermine the vaccine programme, Dr O’Connor says. Modern-day “misconceptions” about health and wellness are feeding into this, he adds.

"Just look what happens when we have a drop-off of MMR rates. In countries with political turmoil we tend to see massive outbreaks of measles, as in Venezuela at present," Dr Cotter says.

The controversies over the HPV vaccine and CervicalCheck have sparked a realisation among doctors and scientists that they need to be proactive in commending the virtues of vaccines.

That battle has been brought to social media, where inaccurate claims are more likely to be rebutted now than they were a few years ago. Meanwhile, the uptake of the HPV vaccine, which had slumped to 50 per cent a few years ago, is now back up to 65 per cent and rising.

Diseases come back very rapidly “once they see the open door”, says Dr Cotter.

“These diseases have been controlled through the efforts of vaccination and we need to maintain that momentum.”

Case study

One Dublin mother says her daughter contracted mumps in recent weeks despite having all her vaccinations.

She initially discounted mumps when trying to work out what was causing her daughter’s sore neck, but took her to the local GP after her neck became swollen.

“The GP immediately diagnosed mumps, and told me afterwards that she was dealing with five other [such] cases. A swab was later confirmed as mumps,” she said.

The woman said she wished to inform her daughter’s school, but was advised by the GP that the public health nurse would be in contact with her and would also send letters to the school and clubs etc where children would have come into contact with her daughter during the infectious period.

However, while she understands the public health nurse was in contact with her GP, she was never contacted.

Her daughter was out of school for a week, returning once the GP said it was safe to do so.

The mother informed the headmistress of the mumps case before her daughter returned, as her understanding was they had not been contacted.